Clinical Microscopy Flashcards by Geil Bacus

What is the acronym used when there is a
fire?
a. MSDS
b. RACE
C. NFPA
d. PASS

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What does A stand in the acronym RACE?
a. Alert
b. Activate
C. Alarm
d. Amen

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Correct sequence of DONNING PPE
a. Gown > Mask > Googles > Gloves
b. Gloves > Googles > Gown > Mask
C. Gown > Googles > Mask > Gloves
d.Gloves > Gown > Google > Mask

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Proper handwashing 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

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What does “1+” mean in the degree of hazard?
a. No hazard
b. Slight
C. Severe
d. Moderate

B.
NO SMS EX
0- NO HAZARD/ MINIMAL
1- SLIGHTLY HAZARDOUS
2- MODERATE
3- SERIOUS
4- EXTREME/ SEVERE

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What is the major composition of urine?
a. Urea
b. Chloride
c. Water
d. Sodium

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Which of the following is the inorganic substance found in urine?
a. Sodium
b. Potassium
C. Chloride
d. Urea

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Normal urine pigments
a. Urochrome
b. Urobilin, Urochrome
c. Urobilin, Urochrome, Uroerythrin
d. Urobilin, Urochrome, Uroerythrin, Bilirubin

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Which of the following urine specimen is
used to evaluate orthostatic proteinuria?
a. Random urine
b. First-morning urine
C. 12-hour urine
d. 24-hour urine

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In 24-hr urine, what substance/s is/are
measured because it has diurnal variation?
a. 17-hydroxysteroid
b. 17-hydroxysteroid, electrolytes
C. 17-hydroxysteroid, catecholamines and
creatinine
d. 17-hydroxysteroid, catecholamines and
electrolytes

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Microscopic examination is done on what specimen in Three-Glass collection?
a. 1st specimen only
b. 1st and 3rd specimen
C. 2nd specimen only
d. 1st 2nd and 3rd specimen

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Specimen in four-glass method that is used
for urinary bladder infection
a. EPS
b. VB1
C. VB2
d. VB3

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When must urine temperature be taken for
drug testing?
a. 3 minutes
b. 4 minutes
C. 6 minutes
d. 10 minutes

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It is the process that provides documentation of proper sample identification from the time of collection to the receipt of laboratoryresults.
a. Chain of Evidence
b. Chain of Infection
c. Chain of Custody
d. Chain of Drug of testing

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In what sequence does urine formation occur?
a. Bowman’s capsule, Proximal convoluted tubule, loop of Henle, DCT, CD
b. Glomerulus, Bowman’s capsule, PCT, Loop of Henle, DCT, CD
C. Bowman’s capsule, PCT, DCT, Collecting Ducts
d. Glomerulus, Bowmans’s space, PCT, DCT, Collecting duct, afferent arteriole

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Which of the tubules is impermeable water?
a. Proximal convoluted tubule
b. Descending loop of Henle
c. Ascending loop of Henle
d. Distal convoluted tubule

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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 or secreted by the
tubules

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Calculate the creatinine clearance using
these laboratory result: 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. 23 mL/min
d. 33 mL/min

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Which of the following is the most common
method used to preserve urine specimens?
a. Boric acid
b. Formalin
C. Freezing
d. Refrigeration

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What is the preferred preservative for 24-
hour urine in cortisol determination?
a. Formalin
b. Boric acid
C. Hydrochloric acid, 6N
d. Sodium fluoride

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Patients with diabetes typically have higher urine output volumes; this is referred to as:
a. Oliguria
b. Anuria
C. Polyuria
d. Pyuria

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Which of the following urine characteristics
provides the best rough indicator of urine
concentration and body hydration?
a. Color
b. Clarity
C. Foam
d. Volume

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All of the following are insoluble in dilute acetic acid, except:
a. Bacteria
b. Yeast
C. Sperm
d. RBC

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Which of the following substances is responsible for the foul, fishy odor obtained when the “whiff” test is performed on vaginal secretions?
a. Cystine
b. Garlic
c. Trimethylamine
d. Ketones

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What is the required amount of urine for testing specific gravity using Total solid meters? a. 10-15 mL b. At least 5 mL C. 1-2 gtts/drops d. 4-5 gtts/drops

Which of the following features is not a characteristic of diabetes insipidus? a. Polyuria b. Polydipsia C. Increased production of antidiuretic hormone d. Urine with a low specific gravity

What is the sensitivity of the urine protein reagent pad? a. 15-30 mg/dL b. 75-125 mg/dL C. 0.4-0.8 mg/dL d. 5-10 mg/dL

A specimen with a specific gravity of 1.001 would be considered: a. Hyposthenuric b. Not urine C. Hypersthenurie d. Isosthenuric

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

Which of the following ketones is not detected by the reagent strip or tablet test? a. Acetone b. Acetoacetate c . Acetone and acetoacetate d. B- hydroxybutyrate

D. Parent ketone- Acetoacetate Most abundant ketone and Not detected in urine- B hydroxybutyrate Detected in Chemstrip because of GLYCINE- Acetone

Which of the following is the confirmatory test for bilirubin? a. Diazo b. Ictotest c. Evelyn and Malloy d. Sodium nitroprusside

Which of the following can cause false- negative ketone results? a. Alarge amount of ascorbic acid in urine b. Improperly preserve urine specimen C. Drugs containing free sulfhydryl groups d. Highly pigmented red urine

What is the sensitivity value of Clinitest tablet for glucose? a. 75-125 mg/dL b. 200 mg/dL C. 5 mg/dL d. 0.05-0.10 mg/dL

The double indicator system employed by commercial reagent strips to determine urine pH uses which two indicator dyes? a. Methyl orange and Bromphenol blue b. Phenol red and thymol blue c. Methyl red and Bromthymol blue d. Phenolphthalein and Methyl red

Protein Range: Turbidity, granulation, no flocculation: a. Trace b. 2+ C. 100-200 mg/dL d. 30-100 mg/dL

False positive errors in SSA test for protein, except: a. Radiographic dyes b. Tolbutamide C. Penicillin d. Highly buffered alkaline urine

Which protein test does not detect Bence jones protein? a. Heating urine at 40'-60'C up to 100'C b. SSA precipitation test C. Serum immunoelectrophoresis d. Reagent strip

A speckled pattern on the blood pad of the reagent strip indicates: a. Hematuria b. Hemoglobinuria C. Myoglobinuria d. Proteinuria

Reporting of Squamous Epithelial Cells a. Rare, few, moderate, many per LPF b. Rare, few, moderate, many per HPF C. Average number per LPF d. Average number per HPF

Reporting of Oval fat bodies a. Rare, few, moderate, many per LPF b. Rare, few, moderate, many per HPF C. Average number per LPF d. Average number per HPF

A cytospin-preparation of the urine sediment is performed and stained using Hansel stain. A differential white cell count of the sediment reveals 12% eosinophils. Based on this finding and the urinalysis results, the most likely diagnosis is a. Acute glomerulonephritis b. Acute interstitial nephritis C. Acute pyelonephritis d. Nephrotic syndrome

