Clinical Microscopy Flashcards
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
Positive color of Ictotest:
a. Yellow
b. Red
c. Blue
d. Pink
c. Blue
Confirmatory test for: BILIRUBIN B2
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
Aids in identification of Treponema pallidum:
a. Bright-field microscopy
b. Phase-contrast microscopy
c. Dark-field microscopy
d. Interference-contrast microscopy
c. Dark-field microscopy
Which urine clarity is described as few
particulates, print easily seen through the newsprint?
a. Very cloudy
b. Clear
c. Hazy
d. Cloudy
c. Hazy
The color of normal urine is mainly due to the pigment:
A. Bilirubin
B. Urobilin
C. Urochrome
D. Uroerythrin
C. Urochrome
In manual, routine urinalysis, how are squamous epithelial cells reported?
a. Average number per HPF
b. Rare, few, moderate, many per LPF
c. Rare, few, moderate, many per HPF
d. Average number per LPF
b. Rare, few, moderate, many per LPF
Dark green amniotic fluid:
a. Normal
b. Fetal death
c. HDFN
d. Meconium
d. Meconium
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
Clue cells are clinically significant SECs studded with bacilli of which organism?
a. E. coli
b. C. albicans
c. G. vaginalis
d. P. aeruginosa
c. G. vaginalis
Which of the following conditions is most often associated with the formation of a transudate?
a. Pancreatitis
b. Congestive heart failure
c. Surgical procedures
d. Metastatic neoplasm
b. Congestive heart failure
Lack of odor in urine from patients with:
a. Isovaleric acidemia
b. Phenylketonuria
c. Acute tubular necrosis
d. Pre-renal failure
c. Acute tubular necrosis
Pyelonephritis can be differentiated from cystitis by the presence of:
a. Eosinophils
b. Hyaline cast
c. White blood cell cast
d. Bacteriuria
c. White blood cell cast
Which of the following refers to the collection of ascites?
a. Thoracentesis
b. Lumbar puncture
c. Arthrocentesis
d. Paracentesis
d. Paracentesis
Peritoneal fluid = Paracentesis
Which of the following refers to the collection of pleural fluid?
a. Thoracentesis
b. Lumbar puncture
c. Arthrocentesis
d. Paracentesis
a. Thoracentesis
Which of the following refers to the collection of cerebrospinal fluid?
a. Thoracentesis
b. Lumbar puncture
c. Arthrocentesis
d. Paracentesis
b. Lumbar puncture
Which of the following refers to the collection of synovial fluid?
a. Thoracentesis
b. Lumbar puncture
c. Arthrocentesis
d. Paracentesis
c. Arthrocentesis
Typically, the protocol for the performance of CSF analysis when three tubes are collected is which order for cell counts, chemistries, microbiology?
a. 1, 2, 3
b. 2, 1, 3
c. 3, 1, 2
d. 3, 2, 1
c. 3, 1, 2
1 ➡ chemistries (froze)
2 ➡ microbiology (room temp)
3 ➡ cell counts (ref temp)
What stain is used for hemosiderin granules?
a. Hansel stain
b. Gram stain
c. Sternheimer malbin stain
d. Perl’s Prussian blue
d. Perl’s Prussian blue
What forms the initial image of the specimen in light microscopy?
a. Objectives
b. Revolving nosepiece
c. Diopter rings
d. Eyepiece
a. Objectives
A viscosity report of 0 indicates semen that is?
a. Watery
b. Gel-like
c. Mucus-like
d. Formed
a. Watery
0 ➡ watery
4 ➡ Gel-like
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
What is the LAST STEP in the handwashing procedure?
a. Dry hands with a paper towel.
b. Turn off faucet with a clean paper towel to prevent recontamination.
c. Rub to form lather, create friction, and loosen debris.
d. Rinse hands in a downward position
b. Turn off faucet with a clean paper towel to prevent recontamination
CORRECT HANDWASHING TECHNIQUE
- Wet hands with warm water.
- Apply antimicrobial soap.
- Rub to form lather, create friction, and loosen debris.
- Thoroughly clean between fingers, including thumbs, under fingernails and rings, and up to the wrist, for at least 15 SECONDS. (6th 20 seconds)
- Rinse hands in a DOWNWARD POSITION.
- Dry with a paper towel.
- Turn off faucets with a clean paper towel to prevent recontamination.
The required amount of urine for drug testing (COC):
a. 5 to 10 mL
b. 10 to 15 mL
c. 20 to 30 mL
d. 30 to 45 mL
d. 30 to 45 mL
Urine specimen collections may be “witnessed” or “unwitnessed.” The decision to obtain a witnessed collection is indicated when it is suspected that the donor may alter or substitute the specimen or it is the policy of the client ordering the test. If a witnessed specimen collection is ordered, a same-gender collector will observe the collection of 30 to 45 mL of urine. Witnessed and unwitnessed collections should be immediately handed to the collector.
Acceptable urine temperature for drug testing (COC):
a. 20 to 24C
b. 30 to 35C
c. 32.5 to 37.7C
d. 37.7 to 42C
c. 32.5 to 37.7C
The urine temperature must be taken within 4 minutes from the time of collection to confirm the specimen has not been adulterated. The temperature should read within the range of 32.5°C to 37.7°C. If the specimen temperature is not within range, the temperature should be recorded and the supervisor or employer contacted immediately.
