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03-2023 > CM > Flashcards

CM Flashcards

1
Q

The only tissue in the body that is hypertonic with respect to normal plasma (i.e., its osmolality is greater than 290 mOsm/kg):

a. Glomerulus
b. Convoluted tubules
c. Renal cortex
d. Renal medulla

A

D. Renal Medulla

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2
Q

Intraabdominal infections: Peritonitis

aerobic or anaerobic bacteria?

A

Aerobic bacteria

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3
Q

Urine color

  1. Phenazopyridine (Pyridium) - drug commonly administered for urinary tract infection
  2. Phenindione - anticoagulant
  3. Phenol when oxidized
  4. Phenol derivatives- interfere with copper reduction tests
  5. Argyrol (antiseptic) - color disappears with ferric chloride
A
  1. Orange-yellow
  2. Orange-yellow
  3. Blue-green
  4. Black
  5. Black
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4
Q

HANDWASHING: The mechanical action of rubbing the hands together and soaping under the fingernails is the most important part of the process. (BAILEY)

A

Noted

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5
Q

What is the LAST STEP in the handwashing procedure?

Dry hands with a paper towel.
Turn off faucet with a clean paper towel to prevent recontamination.
Rub to form lather, create friction, and loosen debris.
Rinse hands in a downward position.

A

Turn off faucet with a clean paper towel to prevent recontamination.

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6
Q

The required amount of urine for drug testing (COC):

5 to 10 mL
10 to 15 mL
20 to 30 mL
30 to 45 mL

A

30 to 45 mL

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7
Q

Acceptable urine temperature for drug testing (COC):

20 to 24C
30 to 35C
32.5 to 37.7C
37.7 to 42C

A

32.5 to 37.7C

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8
Q

Primary inorganic component of urine:

Urea
Creatinine
Chloride
Potassium

A

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

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9
Q

Polyuria, an increase in daily urine volume:

Greater than 400 mL/day in adults
Greater than 1200 mL/day in adults
Greater than 2L/day in adults
Greater than 2.5 L/day in adults

A

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.

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10
Q

The most routinely used method of urine preservation is:

Boric acid
Formalin
Refrigeration
Sodium fluoride

A

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.2 The specimen must return to room temperature before chemical testing by reagent strips.

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11
Q

A 24-hour urine for CATECHOLAMINE determination may be preserved with:

Formalin
Boric acid
Hydrochloric acid, 6N
Sodium Fluoride

A

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

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12
Q

In the three-glass collection technique for diagnosis of prostatic infection, which tube is used as a control for

First specimen
Second specimen
Third specimen
None of these

A

Second specimen

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13
Q

The human kidneys receive approximately ___ % of the blood pumped through the heart at all times.

Approximately 5%
Approximately 15%
Approximately 25%
Approximately 50%

A

Approximately 25%

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14
Q

The part of the nephron that functions as a SIEVE:

Glomerulus
Loop of Henle
Proximal convoluted tubules
Distal convoluted tubules

A

Glomerulus

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15
Q

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:

Renin
Angiotensin I
Angiotensin II
Aldosterone

A

Angiotensin II

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16
Q

The original reference method for clearance tests:

Creatinine clearance
Inulin clearance
Urea clearance
Beta2- microglobulin

A

Inulin clearance

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17
Q

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.

3 mL/min
13 mL/min
21 mL/min
68 mL/min

A

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

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18
Q

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.

1.1 mL/min
5 mL/min
13 mL/min
18 mL/min

A

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

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19
Q

The test most commonly associated with tubular secretion and renal blood flow

Creatinine clearance
Fishberg test
Mosenthal test
p-aminohippuric acid (PAH) test

A

p-aminohippuric acid (PAH) test

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20
Q

Patients with DIABETES INSIPIDUS tend to produce urine in _____ volume with _____ specific gravity.

