Clinical Microscopy Flashcards
Which of the following organizations publishes guidelines for writing procedures and policies in the urinalysis?
A. CDC
B. OSHA
C. CLSI
D. CLIA
C. CLSI
Exposure to toxic, carcinogenic, or caustic agents is what type of laboratory safety hazard?
A. Biological
B. Sharps
C. Chemical
D. Fire/explosive
C. Chemical
In the urinalysis laboratory, the primary source in the chain of infection would be:
A. Patients
B. Needlesticks
C. Specimens
D. Biohazardous waste
C. Specimens
The best way to break the chain of infection is:
A. Hand sanitizing
B. Personal protective equipment
C. Aerosol prevention
D. Decontamination
A. Hand sanitizing
The current routine infection control policy developed by CDC and followed in all health-care settings is:
A. Universal Precautions
B. Isolation Precautions
C. Blood and Body Fluid Precautions
D. Standard Precautions
D. Standard Precautions
An employee who is accidentally exposed to a possible bloodborne pathogen should immediately:
A. Report to a supervisor
B. Flush the area with water
C. Clean the area with disinfectant
D. Receive HIV prophylaxis
A. Report to a supervisor
Personnel in the urinalysis laboratory should wear laboratory coats that:
A. Do not have buttons
B. Are fluid-resistant
C. Have short sleeves
D. Have full-length zippers
B. Are fluid-resistant
All of the following should be discarded in biohazardous waste containers except:
A. Urine specimen containers
B. Towels used for decontamination
C. Disposable laboratory coats
D. Blood collection tubes
A. Urine specimen containers
An employer who fails to provide sufficient gloves for the employees may be fined by the:
A. CDC
B. NFPA
C. OSHA
D. FDA
C. OSHA
An acceptable disinfectant for decontamination of blood and body fluids is:
A. Sodium hydroxide
B. Antimicrobial soap
C. Hydrogen peroxide
D. Sodium hypochlorite
D. Sodium hypochlorite
Correct hand washing includes all of the following except:
A. Using warm water
B. Rubbing to create a lather
C. Rinsing hands in a downward position
D. Turning on the water with a paper towel
D. Turning on the water with a paper towel
Centrifuging an uncapped specimen may produce a biological hazard in the form of:
A. Vectors
B. Sharps contamination
C. Aerosols
D. Specimen contamination
C. Aerosols
An employee who accidentally spills acid on his arm should immediately:
A. Neutralize the acid with a base
B. Hold the arm under running water for 15 minutes
C. Consult the SDS
D. Wrap the arm in gauze and go to the emergency department
B. Hold the arm under running water for 15 minutes
When combining acid and water, ensure that:
A. Acid is added to water
B. Water is added to acid
C. They are added simultaneously
D. Water is slowly added to acid
A. Acid is added to water
An employee can learn the carcinogenic potential of potassium chloride by consulting the:
A. Chemical hygiene plan
B. Safety Data Sheet
C. OSHA standards
D. Urinalysis procedure manual
B. Safety Data Sheet
Employees should not work with radioisotopes if they are:
A. Wearing contact lenses
B. Allergic to iodine
C. Sensitive to latex
D. Pregnant
D. Pregnant
All of the following are safe to do when removing the source of an electric shock except:
A. Pulling the person away from the instrument
B. Turning off the circuit breaker
C. Using a glass container to move the instrument
D. Unplugging the instrument
A. Pulling the person away from the instrument
The acronym PASS refers to:
A. Presence of vital chemicals
B. Operation of a fire extinguisher
C. Labeling of hazardous material
D. Presence of radioactive substances
B. Operation of a fire extinguisher
The system used by firefighters to assess the risk potential when a fire occurs in the laboratory is:
A. SDS
B. RACE
C. NFPA
D. PASS
C. NFPA
A class ABC fire extinguisher contains:
A. Sand
B. Water
C. Dry chemicals
D. Acid
C. Dry chemicals
The first thing to do when a fire is discovered is to:
A. Rescue people in danger
B. Activate the alarm system
C. Close doors to other areas
D. Extinguish the fire if possible
A. Rescue people in danger
If a red rash is observed after removing gloves, the employee:
A. May be washing her hands too often
B. May have developed a latex allergy
C. Should apply cortisone cream
D. Should not rub her hands so vigorously
B. May have developed a latex allergy
Pipetting by mouth is:
A. Acceptable for urine but not serum
B. Not acceptable without proper training
C. Acceptable for reagents but not specimens
D. Not acceptable in the laboratory
D. Not acceptable in the laboratory
The NPFA classification symbol contains information on all of the following except:
A. Fire hazards
B. Biohazards
C. Reactivity
D. Health hazards
B. Biohazards
The GHS requires the following on a chemical label:
A. Biohazard symbol, warning sign, environmental impact
B. Hazard pictogram, signal words, hazard statement
C. Biological symbol, hazard pictogram, long-term effects
D. Signal words, hazard statement, biological symbol
B. Hazard pictogram, signal words, hazard statement
The classification of a fire that can be extinguished with water is:
A. Class A
B. Class B
C. Class C
D. Class D
A. Class A
Employers are required to provide free immunization for:
A. HIV
B. HTLV-1
C. HBV
D. HCV
C. HBV
A possible physical hazard in the hospital is:
A. Wearing closed-toed shoes
B. Not wearing jewelry
C. Having short hair
D. Running to answer the telephone
D. Running to answer the telephone
Quality management refers to:
A. Analysis of testing controls
B. Increased productivity
C. Precise control results
D. Quality of specimens and patient care
D. Quality of specimens and patient care
During laboratory accreditation inspections, procedure manuals are examined for the presence of:
A. Critical values
B. Procedure references
C. Procedures for specimen preservation
D. All of the above
D. All of the above
As the supervisor of the urinalysis laboratory, you have just adopted a new procedure. You should:
A. Put the package insert in the procedure manual
B. Put a complete, referenced procedure in the manual
C. Notify the microbiology department
D. Put a cost analysis study in the procedure manual
B. Put a complete, referenced procedure in the manual
Indicate whether each of the following would be considered a 1) preexamination, 2) examination, or
3) postexamination factor by placing the appropriate
number in the blank:
1. Reagent expiration date
2. Rejecting a contaminated specimen
3. Constructing a Levy-Jennings chart
4. Telephoning a positive Clinitest result on a newborn
5. Calibrating the centrifuge
6. Collecting a timed urine specimen
- 2
- 1
- 2
- 3
- 2
- 1
The testing of a specimen from an outside agency and the comparison of results with participating laboratories
is called:
A. External QC
B. Electronic QC
C. Internal QC
D. Proficiency testing
D. Proficiency testing
A color change indicating that a sufficient amount of a patient’s specimen or reagent is added correctly to the test system would be an example of:
A. External QC
B. Equivalent QC
C. Internal QC
D. Proficiency testing
C. Internal QC
What steps are taken when the results of reagent strip QC are outside the stated confidence limits?
A. Check the expiration date of the reagent strip
B. Run a new control
C. Open a new reagent strips container
D. All of the above
D. All of the above
When a new bottle of QC material is opened, what information is placed on the label?
A. The supervisor’s initials
B. The lot number
C. The date and the laboratory worker’s initials
D. The time the bottle was opened
C. The date and the laboratory worker’s initials
When a control is run, what information is documented?
A. The lot number
B. Expiration date of the control
C. The test results
D. All of the above
D. All of the above
The principle commonly used to measure the concentration of a particular analyte in the chemical examination of urine is:
A. Reflectance photometry
B. Digital imaging
C. Flow cytometry
D. Auto particle recognition
A. Reflectance photometry
In automated urinalysis, the specific gravity is measured by:
A. Light transmittance
B. Light scattering
C. Refractometry
D. Turbidity
C. Refractometry
All of the following are true concerning fully automated urine chemistry analyzers, except:
A. They are designed for a high-volume urinalysis laboratory.
B. The reagent strip is dipped into the well-mixed urine.
C. The urine tube moves through the instrument.
D. A sample probe aspirates the urine.
B. The reagent strip is dipped into the well-mixed urine.
The advantages of an automated urine microscopy analyzer over manual microscopy includes:
A. Cost-effective
B. Centrifugation not required
C. Standardized results
D. All of the above
D. All of the above
Which of the following is a complete urinalysis automated urinalysis system?
A. AUTION ELEVEN AE 4022
B. Clinitek Atlas
C. iQ200 Automated Urine Microscopy
D. Clinitek AUWi Pro System
D. Clinitek AUWi Pro System
What two technologies are used for urine sediment analysis?
A. Light scattering and refractometry
B. Light scattering and flow cytometry
C. Flow cytometry and digital imaging
D. Digital imaging and refractometry
C. Flow cytometry and digital imaging
Which automated urine particle counter combines urine flow cytometry with digital image analysis?
A. UN-2000
B. iRICELL
C. UF-1000i
D. iQ 200
A. UN-2000
Which of the following urine sediment particles cannot be autovalidated but will be flagged and must be reviewed by laboratory personnel?
A. RBCs
B. WBCs
C. RTEs
D. Squamous epithelial cells
C. RTEs
Which of the automated body fluid analyzers does not need to dilute or pretreat body fluids before analysis?
A. ADVIA 2120i
B. XN Series
C. iQ 200
D. None of the above
B. XN Series
What is a disadvantage of counting body fluid cells using an automated instrument versus a Neubauer hemocytometer?
A. Less labor-intensive and time-consuming
B. More precise
C. Unable to count low WBC numbers and malignant cells
D. Able to perform a WBC differential
C. Unable to count low WBC numbers and malignant cells
The primary inorganic substance found in urine is:
A. Sodium
B. Phosphate
C. Chloride
D. Calcium
C. Chloride
An unidentified fluid is received in the laboratory with a request to determine whether the fluid is urine or another body fluid. Using routine laboratory tests, which substances
would determine that the fluid is most probably urine?
A. Glucose and ketones
B. Urea and creatinine
C. Uric acid and amino acids
D. Protein and amino acids
B. Urea and creatinine
The average daily output of urine is:
A. 200 mL
B. 500 mL
C. 1200 mL
D. 2500 mL
C. 1200 mL
A patient presenting with polyuria, nocturia, polydipsia, and a low urine specific gravity is exhibiting symptoms of:
A. Diabetes insipidus
B. Diabetes mellitus
C. Urinary tract infection
D. Uremia
A. Diabetes insipidus
A patient with oliguria might progress to having:
A. Nocturia
B. Polyuria
C. Polydipsia
D. Anuria
D. Anuria
All of the following are characteristics of recommended urine containers except:
A. A flat bottom
B. A capacity of 50 mL
C. A snap-on lid
D. Are disposable
C. A snap-on lid
Labels for urine containers are:
A. Attached to the container
B. Attached to the lid
C. Placed on the container before collection
D. Not detachable
C. Placed on the container before collection
A urine specimen may be rejected by the laboratory for all of the following reasons except the fact that the:
A. Requisition form states the specimen is catheterized
B. Specimen contains toilet paper
C. Label and requisition form do not match
D. Outside of the container has contamination from fecal material
A. Requisition form states the specimen is catheterized
A cloudy specimen received in the laboratory may have been preserved using:
A. Boric acid
B. Chloroform
C. Refrigeration
D. Formalin
C. Refrigeration
For general screening, the specimen collected most frequently is a:
A. Random one
B. First morning
C. Midstream clean-catch
D. Timed
A. Random one
The primary advantage of a first morning specimen over a random specimen is that it:
A. Is less contaminated
B. Is more concentrated
C. Is less concentrated
D. Has a higher volume
B. Is more concentrated
If a routine urinalysis and a culture are requested on a catheterized specimen, then:
A. Two separate containers must be collected
B. The routine urinalysis is performed first
C. The patient must be recatheterized
D. The culture is performed first
D. The culture is performed first
If a patient fails to discard the first specimen when collecting a timed specimen, then the:
A. Specimen must be re-collected
B. Results will be falsely elevated
C. Results will be falsely decreased
D. Both A and B
D. Both A and B
The primary cause of unsatisfactory results in an unpreserved routine specimen not tested for 8 hours is:
A. Bacterial growth
B. Glycolysis
C. Decreased pH
D. Chemical oxidation
A. Bacterial growth
Prolonged exposure of a preserved urine specimen to light will cause:
A. Decreased glucose
B. Increased cells and casts
C. Decreased bilirubin
D. Increased bacteria
C. Decreased bilirubin
Which of the following would be least affected in a specimen that has remained unpreserved at room temperature for more than 2 hours?