Urine temperatures outside of the recommended range may indicate specimen contamination. Recollection of a second specimen as soon as possible will be necessary.
Primary inorganic component of urine:
a. Urea
b. Creatinine
c. Chloride
d. Potassium
c. Chloride
UREA: primary ORGANIC component; product of protein and amino acid
metabolism
CHLORIDE: primary INORGANIC component; found in combination with sodium (table salt) and many other inorganic substances
Polyuria, an increase in daily urine volume:
a. Greater than 400 mL/day in adults
b. Greater than 1200 mL/day in adults
c. Greater than 2L/day in adults
d. Greater than 2.5 L/day in adults
d. Greater than 2.5 L/day in adults
Normal daily urine output is usually 1200 to 1500 mL, a range of 600 to 2000 mL is considered normal.
Polyuria, an increase in daily urine volume (greater than 2.5 L/day in adults and 2.5 to 3 mL/kg/day in children), is often associated with diabetes mellitus and diabetes insipidus; however, it may be artificially induced by diuretics, caffeine, or alcohol, all of which suppress the secretion of antidiuretic hormone.
Oliguria, a decrease in urine output (which is less than 1 mL/kg/hr in infants, less than 0.5 mL/kg/hr in children, and less than 400 mL/day in adults), is commonly seen when the body enters a state of dehydration as a result of excessive water loss from vomiting, diarrhea, perspiration, or severe burns.
The most routinely used method of urine preservation is:
a. Boric acid
b. Formalin
c. Refrigeration
d. Sodium fluoride
c. Refrigeration
The most routinely used method of preservation is refrigeration at 2°C to 8°C, which decreases bacterial growth and metabolism.
If the urine is to be cultured, it should be refrigerated during transit and kept refrigerated until cultured up to 24 hours. The specimen must return to room temperature before chemical testing by reagent strips.
A 24-hour urine for CATECHOLAMINE determination may be preserved with:
a. Formalin
b. Boric acid
c. Hydrochloric acid, 6N
d. Sodium fluoride
c. Hydrochloric acid, 6N
FROM HENRY: 24-HOUR URINE COLLECTION PRESERVATIVES
None (refrigerate): amino acids, amylase, calcium, citrate, chloride, copper, creatinine, delta ALA, glucose, 5-HIAA, heavy metals (arsenic, lead, mercury), histamine, immunoelectrophoresis, lysozyme, magnesium, methylmalonic acid, microalbumin, mucopolysaccharides, phosphorus, porphobilinogen, porphyrins, potassium, protein, protein electrophoresis, sodium, urea, uric acid, xylose tolerance
10 g boric acid: aldosterone, cortisol
10 mL 6N HCl: catecholamines, cystine, homovanillic acid, hydroxyproline, metanephrines, oxalate, VMA
If processing delayed longer than 24 hours: equal amounts of 50% alcohol, Saccomanno’s fixative, and SurePath or Preserve CT Cytologic examination
In the three-glass collection technique for diagnosis of prostatic infection, which tube is used as a control for bladder and kidney infection?
a. First specimen
b. Second specimen
c. Third specimen
d. None of these
b. Second specimen
THREE-GLASS COLLECTION
In prostatic infection, the third specimen will have a white blood cell/ high-power field count and a bacterial count 10 times that of the first specimen. Macrophages containing lipids may also be present.
The second specimen is used as a control for bladder and kidney infection. If it is positive, the results from the third specimen are invalid because infected urine has contaminated the specimen.
The human kidneys receive approximately ___ % of the blood pumped through the heart at all times.
a. Approximately 5%
b. Approximately 15%
c. Approximately 25%
d. Approximately 50%
c. Approximately 25%
The renal artery supplies blood to the kidney.
The human kidneys receive approximately 25% of the blood pumped through the heart at all times.
The part of the nephron that functions as a SIEVE:
a. Glomerulus
b. Loop of Henle
c. Proximal convoluted tubules
d. Distal convoluted tubules
a. Glomerulus
The glomerulus functions as a sieve or filter.
The glomerulus serves as a nonselective filter of plasma substances with molecular weights less than 70,000, several factors influence the actual filtration process.
These include the cellular structure of the capillary walls and Bowman’s capsule, hydrostatic pressure and oncotic pressure, and the feedback mechanisms of the renin-angiotensin-aldosterone system (RAAS).
It corrects renal blood flow in the following ways: causing VASODILATION OF THE AFFERENT ARTERIOLES and CONSTRICTION OF THE EFFERENT ARTERIOLES, stimulating reabsorption of sodium and water in the proximal convoluted tubules, and triggering the release of the sodium-retaining hormone aldosterone by the adrenal cortex and antidiuretic hormone by the hypothalamus:
a. Renin
b. Angiotensin I
c. Angiotensin II
d. Aldosterone
c. Angiotensin II
Angiotensin II corrects renal blood flow in the following ways:
- causing vasodilation of the afferent arterioles
- constriction of the efferent arterioles
- stimulating reabsorption of sodium and water in the proximal convoluted tubules
- triggering the release of the sodium-retaining hormone aldosterone by the adrenal cortex and antidiuretic hormone by the hypothalamus.
The original reference method for clearance tests:
a. Creatinine clearance
b. Inulin clearance
c. Urea clearance
d. Beta2- microglobulin
b. Inulin clearance
Although inulin was the original reference method for clearance tests, current methods are available that are endogenous and can provide accurate GFR results.