Increased; decreased
Increased; increased
Decreased; decreased
Decreased; increased

A

Increased; decreased

DIABETES INSIPIDUS: high urine volume, low specific gravity
DIABETES MELLITUS: high urine volume, high specific gravity

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21
Q

A catheterized urine specimen is collected:

After stimulating urine production with intravenous histamine
By aspirating it with a sterile syringe inserted into the bladder
Following midstream, clean-catch urine collection procedures
From a sterile tube passed through the urethra into the bladder

A

From a sterile tube passed through the urethra into the bladder

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22
Q

All of the following should be discarded in biohazardous waste containers EXCEPT:

Urine specimen containers, urine
Towels used for decontamination
Disposable lab coats
Blood collection tubes

A

Urine specimen containers, urine

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23
Q

The correct method for labeling urine specimen containers is to:

Attach the label to the lid
Attach the label to the bottom
Attach the label to the container
Use only a wax pencil for labeling

A

Attach the label to the container

Labels must be ATTACHED TO THE CONTAINER, NOT TO THE LID, and should not become detached if the container is refrigerated or frozen.

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24
Q

Storage of urine specimens for BILIRUBIN and UROBILINOGEN testing:

Clear container
Amber container
Preserved with formalin
None of these

A

Amber container

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25
Q

First-morning urine, EXCEPT:

Routine screening
Pregnancy testing
Urobilinogen determination
Evaluation of orthostatic proteinuria

A

Urobilinogen determination

AFTERNOON SPECIMEN (2 PM to 4 PM)
UROBILINOGEN DETERMINATION
GREATEST UROBILINOGEN EXCRETION

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26
Q

Phenol derivatives found in certain intravenous medications produce ______ urine on oxidation.

Yellow
Orange
Green
Purple

A

Green

STRASINGER PAGE 62: Green
STRASINGER PAGE 62: Brown/black

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27
Q

The clarity of a urine sample should be determined:

Using glass tubes only, never plastic
Following thorough mixing of the specimen
After addition of salicylic acid
After the specimen cools to room temperature

A

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.

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28
Q

Many particulates, print blurred through urine:

Hazy
Cloudy
Turbid
Milky

A

Cloudy

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

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29
Q

Sensitivity of the urine specific gravity reagent pad:

1.010 to 1.035
1.015 to 1.035
1.000 to 1.002
1.000 to 1.030

A

1.000 to 1.030

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30
Q

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:

Old and has deteriorated
Contains radiographic contrast media
Concentrated because the patient is ill and dehydrated
Contains abnormally high levels of sodium and other electrolytes because the patient is taking diuretics

A

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

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31
Q

Cabbage urine odor:

Isovaleric acidemia
Methionine malabsorption
Phenylketonuria
Urinary tract infection

A

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

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32
Q

A lack of any urine odor may indicate:

Acute tubular necrosis
Isovaleric acidemia
Methionine malabsorption
Phenylketonuria

A

Acute tubular necrosis

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33
Q

All of the following are important to protect the integrity of reagent strips EXCEPT:

Removing the desiccant from the bottle
Storing in an opaque bottle
Storing at room temperature
Resealing the bottle after removing a strip

A

Removing the desiccant from the bottle

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34
Q

Which of the following tests is affected LEAST by standing or improperly stored urine?

Glucose
Protein
pH
Bilirubin

A

Protein

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35
Q

A sensitive, although not specific indicator of damage to the kidneys:

Urea
Creatinine
Proteinuria
Ketonuria

A

Proteinuria

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36
Q

An indicator of PREECLAMPSIA:

Cylindruria
Hematuria
Ketonuria
Proteinuria

A

Proteinuria

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37
Q

Concentration of SSA in the cold precipitation method:

1% sulfosalicylic acid
3% sulfosalicylic acid
5% sulfosalicylic acid
10% sulfosalicylic acid

A

3% sulfosalicylic acid

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38
Q

REPORTING OF SSA TURBIDITY: Turbidity, granulation, no flocculation:

Trace
1+
2+
3+
4+

A

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

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39
Q

Significant albumin excretion rate (AER):

0.02 to 1 ug/min
1 to 2 ug/min
5 to 15 ug/min
2 to 20 ug/min
20 to 200 ug/min

A

20 to 200 ug/min

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40
Q

Sensitivity of the Multistix protein pad:

1 to 5 mg/dL albumin
5 to 10 mg/dL albumin
10 to 15 mg/dL albumin
15 to 30 mg/dL albumin

A

15 to 30 mg/dL albumin

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41
Q

Bence Jones protein precipitates at temperatures between ___, and redissolves at near ___ ° C.

Precipitates at 100-120C, and redissolves at 60C
Precipitates at 10 to 20C, and redissolves at 100C
Precipitates at 80-100C, and redissolves at 60C
Precipitates at 40 to 60C, and redissolves at 100C

A

Precipitates at 40 to 60C, and redissolves at 100C

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42
Q

The principle of “protein error of indicators” is based on:

Protein changing the pH of the specimen
Protein changing the pKa of the specimen
Protein accepting hydrogen from the indicator
Protein giving up hydrogen to the indicator

A

Protein accepting hydrogen from the indicator

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43
Q

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:

Normal diurnal variation in protein loss
Early glomerulonephritis
Orthostatic or postural albuminuria
Microalbuminuria

A

Orthostatic or postural albuminuria

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44
Q

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?

Urine contained excessive amount of amorphous urates or phosphates that caused the turbidity seen with SSA
Urine pH was greater than 8, exceeding the buffering capacity of the strip, thus causing false-negative reaction
Protein other than albumin must be present in the urine
Reading time of the reagent strip test was exceeded, causing a false negative reaction to be detected

A

Protein other than albumin must be present in the urine

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45
Q

Most frequently performed chemical analysis on urine:

Bilirubin
Glucose
Ketone
Protein

A

Glucose

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46
Q

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?

Your lab results pattern suggests diabetes mellitus.
You probably have been crash dieting recently.
The two results do not fit any disease pattern.
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.

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47
Q

Glucosuria not accompanied by hyperglycemia can be seen in which of the following?

Hormonal disorders
Gestational diabetes
Diabetes mellitus
Renal disease

A

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

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48
Q

The primary reason for performing a Clinitest is to:

Check for high ascorbic acid levels
Confirm a positive reagent strip glucose
Check for newborn galactosuria
Confirm a negative glucose reading

A

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.

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49
Q

Negative Clinitest:

Glucose
Galactose
Lactose
Sucrose

A

Sucrose

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50
Q

A urine sample that tests positive for ketones but negative for glucose is most likely from a patient suffering from:

Diabetes mellitus
Diabetes insipidus
Polydipsia
Starvation

A

Starvation

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51
Q

Ketonuria may be caused by all of the following except:

Bacterial infections
Diabetic acidosis
Starvation
Vomiting

A

Bacterial infections

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52
Q

The primary reagent in the reagent strip test for ketones is:

Glycine
Lactose
Sodium hydroxide
Sodium nitroprusside

A

Sodium nitroprusside

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53
Q

Positive result in the ketone reagent pad:

Brown
Blue
Pink
Purple

A

Purple

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54
Q

Reagent pad positive result in the presence of hemoglobin or myoglobin:

Brown
Red
Pink-purple
Green-blue

A

Green-blue

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55
Q

A speckled pattern on the blood pad of the reagent strip indicates:

Hematuria
Hemoglobinuria
Myoglobinuria
All of the above

A

Hematuria

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56
Q

The LE test detects the presence of esterase in the granulocytic white blood cells (neutrophils, eosinophils, and basophils) and monocytes, but not lymphocytes.