What is the color of glitter cells using Sedi stain? a. Violet b. Pink c. Light blue d. Colorless

What part of a microscope is replaced to convert a bright field to dark field microscope? a. Polarizing filter b. A split aperture C. Iris diaphragm d. Condenser

In a brightfield microscope, which lens produces the primary image magnification? a. Condenser b. Eyepiece (ocular) C. Rheostat d. Objective

In which part of nephrons casts with tapered ends are formed? a. At the junction of DCT and CD b. At the junction of PCT and DCT C. At the junction of ALH and DCT d. At the junction of DLH and ALH

Tamm-Horsfall protein is also known as a. Uromodulin b. Urochrome C. Bence-Jones protein d. Uroerythrin

Most commonly seen broad casts are? a. Hyaline and granular b. Hyaline and Waxy c. Granular and waxy d. All of the above

A parasite associated with positive leukocyte esterase-is: a. Enterobius vermicularis b. Trichomonas vaginalis C. Schistosoma haemotobium d. Candida albicans

Which of the following has been observed in urine as the MOST common sign of fecal contamination? a. Enterobius Ova b. Schistosoma haematobium C. Trichomonas vaginalis d. Entamoeba histolytica

Which of the following is an important characteristic finding in Nephrotic Syndrome? a. Glucosuria b. Hematuria C. Bilirubinuria d. Proteinuria

What disorder has a characteristic of crystals which look like rectangular plates with a notch in one corner? a. Lipiduria b. Hepatitis C. Ethylene glycol poisoning d. Gout

A generalized loss of proximal tubular function is a characteristic of a. Fanconi syndrome b. Nephrotic syndrome C. Renal glucosuria d. Renal tubular acidosis

Which of the following disorders is the major cause of the nephrotic syndrome in children? a. IgA nephropathy b. Membranoproliferative glomerulonephritis c. Membranous glomerulonephritis d. Minimal change disease

All of the following are pathologic crystals, except: a. Calcium oxalate b. Cholesterol C. Sulfonamides d. Hemosiderin

Which of the following crystals are found in urine with a pH 7 and below? a. Amorphous phosphates, calcium carbonate, triple phosphate b. Calcium oxalate, uric acid, and amorphous urates C. Uric acid, Amorphous rates, calcium carbonate d. Amorphous biurates, Amorphous urates, and uric acid

Which of the following crystals resemble an old soap? a. Urate stones b. Phosphate stones c. Calcium oxalate stones d. Cystine stones

Elevated compounds in Congenital erythropoietic porphyria a. ALA Porphobilinogen b. Uroporphyrin and Protoporphyrin c. Uroporphyrin and Coproporphyrin d. Protoporphyrin and Coproporphyrin

For low-volume CSF specimen collected on one tube, it should be sent first to a. Chemistry b. Hematology C. Microbiology d. Serology

Regarding CSF, all of the following are indications of a traumatic tap, except a. Clearing of the fluid as it is aspirated b. A clear supernatant after centrifugation c. Xanthochromia d. Presence of clot in the sample

Dilution of slightly bloody CSF for cell count. a. 1:10 b. 1:20 c. 1:100 d. 1:200

It assesses condition with IgG production within the CNS a. CSF/Serum Albumin Index b. Glutamine c. Lactate d. IgG Index

30% albumin added to CF increases which of the following? a. Cell yield b. Cell distortion c. Cell yield and cell distortion d. Cell shrinkage

How many leukocytes are normally present in the CSF obtained from neonates? a. 0-30 cells/uL b. 0-20 cells/uL c. 0-10 cells/uL d. 0-5 cells/uL

For every 1,400 RBC/uL seen, subtract how many WBC from the original WBC count? a. 1 b. 2 c. 3 d. 4

CSF lactate will be more consistently decredsed INCREASED in: a. Bacterial meningitis b. Viral meningitis c. Fungal meningitis d. Tubercular meningitis

Measurement of which of the following can be replaced by CF glutamine analysis in children with Reye syndrome? a. Ammonia b. Lactate c. Glucose d. a-Ketoglutarate

When is the collection in number of weeks after gestation of amniotic fluid for the early intervention for down syndrome? a. 15 to 18 weeks b. 20 to 22 weeks c. 10 to 15 weeks d. 20 to 42 weeks

Which of the following amniotic fluid values represents a risk for respiratory distress syndrome? a. L/S ratio of 2.5 b. Lamellar body count of 30,00/ ul c. Absorbance level of 0.30 at 450 nm d. Increased acetylcholinesterase activity

What is the earliest form of sperm cell? a. Spermatid b. Spermatozoon c. Spermatocyte d. Spermatogonium

Which part of male reproductive organ has high concentration of fructose and flavin? a. Epididymis b. Bulbourethral gland c. Prostate gland d. Seminal vesicles

What is the appropriate grade of viscosity of semen described as gel-like? a. 10 b. 5 c. 4 d. 0

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

Why would a physician be interested in tail morphology of sperm cells? a. The tail is vital for energy production b. The tail is vital to the penetration of the ovum c. Morphology of the tail affects the motility d. The nucleus of the sperm is in the tail

Negrosin-eosin stain will color live sperm cells against a purple background. a. Red b. Bluish white c. Dark green d. Black

WHO criteria: No forward progression a. D b. C c. 0 (zero) d. 1.0

Before determining the sperm motility, allow the sperm to settle for how many minute/s? a. 1 b. 3 to 5 c. 10 d. 15

How is semen preserved for Resorcinol test? a. Keep frozen b. Store at room temperature c. Store in gray top tube d. Keep in heparinized tub

What abnormality is associated with poor sperm motility but the count is normal? a. Lack of seminal vesicle support medium b. Presence of male antisperm antibody c. Female antisperm antibodies d. Viability of the sperm cells

Which of the following is a characteristic of normal synovial fluid? a. It forms small clots upon standing b. It is dark yellow c. It is slightly turbid d. It is viscous

Synovial fluid Grading using Mucin Clot Test: Fair a. Solid clot b. Soft clot c. Friable clot d. No clot at all

What is the normal synovial fluid RBC count? a. Less than 200 cells/uL b. Less than 400 cells/uL c. Less than 1,000 cells/uL d. Less than 2,000 cells/Ul

LE cell is derived from a. Monocytes b. Macrophages c. Neutrophils d. Eosinophils

Synovial fluid crystals found in cases of rheumatoid arthritis: a. Calcium phosphate b. Calcium pyrophosphate c. Cholesterol d. Monosodium urate

Differentiation of synovial fluid crystals, based on their birefringence is achieved using: a. Transmission electron microscopy b. Direct polarizing microscopy c. Compensated polarizing microscopy d. Both Band C

Which of the following crystals is characteristically seen in patients with gout? a. Cholesterol crystals b. Monosodium urate monohydrate crystals c. Hydroxyapatite crystals d. Calcium pyrophosphate dehydrate crystals

Peritoneal fluid extraction is referred to as a. Paracentesis b. Thoracentesis c. Amniocentesis d. Arthrocentesis

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

A pea soup like consistency of a stool specimen could be indicative of: a. Cholera b.Dysentery c. Typhoid fever d. Cystic fibrosis

Fecal specimens may be tested for each of the following except a. Fat. b. Blood. c. Bilirubin. d. Carbohydrates.