The earliest glomerular filtration tests measured urea because of its presence in all urine specimens and the existence of routinely used methods of chemical analysis
Calculate the creatinine clearance using these date obtained from a person with 1.73 m2 body surface area: serum creatinine: 1.8 mg/dL; urine creatinine: 54 mg/dL; and urine volume 640 mL in 24 hours.
a. 3 mL/min
b. 13 mL/min
c. 21 mL/min
d. 68 mL/min
b. 13 mL/min
Urine volume (mL/min)
640 mL/24 hours x 1 hour/60 minutes = 0.44 mL/min.
Creatinine clearance (mL/min)
Formula: UV/P (patient is of the average body surface area)
[(54 mg/dL) x (0.44 mL/min)]/1.8 mg/dL = 13.2 mL/min
Calculate the creatinine clearance using these data: Serum creatinine: 1.8 mg/dL; urine volume: 640 mL in 24 hours; urine creatinine: 54 mg/dL; and body surface area: 1.25 m2.
a. 1.1 mL/min
b. 5 mL/min
c. 13 mL/min
d. 18 mL/min
d. 18 mL/min
Urine volume (mL/min)
640 mL/24 hours x 1 hour/60 minutes = 0.44 mL/min
Creatinine clearance (mL/min)
Formula: (UV/P) x (1.73 m2/A)
[(54 mg/dL) (0.44 mL/min) / 1.8 mg/dL] x 1.73 m2/1.25 m2 = 18.3 mL/min
The test most commonly associated with tubular secretion and renal blood flow
a. Creatinine clearance
b. Fishberg test
c. Mosenthal test
d. p-aminohippuric acid (PAH) test
d. p-aminohippuric acid (PAH) test
The test most commonly associated with tubular secretion
and renal blood flow is the p-aminohippuric acid (PAH) test.
Patients with DIABETES INSIPIDUS tend to produce urine in _____ volume with _____ specific gravity.
a. Increased; decreased
b. Increased; increased
c. Decreased; decreased
d. Decreased; increased
a. Increased; decreased
DIABETES INSIPIDUS: high urine volume, low specific gravity
DIABETES MELLITUS: high urine volume, high specific gravity
A catheterized urine specimen is collected:
a. After stimulating urine production with intravenous histamine
b. By aspirating it with a sterile syringe inserted into the bladder
c. Following midstream, clean-catch urine collection procedures
d. From a sterile tube passed through the urethra into the bladder
d. From a sterile tube passed through the urethra into the bladder
All of the following should be discarded in biohazardous waste containers EXCEPT:
a. Urine specimen containers, urine
b. Towels used for decontamination
c. Disposable lab coats
d. Blood collection tubes
a. Urine specimen containers, urine
The correct method for labeling urine specimen containers is to:
a. Attach the label to the lid
b. Attach the label to the bottom
c. Attach the label to the container
d. Use only a wax pencil for labeling
c. Attach the label to the container
Storage of urine specimens for BILIRUBIN and UROBILINOGEN testing:
a. Clear container
b. Amber container
c. Preserved with formalin
d. None of these
b. Amber container
First-morning urine, EXCEPT:
a. Routine screening
b. Pregnancy testing
c. Urobilinogen determination
d. Evaluation of orthostatic proteinuria
c. Urobilinogen determination
AFTERNOON SPECIMEN (2 PM to 4 PM)
UROBILINOGEN DETERMINATION
GREATEST UROBILINOGEN EXCRETION
Phenol derivatives found in certain intravenous medications produce ______ urine on oxidation.
a. Yellow
b. Orange
c. Green
d. Purple
c. Green
STRASINGER PAGE 62: Green
STRASINGER PAGE 62: Brown/black
The clarity of a urine sample should be determined:
a. Using glass tubes only, never plastic
b. Following thorough mixing of the specimen
c. After addition of salicylic acid
d. After the specimen cools to room temperature
b. Following thorough mixing of the specimen
In routine urinalysis, clarity is determined in the same manner that ancient physicians used: by visually examining the MIXED SPECIMEN while holding it IN FRONT OF A LIGHT SOURCE. The specimen should, of course, be in a clear container.
Many particulates, print blurred through urine:
a. Hazy
b. Cloudy
c. Turbid
d. Milky
b. Cloudy
URINE CLARITY
Clear: no visible particulates, transparent
Hazy: few particulates, print easily seen through urine
Cloudy: many particulates, print blurred through urine
Turbid: print cannot be seen through urine
Milky: may precipitate or be clotted
Sensitivity of the urine specific gravity reagent pad:
a. 1.010 to 1.035
b. 1.015 to 1.035
c. 1.000 to 1.002
d. 1.000 to 1.030
d. 1.000 to 1.030
A routine urinalysis on a urine specimen collected from a hospitalized patient revealed a specific gravity greater than 1.050 with the use of REFRACTOMETRY. The best explanation for this specific gravity result is that the urine:
a. Old and has deteriorated
b. Contains radiographic contrast media
c. Concentrated because the patient is ill and dehydrated
d. Contains abnormally high levels of sodium and other electrolytes because the patient is taking diuretics
b. Contains radiographic contrast media
Abnormally high results—above 1.040—are seen in patients who have recently undergone an intravenous pyelogram. This is caused by the excretion of the injected radiographic contrast media.