A

Noted

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57
Q

Bilirubin combines with 2,6-dichlorobenzene-diazonium-tetrafluoroborate in an acid medium to produce an azodye, with colors ranging from:

Green to blue
Green to brown
Pink to purple
Yellow to orange

A

Pink to purple

BILIRUBIN REAGENT PAD
2, 4-dichloroaniline diazonium salt: TAN
2,6-dichlorobenzene-diazonium-tetrafluoroborate: PINK TO VIOLET

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58
Q

Which of the following are characteristic urine findings from a patient with hemolytic jaundice?

A positive test for bilirubin and an increased amount of urobilinogen
A positive test for bilirubin and a decreased amount of urobilinogen
A negative test for bilirubin and an increased amount of urobilinogen
A negative test for bilirubin and a decreased amount of urobilinogen

A

A negative test for bilirubin and an increased amount of urobilinogen

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59
Q

Which of the following results show characteristic urine findings from a patient with an obstruction of the bile duct?

A positive test for bilirubin and an increased amount of urobilinogen
A positive test for bilirubin and a decreased amount of urobilinogen
A negative test for bilirubin and an increased amount of urobilinogen
A negative test for bilirubin and a decreased amount of urobilinogen

A

A positive test for bilirubin and a decreased amount of urobilinogen

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60
Q

False positive Ehrlich’s reaction for urobilinogen, EXCEPT:

Porphobilinogen
Formalin
Indican
Sulfonamides

A

Formalin

UROBILINOGEN REAGENT PAD (MULTISTIX)
False-positive:
Porphobilinogen
Indican
p-aminosalicylic acid
Sulfonamides
Methyldopa
Procaine
Chlorpromazine
Highly pigmented urine

False-negative:
Old specimens
Preservation in formalin

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61
Q

The positive reagent strip test for nitrite in this patient is probably caused by which of the following?

An infection from gram-negative bacteria
An infection from gram-positive bacteria
A yeast infection
An old urine specimen, unsuitable for examination

A

An infection from gram-negative bacteria

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62
Q

A positive nitrite test and a negative leukocyte esterase test is an indication of a:

Dilute random specimen
Specimen with lysed leukocytes
Vaginal yeast infection
Specimen older than 2 hours

A

Specimen older than 2 hours

False-positive results are obtained if nitrite testing is not performed on fresh samples, because multiplication of contaminant bacteria soon produces measurable amounts of nitrite. A true positive nitrite test should be accompanied by a positive leukocyte esterase test.

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63
Q

Reagent pad contains para-arsanilic acid or sulfanilamide:

pH
Protein
Leukocyte
Nitrite

A

Nitrite

Nitrite is detected by the Greiss reaction, in which nitrite at an acidic pH reacts with an aromatic amine (para-arsanilic acid or sulfanilamide) to form a diazonium compound that then reacts with tetrahydrobenzoquinolin compounds to produce a pink-colored azodye.

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64
Q

Positive reagent pad for nitrite:

Blue
Brown
Pink
Purple

A

Pink

Nitrite is detected by the Greiss reaction, in which nitrite at an acidic pH reacts with an aromatic amine (para-arsanilic acid or sulfanilamide) to form a diazonium compound that then reacts with tetrahydrobenzoquinolin compounds to produce a pink-colored azodye.

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65
Q

Nitrite tests should be performed on first morning specimens or specimens collected after urine has remained in the bladder for at least ___ hours.

At least 1 hour
At least 2 hours
At least 3 hours
At least 4 hours

A

At least 4 hours

Nitrite tests should be performed on first morning specimens or specimens collected after urine has remained in the bladder for at least 4 hours.

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66
Q

Chemical testing in urine that requires patients to include diet that contains green vegetables:

Bilirubin
Glucose
Ketone
Nitrite

A

Nitrite

The reliability of the test depends on the presence of adequate amounts of nitrate in the urine.

This is seldom a problem in patients on a normal diet that contains green vegetables; however, because diet usually is not controlled prior to testing, the possibility of a false-negative result owing to lack of dietary nitrate does exist.