Which of the following statements regarding the test for fetal hemoglobin in feces (the Apt test) is true? a. Any adult hemoglobin present should resist alkali treatment. b. The APT test is used to differentiate various hemoglobinopathies in the newborn. c. Hemoglobin A usually produces a positive test result. d. A pink color after alkali treatment indicates the presence of fetal hemoglobin.

Clinitest is used to detect this substance in newborn feces: a. Fatty acids b. Meat fibers C. Fetal blood d. Carbohydrates

Steatorrhea is present in: a. Colorectal cancer. b. Fetal hemoglobin C. Bacterial invasion of the intestine d. Giardiasis

Which of the following types of fat readily stain with Sudan III or Oil Red O stain? 1. Fatty acids Sudan 2. Cholesterol 3. Soaps (fatty acid salts) 4. Neutral fats (triglycerides) a. 1, 2, and 3 are correct b. 1 and 3 are correct. c. 4 is correct. d. All are correct

In bacterial vaginosis, in trichomoniasis, and in Postmenopausal women, the vaginal pH is: a. Above 4.5 b. Between 3.8 and 4.5 c. Below 3.8 d. It is above 4.5 in some of these and below 3.8 in others

Which of these specimens is best for the detection of Pneumocystis jiroveci? a. Bronchoalveolar lavage b. Vaginal secretions c. Bronchial washings d. Amniotic fluid

Most abundant (granulocyte) in BAL a. Macrophages b. Lymphocyte c. Neutrophils d. Eosinophils

In automated urinalysis Sysmex UF series, the DNA within the cells is stained by a. Oil red O b. Phenanthridine c. Alkaline phosphatase d. Carbocyanin

Which of the following refers to absence of all acids? a. Achlorhydria b. Achylia c. Anacidity d. Euchlorhydria

Which statement regarding renal function is true? A. Glomeruli are far more permeable to H2O and salt than other capillaries B. The collecting tubule reabsorbs sodium and secretes potassium in response to antidiuretic hormone (ADH) C. The collecting tubule is permeable to H2O only in the presence of aldosterone D. The thick ascending limb is highly permeable to H2O and urea

Which statement regarding normal salt and H2O handling by the nephron is correct? A. The ascending limb of the tubule is highly permeable to salt but not H2O B. The stimulus for ADH release is low arterial pressure in the afferent arteriole C. The descending limb of the tubule is impermeable to urea but highly permeable to salt D. Renin is released in response to high plasma osmolality

Which statement concerning renal tubular function is true? A. In salt deprivation, the kidneys will conserve sodium at the expense of potassium B. Potassium is not excreted when serum concentration is below 3.5 mmol/L C. No substance can be excreted into urine at a rate that exceeds the glomerular filtration rate D. When tubular function is lost, the specific gravity of urine will be below 1.005

Which of the following is inappropriate when collecting urine for routine bacteriologic culture? A. The container must be sterile B. The midstream void technique must be used C. The collected sample must be plated within2 hours unless refrigerated D. The sample may be held at 2°C–8°C for up to 48 hours prior to plating

Which statement about sample collection for routine urinalysis is true? A. Preservative tablets should be used for collecting random urine specimens B. Containers may be washed and reused if rinsed in deionized H2O C. Samples may be stored at room temperature for up to 2 hours D. First morning voided samples are not acceptable when renal disease is suspected

Which urine color is correlated correctly with the pigment-producing substance? A. Smoky red urine with homogentisic acid B. Dark amber urine with myoglobin C. Deep yellow urine and yellow foam with bilirubin D. Red-brown urine with biliverdin

Which of the following substances will cause urine to produce red fluorescence when examined with an ultraviolet lamp (360 nm)? A. Myoglobin B. Porphobilinogen (PBG) C. Urobilin D. Coproporphyrin

Which of the following conditions is associated with normal urine color but produces red fluorescence when urine is examined with an ultraviolet (Wood’s) lamp? A. Acute intermittent porphyria B. Lead poisoning C. Erythropoietic porphyria D. Porphyria cutanea tarda

Which statement regarding porphyria is accurate? A. Porphyria is exclusively inherited B. All types cause an increase in urinary porphyrins C. All types are associated with anemia D. Serum, urine, and fecal tests may be needed for diagnosis

Which is the most common form of porphyria? A. Erythropoietic porphyria B. Acute intermittent porphyria C. Variegate porphyria D. Porphyria cutanea tarda

Which of the following methods is the least sensitive and specific for measuring PBG in urine? A. Watson–Schwartz test B. LC–MS C. Ion exchange chromatography–Ehrlich’s reaction D. Isotope dilution–MS

A brown or black pigment in urine can be caused by: A. Gantrisin (Pyridium) B. Phenolsulfonphthalein C. Rifampin D. Melanin

Urine that is dark red or port wine in color may be caused by: A. Lead poisoning B. Porphyria cutanea tarda C. Alkaptonuria D. Hemolytic anemia

Which of the following tests is affected least by standing or improperly stored urine? A. Glucose B. Protein C. pH D. Bilirubin

Which type of urine sample is needed for a D-xylose absorption test on an adult patient? A. 24-hour urine sample collected with 20 mL of 6 N HCl B. 2-hour timed postprandial urine preserved with boric acid C. 5-hour timed urine kept under refrigeration D. Random urine preserved with formalin

Which of the following is inappropriate when collecting a 24-hour urine sample for catecholamines? A. Urine in the bladder is voided and discarded at the start of the test B. At 24 hours, any urine in the bladder is voided and added to the collection C. All urine should be collected in a single container that is kept refrigerated D. Ten mL of 1N sodium hydroxide should be added to the container before collection

Urine production of less than 400 mL/day is: A. Consistent with normal renal function and H2O balance B. Termed isosthenuria C. Defined as oliguria D. Associated with diabetes mellitus

Which of the following contributes to SG, but not to osmolality? A. Protein B. Salt C. Urea D. Glucose

Urine with an SG consistently between 1.002 and 1.003 indicates: A. Acute glomerulonephritis B. Renal tubular failure C. Diabetes insipidus D. Addison’s disease

In which of the following conditions is the urine SG likely to be below 1.025? A. Diabetes mellitus B. Drug overdose C. Chronic renal failure D. Prerenal failure

Which statement regarding methods for measuring SG is true? A. To correct a urinometer, subtract 0.001 per each 3°C below 15.5°C B. Colorimetric SG tests are falsely elevated when a large quantity of glucose is present C. Colorimetric SG readings are falsely elevated when pH is alkaline D. Refractometry should be performed before the urine is centrifuged

What is the principle of the colorimetric reagent strip determination of SG in urine? A. Ionic strength alters the pKa of a polyelectrolyte B. Sodium and other cations are chelated by a ligand that changes color C. Anions displace a pH indicator from a mordant, making it water soluble D. Ionized solutes catalyze oxidation of an azo dye

Which statement regarding urine pH is true? A. High-protein diets promote an alkaline urine pH B. pH tends to decrease as urine is stored C. Contamination should be suspected if urine pH is less than 4.5 D. Bacteriuria is most often associated with a low urine pH