A. Urobilinogen
B. Ketones
C. Protein
D. Nitrite
C. Protein
Bacterial growth in an unpreserved specimen will:
A. Decrease clarity
B. Increase bilirubin
C. Decrease pH
D. Increase glucose
A. Decrease clarity
The most sterile specimen collected is a:
A. Catheterized
B. Midstream clean-catch
C. Three-glass
D. Suprapubic aspiration
D. Suprapubic aspiration
Which of the following would not be given to a patient before the collection of a midstream clean-catch
specimen?
A. Sterile container
B. Iodine cleanser
C. Antiseptic towelette
D. Instructions
B. Iodine cleanser
Urine specimen collection for drug testing requires the collector to do all of the following except:
A. Inspect the specimen color
B. Perform reagent strip testing
C. Read the specimen temperature
D. Fill out a chain-of-custody form
B. Perform reagent strip testing
The type of nephron responsible for renal concentration is the:
A. Cortical
B. Juxtaglomerular
C. Efferent
D. Afferent
B. Juxtaglomerular
The function of the peritubular capillaries is:
A. Reabsorption
B. Filtration
C. Secretion
D. Both A and C
D. Both A and C
Blood flows through the nephron in the following order:
A. Efferent arteriole, peritubular capillaries, vasa recta, afferent arteriole
B. Peritubular capillaries, afferent arteriole, vasa recta, efferent arteriole
C. Afferent arteriole, efferent arteriole, peritubular capillaries, vasa recta
D. Efferent arteriole, vasa recta, peritubular capillaries, afferent arteriole
C. Afferent arteriole, efferent arteriole, peritubular capillaries, vasa recta
Filtration of protein is prevented in the glomerulus by:
A. Hydrostatic pressure
B. Oncotic pressure
C. Renin
D. The glomerular filtration barrier
D. The glomerular filtration barrier
The renin–angiotensin–aldosterone system is responsible
for all of the following except:
A. Vasoconstriction of the afferent arteriole
B. Vasoconstriction of the efferent arteriole
C. Reabsorbing sodium
D. Releasing aldosterone
A. Vasoconstriction of the afferent arteriole
The primary chemical affected by the renin–angiotensin–aldosterone system is:
A. Chloride
B. Sodium
C. Potassium
D. Hydrogen
B. Sodium
Secretion of renin is stimulated by:
A. Juxtaglomerular cells
B. Angiotensin I and II
C. Macula densa cells
D. Circulating angiotensin-converting enzyme
C. Macula densa cells
The hormone aldosterone is responsible for:
A. Hydrogen ion secretion
B. Potassium secretion
C. Chloride retention
D. Sodium retention
D. Sodium retention
The fluid leaving the glomerulus has a specific gravity of:
A. 1.005
B. 1.010
C. 1.015
D. 1.020
B. 1.010
For active transport to occur, a chemical must:
A. Combine with a carrier protein to create electrochemical energy
B. Be filtered through the proximal convoluted tubule
C. Be in higher concentration in the filtrate than in the blood
D. Be in higher concentration in the blood than in the filtrate
A. Combine with a carrier protein to create electrochemical energy
Which of the tubules is impermeable to water?
A. Proximal convoluted tubule
B. Descending loop of Henle
C. Ascending loop of Henle
D. Distal convoluted tubule
C. Ascending loop of Henle
Glucose will appear in the urine when the:
A. Blood level of glucose is 200 mg/dL
B. Tm for glucose is reached
C. Renal threshold for glucose is exceeded
D. All of the above
D. All of the above
Concentration of the tubular filtrate by the countercurrent mechanism depends on all of the following except:
A. High salt concentration in the medulla
B. Water-impermeable walls of the ascending loop of Henle
C. Reabsorption of sodium and chloride from the ascending loop of Henle
D. Reabsorption of water in the descending loop of Henle
D. Reabsorption of water in the descending loop of Henle
ADH regulates the final urine concentration by controlling:
A. Active reabsorption of sodium
B. Tubular permeability
C. Passive reabsorption of urea
D. Passive reabsorption of chloride
B. Tubular permeability
Decreased production of ADH:
A. Produces a low volume of urine
B. Produces a high volume of urine
C. Increases excretion of ammonia
D. Affects active transport of sodium
B. Produces a high volume of urine
Bicarbonate ions filtered by the glomerulus are returned to the blood:
A. In the proximal convoluted tubule
B. Combined with hydrogen ions
C. By tubular secretion
D. All of the above
D. All of the above
If ammonia is not produced by the distal convoluted tubule, the urine pH will be:
A. Acidic
B. Basic
C. Hypothenuric
D. Hypersthenuric
B. Basic
Place the appropriate letter in front of the following clearance substances:
A. Exogenous
B. Endogenous
1. beta2-microglobulin
2. creatinine
3. cystatin C
4. 125 I-iothalmate
- B
- B
- B
- A
The largest source of error in creatinine clearance tests is:
A. Secretion of creatinine
B. Improperly timed urine specimens
C. Refrigeration of the urine
D. Time of collecting blood specimen
B. Improperly timed urine specimens
Clearance tests used to determine the glomerular filtration rate must measure substances that are:
A. Not filtered by the glomerulus
B. Completely reabsorbed by the proximal convoluted tubule
C. Secreted in the distal convoluted tubule
D. Neither reabsorbed nor secreted by the tubules
D. Neither reabsorbed nor secreted by the tubules
Performing a clearance test using radionucleotides:
A. Eliminates the need to collect urine
B. Does not require an infusion
C. Provides visualization of the filtration
D. Both A and C
D. Both A and C
Given the following information, calculate the creatinine
clearance:
24-hour urine volume = 1000 mL; serum creatinine = 2.0 mg/dL;
urine creatinine = 200 mg/dL
200 mg/dl x 1000mL /
2.0 mg/dL x 1440 mg
3.= 69 mL/min
Variables that are included in the MDRD-IDSM estimated calculations of creatinine clearance include all
of the following except:
A. Serum creatinine
B. Weight
C. Age
D. Gender
B. Weight
An advantage to using cystatin C to monitor GFR is that:
A. It does not require urine collection
B. It is not secreted by the tubules
C. It can be measured by immunoassay
D. All of the above
D. All of the above
Solute dissolved in solvent will:
A. Raise the vapor pressure
B. Lower the boiling point
C. Decrease the osmotic pressure
D. Lower the freezing point
D. Lower the freezing point
Substances that may interfere with freezing-point measurement of urine and serum osmolarity include all
of the following except:
A. Ethanol
B. Lactic acid
C. Sodium
D. Lipids
C. Sodium
Clinical osmometers use NaCl as a reference solution because:
A. 1 g molecular weight of NaCl will lower the freezing point 1.86°C
B. NaCl is readily frozen
C. NaCl is partially ionized, similar to the composition of urine
D. 1 g equivalent weight of NaCl will raise the freezing point 1.86°C
C. NaCl is partially ionized, similar to the composition of urine
The normal serum osmolarity is:
A. 50 to 100 mOsm
B. 275 to 300 mOsm
C. 400 to 500 mOsm
D. 3 times the urine osmolarity
B. 275 to 300 mOsm
After controlled fluid intake, the urine-to-serum osmolarity ratio should be at least:
A. 1:1
B. 2:1
C. 3:1
D. 4:1
A. 1:1
To provide an accurate measure of renal blood flow, a test substance should be completely:
A. Filtered by the glomerulus
B. Reabsorbed by the tubules
C. Secreted when it reaches the distal convoluted tubule
D. Cleared on each contact with functional renal tissue
D. Cleared on each contact with functional renal tissue
Renal tubular acidosis can be caused by the:
A. Production of excessively acidic urine due to increased filtration of hydrogen ions
B. Production of excessively acidic urine due to increased secretion of hydrogen ions
C. Inability to produce an acidic urine due to impaired production of ammonia
D. Inability to produce an acidic urine due to increased production of ammonia
C. Inability to produce an acidic urine due to impaired production of ammonia
Tests performed to detect renal tubular acidosis after administering an ammonium chloride load include all of
the following except:
A. Urine ammonia
B. Arterial pH
C. Urine pH
D. Titratable acidity
B. Arterial pH
The concentration of a normal urine specimen can be estimated by which of the following?
A. Color
B. Clarity
C. Foam
D. Odor
A. Color
The normal yellow color of urine is produced by:
A. Bilirubin
B. Hemoglobin
C. Urobilinogen
D. Urochrome
D. Urochrome
The presence of bilirubin in a urine specimen produces a:
A. Yellow foam when shaken
B. White foam when shaken
C. Cloudy specimen
D. Yellow-red specimen
A. Yellow foam when shaken
A urine specimen containing melanin will appear:
A. Pale pink
B. Dark yellow
C. Blue-green
D. Black
D. Black
Specimens that contain hemoglobin can be visually distinguished from those that contain RBCs because:
A. Hemoglobin produces a clear yellow specimen
B. Hemoglobin produces a cloudy pink specimen
C. RBCs produce a cloudy red specimen
D. RBCs produce a clear red specimen
C. RBCs produce a cloudy red specimen
A patient with a viscous orange specimen may have been:
A. Treated for a urinary tract infection
B. Taking vitamin B pills
C. Eating fresh carrots
D. Taking antidepressants
A. Treated for a urinary tract infection
The presence of a pink precipitate in a refrigerated specimen is caused by:
A. Hemoglobin
B. Urobilin
C. Uroerythrin
D. Beets
C. Uroerythrin
Microscopic examination of a clear urine that produces a white precipitate after refrigeration will show:
A. Amorphous urates
B. Porphyrins
C. Amorphous phosphates
D. Yeast
C. Amorphous phosphates
The color of urine containing porphyrins will be:
A. Yellow-brown
B. Green
C. Orange
D. Port wine
D. Port wine
Which of the following specific gravities would be most likely to correlate with a urine that is pale yellow?