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67
Q

High urine specific gravity:

False positive nitrite
False negative nitrite
False positive blood
False positive glucose

A

False negative nitrite

HIGH URINE SPECIFIC GRAVITY
FALSE POSITIVE: Protein
FALSE NEGATIVE: Glucose, blood, nitrite

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68
Q

The reagent strip reaction that requires the longest reaction time is the:

Bilirubin
pH
Leukocyte esterase
Glucose

A

Leukocyte esterase

READING TIMES
30 seconds: glucose, bilirubin
40 seconds: ketone
45 seconds: specific gravity
60 seconds (1 minute): pH, protein, blood, urobilinogen and nitrite
120 seconds (2 minutes): leukocyte esterase

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69
Q

All of the following can be detected by the leukocyte esterase reaction except:

Neutrophils
Eosinophils
Lymphocytes
Basophils

A

Lymphocytes

The LE test detects the presence of esterase in the granulocytic white blood cells (neutrophils, eosinophils, and basophils) and monocytes, but not lymphocytes.

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70
Q

Urine volume frequently used because multiparameter reagent strips are easily immersed in this volume:

5 mL volume
12 mL volume
30 mL volume
45 mL volume

A

12 mL volume

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71
Q

Centrifugation speed that produces an optimum amount of urine sediment with the least chance of damaging the elements:

5 minutes at a relative centrifugal force (RCF) of 400
5 minutes at a relative centrifugal force (RCF) of 500
5 minutes at a relative centrifugal force (RCF) of 600
5 minutes at a relative centrifugal force (RCF) of 1,000

A

5 minutes at a relative centrifugal force (RCF) of 400

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72
Q

Initial magnification:

Objective
Ocular

A

Objective

SLIDE > OBJECTIVE > OCULAR

Objective: FIRST LENS SYSTEM, INITIAL MAGNIFICATION
Ocular: SECOND LENS SYSTEM, FURTHER MAGNIFICATION

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73
Q

Further magnification:

Objective
Ocular

A

Ocular

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74
Q

Microscope component that GATHERS AND FOCUSES THE ILLUMINATION LIGHT onto the specimen for viewing.

Aperture diaphragm
Rheostat
Condenser
Ocular

A

Condenser

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75
Q

Which of the following should be used to REDUCE LIGHT INTENSITY in bright-field microscopy?

Aperture diaphragm
Rheostat
Condenser
Objective

A

Rheostat

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76
Q

Type of microscope that ENHANCES VISUALIZATION OF ELEMENTS WITH LOW REFRACTIVE INDICES, such as hyaline casts, mixed cellular casts, mucous threads, and Trichomonas.

Fluorescence microscope
Interference-contrast microscope
Phase-contrast microscope
Polarizing microscope

A

Phase-contrast microscope

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77
Q

A type of microscope that produces a three-dimensional microscopy-image and layer-by-layer imaging of a specimen

Fluorescence microscope
Interference-contrast microscope
Phase-contrast microscope
Polarizing microscope

A

Interference-contrast microscope

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78
Q

Of all the urine sediment elements, _____ are the most difficult to recognize.

RBCs
WBCs
RTE cells
Sperms

A

RBCs

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79
Q

Significant number of eosinophils in urine:

More than 1% eosinophils
More than 5% eosinophils
More than 10% eosinophils
More than 15% eosinophils

A

More than 1% eosinophils

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80
Q

FECAL CONTAMINATION of a urine specimen can also result in the presence of ova from intestinal parasites in the urine sediment. The most common contaminant is:

Enterobius vermicularis
Schistosoma haematobium
Trichomonas vaginalis
Entamoeba histolytica

A

Enterobius vermicularis

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81
Q

MOST FREQUENT PARASITE ENCOUNTERED IN THE URINE:

Enterobius vermicularis
Schistosoma haematobium
Trichomonas vaginalis
Entamoeba histolytica

A

Trichomonas vaginalis

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82
Q

Reporting of Trichomonas vaginalis:

With WBCs
With motility

A

With motility

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83
Q

When not moving, Trichomonas is more difficult to identify and may resemble a:

WBC
Transitional epithelial cell
Renal tubular epithelial cell
All of these

A

All of these

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84
Q

Reporting of spermatozoa:

Do not report
Rare, few, moderate or many per LPF
Rare, few, moderate or many per HPF
Present, based on laboratory protocol

A

Present, based on laboratory protocol

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85
Q

Only elements found in the urinary sediment that are unique to the kidney:

Red blood cells
Epithelial cells
Casts
Crystals

A

Casts

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86
Q

During microscopy casts are usually seen:

Center of coverslip
Near the edge of coverslip
Outside the coverslip
All of these

A

Near the edge of coverslip

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87
Q

Casts increased in CONGESTIVE HEART FAILURE:

Granular casts
Hyaline casts
WBC casts
Epithelial casts

A

Hyaline casts

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88
Q

Pyelonephritis can be differentiated from cystitis by the presence of ________.

Eosinophils
Hyaline casts
WBC casts
Bacteriuria

A

WBC casts

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89
Q

Which of the following could be a broad cast?

Hyaline cast
Granular cast
Waxy cast
All of these

A

All of these

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90
Q

Most commonly seen broad casts:

RBC and WBC casts
WBC and epithelial casts
Hyaline and granular casts
Granular and waxy casts

A

Granular and waxy casts

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91
Q

A 62-year-old patient with hyperlipoproteinemia has a large amount of protein in his urine. Microscopic analysis yields moderate to many fatty, waxy, granular and cellular casts. Many oval fat bodies are also noted. This is most consistent with:

Nephrotic syndrome
Acute pyelonephritis
Viral infection
Acute glomerulonephritis

A

Nephrotic syndrome

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92
Q

Reporting of normal crystals:

Averaged and reported per LPF
Averaged and reported per HPF
Rare, few, moderate or many per LPF
Rare, few, moderate or many per HPF

A

Rare, few, moderate or many per HPF

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93
Q

Lemon-shaped crystals:

Ammonium biurate
Calcium phosphate
Uric acid
Triple phosphate

A

Uric acid

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94
Q

Increased amounts of these crystals in fresh urine is seen in patients with leukemia who are receiving chemotherapy:

Calcium phosphate
Calcium oxalate
Triple phosphate
Uric acid

A

Uric acid

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95
Q

MT notices calcium oxalate crystals in urine, but the atypical form. To confirm identity of these crystals:

Soluble with acetic acid
Soluble with dilute HCl
Soluble with acetic acid and dilute HCl
None of these

A

Soluble with dilute HCl

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96
Q

Crystals associated with ethylene glycol poisoning:

Envelope or pyramidal crystals
Oval or dumbbell crystals

A

Oval or dumbbell crystals

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97
Q

Apatite crystals:

Calcium phosphate
Monohydrate calcium oxalate
Dihydrate calcium oxalate
Triple phosphate

A

Calcium phosphate

Calcium phosphate: APATITE
Monohydrate calcium oxalate: WHEWELLITE
Dihydrate calcium oxalate: WEDDELITE
Triple phosphate: STRUVITE

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98
Q

Calculi formation at pH > 7:

Uric acid, cystine, xanthine
Triple phosphate, calcium phosphate
Calcium oxalate, apatite
All of these

A

Triple phosphate, calcium phosphate

pH < 5.5: Uric acid, cystine, or xanthine calculi
pH 5 to 6: Calcium oxalate and apatite calculi
pH >7: Magnesium ammonium phosphate or calcium phosphate

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99
Q

Calculi associated with RAPID PROTEIN CATABOLISM:

Calcium oxalate
Cystine
Uric acid
None of these

A

Uric acid

URIC ACID AND URATE CALCULI
1. Gout
2. Polycythemia
3. Leukemia
4. Lymphoma
5. Liver disease
6. Acid isohydria
7. Theophylline and thiazide therapy
8. Conditions associated with rapid protein catabolism