The reagent strip specific gravity measures only ionic solutes, thereby eliminating the interference by the large organic molecules, such as urea and glucose, and by radiographic contrast media and plasma expanders that are included in physical measurements of specific gravity.
Cabbage urine odor:
a. Isovaleric acidemia
b. Methionine malabsorption
c. Phenylketonuria
d. Urinary tract infection
b. Methionine malabsorption
Aromatic: normal
Foul, ammonia-like: bacterial decomposition, urinary tract infection
Fruity, sweet: ketones (diabetes mellitus, starvation, vomiting)
Maple syrup: maple syrup urine disease
Mousy: phenylketonuria
Rancid: tyrosinemia
Sweaty feet: isovaleric acidemia
Cabbage: methionine malabsorption
Bleach: contamination
A lack of any urine odor may indicate:
a. Acute tubular necrosis
b. Isovaleric acidemia
c. Methionine malabsorption
d. Phenylketonuria
a. Acute tubular necrosis
Lack of odor in urine from patients with acute renal failure suggests acute tubular necrosis rather than prerenal failure.
All of the following are important to protect the integrity of reagent strips EXCEPT:
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
Which of the following tests is affected LEAST by standing or improperly stored urine?
a. Glucose
b. Protein
c. pH
d. Bilirubin
b. Protein
CHANGES IN UNPRESERVED URINE
1. Color - modified or darkened
2. Clarity - decreased
3. Odor - increased
4. pH - increased
5. Glucose - decreased
6. Ketones - decreased
7. Bilirubin - decreased
8. Urobilinogen - decreased
9. Nitrite - increased
10. RBCs, WBCs - decreased
11. Bacteria - increased
A sensitive, although not specific indicator of damage to the kidneys:
a. Urea
b. Creatinine
c. Proteinuria
d. Ketonuria
c. Proteinuria
Demonstration of proteinuria in a routine analysis does not always signify renal disease; however, its presence does require additional testing to determine whether the protein represents a normal or a pathologic condition.
An indicator of PREECLAMPSIA:
a. Cylindruria
b. Hematuria
c. Ketonuria
d. Proteinuria
d. Proteinuria
Preeclampsia is a pregnancy condition characterized by hypertension, proteinuria, and often edema, usually occurring late in the second trimester or early in the third trimester, and affecting 5 to 10% of pregnancies. It is a major cause of maternal and perinatal mortality.
If the mother develops convulsions, the condition is called eclampsia.
The only cure for preeclampsia is delivery of the placenta.
Concentration of SSA in the cold precipitation method:
a. 1% sulfosalicylic acid
b. 3% sulfosalicylic acid
c. 5% sulfosalicylic acid
d. 10% sulfosalicylic acid
b. 3% sulfosalicylic acid
REPORTING OF SSA TURBIDITY: Turbidity, granulation, no flocculation:
a. 1+
b. 2+
c. 3+
d. 4+
e. Trace
b. 2+
SULFOSALICYLIC ACID (3% SSA) PRECIPITATION TEST
Negative = No increase in turbidity <6 mg/dL
Trace = Noticeable turbidity 6-30 mg/dL
1+ = Distinct turbidity with no granulation 30-100 mg/dL
2+ = Turbidity with granulation, no flocculation 100-200 mg/dL
3+ = Turbidity with granulation and flocculation 200-400 mg/dL
4+ = Clumps of protein >400 mg/dL
Significant albumin excretion rate (AER):
a. 0.02 to 1 ug/min
b. 1 to 2 ug/min
c. 5 to 15 ug/min
d. 2 to 20 ug/min
e. 20 to 200 ug/min
e. 20 to 200 ug/min
Microalbumin was considered significant when 30 to 300 mg of albumin is excreted in 24 hours or the AER is 20 to 200 μg/min.
Sensitivity of the Multistix protein pad:
a. 1 to 5 mg/dL albumin
b. 5 to 10 mg/dL albumin
c. 10 to 15 mg/dL albumin
d. 15 to 30 mg/dL albumin
d. 15 to 30 mg/dL albumin
PROTEIN REAGENT PAD
Multistix: 15 to 30 mg/dL albumin
Chemstrip: 6 mg/dL albumin
Bence Jones protein precipitates at temperatures between ___, and redissolves at near ___ ° C.
a. Precipitates at 100-120C, and redissolves at 60C
b. Precipitates at 10 to 20C, and redissolves at 100C
c. Precipitates at 80-100C, and redissolves at 60C
d. Precipitates at 40 to 60C, and redissolves at 100C
d. Precipitates at 40 to 60C, and redissolves at 100C
The principle of “protein error of indicators” is based on:
a. Protein changing the pH of the specimen
b. Protein changing the pKa of the specimen
c. Protein accepting hydrogen from the indicator
d. Protein giving up hydrogen to the indicator
c. Protein accepting hydrogen from the indicator
Protein (primarily albumin) accepts hydrogen ions from the indicator.
