Clinical Microscopy

Question 1

Urine specimens should be analyzed asap after collection. If urine specimens are allowed to stand at room temperature for an excessive amount of time, the urine pH will become alkaline because of bacterial composition of:
A. Protein
B. Urea
C. Ketones
D. Creatinine

Answer 1

B. Urea

The bacteria are capable of metabolizing the urinary urea to ammonia. The ammonia will cause alkalinization of the urine

Question 2

The reagent strips used for the detection of protein in urine are most reactive to:

A. Albumin
B. Hemoglobin
C. Alpha globulin
D. Beta globulin

Answer 2

A. Albumin

Question 3

The colorimetric reagent strip for protein is able to detect as little as 5-20mg of protein per deciliter. What may cause a false positive urine protein reading?
A. Uric acid concentration is grater than 0.5g/day
B. Vitamin C concentration is greater than 0.5g/day
C. Glucose concentration is greater than 130mg/day
D. pH greater than 8.0

Answer 3

D. pH greater than 8.0

The principle of the reagent strip method for the detection of protein. Urine is based on a color change in an indicator system such as tetrabromophenol blue that is buffered to pH 3.0. With a urine pH greater than 8.0, the buffering capacity of the strip may be exceeded and a false positive color change in the impregnated area will reflect the pH of the urine rather than the presence of protein

Question 4

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. The urine contained an excessive amount of amorphous urates or phosphates that caused the turbidity seen in ssa.
B. The urine pH was grater than 8.0 exceeding the buffering capacity of the reagent strip thus causing a false negative reaction
C. A protein other than albumin must be present in urine
D. The reading time of reagent strip was exceeded causing false negative reaction.

Answer 4

C.
When globulin, mucoprotein, or BJ protein is present, the reagent strip may give negative result because the strip is more sensitive to albumin. However, ssa is able to detect albumin, globulin, mucoprotein and BJ protein.

Question 5

Major organic substance found in urine?

A. Sodium
B. Potassium
C. Glucose
D. Urea

Answer 5

D. Urea

Sodium - major inorganic

Question 6

The presence of ketone bodies in urine specimens may be detected by use of a reagent strip impregnated with sodium nitroprusside. The strip testis sensitive to the presence of:

A. Acetoacetic acid and beta hydroxybutyric acid
B. Acetoacetic and acetone
C. Diacetic acid and beta hydroxybutyric acid
D. Beta hydroxybutyric acid and acetone

Answer 6

B. Acetoacetic acid and acetone

Question 7

A routine urinalysis is performed on a child suffering from diarrhea. The reagent strip is negative for glucose but positive for ketones. These results may be explained by which of the following:
A. The child has type 1 DM
B. The child is suffering from lactic acidosis, and the lactic acid has falsely reacted with the impregnated reagent area for ketones.
C. The child is suffering from increased catabolism of fat because of decreased intestinal absorption
D. The reagent area for ketones was read after the max reading time allowed

Answer 7

C.

Question 8

Which of the following will contribute to a specimen’s specific gravity if it is present in a person’s urine?

A. 50-100 RBC per HPF
B. 85mg/dl glucose
C. 3+ amorphous phosphates
D. Moderate bacteria

Answer 8

B. Only dissolved solutes affect specific gravity

Question 9

A random urine is collected from a patient and the results obtained are as follows: Urine albumin=16md/dL   Urine creatinine=140md/dL  
These findings are consistent with:
A. Microalbuminuria
B. Macroalbuminuria
C. Nephrotic syndrome
D. Obstructive jaundice

Answer 9

A. Microalbuminuria
Ratio of urine albumin to creatinine in a random specimen is commonly used to evaluate microalbuminuria esp in px with DM.

30-299mg/g - MICROALBUMINURIA
>299mg/g - MACROALBUMINURIA

Question 10

To detect more easily the presence of casts in urine sediments, which microscopic method can be used?

A. Fluorescent
B. Phase-contrast
C. Polarized
D. Brightfield

Answer 10

B. Phase-contrast

Question 11

Glitter cell is a term used to describe:

A. Ketone body
B. Oval fat body
C. Fatty droplet
D. Neutrophil

Answer 11

D. Neutrophil when exposed to HYPOTONIC urine. The neutrophil temd to swell and the cytoplasmic granules contained within the cell exhibit Brownian Movement.

Question 12

Final phase of degeneration that granular cast undergo is:

A. Fine
B. Coarse
C. Cellular
D. Waxy

Answer 12

D. Waxy cast

Question 13

Alkaptonuria is characterized by the urinary excretion of:

A. Alkaptone
B. Phenylalanine
C. 5-HIAA
D. Homogentisic acid

Answer 13

D. Homogentisic acid

Question 14

A 22 y/o female clinical laboratory student performs urinalysis on her own urine. Significant results include:
Color- yellow; appearance- cloudy; pH=7.5; nitrite-positive; leukocyte esterase=2+; 25-40 WBC/hpf; 0-3RBC/hpf; 2-5squamous EC/lpf; moderate bacteria. Other results were normal. These findings suggest:
A. Glomerulonephritis
B. Upper UTI
C. Lower UTI
D. Nephrolithiasis

Answer 14

C. Lower UTI aka cystitis.

Major distuingishing features between upper and lower uti include protein amd cast in an upper uti and not in lower uti.