In renal tubular acidosis, the pH of urine is: A. Consistently acid B. Consistently alkaline C. Neutral D. Variable, depending upon diet

The normal daily urine output for an adult is approximately: A. 0.2–0.5 L B. 0.6–1.6 L C. 2.7–3.0 L D. 3.2–3.5 L

The SG of the filtrate in Bowman’s space is approximately: A. 1.000–1.002 B. 1.004–1.006 C. 1.008–1.010 D. 1.012–1.014

A patient with partially compensated respiratory alkalosis would have a urine pH of: A. 4.5–5.5 B. 5.5–6.5 C. 6.5–7.5 D. 7.5–8.5

Which of the following is most likely to cause a false-positive dry reagent strip test for urinary protein? A. Urine of high SG B. Highly buffered alkaline urine C. Bence–Jones protein D. Salicylates

When testing for urinary protein with sulfosalicylic acid (SSA), which condition may produce a false-positive result? A. Highly buffered alkaline urine B. The presence of x-ray contrast media C. Increased urinary SG D. The presence of red blood cells (RBCs)

A discrepancy between the urine SG determined by measuring refractive index and urine osmolality would be most likely to occur: A. After catheterization of the urinary tract B. In diabetes mellitus C. After an intravenous pyelogram (IVP) D. In uremia

Which of the following is likely to result in a false-negative dry reagent strip test for proteinuria? A. Penicillin B. Aspirin C. Amorphous phosphates D. Bence–Jones protein

Daily loss of protein in urine normally does not exceed: A. 30 mg B. 50 mg C. 100 mg D. 150 mg

Which of the following is least likely to cause a false-positive result with turbidimetric protein tests? A. Tolbutamide B. X-ray contrast media C. Penicillin or sulfa antibiotics D. Ascorbic acid

Which statement best describes the clinical utility of tests for microalbuminuria? A. Testing may detect early renal involvement in diabetes mellitus B. Microalbuminuria refers to a specific subfraction of albumin found only in persons with diabetic nephropathy C. A positive test result indicates the presence of orthostatic albuminuria D. Testing should be part of the routine urinalysis

Dry reagent strip tests for microalbuminuria that compare albumin to creatinine determine the creatinine concentration based upon which principle? A. Formation of a Cu+2-creatinine complex B. Enzymatic assay using sarcosine oxidase and peroxidase C. Reaction of creatinine with alkaline sodium picrate D. Change in pH as creatinine is converted to creatine

Which of the following conditions is least likely to be detected by dry reagent strip tests for proteinuria? A. Orthostatic albuminuria B. Chronic renal failure C. Pyelonephritis D. Renal tubular proteinuria

The normal renal threshold for glucose is: A. 70–85 mg/dL B. 100–115 mg/dL C. 130–145 mg/dL D. 165–180 mg/dL

In which of the following conditions is glycosuria most likely? A. Addison’s disease B. Hypothyroidism C. Pregnancy D. Hypopituitarism

In addition to ascorbate, the glucose oxidase reaction may be inhibited by which substance? A. Acetoacetic acid (AAA) B. ε-Aminocaproic acid C. Creatinine D. Azopyridium

A positive glucose oxidase test and a negative test for reducing sugars indicates: A. True glycosuria B. False-positive reagent strip test C. False-negative reducing test caused by ascorbate D. Galactosuria

A negative glucose oxidase test and a positive test for reducing sugars in urine indicates: A. True glycosuria B. A false-negative glucose oxidase reaction C. The presence of a nonglucose reducing sugar such as galactose D. A trace quantity of glucose

In what condition may urinary ketone tests underestimate ketosis? A. Acidosis B. Hemolytic anemia C. Renal failure D. Excessive use of vitamin C

AAA is detected in urine by reaction with: A. Sodium nitroprusside B. o-Toluidine C. m-Dinitrobenzene D. m-Dinitrophenylhydrazine

Nondiabetic ketonuria can occur in all of the following except: A. Pregnancy B. Renal failure C. Starvation D. Lactate acidosis

Which of the following statements regarding the classical nitroprusside reaction for ketones is true? A. The reaction is most sensitive to acetone B. Nitroprusside reacts with acetone, AAA, and β-hydroxybutyric acid C. It may be falsely positive in phenylketonuria D. The reaction is recommended for diagnosing ketoacidosis

Hemoglobin in urine can be differentiated from myoglobin using: A. 80% ammonium sulfate to precipitate hemoglobin B. Sodium dithionite to reduce hemoglobin C. o-Dianisidine instead of benzidine as the color indicator D. The dry reagent strip blood test

Which of the following conditions is associated with a negative blood test and an increase in urine urobilinogen? A. Calculi of the kidney or bladder B. Malignancy of the kidney or urinary system C. Crush injury D. Extravascular hemolytic anemia

Which statement about the dry reagent strip blood test is true? A. The test is based on the reaction of hemoglobin with peroxidase B. Abnormal color may be absent from the urine when the reaction is positive C. A nonhemolyzed trace is present when there are 1–2 RBCs per high-power field D. Salicylates cause a false-positive reaction

A moderate-positive blood test and trace protein test are seen on the dry reagent strip, and 11–20 red blood cells per high-power field are seen in the microscopic exam. These results are most likely caused by which of the following? A. Transfusion reaction B. Myoglobinuria C. Intravascular hemolytic anemia D. Recent urinary tract catheterization

Which of the following results are discrepant? A. Small amount of blood but negative protein B. Moderate amount of blood but no RBCs in microscopic exam C. Negative blood but 6–10 RBCs/high-power field (HPF) D. Negative blood, positive protein

Which of the following statements regarding the dry reagent strip test for bilirubin is true? A. A positive test is seen in prehepatic, hepatic, and posthepatic jaundice B. The test detects only conjugated bilirubin C. Standing urine may become falsely positive due to bacterial contamination D. High levels of ascorbate will cause positive interference

Which of the following reagents is used to detect urobilinogen in urine? A. p-Dinitrobenzene B. p-Aminosalicylate C. p-Dimethylaminobenzaldehyde D. p-Dichloroaniline

Which of the following statements regarding urinary urobilinogen is true? A. Diurnal variation occurs with highest levels seen in the early morning B. High levels occurring with a positive bilirubin test indicate obstructive jaundice C. Dry reagent strip tests do not detect decreased levels D. False-positive results may occur if urine is stored for more than 2 hours

Which of the following statements regarding the test for nitrite in urine is true? A. It detects more than 95% of clinically significant bacteriuria B. Formation of nitrite is unaffected by the urine pH C. The test is dependent upon an adequate dietary nitrate content D. A positive test differentiates bacteriuria from in vitro bacterial contamination

Which statement about the dry reagent strip test for leukocytes is true? A. The test detects only intact white blood cells (WBCs) B. The reaction is based upon the hydrolysis of substrate by WBC esterases C. Several antibiotics may give a false-positive reaction D. The test is sensitive to 2–3 WBCs per HPF