A. 1.005
B. 1.010
C. 1.020
D. 1.030
A. 1.005
A urine specific gravity measured by a refractometer is 1.029, and the temperature of the urine is 14°C. The
specific gravity should be reported as:
A. 1.023
B. 1.027
C. 1.029
D. 1.032
C. 1.029
The principle of refractive index is to compare:
A. Light velocity in solutions with light velocity in solids
B. Light velocity in air with light velocity in solutions
C. Light scattering by air with light scattering by solutions
D. Light scattering by particles in solution
B. Light velocity in air with light velocity in solutions
A correlation exists between a specific gravity by a refractometer of 1.050 and a:
A. 2+ glucose
B. 2+ protein
C. First morning specimen
D. Radiographic dye infusion
D. Radiographic dye infusion
A cloudy urine specimen turns black upon standing and has a specific gravity of 1.012. The major concern about this specimen would be:
A. Color
B. Turbidity
C. Specific gravity
D. All of the above
A. Color
A specimen with a specific gravity of 1.035 would be considered:
A. Isosthenuric
B. Hyposthenuric
C. Hypersthenuric
D. Not urine
C. Hypersthenuric
A specimen with a specific gravity of 1.001 would be considered:
A. Hyposthenuric
B. Not urine
C. Hypersthenuric
D. Isosthenuric
B. Not urine
A strong odor of ammonia in a urine specimen could indicate:
A. Ketones
B. Normalcy
C. Phenylketonuria
D. An old specimen
D. An old specimen
The microscopic examination of a clear red urine is reported as many WBCs and epithelial cells. What does
this suggest?
A. Urinary tract infection
B. Dilute random specimen
C. Hematuria
D. Possible mix-up of specimen and sediment
D. Possible mix-up of specimen and sediment
Which of the following would contribute the most to a urine osmolality?
A. One osmole of glucose
B. One osmole of urea
C. One osmole of sodium chloride
D. All contribute equally
C. One osmole of sodium chloride
Which of the following colligative properties is not stated correctly?
A. The boiling point is raised by solute
B. The freezing point is raised by solute
C. The vapor pressure is lowered by solute
D. The osmotic pressure is raised by solute
B. The freezing point is raised by solute
An osmole contains:
A. One gram molecular weight of solute dissolved in 1 liter of solvent
B. One gram molecular weight of solute dissolved in 1 kilogram of solvent
C. Two gram molecular weights of solute dissolved in 1 liter of solvent
D. Two gram molecular weights of solute dissolved in 1 kilogram of solvent
B. One gram molecular weight of solute dissolved in 1 kilogram of solvent
The unit of osmolality measured in the clinical laboratory is the:
A. Osmole
B. Milliosmole
C. Molecular weight
D. Ionic charge
A. Osmole
In the reagent strip specific gravity reaction, the polyelectrolyte:
A. Combines with hydrogen ions in response to ion concentration
B. Releases hydrogen ions in response to ion concentration
C. Releases hydrogen ions in response to pH
D. Combines with sodium ions in response to pH
B. Releases hydrogen ions in response to ion concentration
Which of the following will react in the reagent strip specific gravity test?
A. Glucose
B. Radiographic dye
C. Protein
D. Chloride
D. Chloride
page 14 no. 1
Leaving excess urine on the reagent strip after removing it from the specimen will:
A. Cause runover between reagent pads
B. Alter the color of the specimen
C. Cause reagents to leach from the pads
D. Not affect the chemical reactions
A. Cause runover between reagent pads
Failure to mix a specimen before inserting the
reagent strip will primarily affect the:
A. Glucose reading
B. Blood reading
C. Leukocyte reading
D. Both B and C
D. Both B and C
Testing a refrigerated specimen that has not warmed to room temperature will adversely affect:
A. Enzymatic reactions
B. Dye-binding reactions
C. The sodium nitroprusside reaction
D. Diazo reactions
A. Enzymatic reactions
The reagent strip reaction that requires the longest reaction time is the:
A. Bilirubin
B. pH
C. Leukocyte esterase
D. Glucose
C. Leukocyte esterase
Quality control of reagent strips is performed:
A. Using positive and negative controls
B. When results are questionable
C. Per laboratory policy
D. All of the above
D. All of the above
All of the following are important to protect the integrity of reagent strips except:
A. Removing the desiccant from the bottle
B. Storing in an opaque bottle
C. Storing at room temperature
D. Resealing the bottle after removing a strip
A. Removing the desiccant from the bottle
The principle of the reagent strip test for pH is the:
A. Protein error of indicators
B. Greiss reaction
C. Dissociation of a polyelectrolyte
D. Double indicator reaction
D. Double indicator reaction
A urine specimen with a pH of 9.0:
A. Indicates metabolic acidosis
B. Should be re-collected
C. May contain calcium oxalate crystals
D. Is seen after drinking cranberry juice
B. Should be re-collected
In the laboratory, a primary consideration
associated with pH is:
A. Identifying urinary crystals
B. Monitoring vegetarian diets
C. Determining specimen acceptability
D. Both A and C
D. Both A and C
Indicate the source of the following proteinurias by placing a 1 for prerenal, 2 for renal, or 3 for postrenal in front of the condition.
A._____ Microalbuminuria
B._____ Acute-phase reactants
C._____ Preeclampsia
D._____ Vaginal inflammation
E. _____ Multiple myeloma
F. _____ Orthostatic proteinuria
G._____ Prostatitis
a. 2
b. 1
c. 2
d. 3
e. 1
f. 2
g. 3
The principle of the protein error of indicators reaction is that:
A. Protein keeps the pH of the urine constant
B. Albumin accepts hydrogen ions from the indicator
C. The indicator accepts hydrogen ions from albumin
D. Albumin changes the pH of the urine
B. Albumin accepts hydrogen ions from the indicator
All of the following will cause false-positive protein values on a reagent strip except:
A. Microalbuminuria
B. Highly buffered alkaline urines
C. Delay in removing the reagent strip from the specimen
D. Contamination by quaternary ammonium compounds
A. Microalbuminuria
A patient with a 2+ protein reading in the afternoon is asked to submit a first morning specimen. The second specimen has a negative protein reading. This patient is:
A. Positive for orthostatic proteinuria
B. Negative for orthostatic proteinuria
C. Positive for Bence Jones protein
D. Negative for clinical proteinuria
A. Positive for orthostatic proteinuria
Testing for microalbuminuria is valuable for early detection of kidney disease and monitoring patients with:
A. Hypertension
B. Diabetes mellitus
C. Cardiovascular disease risk
D. All of the above
D. All of the above
The primary chemical on the reagent strip in the MicralTest for microalbumin binds to:
A. Protein
B. Antihuman albumin antibody
C. Conjugated enzyme
D. Galactoside
B. Antihuman albumin antibody
All of the following are true for the ImmunoDip test for microalbumin except:
A. Unbound antibody migrates farther than bound antibody
B. Blue latex particles are coated with antihuman
albumin antibody
C. Bound antibody migrates farther than unbound
antibody
D. It utilizes an immunochromographic principle
A. Unbound antibody migrates farther than bound antibody
The principle of the protein-high pad on the Multistix Pro reagent strip is the:
A. Diazo reaction
B. Enzymatic dye-binding reaction
C. Protein error of indicators
D. Microalbumin-Micral-Test
C. Protein error of indicators
Which of the following is not tested on the Multistix Pro reagent strip?
A. Urobilinogen
B. Specific gravity
C. Creatinine
D. Protein-high
A. Urobilinogen
The principle of the protein-low reagent pad on the Multistix Pro is the:
A. Binding of albumin to sulphonphthalein dye
B. Immunological binding of albumin to antibody
C. Reverse protein error of indicators reaction
D. Enzymatic reaction between albumin and dye
A. Binding of albumin to sulphonphthalein dye
The principle of the creatinine reagent pad on microalbumin reagent strips is the:
A. Double indicator reaction
B. Diazo reaction
C. Pseudoperoxidase reaction
D. Reduction of a chromogen
C. Pseudoperoxidase reaction
The purpose of performing an albumin:creatinine ratio is to:
A. Estimate the glomerular filtration rate
B. Correct for hydration in random specimens
C. Avoid interference for alkaline urines
D. Correct for abnormally colored urines
A. Estimate the glomerular filtration rate
A patient with a normal blood glucose and a positive urine glucose should be further checked for:
A. Diabetes mellitus
B. Renal disease
C. Gestational diabetes
D. Pancreatitis
B. Renal disease
The principle of the reagent strip tests for glucose is the:
A. Peroxidase activity of glucose
B. Glucose oxidase reaction
C. Double sequential enzyme reaction
D. Dye-binding of glucose and chromogen
C. Double sequential enzyme reaction
All of the following may produce false-negative
glucose reactions except:
A. Detergent contamination
B. Ascorbic acid
C. Unpreserved specimensD. Low urine temperature
A. Detergent contamination
The primary reason for performing a Clinitest is to:
A. Check for high ascorbic acid levels
B. Confirm a positive reagent strip glucose
C. Check for newborn galactosuria
D. Confirm a negative glucose reading
C. Check for newborn galactosuria
The three intermediate products of fat metabolism include all of the following except:
A. Acetoacetic acid
B. Ketoacetic acid
C. β-hydroxybutyric acid
D. Acetone
B. Ketoacetic acid
The most significant reagent strip test that is associated with a positive ketone result is:
A. Glucose
B. Protein
C. pH
D. Specific gravity
A. Glucose
The primary reagent in the reagent strip test for ketones is:
A. Glycine
B. Lactose
C. Sodium hydroxide
D. Sodium nitroprusside
D. Sodium nitroprusside
Ketonuria may be caused by all of the following except:
A. Bacterial infections
B. Diabetic acidosis
C. Starvation
D. Vomiting
A. Bacterial infections
Urinalysis is frequently performed on a patient with severe back and abdominal pain to check for:
A. Glucosuria
B. Proteinuria
C. Hematuria
D. Hemoglobinuria
C. Hematuria
Place the appropriate number or numbers in front of each of the following statements. Use both numbers for an answer if needed.
1. Hemoglobinuria
2. Myoglobinuria
A.____ Associated with transfusion reactions
B.____ Clear red urine and pale yellow plasma
C.____ Clear red urine and red plasma
D.____ Associated wit rhabdomyolysis
E. ____ Produces hemosiderin granules in urinary sediments
F. ____ Associated with acute renal failure
a. 1
b.2
c.1
d.2
e.1
f. 2
The principle of the reagent strip test for blood is based on the: (pg. 10)
A. Binding of heme and a chromogenic dye
B. Peroxidase activity of heme
C. Reaction of peroxide and chromogen
D. Diazo activity of heme
B. Peroxidase activity of heme
A speckled pattern on the blood pad of the reagent strip indicates:
A. Hematuria
B. Hemoglobinuria
C. Myoglobinuria
D. All of the above
A. Hematuria
List the following products of hemoglobin degradation in the correct order of metabolism by placing numbers 1 to 4 in the blank, where 1
indicates the beginning and 4 indicates the end product.