Question 15

Metastatic carcinoid tumors arising from the enterochromaffin cells of gastrointestinal tract are characterized by increased excretion of urinary

A. Serotonin
B. 5-hydroxytryptophan
C. Homogentisic acid
D. 5-HIAA

Answer 15

D. 5-HIAA

Question 16

Some clinical conditions are characterized by unique urinalysis result patterns. Which of the following shows such a relationship?

A. Nephrotic syndrome: positive protein on reagent strip;negative in ssa
B. Intensive dieting: increased ketones, negative glucose
C. Multiple myeloma: positive protein by both strip and ssa
D. Cystitis: positive nitrite and protein

Answer 16

B. INTENSIVE DIETING 🐷
Because of increased lipid metabolismin long term, intensive dieting, ketone body formation will increase. Blood glucose will be normal or decreased.

Question 17

Nitrite in urine specimen suggests the presence of

A. WBC
B. RBC
C. Bacteria
D. Yeast

Answer 17

C. Bacteria

Question 18

If a fasting plasma glucose level of 100mg/dL is obtained on an individual, what is the expected fasting CSF glucose level in mg/dL?

A. 25
B. 50
C. 65
D. 100

Answer 18

C. 65

Normally, fasting CSF glucose level range between 50 and 80mg/dL representing approx 60-70% of the blood glucose level.

Question 19

A 67 y/o male has routine testing done and shows an estimated glomerular filtration rate (eGFR) of 42mL/min/1.73m2. Which of the following is true for this patient?
A. The test requires a 24hour urine collection
B. The patient does not have chronic kidney damage
C. Similar results would be obtained using Cockgroft-Gault formula
D. The patient is in stage 3 chronic kidney damage.

Answer 19

D. Stage 3 chronic kidney damage (35-59mL/min/1.73m2)

It does not use a urine sample at all, instead requires only a serum creatinine and patient’s age, gender, and race.

Question 20

Which of the following is true about the final concentrating of urine in the kidney?
A. The DCT thru active transport reabsorbs water
B. Water is reabsorbed under the direct influence of angiotensin ii
C. Vasopressin controls the collecting duct reabsorption of water
D. Water reabsorption is influenced by urine filtrate levels of potassium

Answer 20

C. Dct and collecting ducts provide water reabsorption through action of adh(vasopressin)

Question 21

Phenylketonuria may be characterized by which of the following statements?
A. It may cause brain damage if untreated
B. It is caused by the absence of phenylalanine oxidase
C. Phenylpyruvic acid excess appears in the blood
D. Excess tyrosine accumulates in the blood

Answer 21

A.

absence of phenylalanine hydroxylase

Question 22

Xanthochromia of CSF samples may be due to increased levels of which of the following?
A. Chloride
B. Protein
C. Glucose
D. Magnesium

Answer 22

B. Protein, oxyhemoglobin, carotenoids and bilirubin have beenpassociated with a xanthochromic appearance of CSF.

Question 23

To determine amniotic fluid contamination with maternal urine, which of the following measurement could be used?

A. Creatinine concentration
B. Delta absorbance at 410nm
C. Albumin/Globulin ratio
D. Lactate dehydrogenase

Answer 23

A. Creatinine concentration

Urinary concentration of creatinine and urea nitrogen are anywhere from 10-50 times the amniotic concentration and an increased concentration of either in the amniotic fluid would be sensitive indicators of urinary contamination.

Question 24

With the development of fetal lung maturity, which of the following phospholipid concentrationin amniotic fluid significantly and consistently increases?

A. Sphingomyelin
B. Phosphatidyl ethanolamine
C. Phosphatidyl inositol
D. Phosphatidyl choline

Answer 24

D. Phosphatidyl choline

Question 25

A pleural effusion if found is found to have 3000 wbc per microliter and 5 g/dL total protein. From this it can be determined that the patient’s effusion is a/an:

A. Transudate
B. Exudate
C. Non inflammatory
D. Hemorrhagic

Answer 25

B. Exudate

Transudate: (non inflammatory) low numbers of cell and

Question 26

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

Answer 26

A. DI is caused by deficiency in ADH, and may result in high urine volumes and low final solute concentration.

Question 27

The estimation of hyaluronic acid concentration by measurement of viscosity is useful in evaluating _______

A. CSF
B. Peritoneal
C. Pleural
D. Synovial

Answer 27

D. Synovial fluid is a form of plasma ultrafiltrate with added hyaluronic acid.

Question 28

Expected pH range of a freshly voided urine specimen?

A. 3.5-8.0
B. 3.5-9.0
C. 4.0-8.5
D. 4.5-8.0

Answer 28

D. 4.5-8.0