Which of the following statements about creatinine clearance is correct? A. Dietary restrictions are required during the 24 hours preceding the test B. Fluid intake must be restricted to below 600 mL in the 6 hours preceding the test C. Creatinine clearance is mainly determined by renal tubular function D. Creatinine clearance is dependent upon lean body mass

A male patient’s eGFR is 75 mL/min. This indicates: A. Normal glomerular filtration rate B. The patient is uremic and will be hyperkalemic C. Renal tubular dysfunction D. Reduced glomerular filtration without uremia

Which of the following tests is a specific measure of glomerular filtration? A. p-Aminohippuric acid (PAH) clearance B. Fishberg concentration test C. Mosenthal dilution test D. Cystatin C

Which statement regarding urea is true? A. Urea is 100% filtered by the glomeruli B. Blood urea levels are independent of diet C. Urea is not significantly reabsorbed by the tubules D. Urea excretion is a specific measure of glomerular function

Given the following data, calculate the creatinine clearance. Serum creatinine = 1.2 mg/dL; urine creatinine = 100 mg/dL; urine volume = 1.4 L/day; body surface area = 1.80 m2 A. 47 mL/min B. 78 mL/min C. 100 mL/min D. 116 mL/min

Which of the following dyes are used in Sternheimer–Malbin stain? A. Hematoxylin and eosin B. Crystal violet and safranin C. Methylene blue and eosin D. Methylene blue and safranin

Which of the following statements regarding WBCs in urinary sediment is true? A. “Glitter cells” seen in the urinary sediment are a sign of renal disease B. Bacteriuria in the absence of WBCs indicates lower urinary tract infection (UTI) C. WBCs other than PMNs are not found in urinary sediment D. WBC casts indicate that pyuria is of renal, rather than lower urinary, origin

Which description of sediment with Sternheimer–Malbin stain is correct? A. Transitional epithelium: cytoplasm pale blue, nucleus dark blue B. Renal epithelium: cytoplasm light blue, nucleus dark purple C. Glitter cells: cytoplasm dark blue, nucleus dark purple D. Squamous epithelium: cytoplasm pink, nucleus pale blue

A 5-mL urine specimen is submitted for routine urinalysis and analyzed immediately. The SG of the sample is 1.012 and the pH is 6.5. The dry reagent strip test for blood is a large positive (3+) and the microscopic examination shows 11–20 RBCs per HPF. The leukocyte esterase reaction is a small positive (1+), and the microscopic examination shows 0–5 WBCs per HPF. What is the most likely cause of these results? A. Myoglobin is present in the sample B. Free hemoglobin is present C. Insufficient volume is causing microscopic results to be underestimated D. Some WBCs have been misidentified as RBCs

Which of the following statements regarding epithelial cells in the urinary system is correct? A. Caudate epithelial cells originate from the upper urethra B. Transitional cells originate from the upper urethra, ureters, bladder, or renal pelvis C. Cells from the proximal renal tubule are usually round in shape D. Squamous epithelium line the vagina, urethra, and wall of the urinary bladder

Which of the statements regarding examination of unstained sediment is true? A. Renal cells can be differentiated reliably from WBCs B. Large numbers of transitional cells are often seen after catheterization C. Neoplastic cells from the bladder are not found in urinary sediment D. RBCs are easily differentiated from nonbudding yeast

Which of the following statements regarding cells found in urinary sediment is true? A. Transitional cells resist swelling in hypotonic urine B. Renal tubular cells are often polyhedral and have an eccentric round nucleus C. Trichomonads have an oval shape with a prominent nucleus and a single anterior flagellum D. Clumps of bacteria are frequently mistaken for blood casts

The ova of which parasite may be found in the urinary sediment? A. T. vaginalis B. Entamoeba histolytica C. Schistosoma hematobium D. Trichuris trichiura

Oval fat bodies are often seen in: A. Chronic glomerulonephritis B. Nephrotic syndrome C. Acute tubular nephrosis D. Renal failure of any cause

Which condition promotes the formation of casts in the urine? A. Chronic production of alkaline urine B. Polyuria C. Reduced filtrate formation D. Low urine SG

The mucoprotein that forms the matrix of a hyaline cast is called: A. Bence–Jones protein B. β-Microglobulin C. Tamm–Horsfall protein D. Arginine-rich glycoprotein

“Pseudocasts” are often caused by: A. A dirty cover glass or slide B. Bacterial contamination C. Amorphous urates D. Mucus in the urine

Which of the following statements regarding urinary casts is correct? A. Fine granular casts are more significant than coarse granular casts B. Cylindruria is always clinically significant C. The appearance of cylindroids signals the onset of end-stage renal disease D. Broad casts are associated with severe renal tubular obstruction

A sediment with moderate hematuria and RBC casts most likely results from: A. Chronic pyelonephritis B. Nephrotic syndrome C. Acute glomerulonephritis D. Lower urinary tract obstruction

Urine sediment characterized by pyuria with bacterial and WBC casts indicates: A. Nephrotic syndrome B. Pyelonephritis C. Polycystic kidney disease D. Cystitis

Which type of casts signals the presence of chronic renal failure? A. Blood casts B. Fine granular casts C. Waxy casts D. Fatty casts

Urinalysis of a sample from a patient suspected of having a transfusion reaction reveals small yellow-brown crystals in the microscopic examination. Dry reagent strip tests are normal with the exception of a positive blood reaction (moderate) and trace positive protein. The pH of the urine is 6.5. What test should be performed to positively identify the crystals? A. Confirmatory test for bilirubin B. Cyanide–nitroprusside test C. Polarizing microscopy D. Prussian blue stain

When examining urinary sediment, which of the following is considered an abnormal finding? A. 0–2 RBCs per HPF B. 0–1 hyaline casts per low-power field (LPF) C. 0–1 renal cell casts per LPF D. 2–5 WBCs per HPF

A urine sample with a pH of 6.0 produces an abundance of pink sediment after centrifugation that appears as densely packed yellow- to reddish-brown granules under the microscope. The crystals are so dense that no other formed elements can be evaluated. What is the best course of action? A. Request a new urine specimen B. Suspend the sediment in prewarmed saline, then repeat centrifugation C. Acidify a 12-mL aliquot with three drops of glacial acetic acid and heat to 56°C for 5 minutes before centrifuging D. Add five drops of 1N HCl to the sediment and examine

How can hexagonal uric acid crystals be distinguished from cystine crystals? A. Cystine is insoluble in hydrochloric acid but uric acid is soluble B. Cystine gives a positive nitroprusside test after reduction with sodium cyanide C. Cystine crystals are more highly pigmented D. Cystine crystals form at neutral or alkaline pH, uric acid forms at neutral to acidic pH

The presence of tyrosine and leucine crystals together in a urine sediment usually indicates: A. Renal failure B. Chronic liver disease C. Hemolytic anemia D. Hartnup disease

Which of the following crystals is considered nonpathological? A. Hemosiderin B. Bilirubin C. Ammonium biurate D. Cholesterol

At which pH are ammonium biurate crystals usually found in urine? A. Acid urine only B. Acid or neutral urine C. Neutral or alkaline urine D. Alkaline urine only