A. _____ Conjugated bilirubin
B. _____ Urobilinogen and stercobilinogen
C. _____ Urobilin
D. _____ Unconjugated bilirubin
a. 1
b. 3
c. 4
d. 2
The principle of the reagent strip test for bilirubin is the:
A. Diazo reaction
B. Ehrlich reaction
C. Greiss reaction
D. Peroxidase reaction
A. Diazo reaction
An elevated urine bilirubin with a normal urobilinogen is indicative of:
A. Cirrhosis of the liver
B. Hemolytic disease
C. Hepatitis
D. Biliary obstruction
D. Biliary obstruction
The primary cause of a false-negative bilirubin reaction is:
A. Highly pigmented urine
B. Specimen contamination
C. Specimen exposure to light
D. Excess conjugated bilirubin
C. Specimen exposure to light
The purpose of the special mat supplied with the Ictotest tablets is that:
A. Bilirubin remains on the surface of the mat
B. It contains the dye needed to produce color
C. It removes interfering substances
D. Bilirubin is absorbed into the mat
A. Bilirubin remains on the surface of the mat
The reagent in the Multistix reaction for urobilinogen is:
A. A diazonium salt
B. Tetramethylbenzidine
C. p-Dimethylaminobenzaldehyde
D. Hoesch reagent
C. p-Dimethylaminobenzaldehyde
The primary problem with urobilinogen tests using Ehrlich reagent is:
A. Positive reactions with porphobilinogen
B. Lack of specificity
C. Positive reactions with Ehrlich reactive substances
D. All of the above
C. Positive reactions with Ehrlich reactive substances
The reagent strip test for nitrite uses the:
A. Greiss reaction
B. Ehrlich reaction
C. Peroxidase reaction
D. Pseudoperoxidase reaction
A. Greiss reaction
All of the following can cause a negative nitrite reading except:
A. Gram-positive bacteria
B. Gram-negative bacteria
C. Random urine specimens
D. Heavy bacterial infections
B. Gram-negative bacteria
A positive nitrite test and a negative leukocyte esterase test is an indication of a:
A. Dilute random specimen
B. Specimen with lysed leukocytes
C. Vaginal yeast infection
D. Specimen older than 2 hours
D. Specimen older than 2 hours
All of the following can be detected by the leukocyte esterase reaction except:
A. Neutrophils
B. Eosinophils
C. Lymphocytes
D. Basophils
C. Lymphocytes
Screening tests for urinary infection combine the leukocyte esterase test with the test for:
A. pH
B. Nitrite
C. Protein
D. Blood
B. Nitrite
The principle of the leukocyte esterase reagent strip test uses a:
A. Peroxidase reaction
B. Double indicator reaction
C. Diazo reaction
D. Dye-binding technique
C. Diazo reaction
The principle of the reagent strip test for specific gravity uses the dissociation constant of a(n):
A. Diazonium salt
B. Indicator dye
C. Polyelectrolyte
D. Enzyme substrate
C. Polyelectrolyte
A specific gravity of 1.005 would produce the reagent strip color:
A. Blue
B. Green
C. Yellow
D. Red
A. Blue
Specific gravity readings on a reagent strip are affected by:
A. Glucose
B. Radiographic dye
C. Alkaline urine
D. All of the above
C. Alkaline urine
Macroscopic screening of urine specimens is used to:
A. Provide results as soon as possible
B. Predict the type of urinary casts present
C. Increase cost-effectiveness of urinalysis
D. Decrease the need for polarized microscopy
C. Increase cost-effectiveness of urinalysis
Variations in the microscopic analysis of urine include all of the following except:
A. Preparation of the urine sediment
B. Amount of sediment analyzed
C. Method of reporting
D. Identification of formed elements
D. Identification of formed elements
All of the following can cause false-negative microscopic results except:
A. Braking the centrifuge
B. Failing to mix the specimen
C. Diluting alkaline urine
D. Using midstream clean-catch specimens
D. Using midstream clean-catch specimens
The two factors that determine relative centrifugal force are:
A. Radius of rotor head and RPM
B. Radius of rotor head and time of centrifugation
C. Diameter of rotor head and RPM
D. RPM and time of centrifugation
C. Diameter of rotor head and RPM
When using the glass-slide and cover-slip method, which of the following might be missed if the cover slip is overflowed?
A. Casts
B. RBCs
C. WBCs
D. Bacteria
A. Casts
Initial screening of the urine sediment is performed using an objective power of:
A. 4×
B. 10×
C. 40×
D. 100×
B. 10×
Which of the following should be used to reduce light intensity in bright-field microscopy?
A. Centering screws
B. Aperture diaphragm
C. Rheostat
D. Condenser aperture diaphragm
C. Rheostat
Which of the following are reported as number per lpf?
A. RBCs
B. WBCs
C. Crystals
D. Casts
D. Casts
The Sternheimer-Malbin stain is added to urine sediments to do all of the following except:
A. Increase visibility of sediment constituents
B. Change the constituents’ refractive index
C. Decrease precipitation of crystals
D. Delineate constituent structures
C. Decrease precipitation of crystals
Nuclear detail can be enhanced by:
A. Prussian blue
B. Toluidine blue
C. Acetic acid
D. Both B and C
D. Both B and C
Which of the following lipids is/are stained by Sudan III?
A. Cholesterol
B. Neutral fats
C. Triglycerides
D. Both B and C
D. Both B and C
Which of the following lipids is/are capable of polarizing light?
A. Cholesterol
B. Neutral fats
C. Triglycerides
D. Both A and B
A. Cholesterol
The purpose of the Hansel stain is to identify:
A. Neutrophils
B. Renal tubular cells
C. Eosinophils
D. Monocytes
C. Eosinophils
Crenated RBCs are seen in urine that is:
A. Hyposthenuric
B. Hypersthenuric
C. Highly acidic
D. Highly alkaline
B. Hypersthenuric
Differentiation among RBCs, yeast, and oil droplets may be accomplished by all of the following except:
A. Observation of budding in yeast cells
B. Increased refractility of oil droplets
C. Lysis of yeast cells by acetic acid
D. Lysis of RBCs by acetic acid
C. Lysis of yeast cells by acetic acid
A finding of dysmorphic RBCs is indicative of:
A. Glomerular bleeding
B. Renal calculi
C. Traumatic injury
D. Coagulation disorders
A. Glomerular bleeding
Leukocytes that stain pale blue with Sternheimer-Malbin stain and exhibit brownian movement are:
A. Indicative of pyelonephritis
B. Basophils
C. Mononuclear leukocytes
D. Glitter cells
D. Glitter cells
Sometimes mononuclear leukocytes are mistaken for:
A. Yeast cells
B. Squamous epithelial cells
C. Pollen grains
D. Renal tubular cells
D. Renal tubular cells
When pyuria is detected in a urine sediment, the slide should be checked carefully for the presence of:
A. RBCs
B. Bacteria
C. Hyaline casts
D. Mucus
B. Bacteria
Transitional epithelial cells are sloughed from the:
A. Collecting duct
B. Vagina
C. Bladder
D. Proximal convoluted tubule
C. Bladder
The largest cells in the urine sediment are:
A. Squamous epithelial cells
B. Urothelial epithelial cells
C. Cuboidal epithelial cells
D. Columnar epithelial cells
A. Squamous epithelial cells
A squamous epithelial cell that is clinically significant is the:
A. Cuboidal cell
B. Clue cell
C. Caudate cell
D. Columnar cell
B. Clue cell
Forms of transitional epithelial cells include all of the following except:
A. Spherical
B. Caudate
C. Convoluted
D. Polyhedral
C. Convoluted
Increased transitional cells are indicative of:
A. Catheterization
B. Malignancy
C. Pyelonephritis
D. Both A and B
D. Both A and B
A primary characteristic used to identify renal tubular epithelial cells is:
A. Elongated structure
B. Centrally located nucleus
C. Spherical appearance
D. Eccentrically located nucleus
D. Eccentrically located nucleus
After an episode of hemoglobinuria, RTE cells may contain:
A. Bilirubin
B. Hemosiderin granules
C. Porphobilinogen
D. Myoglobin
B. Hemosiderin granules
The predecessor of the oval fat body is the:
A. Histiocyte
B. Urothelial cell
C. Monocyte
D. Renal tubular cell
D. Renal tubular cell
A structure believed to be an oval fat body produced a Maltese cross formation under polarized light but does not stain with Sudan III. The structure:
A. Contains cholesterol
B. Is not an oval fat body
C. Contains neutral fats
D. Is contaminated with immersion oil
A. Contains cholesterol
The finding of yeast cells in the urine is commonly associated with:
A. Cystitis
B. Diabetes mellitus
C. Pyelonephritis
D. Liver disorders
B. Diabetes mellitus
The primary component of urinary mucus is:
A. Bence Jones protein
B. Microalbumin
C. Uromodulin
D. Orthostatic protein
C. Uromodulin
The majority of casts are formed in the:
A. Proximal convoluted tubules
B. Ascending loop of Henle
C. Distal convoluted tubules
D. Collecting ducts
C. Distal convoluted tubules
Cylindruria refers to the presence of:
A. Cylindrical renal tubular cells
B. Mucus-resembling casts
C. Hyaline and waxy casts
D. All types of casts
D. All types of casts
A person submitting a urine specimen after a strenuous exercise routine normally can have all of the following in the sediment except:
A. Hyaline casts
B. Granular casts
C. RBC casts
D. WBC casts
D. WBC casts
Before identifying an RBC cast, all of the following should be observed:
A. Free-floating RBCs
B. Intact RBCs in the cast matrix
C. A positive reagent strip blood reaction
D. All of the above
D. All of the above
WBC casts are associated primarily with:
A. Pyelonephritis
B. Cystitis
C. Glomerulonephritis
D. Viral infections
A. Pyelonephritis
The shape of the RTE cell associated with RTE casts is primarily:
A. Elongated
B. Cuboidal
C. Round
D. Columnar
C. Round
When observing RTE casts, the cells are primarily:
A. Embedded in a clear matrix
B. Embedded in a granular matrix
C. Attached to the surface of a matrix
D. Stained by components of the urine filtrate
C. Attached to the surface of a matrix
The presence of fatty casts is associated with:
A. Nephrotic syndrome
B. Crush injuries
C. Diabetes mellitus
D. All of the above
D. All of the above
Nonpathogenic granular casts contain:
A. Cellular lysosomes
B. Degenerated cells
C. Protein aggregates
D. Gram-positive cocci
A. Cellular lysosomes
All of the following are true about waxy casts except they:
A. Represent extreme urine stasis
B. May have a brittle consistency
C. Require staining to be visualized
D. Contain degenerated granules
C. Require staining to be visualized
Observation of broad casts represents:
A. Destruction of tubular walls
B. Dehydration and high fever
C. Formation in the collecting ducts
D. Both A and C
D. Both A and C
All of the following contribute to urinary crystals formation except:
A. Protein concentration
B. pH
C. Solute concentration
D. Temperature
A. Protein concentration
The most valuable initial aid for identifying crystals in a urine specimen is:
A. pH
B. Solubility
C. Staining
D. Polarized microscopy
A. pH
Crystals associated with severe liver disease include all of the following except:
A. Bilirubin
B. Leucine
C. Cystine
D. Tyrosine
C. Cystine
All of the following crystals routinely polarize except:
A. Uric acid
B. Cholesterol
C. Radiographic dye
D. Cystine
D. Cystine
Casts and fibers usually can be differentiated using:
A. Solubility characteristics
B. Patient history
C. Polarized light
D. Fluorescent light
C. Polarized light
Most glomerular disorders are caused by:
A. Sudden drops in blood pressure
B. Immunologic disorders
C. Exposure to toxic substances
D. Bacterial infections
B. Immunologic disorders
Dysmorphic RBC casts would be a significant finding with all of the following except:
A. Goodpasture syndrome
B. AGN
C. Chronic pyelonephritis
D. Henoch-Schönlein purpura
C. Chronic pyelonephritis
Occasional episodes of macroscopic hematuria over
periods of 20 or more years are seen in patients with:
A. Crescentic glomerulonephritis
B. IgA nephropathy
C. Nephrotic syndrome
D. GPA
B. IgA nephropathy
Antiglomerular basement membrane antibody is seen with:
A. GPA
B. IgA nephropathy
C. Goodpasture syndrome
D. Diabetic nephropathy
C. Goodpasture syndrome
ANCA is diagnostic for:
A. IgA nephropathy
B. GPA
C. Henoch-Schönlein purpura
D. Goodpasture syndrome
B. GPA
Respiratory and renal symptoms are associated with all of the following except:
A. IgA nephropathy
B. GPA
C. Henoch-Schönlein purpura
D. Goodpasture syndrome
A. IgA nephropathy
The presence of fatty casts is associated with all of the following except:
A. Nephrotic syndrome
B. FSGS
C. Nephrogenic DI
D. MCD
C. Nephrogenic DI
The highest levels of proteinuria are seen with:
A. Alport syndrome
B. Diabetic nephropathy
C. IgA nephropathy
D. NS
D. NS
Ischemia frequently produces:
A. Acute renal tubular necrosis
B. MCD
C. Renal glycosuria
D. Goodpasture syndrome
A. Acute renal tubular necrosis
A disorder associated with polyuria and low specific gravity is:
A. Renal glucosuria
B. MCD
C. Nephrogenic DI
D. FSGS
C. Nephrogenic DI
An inherited disorder producing a generalized defect in tubular reabsorption is:
A. Alport syndrome
B. AIN
C. Fanconi syndrome
D. Renal glycosuria
C. Fanconi syndrome
A teenage boy who develops gout in his big toe and has a high serum uric acid should be monitored for:
A. Fanconi syndrome
B. Renal calculi
C. Uromodulin-associated kidney disease
D. Chronic interstitial nephritis
C. Uromodulin-associated kidney disease
The only protein produced by the kidney is:
A. Albumin
B. Uromodulin
C. Uroprotein
D. Globulin
B. Uromodulin
The presence of RTE cells and casts is an indication of:
A. AIN
B. CGN
C. MCD
D. ATN
D. ATN
Differentiation between cystitis and pyelonephritis is aided by the presence of:
A. WBC casts
B. RBC casts
C. Bacteria
D. Granular casts
A. WBC casts
The presence of WBCs and WBC casts with no bacteria is indicative of:
A. Chronic pyelonephritis
B. ATN
C. AIN
D. Both B and C
C. AIN
ESRD is characterized by all of the following except:
A. Hypersthenuria
B. Isosthenuria
C. Azotemia
D. Electrolyte imbalance
A. Hypersthenuria
Prerenal acute renal failure could be caused by:
A. Massive hemorrhage
B. ATN
C. AIN
D. Malignant tumors
A. Massive hemorrhage
The most common component of renal calculi is:
A. Calcium oxalate
B. Magnesium ammonium phosphate
C. Cystine
D. Uric acid
A. Calcium oxalate
Urinalysis on a patient with severe back pain being evaluated for renal calculi would be most beneficial if it showed:
A. Heavy proteinuria
B. Low specific gravity
C. Uric acid crystals
D. Microscopic hematuria
D. Microscopic hematuria
Abnormal urine screening tests categorized as an overflow disorder include all of the following except:
A. Alkaptonuria
B. Galactosemia
C. Melanuria
D. Cystinuria
C. Melanuria
All states require newborn screening for PKU for early:
A. Modifications of the diet
B. Administration of antibiotics
C. Detection of diabetes
D. Initiation of gene therapy
A. Modifications of the diet
All of the following disorders can be detected by newborn screening except:
A. Tyrosyluria
B. MSUD
C. Melanuria
D. Galactosemia
C. Melanuria
The best specimen for early newborn screening is a:
A. Timed urine specimen
B. Blood specimen
C. First morning urine specimen
D. Fecal specimen
B. Blood specimen
Which of the following disorders is not associated with the phenylalanine–tyrosine pathway?