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100
Q

Calculi associated with EXCESSIVE GLYCOGEN BREAKDOWN:

Calcium oxalate
Cystine
Uric acid
None of these

A

Calcium oxalate

CALCIUM OXALATE CALCULI
1. Oxaluria
2. Incomplete catabolism of carbohydrates
3. Isohydria at pH 5.5 to 6.0
4. Excessive glycogen breakdown

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101
Q

The most common composition of renal calculi is:

Calcium oxalate
Magnesium ammonium phosphate
Cystine
Uric acid

A

Calcium oxalate

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102
Q

Urinalysis on a patient with severe back pain being evaluated for renal calculi would be most beneficial if it showed:

Heavy proteinuria
Low specific gravity
Uric acid crystals
Microscopic hematuria

A

Microscopic hematuria

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103
Q

Positive result for the acid-albumin and CTAB test for mucopolysaccharides:

White turbidity
Yellow turbidity
Yellow spot
Blue spot

A

White turbidity

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104
Q

Positive result for the METACHROMATIC STAINING SPOT TEST for mucopolysaccahrides:

White turbidity
Yellow turbidity
Yellow spot
Blue spot

A

Blue spot

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105
Q

Key to the diagnosis is the demonstration of antineutrophilic cytoplasmic antibody (ANCA) in the patient’s serum:

Berger disease
Goodpasture’s syndrome
Henoch-Schonlein purpura
Wegener granulomatosis

A

Wegener granulomatosis

Wegener granulomatosis causes a granuloma-producing inflammation
of the small blood vessels primarily of the kidney and respiratory system.

Key to the diagnosis of Wegener granulomatosis is the demonstration of antineutrophilic cytoplasmic antibody (ANCA) in the patient’s serum.

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106
Q

The presence of renal tubular epithelial cells and casts is an indication of:

Acute interstitial nephritis
Chronic glomerulopnephritis
Minimal change disease
Acute tubular necrosis

A

Acute tubular necrosis

Urinalysis findings include mild proteinuria, microscopic hematuria, and, most noticeably, the presence of RTE cells and RTE cell casts containing tubular fragments consisting of three or more cells.

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107
Q

Increased eosinophils, WBC casts without bacteria:

Acute glomerulophritis
Acute interstitial nephritis
Acute pyelonephritis
Acute tubular necrosis

A

Acute interstitial nephritis

AIN is primarily associated with an allergic reaction to medications that occurs within the renal interstitium, possibly caused by the medication binding to the interstitial protein.

Urinalysis results include hematuria, possibly macroscopic, mild to moderate proteinuria, numerous WBCs, and WBC casts without bacteria. Differential leukocyte staining for the presence of increased eosinophils may be useful to confirm the diagnosis.

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108
Q

The only protein produced by the kidney is:

Albumin
Uromodulin
Uroprotein
Globulin

A

Uromodulin

Uromodulin is a more recent name for Tamm-Horsfall protein

Uromodulin is a glycoprotein and is the only protein produced by the kidney. It is produced by the proximal and distal convoluted tubules.

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109
Q

In automated microscopy, the DNA within the cells is stained by an orange dye:

In automated microscopy, the nuclear membranes, mitochondria and negatively charged cell membranes are stained by the green dye:

Phenathridine
Carbocyanine

A

PHENATHRIDINE: ORANGE, DNA

CARBOCYANINE: GREEN
Nuclear membranes, mitochondria, and negatively charged cell membranes

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110
Q
  1. Single marker that denotes renal failure
  2. Marker of renal tubular integrity
A
  1. Creatinine
  2. B2-microglobulin

To ensure that glomerular filtration is being measured accurately, the substance is analyzed must be one that is neither reabsorbed nor secreted by the tubules