Which of the following crystals is seen commonly in alkaline and neutral urine? A. Calcium oxalate B. Uric acid C. Magnesium ammonium phosphate D. Cholesterol

Which crystal appears in urine as a long, thin hexagonal plate, and is linked to ingestion of large amounts of benzoic acid? A. Cystine B. Hippuric acid C. Oxalic acid D. Uric acid

Small yellow needles are seen in the sediment of a urine sample with a pH of 6.0. Which of the following crystals can be ruled out? A. Sulfa crystals B. Bilirubin crystals C. Uric acid crystals D. Cholesterol crystals

Oval fat bodies are derived from: A. Renal tubular epithelium B. Transitional epithelium C. Degenerated WBCs D. Mucoprotein matrix

Oval fat bodies are often associated with: A. Lipoid nephrosis B. Acute glomerulonephritis C. Aminoaciduria D. Pyelonephritis

Urine of constant SG ranging from 1.008 to 1.010 most likely indicates: A. Addison’s disease B. Renal tubular failure C. Prerenal failure D. Diabetes insipidus

Which of the following characterizes prerenal failure, and helps to differentiate it from acute renal failure caused by renal disease? A. BUN:creatinine ratio of 20:1 or higher B. Urine:plasma osmolal ratio less than 2:1 C. Excess loss of sodium in the urine D. Dehydration

Which of the following conditions characterizes chronic glomerulonephritis and helps to differentiate it from acute glomerulonephritis? A. Hematuria B. Polyuria C. Hypertension D. Azotemia

Which of the following conditions is seen in acute renal failure and helps to differentiate it from prerenal failure? A. Hyperkalemia and uremia B. Oliguria and edema C. Low creatinine clearance D. Abnormal urinary sediment

Which of the following conditions is associated with the greatest proteinuria? A. Acute glomerulonephritis B. Chronic glomerulonephritis C. Nephrotic syndrome D. Acute pyelonephritis

Which of the following conditions is often a cause of glomerulonephritis? A. Hypertension B. Cytomegalovirus infection C. Systemic lupus erythematosus D. Heavy metal poisoning

Acute pyelonephritis is commonly caused by: A. Bacterial infection of medullary interstitium B. Circulatory failure C. Renal calculi D. Antigen–antibody reactions within the glomeruli

All of the following are common characteristics of the nephrotic syndrome except: A. Hyperlipidemia B. Hypoalbuminemia C. Hematuria and pyuria D. Severe edema

Which of the following conditions is a characteristic finding in patients with obstructive renal disease? A. Polyuria B. Azotemia C. Dehydration D. Alkalosis

Whewellite and weddellite kidney stones are composed of: A. Magnesium ammonium phosphate B. Calcium oxalate C. Calcium phosphate D. Calcium carbonate

Which statement about renal calculi is true? A. Calcium oxalate and calcium phosphate account for about three-fourths of all stones B. Uric acid stones can be seen by x-ray C. Triple phosphate stones are found principally in the ureters D. Stones are usually comprised of single salts

Cerebrospinal fluid (CSF) is formed by ultrafiltration of plasma through the: A. Choroid plexus B. Sagittal sinus C. Anterior cerebral lymphatics D. Arachnoid membrane

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

When collecting CSF, a difference between opening and closing fluid pressure greater than 100 mm H2O indicates: A. Low CSF volume B. Subarachnoid hemorrhage C. Meningitis D. Hydrocephalus

The term used to denote a high WBC count in the CSF is: A. Empyema B. Neutrophilia C. Pleocytosis D. Hyperglycorrhachia

What is the most likely cause of the following CSF results? CSF glucose 20 mg/dL; CSF protein 200 mg/dL; CSF lactate 50 mg/dL (reference range 5–25 mg/dL) A. Viral meningitis B. Viral encephalitis C. Cryptococcal meningitis D. Acute bacterial meningitis

Which of the following conditions is most often associated with normal CSF glucose and protein? A. Multiple sclerosis B. Malignancy C. Subarachnoid hemorrhage D. Viral meningitis

The diagnosis of multiple sclerosis is often based upon which finding? A. The presence of elevated protein and low glucose B. A decreased IgG index C. The presence of oligoclonal bands by electrophoresis D. An increased level of CSF β microglobulin

Which of the following results is consistent with fungal meningitis? A. Normal CSF glucose B. Pleocytosis of mixed cellularity C. Normal CSF protein D. High CSF lactate

In what suspected condition should a wet prep using a warm slide be examined? A. Cryptococcal meningitis B. Amoebic meningoencephalitis C. Mycobacterium tuberculosis infection D. Neurosyphilis

Which of the following CSF test results is most commonly increased in patients with multiple sclerosis? A. Glutamine B. Lactate C. IgG index D. Ammonia

Which of the following is an inappropriate procedure for performing routine CSF analysis? A. A differential is done only if the total WBC count is greater than 10/μL B. A differential should be done on a stained CSF concentrate C. A minimum of 30 WBCs should be differentiated D. A Wright’s-stained slide should be examined rather than a chamber differential

Which cell is present in the CSF in greater numbers in newborns than in older children or adults? A. Eosinophils B. Lymphocytes C. Monocytes D. Neutrophils

Neutrophilic pleocytosis is usually associated with all of the following except: A. Cerebral infarction B. Malignancy C. Myelography D. Neurosyphilis

Which statement about CSF protein is true? A. An abnormal serum protein electrophoretic pattern does not affect the CSF pattern B. The upper reference limit for CSF total protein in newborns is one-half adult levels C. CSF IgG is increased in panencephalitis, malignancy, and neurosyphilis D. Antibodies to Treponema pallidum disappear after successful antibiotic therapy

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

Which organism is the most frequent cause of bacterial meningitis in neonates? A. Neisseria meningitidis B. Group B Streptococcus C. Streptococcus pneumoniae D. Klebsiella pneumoniae

Following a head injury, which protein will identify the presence of CSF leakage through the nose? A. Transthyretin B. Myelin basic protein C. Tau protein D. C-reactive protein

Which of the following statements regarding serous fluids is true? A. The normal volume of pleural fluid is 30–50 mL B. Mesothelial cells, PMNs, lymphocytes, and macrophages may be present in normal fluids C. X-ray can detect a 10% increase in the volume of a serous fluid D. Normal serous fluids are colorless

The term effusion refers to: A. A chest fluid that is purulent B. A serous fluid that is chylous C. An increased volume of serous fluid D. An inflammatory process affecting the appearance of a serous fluid

Which of the following laboratory results is characteristic of a transudative fluid? A. SG = 1.018 B. Total protein = 3.2 g/dL C. LD fluid/serum ratio = 0.25 D. Total protein fluid/serum ratio = 0.65

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Which test best correlates with the severity of HDN? A. Rh antibody titer of the mother B. Lecithin/sphingomyelin (L/S) ratio C. Amniotic fluid bilirubin D. Urinary estradiol

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

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

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

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

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

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

Most cases of Down syndrome are the result of: A. Nondisjunction of an E chromosome (E trisomy) B. Nondisjunction of chromosome 21 (G trisomy) C. A 14–21 chromosome translocation D. Deletion of the long arm of chromosome 21