A. MSUD
B. Alkaptonuria
C. Albinism
D. Tyrosinemia
A. MSUD
The least serious form of tyrosylemia is:
A. Immature liver function
B. Type 1
C. Type 2
D. Type 3
A. Immature liver function
An overflow disorder of the phenylalanine–tyrosine pathway that would produce a positive reaction with the reagent strip test for ketones is:
A. Alkaptonuria
B. Melanuria
C. MSUD
D. Tyrosyluria
C. MSUD
An overflow disorder that could produce a false-positive reaction with the Clinitest procedure is:
A. Cystinuria
B. Alkaptonuria
C. Indicanuria
D. Porphyrinuria
B. Alkaptonuria
A urine that turns black after sitting by the sink for several hours could be indicative of:
A. Alkaptonuria
B. MSUD
C. Melanuria
D. Both A and C
D. Both A and C
Ketonuria in a newborn is an indication of:
A. MSUD
B. Isovaleric acidemia
C. Methylmalonic acidemia
D. All of the above
D. All of the above
Urine from a newborn with MSUD will have a significant:
A. Pale color
B. Yellow precipitate
C. Milky appearance
D. Sweet odor
D. Sweet odor
Hartnup disease is a disorder associated with the metabolism of:
A. Organic acids
B. Tryptophan
C. Cystine
D. Phenylalanine
B. Tryptophan
5-HIAA is a degradation product of:
A. Heme
B. Indole
C. Serotonin
D. Melanin
C. Serotonin
Elevated urinary levels of 5-HIAA are associated with:
A. Carcinoid tumors
B. Hartnup disease
C. Cystinuria
D. Platelet disorders
A. Carcinoid tumors
False-positive levels of 5-HIAA can be caused by a diet high in:
A. Meat
B. Carbohydrates
C. Starch
D. Bananas
D. Bananas
Homocystinuria is caused by failure to metabolize:
A. Lysine
B. Methionine
C. Arginine
D. Cystine
B. Methionine
The Ehrlich reaction will detect only the presence of:
A. Uroporphyrin
B. Porphobilinogen
C. Coproporphyrin
D. Protoporphyrin
B. Porphobilinogen
Acetyl acetone is added to the urine before performing the Ehrlich test when checking for:
A. Aminolevulinic acid
B. Porphobilinogen
C. Uroporphyrin
D. Coproporphyrin
B. Porphobilinogen
The classic urine color associated with porphyria is:
A. Dark yellow
B. Indigo blue
C. Pink
D. Port wine
D. Port wine
Which of the following specimens can be used for porphyrin testing?
A. Urine
B. Blood
C. Feces
D. All of the above
D. All of the above
The two stages of heme formation affected by lead poisoning are:
A. Porphobilinogen and uroporphyrin
B. Aminolevulinic acid and porphobilinogen
C. Coproporphyrin and protoporphyrin
D. Aminolevulinic acid and protoporphyrin
D. Aminolevulinic acid and protoporphyrin
Hurler, Hunter, and Sanfilippo syndromes are hereditary disorders affecting the metabolism of:
A. Porphyrins
B. Purines
C. Mucopolysaccharides
D. Tryptophan
C. Mucopolysaccharides
Many uric acid crystals in a pediatric urine specimen may indicate:
A. Hurler syndrome
B. Lesch-Nyhan disease
C. Melituria
D. Sanfilippo syndrome
B. Lesch-Nyhan disease
Deficiency of the GALT enzyme will produce a:
A. Positive Clinitest
B. Glycosuria
C. Galactosemia
D. Both A and C
D. Both A and C
CSF is produced mainly in the:
A. Bone marrow
B. Peripheral blood
C. Choroid plexuses
D. Subarachnoid space
C. Choroid plexuses
The functions of the CSF include all of the following except:
A. Removing metabolic wastes
B. Producing an ultrafiltrate of plasma
C. Supplying nutrients to the CNS
D. Protecting the brain and spinal cord
B. Producing an ultrafiltrate of plasma
The CSF flows through the:
A. Choroid plexus
B. Pia mater
C. Subarachnoid space
D. Dura mater
C. Subarachnoid space
Substances present in the CSF are controlled by the:
A. Arachnoid granulations
B. Blood–brain barrier
C. Presence of one-way valves
D. Blood–CSF barrier
B. Blood–brain barrier
What department is the CSF tube labeled 3 routinely sent to?
A. Hematology
B. Chemistry
C. Microbiology
D. Serology
A. Hematology
The CSF tube that should be kept at room temperature is:
A. Tube 1
B. Tube 2
C. Tube 3
D. Tube 4
B. Tube 2
The presence of xanthochromia can be caused by all of the following except:
A. Immature liver function
B. RBC degradation
C. A recent hemorrhage
D. Elevated CSF protein
C. A recent hemorrhage
A web-like pellicle in a refrigerated CSF specimen indicates:
A. Tubercular meningitis
B. Multiple sclerosis
C. Primary CNS malignancy
D. Viral meningitis
A. Tubercular meningitis
Given the following information, calculate the CSF WBC count: cells counted, 80; dilution, 1:10; large Neubauer squares counted, 10.
A. 8
B. 80
C. 800
D. 8000
C. 800
CSF WBC count is diluted with:
A. Distilled water
B. Normal saline
C. Acetic acid
D. Hypotonic saline
C. Acetic acid
A total CSF cell count on a clear fluid should be:
A. Reported as normal
B. Not reported
C. Diluted with normal saline
D. Counted undiluted
D. Counted undiluted
The purpose of adding albumin to CSF before cytocentrifugation is to:
A. Increase the cell yield
B. Decrease the cellular distortion
C. Improve the cellular staining
D. Both A and B
D. Both A and B
The primary concern when pleocytosis of neutrophils and lymphocytes is found in the CSF is:
A. Meningitis
B. CNS malignancy
C. Multiple sclerosis
D. Hemorrhage
A. Meningitis
Neutrophils with pyknotic nuclei may be mistaken for:
A. Lymphocytes
B. Nucleated RBCs
C. Malignant cells
D. Spindle-shaped cells
B. Nucleated RBCs
The presence of which of the following cells is increased in a parasitic infection?
A. Neutrophils
B. Macrophages
C. Eosinophils
D. Lymphocytes
C. Eosinophils
Macrophages appear in the CSF after:
A. Hemorrhage
B. Repeated spinal taps
C. Diagnostic procedures
D. All of the above
D. All of the above
Nucleated RBCs are seen in the CSF as a result of:
A. Elevated blood RBCs
B. Treatment of anemia
C. Severe hemorrhage
D. Bone marrow contamination
D. Bone marrow contamination
After a CNS diagnostic procedure, which of the following might be seen in the CSF?
A. Choroidal cells
B. Ependymal cells
C. Spindle-shaped cells
D. All of the above
D. All of the above
Hemosiderin granules and hematoidin crystals are seen in:
A. Lymphocytes
B. Macrophages
C. Ependymal cells
D. Neutrophils
B. Macrophages
Myeloblasts are seen in the CSF:
A. In bacterial infections
B. In conjunction with CNS malignancy
C. After cerebral hemorrhage
D. As a complication of acute leukemia
D. As a complication of acute leukemia
Cells resembling large and small lymphocytes with cleaved nuclei represent:
A. Lymphoma cells
B. Choroid cells
C. Melanoma cells
D. Medulloblastoma cells
A. Lymphoma cells
The reference range for CSF protein is:
A. 6 to 8 g/dL
B. 15 to 45 g/Dl
C. 6 to 8 mg/dL
D. 15 to 45 mg/dL
B. 15 to 45 g/Dl
CSF can be differentiated from serum by the presence of
A. Albumin
B. Globulin
C. Transthyretin
D. Tau transferrin
D. Tau transferrin
In serum, the second most prevalent protein is IgG; in CSF, the second most prevalent protein is:
A. Transferrin
B. Transthyretin
C. Prealbumin
D. Ceruloplasmin
C. Prealbumin
Elevated values for CSF protein can be caused by all of the following except:
A. Meningitis
B. Multiple sclerosis
C. Fluid leakage
D. CNS malignancy
C. Fluid leakage
The integrity of the blood–brain barrier is measured using the:
A. CSF/serum albumin index
B. CSF/serum globulin ratio
C. CSF albumin index
D. CSF IgG index
A. CSF/serum albumin index
Given the following results, calculate the IgG index: CSF IgG, 50 mg/dL; serum IgG, 2 g/dL; CSF albumin, 70 mg/dL; serum albumin, 5 g/dL.