A patient’s random urine consistently contains a trace of protein but no casts, cells, or other biochemical abnormality. The first voided morning sample is consistently negative for protein. These findings can be explained by:
a. Normal diurnal variation in protein loss
b. Early glomerulonephritis
c. Orthostatic or postural albuminuria
d. Microalbuminuria
c. Orthostatic or postural albuminuria
ORTHOSTATIC (POSTURAL) PROTEINURIA
Patients suspected of orthostatic proteinuria are requested to empty the
bladder before going to bed, collect a specimen immediately upon arising in the morning, and collect a second specimen after remaining in a vertical position for several hours.
Both specimens are tested for protein, and if orthostatic proteinuria is present, a negative reading will be seen on the first morning specimen, and a positive result will be found on the second specimen.
A urine specimen is tested by a reagent strip test and the sulfosalicylic acid test to determine whether protein is present. The former yields a negative protein, whereas the latter results in a reading of 2+ protein. Which of the following statements best explains this difference?
a. Urine contained excessive amount of amorphous urates or phosphates that caused the turbidity seen with SSA
b. Urine pH was greater than 8, exceeding the buffering capacity of the strip, thus causing false-negative reaction
c. Protein other than albumin must be present in the urine
d. Reading time of the reagent strip test was exceeded, causing a false negative reaction to be detected
c. Protein other than albumin must be present in the urine
Most frequently performed chemical analysis on urine:
a. Bilirubin
b. Glucose
c. Ketone
d. Protein
b. Glucose
Because of its value in the detection and monitoring of diabetes mellitus, the glucose test is the most frequently performed chemical analysis on urine.
A patient sends the following question to an online consumer health Web site: “I am a 22-year-old female who experienced increasing headaches, thirst, and decreasing energy. I was studying in the library when I felt lightheaded and passed out. I was taken to a hospital emergency department and they told me that my serum Acetest® was 40 mg/dL and urine glucose was 500 mg/dL. What does this mean?” How would you reply?
a. Your lab results pattern suggests diabetes mellitus.
b. You probably have been crash dieting recently.
c. The two results do not fit any disease pattern.
d. The tests need to be repeated because they could not possibly occur together
a. Your lab results pattern suggests diabetes mellitus.
A positive urine glucose plus a positive serum ketone strongly suggest uncontrolled diabetes mellitus. There is an increased rate of fatty acid oxidation occurring in light of the inaccessibility of the glucose, especially to skeletal muscle. If the patient had only been dieting, the glucose would be negative.
Glucosuria not accompanied by hyperglycemia can be seen in which of the following?
a. Hormonal disorders
b. Gestational diabetes
c. Diabetes mellitus
d. Renal disease
d. Renal disease
RENAL GLYCOSURIA
Glycosuria occurs in the absence of hyperglycemia when the reabsorption of glucose by the renal tubules is compromised.
This is frequently referred to as “renal glycosuria” and is seen in end-stage renal disease, cystinosis, and Fanconi syndrome.
The primary reason for performing a Clinitest is to:
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
Depending on the laboratory population Clinitest is often performed on pediatric specimens from patients up to at least the age of 2 years.
Galactose in the urine of a newborn represents an “inborn error of metabolism” in which lack of the enzyme galactose-1-phosphate uridyl transferase prevents breakdown of ingested galactose and results in failure to thrive and other complications, including death. All states have incorporated screening for galactosemia into their required newborn screening programs because early detection followed by dietary restriction can control the condition.
Negative Clinitest:
a. Glucose
b. Galactose
c. Lactose
d. Sucrose
d. Sucrose
Keep in mind that table sugar is sucrose, a nonreducing sugar, and does not react with Clinitest or glucose oxidase strips.
A urine sample that tests positive for ketones but negative for glucose is most likely from a patient suffering from:
a. Diabetes mellitus
b. Diabetes insipidus
c. Polydipsia
d. Starvation
d. Starvation
Ketonuria may be caused by all of the following except:
a. Bacterial infections
b. Diabetic acidosis
c. Starvation
d. Vomiting
a. Bacterial infections
CLINICAL SIGNIFICANCE OF KETONES
Clinical reasons for increased fat metabolism include the inability to metabolize carbohydrate, as occurs in diabetes mellitus; increased loss of carbohydrate from vomiting; and inadequate intake of carbohydrate associated with starvation and malabsorption.
The primary reagent in the reagent strip test for ketones is:
a. Glycine
b. Lactose
c. Sodium hydroxide
d. Sodium nitroprusside
d. Sodium nitroprusside
Reagent strip tests use the sodium nitroprusside (nitroferricyanide) reaction to measure ketones.
In this reaction, acetoacetic acid in an alkaline medium reacts with sodium nitroprusside to produce a purple color.
The test does not measure B-hydroxybutyrate and is only slightly sensitive to acetone when glycine is also present.
Positive result in the ketone reagent pad:
a. Brown
b. Blue
c. Pink
d. Purple
d. Purple
Acetoacetate (and acetone) + sodium nitroprusside + (glycine)
= PURPLE COLOR
Positive result in the ketone reagent pad:
a. Brown
b. Blue
c. Pink
d. Purple
d. Purple
ate (and acetone) + sodium nitroprusside + (glycine)
= PURPLE COLOR
Reagent pad positive result in the presence of hemoglobin or myoglobin:
a. Brown
b. Red
c. Pink-purple
d. Green-blue
d. Green-blue
In the presence of free hemoglobin/myoglobin, uniform color ranging from a negative yellow through green to a strongly positive green-blue appears on the pad.