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

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

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

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

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

What is the term for sperm when the anterior portion of the headpiece is smaller than normal? A. Azoospermia B. Microcephaly C. Acrosomal deficiency D. Necrozoospermia

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Given the following dry reagent strip urinalysis results, select the most appropriate course of action: A 6-mL pediatric urine sample is processed for routine urinalysis in the usual manner. The sediment is prepared by centrifuging all of the urine remaining after performing the biochemical tests. The following results are obtained: pH = 8.0 Protein = 1+ Ketone = Neg Glucose = Neg Nitrite = Neg Blood = Neg Bilirubin = Neg A. Report the results, assuming acceptable quality control B. Check pH with a pH meter before reporting C. Perform a turbidimetric protein test and report instead of the dipstick protein D. Request a new specimen

Given the following urinalysis results, select the most appropriate course of action: pH = 8.0 Protein = Trace Ketone = Small Blood = Neg Microscopic findings: RBCs = 0–2/HPF WBCs = 20–50/HPF Bacteria = Large Crystals = Small, CaCO3 A. Call for a new specimen because urine was contaminated in vitro B. Recheck pH because calcium carbonate (CaCO3) does not occur at alkaline pH C. No indication of error is present; results indicate a UTI D. Report all results except bacteria because the nitrite test was negative

SG = 1.015 RBCs: 5–10/HPF Protein = 2+ WBCs: 5–10/HPF Blood = Large Glucose = Neg Nitrite = Neg Select the most appropriate course of action. A. Report these results; blood and protein correlate with microscopic results B. Report biochemical results only; request a new sample for the microscopic examination C. Request a new sample and report as quantity not sufficient (QNS) D. Recentrifuge the supernatant and repeat the microscopic examination

A biochemical profile gives the following results: Creatinine = 1.4 mg/dL BUN = 35 mg/dL K = 5.5 mmol/L All other results are normal and all tests are in control. Urine from the patient has an osmolality of 975 mOsm/kg. Select the most appropriate course of action. A. Check for hemolysis B. Repeat the BUN and report only if normal C. Repeat the serum creatinine and report only if elevated D. Report these results

A 2 p.m. urinalysis has a trace glucose by the dry reagent strip test. A fasting blood glucose drawn 8 hours earlier is 100 mg/dL. No other results are abnormal. Select the most appropriate course of action. A. Repeat the urine glucose and report if positive B. Perform a test for reducing sugars and report the result C. Perform a quantitative urine glucose; report as trace if greater than 100 mg/dL D. Request a new urine specimen

Following a transfusion reaction, urine from a patient gives positive tests for blood and protein. The SG is 1.015. No RBCs or WBCs are seen in the microscopic examination. These results: A. Indicate renal injury induced by transfusion reaction B. Support the finding of an extravascular transfusion reaction C. Support the finding of an intravascular transfusion reaction D. Rule out a transfusion reaction caused by RBC incompatibility

A urine sample taken after a suspected transfusion reaction has a positive test for blood, but intact RBCs are not seen on microscopic examination. Which one test result would rule out an intravascular hemolytic transfusion reaction? A. Negative urine urobilinogen B. Serum unconjugated bilirubin below 1.0 mg/dL C. Serum potassium below 6.0 mmol/L D. Normal plasma haptoglobin

Given the following urinalysis results, select the most appropriate course of action: Urinalysis results from a 35-year-old woman are: pH = 5.0 Protein = Neg Blood = Neg Ketone = Moderate Glucose = 1,000 mg/dL Bilirubin = Neg SSA protein = 1+ A. Report the SSA protein result instead of the dry reagent strip result B. Call for a list of medications administered to the patient C. Perform a quantitative urinary albumin D. Perform a test for microalbuminuria

Urinalysis results from a 35-year-old woman are: SG = 1.015 Glucose = Small Leukocytes = Moderate Microscopic findings: RBCs: 5–10/HPF pH = 7.5 Ketone = Neg Protein = Trace Blood = Neg WBCs: 25–50/HPF Select the most appropriate course of action. A. Recheck the blood reaction; if negative, look for budding yeast B. Repeat the WBC count C. Report all results except blood D. Request a list of medications

A routine urinalysis gives the following results: pH =6.5 Protein = Neg Glucose= Trace Ketone = Neg Blood = Neg Microscopic findings: Blood casts: 5–10/LFP Mucus: Small Crystals: Large, Amorphous These results are most likely explained by: A. False-negative blood reaction B. False-negative protein reaction C. Pseudocasts of urate mistaken for true casts D. Mucus mistaken for casts

When examining a urinary sediment under 400× magnification, the technologist noted many red blood cells to have cytoplasmic blebs and an irregular distribution of the hemoglobin. This phenomenon is most often caused by: A. Intravascular hemolytic anemia B. Glomerular disease C. Hypotonic or alkaline urine D. Severe dehydration

A urine specimen is dark orange and turns brown after storage in the refrigerator overnight. The technologist requests a new specimen. The second specimen is bright orange and is tested immediately. Which test result would differ between the two specimens? A. Ketone B. Leukocyte esterase C. Urobilinogen D. Nitrite

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

A urine sample with a pH of 8.0 and a specific gravity of 1.005 had a small positive blood reaction, but is negative for protein and no RBCs are present in the microscopic examination of urinary sediment. What best explains these findings? A. High pH and low SG caused a false-positive blood reaction B. The blood reaction and protein reaction are discrepant C. Hemoglobin is present without intact RBCs due to hemolysis D. An error was made in the microscopic examination

A urine sample has a negative blood reaction and 5–10 cells per high-power field that resemble red blood cells. What is the best course of action? A. Mix a drop of sediment with 1 drop of WBC counting fluid and reexamine B. Report the results without further testing C. Repeat the blood test and if negative report the results D. If the leukocyte esterase test is positive, report the cells as WBCs

A pleural fluid submitted to the laboratory is milky in appearance. Which test would be most useful in differentiating between a chylous and pseudochylous effusion? A. Fluid to serum triglyceride ratio B. Fluid WBC count C. Fluid total protein D. Fluid to serum LD ratio

A cerebrospinal fluid sample from an 8-year-old child with a fever of unknown origin was tested for glucose, total protein, lactate, and IgG index. The glucose was 180 mg/dL but all other results were within the reference range. The CSF WBC count was 9 × 106/L and the RBC count was 10 × 106/L. The differential showed 50% lymphocytes, 35% monocytes, 10% macrophages, 3% neutrophils, and 2% neuroectodermal cells. What is the most likely cause of these results? A. Aseptic meningitis B. Traumatic tap C. Subarachnoid hemorrhage D. Hyperglycemia

A WBC count and differential performed on ascites fluid gave a WBC count of 20,000μL with 90% macrophages. The gross appearance of the fluid was described by the technologist as “thick and bloody.” It was noted on the report that several clusters of these cells were observed and that the majority of the cells contained many vacuoles resembling paper-punch holes. What do the observations above suggest? A. Malignant mesothelial cells were counted as macrophages B. Adenocarcinoma from a metastatic site C. Lymphoma infiltrating the peritoneal cavity D. Nodular sclerosing type Hodgkin’s disease