A. 0.6
B. 6.0
C. 1.8
D. 2.8
C. 1.8
The CSF IgG index calculated in Study Question 28 indicates:
A. Synthesis of IgG in the CNS
B. Damage to the blood–brain barrier
C. Cerebral hemorrhage
D. Lymphoma infiltration
A. Synthesis of IgG in the CNS
The finding of oligoclonal bands in the CSF and not in the serum is seen with:
A. Multiple myeloma
B. CNS malignancy
C. Multiple sclerosis
D. Viral infections
C. Multiple sclerosis
Which condition is suggested by the following results: a CSF glucose of 15 mg/dL, WBC count of 5000, 90% neutrophils, and protein of 80 mg/dL?
A. Fungal meningitis
B. Viral meningitis
C. Tubercular meningitis
D. Bacterial meningitis
D. Bacterial meningitis
A patient with a blood glucose of 120 mg/dL would have a normal CSF glucose of:
A. 20 mg/dL
B. 60 mg/dL
C. 80 mg/dL
D. 120 mg/dL
C. 80 mg/dL
CSF lactate will be more consistently decreased in:
A. Bacterial meningitis
B. Viral meningitis
C. Fungal meningitis
D. Tubercular meningitis
B. Viral meningitis
Measurement of which of the following can be replaced by CSF glutamine analysis in children with Reye syndrome?
A. Ammonia
B. Lactate
C. Glucose
D. a-Ketoglutarate
A. Ammonia
Before performing a Gram stain on CSF, the specimen must be:
A. Filtered
B. Warmed to 37°C
C. Centrifuged
D. Mixed
C. Centrifuged
All of the following statements are true about cryptococcal meningitis except:
A. An India ink preparation is positive
B. A starburst pattern is seen on Gram stain
C. The WBC count is over 2000
D. A confirmatory immunology test is available
C. The WBC count is over 2000
The most sensitive and specific method to detect the causative organism in meningitis is:
A. Gram stain
B. Culture and sensitivity
C. India ink stain
D. PCR assay
D. PCR assay
The test of choice to detect neurosyphilis is the:
A. RPR
B. VDRL
C. FAB
D. FTA-ABS
B. VDRL
Maturation of spermatozoa takes place in the:
A. Sertoli cells
B. Seminiferous tubules
C. Epididymis
D. Seminal vesicles
C. Epididymis
Enzymes for the coagulation and liquefaction of semen are produced by the:
A. Seminal vesicles
B. Bulbourethral glands
C. Ductus deferens
D. Prostate gland
D. Prostate gland
The major component of seminal fluid is:
A. Glucose
B. Fructose
C. Acid phosphatase
D. Citric acid
B. Fructose
If the first portion of a semen specimen is not collected, the semen analysis will have which of the following?
A. Decreased pH
B. Increased viscosity
C. Decreased sperm count
D. Decreased sperm motility
C. Decreased sperm count
Failure of laboratory personnel to document the time a semen specimen is collected primarily affects the interpretation of semen:
A. Appearance
B. Volume
C. pH
D. Viscosity
D. Viscosity
Liquefaction of a semen specimen should take place
within:
A. 1 hour
B. 2 hours
C. 3 hours
D. 4 hours
A. 1 hour
A semen specimen delivered to the laboratory in a condom has a normal sperm count and markedly decreased sperm motility. This indicates:
A. Decreased fructose
B. Antispermicide in the condom
C. Increased semen viscosity
D. Increased semen alkalinity
B. Antispermicide in the condom
An increased semen pH may be caused by:
A. Poorly developed seminal vesicles
B. Increased prostatic secretions
C. Obstruction of the ejaculation duct
D. Prostatic infection
D. Prostatic infection
Proteolytic enzymes may be added to semen specimens to:
A. Increase the viscosity
B. Dilute the specimen
C. Decrease the viscosity
D. Neutralize the specimen
C. Decrease the viscosity
The normal sperm concentration is:
A. Less than 20 million/μL
B. More than 20 million/mL
C. Less than 20 million/mL
D. More than 20 million/μL
B. More than 20 million/mL
Given the following information, calculate the sperm concentration: dilution, 1:20; sperm counted in five RBC squares on each side of the hemocytometer, 80 and 86; volume, 3 mL.
A. 80 million/mL
B. 83 million/mL
C. 86 million/mL
D. 169 million/μL
B. 83 million/mL
Using the information from question 11, calculate the sperm concentration when 80 sperm are counted in 1 WBC square and 86 sperm are counted in another WBC square.
A. 83 million/mL
B. 166 million per ejaculate
C. 16.6 million/mL
D. 50 million per ejaculate
C. 16.6 million/mL
The primary reason to dilute a semen specimen before performing a sperm concentration is to:
A. Immobilize the sperm
B. Facilitate the chamber count
C. Decrease the viscosity
D. Stain the sperm
A. Immobilize the sperm
When performing a sperm concentration, 60 sperm are counted in the RBC squares on one side of the hemocytometer and 90 sperm are counted in the
RBC squares on the other side. The specimen is diluted 1:20. The:
A. Specimen should be rediluted and counted
B. Sperm count is 75 million/mL
C. Sperm count is greater than 5 million/mL
D. Sperm concentration is abnormal
A. Specimen should be rediluted and counted
Sperm motility evaluations are performed:
A. Immediately after the specimen is collected
B. Within 1 hour of collection
C. After 3 hours of incubation
D. At 6-hour intervals for 1 day
B. Within 1 hour of collection
The percentage of sperm showing average motility that is considered normal is:
A. 25%
B. 50%
C. 60%
D. 75%
B. 50%
The purpose of the acrosomal cap is to:
A. Penetrate the ovum
B. Protect the nucleus
C. Create energy for tail movement
D. Protect the neckpieceB. Protect the nucleus
A. Penetrate the ovum
The sperm part containing a mitochondrial sheath is the:
A. Head
B. Neckpiece
C. Midpiece
D. Tail
C. Midpiece
All of the following are associated with sperm motility except the:
A. Head
B. Neckpiece
C. Midpiece
D. Tail
A. Head
The morphological shape of a normal sperm head is:
A. Round
B. Tapered
C. Oval
D. Amorphous
C. Oval
Normal sperm morphology when using the WHO criteria is:
A. >30% normal forms
B. <30% normal forms
C. >15% abnormal forms
D. <15% normal forms
A. >30% normal forms
Additional parameters measured by Kruger’s strict morphology include all of the following, except:
a. Vitality
b. Presence of vacuoles
c. Acrosome size
d. Tail length
a. Vitality
Round cells that are of concern and may be included in sperm counts and morphology analysis are:
A. Leukocytes
B. Spermatids
C. RBCs
D. Both A and B
D. Both A and B
If 5 round cells per 100 sperm are counted in a sperm morphology smear and the sperm concentration is 30 million, the concentration of round cells is:
A. 150,000
B. 1.5 million
C. 300,000
D. 15 million
B. 1.5 million
After an abnormal sperm motility test with a normal sperm count, what additional test might be ordered?
A. Fructose level
B. Zinc level
C. MAR test
D. Eosin-nigrosin stain
D. Eosin-nigrosin stain
Follow-up testing for a low sperm concentration would include testing for:
A. Antisperm antibodies
B. Seminal fluid fructose
C. Sperm vitality
D. Prostatic acid phosphatase
B. Seminal fluid fructose
The immunobead test for antisperm antibodies:
A. Detects the presence of male antibodies
B. Determines the presence of IgG, IgM, and IgA antibodies
C. Determines the location of antisperm antibodies
D. All of the above
D. All of the above
Measurement of α-glucosidase is performed to detect a disorder of the:
A. Seminiferous tubules
B. Epididymis
C. Prostate gland
D. Bulbourethral glands
B. Epididymis
A specimen delivered to the laboratory with a request for prostatic acid phosphatase and
glycoprotein p30 was collected to determine:
A. Prostatic infection
B. Presence of antisperm antibodies
C. A possible rape
D. Successful vasectomy
C. A possible rape
After a negative post vasectomy wet preparation, the specimen should be:
A. Centrifuged and reexamined
B. Stained and reexamined
C. Reported as no sperm seen
D. Both A and B
A. Centrifuged and reexamined
Standardization of procedures and reference values for semen analysis is provided primarily by the:
A. Manufacturers of instrumentation
B. WHO
C. Manufacturers of control samples
D. Clinical Laboratory Improvement Amendments
B. WHO
The functions of synovial fluid include all of the following except:
A. Lubrication for the joints
B. Removal of cartilage debris
C. Cushioning joints during jogging
D. Providing nutrients for cartilage
B. Removal of cartilage debris
The primary function of synoviocytes is to:
A. Provide nutrients for the joints
B. Secrete protein
C. Regulate glucose filtration
D. Prevent crystal formation
A. Provide nutrients for the joints
Which of the following tests is not performed frequently on synovial fluid?
A. Uric acid
B. WBC count
C. Crystal examination
D. Gram stain
A. Uric acid
The procedure for collecting synovial fluid is called:
A. Synovialcentesis
B. Arthrocentesis
C. Joint puncture
D. Arteriocentesis
B. Arthrocentesis
Normal synovial fluid resembles:
A. Egg white
B. Normal serum
C. Dilute urine
D. Lipemic serum
A. Egg white
Before testing, very viscous synovial fluid should be treated with:
A. Normal saline
B. Hyaluronidase
C. Distilled water
D. Hypotonic saline
B. Hyaluronidase
The color of the synovial fluid from a patient with a
bacterial infection may be:
A. Yellow tinged
B. Green tinged
C. Red streaked
D. Opalescent
B. Green tinged
Which of the following could be affected most significantly if a synovial fluid is refrigerated before testing?
A. Glucose
B. Crystal examination
C. Mucin clot test
D. Differential
B. Crystal examination
The highest WBC count can be expected to be seen in patients with:
A. Noninflammatory arthritis
B. Inflammatory arthritis
C. Septic arthritis
D. Hemorrhagic arthritis
C. Septic arthritis
When diluting a synovial fluid WBC count, all of the following are acceptable except:
A. Acetic acid
B. Isotonic saline
C. Hypotonic saline
D. Saline with saponin
A. Acetic acid
The lowest percentage of neutrophils would be seen in patients with:
A. Noninflammatory arthritis
B. Inflammatory arthritis
C. Septic arthritis
D. Hemorrhagic arthritis
A. Noninflammatory arthritis
All of the following are abnormal when seen in synovial fluid except:
A. Neutrophages
B. Ragocytes
C. Synovial lining cells
D. Lipid droplets
C. Synovial lining cells
Synovial fluid crystals that occur as a result of purine metabolism or chemotherapy for leukemia are:
A. Monosodium urate
B. Cholesterol
C. Calcium pyrophosphate
D. Apatite
A. Monosodium urate
Synovial fluid crystals associated with inflammation in patients on dialysis are:
A. Calcium pyrophosphate dihydrate
B. Calcium oxalate
C. Corticosteroid
D. Monosodium urate
B. Calcium oxalate
Crystals associated with pseudogout are:
A. Monosodium urate
B. Calcium pyrophosphate dihydrate
C. Apatite
D. Corticosteroid
B. Calcium pyrophosphate dihydrate
Synovial fluid for crystal examination should be examined as a/an:
A. Wet preparation
B. Wright’s stain
C. Gram stain
D. Acid-fast stain
A. Wet preparation
Crystals that have the ability to polarize light are:
A. Corticosteroid
B. Monosodium urate
C. Calcium oxalate
D. All of the above
D. All of the above
In an examination of synovial fluid under compensated polarized light, rhomboid-shaped crystals are observed. What color would these crystals be when aligned parallel to the slow vibration?