A speckled pattern on the blood pad of the reagent strip indicates:
a. Hematuria
b. Hemoglobinuria
c. Myoglobinuria
d. All of the above
a. Hematuria
Intact red blood cells are lysed when they come in contact with the pad, and the liberated hemoglobin produces an isolated reaction that results in a speckled pattern on the pad.
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, peritubular capillaries, vasa recta, efferent arteriole
d. Efferent arteriole, vasa recta, peritubular capillaries, afferent arteriole
c. Afferent arteriole, peritubular capillaries, vasa recta, efferent arteriole
Which of the following 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. Reno threshold for glucose is exceeded
d. All of the above
d. All of the above
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 increase secretion of hydrogen ions
c. Inability to produce an acidic urine due to impaired production of ammonia
d. Inability to produce an acidic urine to increase production of ammonia
c. Inability to produce an acidic urine due to impaired production of ammonia
Clearance tests used to determine in the glomerular filtration rate must measure substances that are:
a. Not filtered by the glomerulus
b. Completely absorbed by the proximal convoluted tubule
c. Secreted in the distal convoluted tubule
d. Neither re-absorbed or secreted by the tubules
d. Neither re-absorbed or secreted by the tubules
Osmolality is a measure of:
a. Dissolved particles, including ions
b. Undissociated molecules only
c. Total salt concentration
d. Molecule size
a. Dissolved particles, including ions
Which of the following urinary parameters are measured during the course of concentration and dilution test to assess renal tubular function?
a. Urea, nitrogen, creatinine
b. Osmolality and specific gravity
c. Sodium and chloride
d. Sodium and osmolality
b. Osmolality and specific gravity
It corrects renal blood flow in the following ways: causing vasodilation of afferent arterioles and constriction of the efferent arterioles, stimulating absorption of sodium and water in the PCT, and triggering the release of aldosterone by the adrenal cortex and antidiuretic hormone by the hypothalamus.
a. Renin
b. Angiotensin I
c. Angiotensin II
d. Aldosterone
c. Angiotensin II
It corrects renal blood flow in the following ways: causing vasodilation of afferent arterioles and constriction of the efferent arterioles, stimulating absorption of sodium and water in the PCT, and triggering the release of aldosterone by the adrenal cortex and antidiuretic hormone by the hypothalamus.
a. Renin
b. Angiotensin I
c. Angiotensin II
d. Aldosterone
c. Angiotensin II
A urine specific gravity measured by refractometer is 1.029, and the temperature of the urine is 16 C. The specific gravity should be reported as:
a. 1.023
b. 1.027
c. 1.029
d. 1.032
c. 1.029
A specimen with a specific gravity of 1.001 would be considered:
a. Hyposthenuric
b. Not urine
c. Isothenuric
d. Hypersthenuric
b. Not urine
Which of the following will react in the rgt strip specific gravity test?
a. Glucose
b. Radiographic dye
c. Protein
d. Chloride
d. Chloride
A patient with uncontrolled diabetes mellitus will most likely have:
a. Pale urine with a high specific gravity
b. Concentrated urine with a high specific gravity
c. Pale urine with a low specific gravity
d. Dark urine with a high specific gravity
a. Pale urine with a high specific gravity
A urine specimen collected on an apparently healthy 25 year-old man shortly after he finished eating lunch was cloudy but showed normal results on a multiple reagent strip analysis. The most likely cause of the turbidity is:
a. Fat
b. WBC
c. Urates
d. Phosphates
d. Phosphates
A px urine sample has an increased protein and high specific gravity. Which of the following would be a more accurate measure of urine concentration?
a. Osmolality
b. Ketones
c. Refractive index
d. pH
a. Osmolality
Use of a refractometer over a urinometer is preferred due to the fact that the refractometer uses:
a. Large volume of urine and compensates for temperature
b. Small volume of urine and compensates for glucose
c. Small volume of urine and compensates for temperature
d. Small volume of urine and compensates for protein
c. Small volume of urine and compensates for temperature
To prepare a solution appropriate for quality control of the refractometer, a technician should use:
a. Urea with specific gravity of 1.040
b. Water with a specific gravity of 1.005
c. Sodium chloride with a specific gravity of 1.022
d. Calcium chloride with an osmolality of 460
c. Sodium chloride with a specific gravity of 1.022
An ammonia-like odor is characteristically associated with urine from patients who:
a. are diabetic
b. have hepatitis
c. have an infection with Proteus spp.
d. have a yeast infection
c. have an infection with Proteus spp.
Phenol derivatives found in certain intravenous medications produce ____ urine on oxidation.