Given the following data for creatinine clearance, select the most appropriate course of action. Volume = 2.8 L/day; surface area = 1.73 m2; urine creatinine = 100 mg/dL; serum creatinine = 1.2 mg/dL A. Report a creatinine clearance of 162 mL/min B. Repeat the urine creatinine; results point to a dilution error C. Request a new 24-hour urine sample D. Request the patient’s age and sex

An elevated amylase is obtained on a stat serum collected at 8 p.m. An amylase performed at 8 a.m. that morning was within normal limits. The technologist also noted that a urine amylase was measured at 6 p.m. Select the most appropriate course of action. A. Repeat the stat amylase; report only if within normal limits B. Repeat both the a.m. and p.m. serum amylase and report only if they agree C. Request a new specimen; do not report results of the stat sample D. Review the amylase result on the 6 p.m. urine sample; if elevated, report the stat amylase

Results of a fetal lung maturity (FLM) study from a patient with diabetes mellitus are as follows: L/S ratio = 2.0; Phosphatidyl glycerol = Pos; Creatinine = 2.5 mg/dL Given these results, the technologist should: A. Report the result and recommend repeating the L/S ratio in 24 hours B. Perform scanning spectrophotometry on the fluid to determine if blood is present C. Repeat the L/S ratio after 4 hours and report those results D. Report results as invalid

A 24-hour urine sample from an adult submitted for catecholamines gives a result of 140 μg/day (upper reference limit 150 μg/day). The 24-hour urine creatinine level is 0.6 g/day. Select the best course of action. A. Check the urine pH to verify that it is less than 2.0 B. Report the result in μg catecholamines per mg creatinine C. Request a new 24-hour urine sample D. Measure the VMA and report the catecholamineresult only if elevated

A 5-hour urinary D-xylose test on a 7-year-old boy who was given 0.5 g of D-xylose per pound is 15%. The 2-hour timed blood D-xylose is 15 mg/dL (lower reference limit 30 mg/dL). Select the most appropriate action. A. Request that a β carotene absorption test be performed B. Repeat the urinary result because it is borderline C. Request a retest using a 25-g dose of D-xylose D. Request a retest using only a 1-hour timed blood sample

A quantitative serum hCG is ordered on a male patient. The technologist should: A. Perform the test and report the result B. Request that the order be cancelled C. Perform the test and report the result if negative D. Perform the test and report the result only if greater than 25 IU/L

SITUATION: A lamellar body count (LBC) was performed on an amniotic fluid sample that was slightly pink in color within 1 hour of specimen collection. The sample was stored at 4°C prior to analysis. The result was 25,000/μL, classified as intermediate risk of respiratory distress syndrome. The physician waited 24 hours and collected a new sample that was counted within 2 hours of collection on the same instrument. The LCB count of the new sample was 14,000/ μL and the patient was reclassified as high risk. Which statement best explains these results? A. Loss of lamellar bodies occurred in the second sample because of storage B. Blood caused a falsely elevated result for the first sample C. The fetal status changed in 24 hours owing to respiratory illness D. The difference in counts is the result of day-to-day physiological and instrument variance

When testing for drugs of abuse in urine, which of the following test results indicate dilution and would be cause for rejecting the sample? A. Temperature upon sample submission 92°F B. Specific gravity 1.002; Creatinine 15 mg/dL C. pH 5.8; temperature 94°C D. Specific gravity 1.012, creatinine 25 mg/dL

A urine specimen has a specific gravity of 1.025 and is strongly positive for nitrite. All other dry reagent strip test results are normal, and the microscopic exam was unremarkable, showing no WBCs or bacteria. The urine sample was submitted as part of a preemployment physical exam that also includes drug testing. Which most likely caused these results? A. A viral infection of the kidney B. A urinary tract infection in an immunosuppressed person C. An adulterated urine specimen D. Error in reading the nitrite pad caused by poor reflectometer calibration

A CSF sample submitted for cell counts has a visible clot. What is the best course of action? A. Count RBCs and WBCs manually after diluting the fluid with normal saline B. Tease the cells out of the clot before counting, then dilute with WBC counting fluid C. Request a new sample D. Perform a WBC count without correction

Total hemolytic complement and glucose are ordered on a synovial fluid sample that is too viscous to pipet. What is the best course of action? A. Dilute the sample in saline B. Add 1 mg/mL hyaluronidase to the sample and incubate at room temperature for 30 minutes C. Warm the sample to 65°C for 10 minutes D. Request a new specimen

A CSF CytoPrep smear shows many smudge cells and macrophages with torn cell membranes. What most likely caused this problem? A. Failure to add albumin to the cytospin cup B. Failure to collect the CSF in EDTA C. Centrifuge speed too low D. Improper alignment

An automated electronic blood cell counter was used to count RBCs and WBCs in a turbid pleural fluid sample. The WBC count was 5 × 1010/L (50,000/μL) and the RBC count was 5.5 × 1010/L (55,000/ μL). What is the significance of the RBC count? A. The RBC count is not significant and should be reported as 5,000/μL B. The RBC count should be reported as determined by the analyzer C. A manual RBC count should be performed D. A manual RBC and WBC count should be performed and reported instead

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Which of the following results is not consistent with cystitis? Color: Yellow Clarity: Hazy Specific gravity: 1.015 pH: 7.0 80-100 WBC/hpf 10- 15 renal tubular epithelial cells/hpf Protein: 1 + Glucose: Negative Ketones: Negative Bilirubin: Negative 5-10 red blood cells/hpf Blood: Trace Urobilinogen: 1.0 EU Nitrite: Positive Leukocyte esterase: ++ Many bacteria a. pH b. Protein c. 5 to 10 RBC/hpf d. 10 to 15 renal tubular epithelial cells/hpf

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

Three tubes of cerebrospinal fluid are submitted to the laboratory. They are numbered l, 2, and 3 and show blood in all tubes but decreasing in amount in tubes l through 3. This observation should be interpreted as: a. The tubes were numbered in wrong sequence, because an increasing amount of blood would be expected b. A traumatic or bloody tap and in all likelihood of no pathogenic significance c. The pathologic presence of RBCs and reported to your supervisor immediately d. A pathologic presence of RBCs, but because the RBC morphology is normal, the importance is minimal

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

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

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

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

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

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

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

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

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

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

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

Which of the following sets of results most closely indicates a transudate? a. Clear, fluid-to–serum LD ratio: 0.8, fluid-to– serum protein ratio: 0.7, WBC count: 1000/mL b. Cloudy, fluid-to–serum LD ratio: 0.5, fluid- to–serum protein ratio: 0.6, WBC count: 1200/mL c. Cloudy, fluid-to–serum LD ratio: 0.8, fluid- to–serum protein ratio: 0.7, WBC count: 2500/mL d. Clear, fluid-to–serum LD ratio: 0.45, fluid-to– serum protein ratio: 0.40, WBC count: 800/mL

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

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

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

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

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

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

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

The most sensitive fecal enzyme test for the diag- nosis of pancreatic insufficiency measures _____________. a. Lipase b. Trypsin c. Elastase I d. Chymotrypsin