A. White
B. Yellow
C. Blue
D. Red
B. Yellow
If crystals shaped like needles are aligned perpendicular to the slow vibration of compensated
polarized light, what color are they?
A. White
B. Yellow
C. Blue
D. Red
C. Blue
Negative birefringence occurs under red-compensated polarized light when:
A. Slow light is impeded more than fast light
B. Slow light is impeded less than fast light
C. Fast light runs against the molecular grain of the crystal
D. Both B and C
C. Fast light runs against the molecular grain of the crystal
Often synovial fluid cultures are plated on chocolate agar to detect the presence of:
A. Neisseria gonorrhoeae
B. Staphylococcus agalactiae
C. Streptococcus viridans
D. Enterococcus faecalis
A. Neisseria gonorrhoeae
The chemical test performed most frequently on synovial fluid is:
A. Total protein
B. Uric acid
C. Calcium
D. Glucose
D. Glucose
Which of the following chemistry tests can be performed on synovial fluid to determine the
severity of RA?
A. Glucose
B. Protein
C. Acid phosphatase
D. Uric acid
C. Acid phosphatase
Serological tests on patients’ serum may be performed to detect antibodies causing arthritis for all of the following disorders except:
A. Pseudogout
B. Rheumatoid arthritis
C. Systemic lupus erythematosus
D. Lyme arthritis
A. Pseudogout
The primary purpose of serous fluid is to:
A. Remove waste products
B. Lower capillary pressure
C. Lubricate serous membranes
D. Nourish serous membranes
C. Lubricate serous membranes
The membrane that lines the wall of a cavity is the:
A. Visceral
B. Peritoneal
C. Pleural
D. Parietal
D. Parietal
During normal production of serous fluid, the slight excess of fluid is:
A. Absorbed by the lymphatic system
B. Absorbed through the visceral capillaries
C. Stored in the mesothelial cells
D. Metabolized by the mesothelial cells
A. Absorbed by the lymphatic system
Production of serous fluid is controlled by:
A. Capillary oncotic pressure
B. Capillary hydrostatic pressure
C. Capillary permeability
D. All of the above
D. All of the above
An increase in the amount of serous fluid is called a/an:
A. Exudate
B. Transudate
C. Effusion
D. Malignancy
C. Effusion
Pleural fluid is collected by:
A. Pleurocentesis
B. Paracentesis
C. Pericentesis
D. Thoracentesis
D. Thoracentesis
Fluid: serum protein and lactic dehydrogenase ratios are performed on serous fluids:
A. When malignancy is suspected
B. To classify transudates and exudates
C. To determine the type of serous fluid
D. When a traumatic tap has occurred
B. To classify transudates and exudates
Which of the following requires the most additional testing?
A. Transudate
B. Exudate
B. Exudate
An additional test performed on pleural fluid to classify the fluid as a transudate or exudate is the:
A. WBC count
B. RBC count
C. Fluid:cholesterol ratio
D. Fluid-to-serum protein gradient
C. Fluid:cholesterol ratio
A milky-appearing pleural fluid indicates:
A. Thoracic duct leakage
B. Chronic inflammation
C. Microbial infection
D. Both A and B
D. Both A and B
Which of the following best represents a hemothorax?
A. Blood HCT: 42 Fluid HCT: 15
B. Blood HCT: 42 Fluid HCT: 10
C. Blood HCT: 30 Fluid HCT: 10
D. Blood HCT: 30 Fluid HCT: 20
D. Blood HCT: 30 Fluid HCT: 20
All of the following are normal cells seen in pleural fluid except:
A. Mesothelial cells
B. Neutrophils
C. Lymphocytes
D. Mesothelioma cells
D. Mesothelioma cells
A differential observation of pleural fluid associated with tuberculosis is:
A. Increased neutrophils
B. Decreased lymphocytes
C. Decreased mesothelial cells
D. Increased mesothelial cells
C. Decreased mesothelial cells
All of the following are characteristics of malignant cells except:
A. Cytoplasmic molding
B. Absence of nucleoli
C. Mucin-containing vacuoles
D. Increased nucleus:cytoplasm ratio
B. Absence of nucleoli
A pleural fluid pH of 6.0 indicates:
A. Esophageal rupture
B. Mesothelioma
C. Malignancy
D. Rheumatoid effusion
A. Esophageal rupture
Plasma cells seen in pleural fluid indicate:
A. Bacterial endocarditis
B. Primary malignancy
C. Metastatic lung malignancy
D. Tuberculosis infection
D. Tuberculosis infection
A significant cell found in pericardial or pleural fluid that should be referred to cytology is a:
A. Reactive lymphocyte
B. Mesothelioma cell
C. Monocyte
D. Mesothelial cell
B. Mesothelioma cell
Another name for a peritoneal effusion is:
A. Peritonitis
B. Lavage
C. Ascites
D. Cirrhosis
C. Ascites
A test performed primarily on peritoneal lavage fluid is a/an:
A. WBC count
B. RBC count
C. Absolute neutrophil count
D. Amylase
B. RBC count
The recommended test for determining whether peritoneal fluid is a transudate or an exudate is the:
A. Fluid:serum albumin ratio
B. Serum ascites albumin gradient
C. Fluid:serum lactic dehydrogenase ratio
D. Absolute neutrophil count
B. Serum ascites albumin gradient
Given the following results, classify this peritoneal fluid: serum albumin, 2.2 g/dL; serum protein, 6.0 g/dL; fluid albumin, 1.6 g/dL.
A. Transudate
B. Exudate
B. Exudate
Differentiation between bacterial peritonitis and cirrhosis is done by performing a/an:
A. WBC count
B. Differential
C. Absolute neutrophil count
D. Absolute lymphocyte count
C. Absolute neutrophil count
Detection of the CA 125 tumor marker in peritoneal fluid indicates:
A. Colon cancer
B. Ovarian cancer
C. Gastric malignancy
D. Prostate cancer
B. Ovarian cancer
Chemical tests primarily performed on peritoneal fluid include all of the following except:
A. Amylase
B. Glucose
C. Alkaline phosphatase
D. Calcium
D. Calcium
Cultures of peritoneal fluid are incubated:
A. Aerobically
B. Anaerobically
C. At 37°C and 42°C
D. Both A and B
D. Both A and B
All of the following could be diagnosed by collecting and analyzing a BAL except:
A. Asbestos-related pulmonary disease (dust particles)
B. Interstitial lung disease
C. Alveolar hemorrhage
D. Meningitis
D. Meningitis
What procedure is used for bronchoalveolar lavage?
A. Bronchoscopy
B. Arthrocentesis
C. Colonoscopy
D. Thoracentesis
A. Bronchoscopy
In bronchoalveolar lavage, the targeted area of the lung is:
A. Flushed with antibiotics
B. Rinsed with sterile saline
C. Rinsed with water
D. Flushed with a fluorometric stain
C. Rinsed with water
A BAL fluid that appears orange-red is an indication of which of the following:
A. Acute diffuse alveolar hemorrhage
B. Alveolar proteinosis
C. Patient who is a heavy smoker
D. Older hemorrhage syndrome
D. Older hemorrhage syndrome
Cell counts from a BAL fluid must be performed within:
A. 1 hour
B. 3 hours
C. 24 hours
D. 36 hours
A. 1 hour
An elevated CD4/CD8 lymphocyte ratio indicates:
A. Sarcoidosis
B. Tuberculosis
C. HIV infection
D. Silicosis
A. Sarcoidosis
Immunological study of cells is typically performed by:
A. Cytocentrifugation
B. Flow cytometry
C. Differential count
D. Hemocytometer cell count
B. Flow cytometry
The cell in a BAL fluid seen most frequently is:
A. Eosinophil
B. Neutrophil
C. Lymphocyte
D. Macrophage
D. Macrophage
What is an opportunistic pathogen in patients with AIDS that can be recovered in BAL fluid?
A. Toxoplasma gondii
B. Legionella pneumophila
C. Cryptococcus neoformans
D. Mycobacterium tuberculosis
C. Cryptococcus neoformans
The stain used in cytology for the diagnosis of lipid laden alveolar macrophages is:
A. Periodic acid stain
B. Oil Red O stain
C. Sudan III stain
D. Iron stain
C. Sudan III stain
Which of the following is not a function of amniotic fluid?
A. Allows movement of the fetus
B. Allows exchange of carbon dioxide and oxygen
C. Protects the fetus from extreme temperature changes
D. Acts as a protective cushion for the fetus
B. Allows exchange of carbon dioxide and oxygen
What is the primary cause of the normal increase in amniotic fluid as a pregnancy progresses?
A. Fetal cell metabolism
B. Fetal swallowing
C. Fetal urine
D. Transfer of water across the placenta
C. Fetal urine
Which of the following is not a reason for decreased amounts of amniotic fluid?
A. Fetal failure to begin swallowing
B. Increased fetal swallowing
C. Membrane leakage
D. Urinary tract defects
A. Fetal failure to begin swallowing
Why might a creatinine level be requested on an amniotic fluid?
A. Detect oligohydramnios
B. Detect polyhydramnios
C. Differentiate amniotic fluid from maternal urine
D. Evaluate lung maturity
C. Differentiate amniotic fluid from maternal urine
Amniotic fluid specimens are placed in amber-colored tubes before sending them to the laboratory to prevent the destruction of:
A. Alpha-fetoprotein
B. Bilirubin
C. Cells for cytogenetics
D. Lecithin
B. Bilirubin
How are specimens for FLM testing delivered to and stored in the laboratory?
A. Delivered on ice and refrigerated
B. Immediately centrifuged
C. Kept at room temperature
D. Delivered in a vacuum tube
A. Delivered on ice and refrigerated
Why are amniotic specimens for cytogenetic analysis incubated at 37°C before analysis?
A. To detect the presence of meconium
B. To differentiate amniotic fluid from urine
C. To prevent photo-oxidation of bilirubin to biliverdin
D. To prolong fetal cell viability and integrity
D. To prolong fetal cell viability and integrity
A significant rise in the OD of amniotic fluid at 450 nm indicates the presence of which analyte?
A. Bilirubin
B. Lecithin
C. Oxyhemoglobin
D. Sphingomyelin
A. Bilirubin
Plotting the amniotic fluid OD on a Liley graph represents the severity of hemolytic disease of the fetus and newborn. A value that is plotted in zone II indicates what condition of the fetus?
A. No hemolysis
B. Mildly affected fetus
C. Moderately affected fetus that requires close monitoring
D. Severely affected fetus that requires
intervention
C. Moderately affected fetus that requires close monitoring
The presence of a fetal neural tube disorder may be detected by:
A. Increased amniotic fluid bilirubin
B. Increased maternal serum alpha-fetoprotein
C. Decreased amniotic fluid phosphatidyl glycerol
D. Decreased maternal serum acetylcholinesterase
B. Increased maternal serum alpha-fetoprotein
True or False: An AFP MoM value greater than two times the median value is considered an indication of a neural tube disorder.
TRUE
When severe HDFN is present, which of the following tests on the amniotic fluid would the physician not order to determine whether the fetal lungs are mature enough to withstand a premature delivery?
A. AFP levels
B. Foam stability index
C. Lecithin/sphingomyelin ratio
D. Phosphatidyl glycerol detection
A. AFP levels
True or False: Before 35 weeks’ gestation, the normal L/S ratio is less than 1.6.