a. Yellow
b. Orange
c. Green
d. Purple
c. Green (Strasinger page 62)
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, what tests 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
A cloudy spx received in the laboratory may have been preserved using:
a. Boric acid
b. Chloroform
c. Refrigeration
d. Formalin
c. Refrigeration
This is commonly used; presence of amorphous urates and amorphous phosphates
For general screening the most frequently collected specimen is a:
a. Random one
b. First morning
c. Midstream clean-catch
d. Timed
a. Random one
If a px fails to discard the first spx when collecting a timed spx, the:
a. Spx must be recollected
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 8hrs is:
a. Bacterial growth
b. Glycolysis
c. Decreased pH
d. Chemical oxidation
a. Bacterial growth
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
After receiving a 24-hr urine for quantitative total protein analysis, the technologist must first:
a. Subculture urine for bacteria
b. Add the appropriate preservative
c. Screen for albumin using a dipstick
d. Measure the total volume
d. Measure the total volume
A clean-catch urine is submitted to the laboratory for routine urinalysis and cultures. The routine urinalysis is done first, and 3hrs later, the specimen is sent to the microbiology department for culture, The specimen should be:
a. Centrifuged and the supernatant cultured
b. Be rejected due to time delay
c. Not be cultured if no bacteria seen
d. Be processed for culture only if nitrate is positive
b. Be rejected due to time delay
A urine specimen comes to the laboratory 7 hours after it is obtained. It is acceptable for urine culture only if the specimen has been stored:
a. at room temperature
b. 4-7 deg. Celsius
c. frozen
d. with a preservative additive
b. 4-7 deg. Celsius
A 24-hr urine from a man who had no evidence of kidney impairment was sent to the laboratory for hormone determination. The volume was 600 mL, but there was some question as to the completeness of the 24-hr collection. The next step would be:
a. Perform hormone determination, since 600 mL is a normal 24-hr urine volume
b. Check the creatinine level; if it is <1 g, do the procedure
c. Report the hormone determination in mg/dL in case the specimen was incomplete
d. Check the creatinine level; if it is >1 g, do the procedure
d. Check the creatinine level; if it is >1 g, do the procedure
First morning urine, except:
a. routine screening
b. pregnancy testing
c. urobilinogen determination
d. evaluation of orthostatic proteinuria
c. urobilinogen determination
an afternoon urine
A cerebrospinal fluid with a milky appearance would most likely contain an increased amount of:
a. Lipids
b. Protein
c. Glucose
d. Bacteria
a. Lipids
CS is a clear, colorless fluid. Specimens with a significantly increased amount of protein may appear cloudy, but the presence of lipids causes the sample to appear milky.
CS should normally appear clear and:
a. Colorless
b. Opalescent
c. Pale yellow
d. Xanthochromic
a. Colorless
Normal CS is clear and colorless with viscosity similar to water.
Which of the following normally accounts for the largest fraction of CSF total proteins?
a. Albumin
b. Fibrinogen
c. Haptoglobin
d. Transthyretin
a. Albumin
CS contains approximately 15-45 mg/dL of proteins. Similar to serum, albumin accounts for the majority of total proteins in CSF.
The principal mucin in synovial fluid is:
a. Pepsin
b. Albumin
c. Hyaluronate
d. Orosomucoid
c. Hyaluronate
Hyaluronic acid, also known as hyaluronate, is the principal mucin in synovial fluid and serves to lubricate the joint. A low hyaluronic acid concentration leads to decreased viscosity of the synovial fluid, and inflammation of the joint.
Normal CSF contains all of the following proteins except:
a. Transferrin
b. Transthyretin
c. Albumin
d. Fibrinogen
d. Fibrinogen
Normal CSF does not contain IgM, fibrinogen, or beta lipoprotein.
Three tubes of CSF are collected, labeled, and sent to the laboratory for testing. Which tube should be used for chemical analyses, including glucose and total protein?
a. Tube 1
b. Tube 2
c. Tube 3
d. These tests should not be performed on CSF
a. Tube 1
In general, tube 1 is used for chemical and serological testing as this tube is the most likely to contain peripheral blood or be contaminated from the collection itself. Tube 2 (or 4) is used for microbiological testing and tube 3 is used for cellular studies.
Myelin basic protein is most commonly measured in CSF to evaluate the effectiveness of treatment for:
a. Viral encephalitis
b. Multiple sclerosis
c. Bacterial meningitis
d. Intracranial hemorrhage
b. Multiple sclerosis
Demyelination of the myelin sheath, as occurs in multiple sclerosis (MS), results in the presence of myelin basic proteins (MBP) in the CSF. Measurement of MBP can be used to monitor disease progression and the effectiveness of treatment for patients with MS.
An L/S ratio of 2.4 on amniotic fluid collected at 34 weeks’ gestation indicates:
a. Fetal lung MATURITY
b. Fetal lung IMMATURITY
c. Increased risk of RESPIRATORY DISTRESS
d. Increased risk of NEURAL TUBE DEFECTS
a. Fetal lung MATURITY
An L:S ratio of <2.0 suggests fetal lung immaturity, whereas a ratio ~2.0 indicates maturity.
Increased presence of fetal fibronection (fFN) in cervicovaginal secretions from a 24-year-old female at 35 weeks’ gestation indicates an increased risk for:
a. Preterm delivery
b. Bacterial vaginosis
c. Gestational diabetes
d. Hemolytic disease of the newborn
a. Preterm delivery
Fetal fibronection (fFN) is a glycoprotein found in the extramedullary matrix at the junction of the placenta and uterine wall. In normal pregnancy, fFN should not be detectable after 24-35 weeks’ gestation. Increased concentrations (>50 g/L) are associated with an increased risk for preterm delivery.
If glucose testing cannot be performed immediately, CSF should be stored:
a. At room temperature
b. In a refrigerator
c. In a freezer
d. In an incubator
c. In a freezer
CSF testing should be performed immediately. If testing will be delayed, the tube(s) to be used for chemical and serological testing should be stored in the freezer to minimize glycolysis by any cellular elements present in the sample. The tube(s) for hematology should be refrigerated (up to 4 hours), and the tube(s) for microbiology should be kept at room temperature.
To avoid falsely elevated cerebrospinal fluid cell counts, use an aliquot:
a. That has been centrifuged
b. From the first tube collected
c. From the last tube collected
d. Treated with glacial acetic acid
c. From the last tube collected
CSF is collected by inserting a sterile needle between the 3rd and 4th, or 4th and 5th, lumbar vertebrae and into the subarachnoid space. The first tube collected may be contaminated with peripheral blood and should not be used for cellular studies. The cell count should be performed on the last tube collected, because it will be the least likely to have been contaminated by peripheral blood. Cell counts are performed on a well-mixed sample; whereas a WBC differential would be performed on a stained, cytocentrifuged slide preparation. The addition of glacial acetic acid would lyse RBCs present in the sample.
Synovial fluid analyzed with a polarizing microscope shows the presence of crystals appearing as sharp needles with strong negative birefringence. These crystals should be reported as:
a. Calcium oxalate crystals
b. Monosodium urate crystals
c. Ammonium biurate crystals
d. Calcium pyrophosphate dihydrate crystals
b. Monosodium urate crystals
Monosodium urate (MS) and calcium pyrophosphate dihydrate (CPPD) crystals are the most common crystals seen in synovial fluid; however, hydroxyapatite, cholesterol, corticosteroid and calcium oxalate crystals are also found. Ammonium biurate crystals are most often see in urine, not synovial fluid. MSU crystals appear as fine sharp needles with negative birefringence. CPPD crystals are rhomboid or square crystals with positive birefringence. Calcium oxalate crystals are octahedrals and demonstrate negative birefringence.
Monosodium urate crystals that are aligned with the slow vibration of the red compensator in a polarizing microscope will appear:
a. Blue
b. Yellow
c. Orange
d. Purple
b. Yellow
When the axes of monosodium urate crystals are aligned (parallel to) the polarizer, they appear yellow. When their axes are perpendicular to the polarizer, they appear blue.
Motility must be observed in at least what percentage of sperm to be considered normal?
a. 10%
b. 25%
c. 50%
d. 75%
c. 50%
The World Health Organization (WHO) established a grading scale of Oto 4, with 4 indicating rapid, straight-line movement and 0 indicating no movement. At least 50% of the evaluated sperm should have a rating of 2 or more. A simpler system for grading motility has also been established by the WHO and includes classifying sperm as having: progressive motility, nonprogressive motility, or no motility. At least 50% of the evaluated sperm should demonstrate motility (progressive or nonprogressive) to be considered normal.
Synovial fluid is typically collected using a sterile needle and syringe and then transferred to collection tubes for testing. Which of the following anticoagulants would be appropriate to use for the aliquot sent for a manual cell count and crystal evaluation?
a. Liquid EDTA
b. Lithium heparin
c. Sodium fluoride
d. Sodium polyanethol sulfonate
a. Liquid EDTA
After synovial fluid is collected using a sterile needle and syringe, it is transferred to appropriately labeled collection tubes based on the testing to be performed. In general, the first portion is placed into a plain red-top tube for chemical and immunologic testing. The second portion is placed into a tube with liquid EDTA or sodium heparin for microscopic studies, including a cell count and crystal identification. The final portion is placed into a sterile red-top tube or sterile tube with sodium heparin or sodium polyanethole sultanate for microbiological studies.
The tau isoform of transferrin is a carbohydrate-deficient protein found only in:
a. CSF
b. Sweat
c. Seminal fluid
d. Amniotic fluid
a. CSF
Tau transferrin is found only in CSF. When present in nasal or middle ear fluids, it confirms the presence of CSF, which aids in the diagnosis of CS rhinorrhea and otorrhea, respectively.
Which of the following fetal lung maturity tests may be performed on amniotic fluid using the platelet channel of an automated hematology analyzer?
a. Bilirubin
b. L/S ratio
c. Lamellar body count
d. Phosphatidylglycerol
c. Lamellar body count
Pulmonary surfactant is packaged into granules for storage starting at the 24th week of gestation. The granules enter amniotic fluid during the 26th week. Quantitative measurement of these granules, known as lamellar bodies, in amniotic fluid is used in the evaluation of fetal lung maturity and risk for respiratory distress syndrome associated with preterm delivery. The diameter of lamellar bodies is similar to that of small platelets; therefore, the lamellar body count (LBC) can be performed using the platelet channel of an automated hematology analyzer.
What substance gives feces its normal color?
a. Uroerythrin
b. Urochrome
c. Urobilin
d. Urobilinogen
c. Urobilin
Bilirubin is a degradation product of hemoglobin. It is conjugated in the liver and converted into urobilinogen and stercobilinogen by bacteria in the intestines. Intestinal oxidation of stercobilinogen forms urobilin, which gives feces its normal orange-brown coloration.
Which of the following results reported for a seminal fluid would be considered abnormal?
a. pH of 7.5
b. Total volume of 1.2 mL
c. Complete liquefaction in 30 minutes
d. Gray-white, translucent appearance
b. Total volume of 1.2 mL
Seminal fluid is gray-white, translucent, and should liquefy within 30 minutes. Complete collections yield a volume of 2-5 ml and fresh semen is slightly alkaline (7.2-7.8). Volumes <2 ml or >5 ml have been associated with infertility.