TRUE
When performing an L/S ratio by thin-layer chromatography, a mature fetal lung will show:
A. Sphingomyelin twice as concentrated as lecithin
B. No sphingomyelin
C. Lecithin twice as concentrated as sphingomyelin
D. Equal concentrations of lecithin and sphingomyelin
C. Lecithin twice as concentrated as sphingomyelin
True or False: Phosphatidyl glycerol is present with
an L/S ratio of 1.1.
TRUE
A rapid immunologic test for FLM that does not require performance of thin-layer chromatography is:
A. AFP levels
B. Amniotic acetylcholinesterase
C. Amniostat-FLM
D. Bilirubin scan
C. Amniostat-FLM
Does the failure to produce bubbles in the Foam Stability Index indicate increased or decreased lecithin?
A. Increased
B. Decreased
B. Decreased
The presence of phosphatidyl glycerol in amniotic fluid fetal lung maturity tests must be confirmed when:
A. Hemolytic disease of the fetus and newborn is
present
B. The mother has maternal diabetes
C. Amniotic fluid is contaminated by hemoglobin
D. A neural tube disorder is suspected
B. The mother has maternal diabetes
A lamellar body count of 50,000 correlates with:
A. Absent phosphatidyl glycerol and L/S ratio of 1.0
B. L/S ratio of 1.5 and absent phosphatidyl glycerol
C. OD at 650 nm of 1.010 and an L/S ratio of 1.1
D. OD at 650 nm of 0.150 and an L/S ratio of 2.0
D. OD at 650 nm of 0.150 and an L/S ratio of 2.0
In what part of the digestive tract do pancreatic enzymes and bile salts contribute to digestion?
A. Large intestine
B. Liver
C. Small intestine
D. Stomach
C. Small intestine
Where does the reabsorption of water take place in the primary digestive process?
A. Large intestine
B. Pancreas
C. Small intestine
D. Stomach
A. Large intestine
Which of the following tests is not performed to detect osmotic diarrhea?
A. Clinitest
B. Fecal fats
C. Fecal neutrophils
D. Muscle fibers
C. Fecal neutrophils
The normal composition of feces includes all of the following except:
A. Bacteria
B. Blood
C. Electrolytes
D. Water
B. Blood
What is the fecal test that requires a 3-day specimen?
A. Fecal occult blood
B. APT test
C. Elastase I
D. Quantitative fecal fat testing
D. Quantitative fecal fat testing
The normal brown color of the feces is produced by:
A. Cellulose
B. Pancreatic enzymes
C. Undigested foodstuffs
D. Urobilin
D. Urobilin
Diarrhea can result from all of the following except:
A. Addition of pathogenic organisms to the normal intestinal flora
B. Disruption of the normal intestinal bacterial flora
C. Increased concentration of fecal electrolytes
D. Increased reabsorption of intestinal water and electrolytes
D. Increased reabsorption of intestinal water and electrolytes
Stools from people with steatorrhea will contain excess amounts of:
A. Barium sulfate
B. Blood
C. Fat
D. Mucus
C. Fat
Which of the following pairings of stool appearance and cause do not match?
A. Black, tarry: blood
B. Pale, frothy: steatorrhea
C. Yellow-gray: bile duct obstruction
D. Yellow-green: barium sulfate
D. Yellow-green: barium sulfate
Stool specimens that appear ribbon-like are indicative of which condition?
A. Bile duct obstruction
B. Colitis
C. Intestinal constriction
D. Malignancy
C. Intestinal constriction
A black tarry stool is indicative of:
A. Upper GI bleeding
B. Lower GI bleeding
C. Excess fat
D. Excess carbohydrates
A. Upper GI bleeding
Chemical screening tests performed on feces include all of the following except:
A. APT test
B. Clinitest
C. Pilocarpine iontophoresis
D. Quantitative fecal fats
C. Pilocarpine iontophoresis
Secretory diarrhea is caused by:
A. Antibiotic administration
B. Lactose intolerance
C. Celiac sprue
D. Vibrio cholerae
D. Vibrio cholerae
The fecal osmotic gap is elevated in which disorder?
A. Dumping syndrome
B. Osmotic diarrhea
C. Secretory diarrhea
D. Steatorrhea
B. Osmotic diarrhea
Microscopic examination of stools provides preliminary information as to the cause of diarrhea because:
A. Neutrophils are present in conditions caused by toxin-producing bacteria
B. Neutrophils are present in conditions that affect the intestinal wall
C. Red and white blood cells are present if the cause is bacterial
D. Neutrophils are present if the condition is of nonbacterial etiology
B. Neutrophils are present in conditions that affect the intestinal wall
True or False: The presence of fecal neutrophils would be expected with diarrhea caused by a rotavirus.
FALSE
Large orange-red droplets seen on direct microscopic examination of stools mixed with Sudan III represent:
A. Cholesterol
B. Fatty acids
C. Neutral fats
D. Soaps
C. Neutral fats
Microscopic examination of stools mixed with Sudan III and glacial acetic acid and then heated will show small orange-red droplets that represent:
A. Fatty acids and soaps
B. Fatty acids and neutral fats
C. Fatty acids, soaps, and neutral fats
D. Soaps
C. Fatty acids, soaps, and neutral fats
When performing a microscopic stool examination for muscle fibers, the structures that should be counted:
A. Are coiled and stain blue
B. Contain no visible striations
C. Have two-dimensional striations
D. Have vertical striations and stain red
C. Have two-dimensional striations
A value of 85% fat retention would indicate:
A. Dumping syndrome
B. Osmotic diarrhea
C. Secretory diarrhea
D. Steatorrhea
D. Steatorrhea
Which of the following tests would not be indicative of steatorrhea?
A. Fecal elastase I
B. Fecal occult blood
C. Sudan III
D. Van de Kamer
B. Fecal occult blood
The term “occult” blood describes blood that:
A. Is produced in the lower GI tract
B. Is produced in the upper GI tract
C. Is not visibly apparent in the stool specimen
D. Produces a black, tarry stool
C. Is not visibly apparent in the stool specimen
What is the recommended number of specimens that should be tested to confirm a negative occult blood result?
A. One random specimen
B. Two samples taken from different parts of three stool specimens
C. Three samples taken from the outermost portion of the stool specimen
D. Three samples taken from different parts of two stool specimens
B. Two samples taken from different parts of three stool specimens
The immunochemical tests for occult blood:
A. Test for human globulin
B. Give false-positive reactions with meat hemoglobin
C. Can give false-positive reactions with aspirin
D. Are inhibited by porphyrin
A. Test for human globulin
Guaiac tests for detecting occult blood rely on the:
A. Reaction of hemoglobin with hydrogen peroxide
B. Pseudoperoxidase activity of hemoglobin
C. Reaction of hemoglobin with ortho-toluidine
D. Pseudoperoxidase activity of hydrogen peroxide
B. Pseudoperoxidase activity of hemoglobin
What is the significance of an APT test that remains pink after the addition of sodium hydroxide?
A. Fecal fat is present.
B. Fetal hemoglobin is present.
C. Fecal trypsin is present.
D. Vitamin C is present.
B. Fetal hemoglobin is present.
In the Van de Kamer method for quantitative fecal fat determinations, fecal lipids are:
A. Converted to fatty acids before titrating with sodium hydroxide
B. Homogenized and titrated to a neutral endpoint with sodium hydroxide
C. Measured gravimetrically after washing
D. Measured by spectrophotometer after addition
of Sudan III
A. Converted to fatty acids before titrating with sodium hydroxide
A patient whose stool exhibits increased fats, undigested muscle fibers, and the inability to digest gelatin may have:
A. Bacterial dysentery
B. A duodenal ulcer
C. Cystic fibrosis
D. Lactose intolerance
C. Cystic fibrosis
A stool specimen collected from an infant with diarrhea has a pH of 5.0. This result correlates with
a:
A. Positive APT test
B. Negative trypsin test
C. Positive Clinitest
D. Negative occult blood test
C. Positive Clinitest
Which of the following tests differentiates a malabsorption cause from a maldigestion cause in steatorrhea?
A. APT test
B. D-xylose test
C. Lactose tolerance test
D. Occult blood test
B. D-xylose test
Which of the following would not be a reason to collect a vaginal fluid for analysis?
A. Vaginitis
B. Complications of pregnancy resulting in preterm delivery
C. Forensic testing in a sexual assault
D. Pregnancy testing
D. Pregnancy testing
Which of the following organisms might not be detected if the specimen for vaginal secretion analysis had been refrigerated?
A. Prevotella bivia
B. Lactobacillus acidophilus
C. Trichomonas vaginalis
D. Candida albicans
C. Trichomonas vaginalis
The appearance of the vaginal discharge in vulvovaginal candidiasis is described as:
A. Clear and colorless
B. Thin, homogeneous, white-to-gray discharge
C. White, curd-like
D. Yellow-green and frothy
C. White, curd-like
A normal range for a vaginal pH is:
A. 3.8 to 4.5
B. 5.0 to 6.0
C. 6.0 to 7.0
D. 7.0 to 7.4
A. 3.8 to 4.5
Which of the following tests differentiates budding yeast cells from RBCs?
A. pH
B. Saline wet mount
C. KOH prep
D. Whiff test
C. KOH prep
Which of the following constituents is normal in healthy vaginal fluid secretions?
A. Lactobacilli
B. Basal cells
C. Trichomonas vaginalis
D. Pseudohyphae
A. Lactobacilli
Vaginal specimens collected for a saline wet prep should be:
A. Refrigerated to preserve motility
B. Prepared as soon as possible
C. Mailed to a reference laboratory
D. Preserved with potassium hydroxide
B. Prepared as soon as possible
A positive amine (whiff) test is observed in which of the following syndromes?
A. Bacterial vaginosis
B. Vulvovaginal candidiasis
C. Atrophic vaginitis
D. Desquamative inflammatory vaginitis
A. Bacterial vaginosis
A squamous epithelial cell covered with coccobacilli that extends beyond the cytoplasm margin is a:
A. Basal cell
B. Parabasal cell
C. Clue cell
D. Blastospore
C. Clue cell
All of the following are diagnostic of bacterial vaginosis except:
A. Vaginal pH of 3.8
B. Presence of clue cells
C. Positive amine (whiff) test
D. Thin, homogeneous, white-to-gray vaginal discharge
A. Vaginal pH of 3.8
Which of the following organisms produces lactic acid and hydrogen peroxide to maintain an acidic vaginal environment?
A. Gardnerella vaginalis
B. Mobiluncus spp.
C. Lactobacilli spp.
D. β-Hemolytic streptococci
C. Lactobacilli spp.
All of the following are diagnostic of vulvovaginal candidiasis except:
A. Large numbers of WBCs
B. Presence of clue cells
C. Positive KOH test
D. Vaginal pH of 4.0
B. Presence of clue cells
All of the following are diagnostic of trichomoniasis except:
A. Vaginal pH of 6.0
B. Positive amine test
C. Positive KOH test
D. Motile trichomonads present
C. Positive KOH test
The bacteria associated with desquamative inflammatory vaginitis is:
A. β-Hemolytic streptococci
B. Trichomonas vaginalis
C. Gardnerella vaginalis
D. Mycoplasma hominis
A. β-Hemolytic streptococci
The protein present in vaginal secretions that can identify patients who are at risk for preterm delivery is:
A. Human chorionic gonadotropin
B. Estrogen
C. PAMG-1
D. Fetal fibronectin
D. Fetal fibronectin
Which of the following immunochromatographic tests detects both AFP and IGFBP-1 proteins to diagnose PROM?
A. AmniSure ROM test
B. Actim PROM
C. ROM Plus
D. Fetal fibronectin
C. ROM Plus