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111
Q

Factors need in the computation usig COCKROFT-GAULT Formula except:

a. Age
b. Plasma creatinine
c. 24 hour urine volume
d. Body weight

A

c. 24 hour urine volume

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112
Q
  1. Most useful as a screening procedure; influenced by the NUMBER AND DENSITY (MW) of the particles
  2. MORE ACCURATE; quantitative measurement of renal concentrating ability; measures only the NUMBER OF PARTICLES in a solution
A
  1. Specific gravity
  2. Osmometry
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113
Q

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

A

C. Afferent arteriole, peritubular capillaries, vasa recta,
efferent arteriole

Should be Afferent arteriole, efferent arteriole, peritubular capillaries, vasa recta

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114
Q

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

A

C. Ascending loop of Henle

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115
Q

Glucose will appear in the urine when the:
A. Blood level of glucose is 200 mg/dL
B. Tm for glucose is reached
C. Renal threshold for glucose is exceeded
D. All of the above

A

D. All of the above

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116
Q

Renal tubular acidosis can be caused by the:
A. Production of excessively acidic urine due to
increased filtration of hydrogen ions
B. Production of excessively acidic urine due to
increased secretion of hydrogen ions
C. Inability to produce an acidic urine due to impaired
production of ammonia
D. Inability to produce an acidic urine due to increased
production of ammonia

A

C. Inability to produce an acidic urine due to impaired
production of ammonia

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117
Q

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

A

D. Neither reabsorbed or secreted by the tubules

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118
Q

Osmolality is a measure of:
A. Dissolved particles, including ions
B. Undissociated molecules only
C. Total salt concentration
D. Molecule size

A

A. Dissolved particles, including ions

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119
Q

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 adn osmolality

A

B. Osmolality and specific gravity

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120
Q

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

A

B. Urea and creatinine

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121
Q

A cloudy specimen received in the laboratory may have
been preserved using:
A. Boric acid
B. Chloroform
C. Refrigeration
D. Formalin

A

C. Refrigeration

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122
Q

For general screening the most frequently collected
specimen is a:
A. Random one
B. First morning
C. Midstream clean-catch
D. Timed

A

A. Random one

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123
Q

If a patient fails to discard the first specimen when
collecting a timed specimen the:
A. Specimen must be recollected
B. Results will be falsely elevated
C. Results will be falsely decreased
D. Both A and B

A

D. Both A and B

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124
Q

The primary cause of unsatisfactory results in an unpreserved routine specimen not tested for 8 hours is:
A. Bacterial growth
B. Glycolysis
C. Decreased pH
D. Chemical oxidation

A

A. Bacterial growth

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125
Q

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

A

B. Perform reagent strip testing

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126
Q

After receiving a 24-hour 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

A

D. Measure the total volume

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127
Q

A clean-catch is submitted to the laboratory for routine urinalysis and culture. The routine urinalysis is done first, and 3 hours later, the specimen is sent to the microbiology department for culture. The specimen should:
A. Be 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

A

B. Be rejected due to time delay

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128
Q

A urine specimen comes to the laboratory 7 hours after it is obtained. It is acceptable for culture only if the specimen has been stored:
A. At room temperature
B. At 4-7 deg. Celsius
C. Frozen
D. With a preservative additive

A

B. At 4-7 deg. Celsius

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129
Q

A 24-hour 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-hour collection. The next step would be to:
a. perform the hormone determination, since 600 mL is a normal 24-hour urine volume
b. check the creatinine level; if it is <1g, 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 >1g, do the procedure

A

d. check the creatinine level; if it is >1g, do the procedure

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130
Q

The concentration of a normal urine specimen can be
estimated by which of the following?
A. Color
B. Clarity
C. Foam
D. Odor

A

A. Color

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131
Q

A urine specific gravity measured by refractometer is
1.029, and the temperature of the urine is 14°C. The specific gravity should be reported as:
A. 1.023
B. 1.027
C. 1.029
D. 1.032

A

C. 1.029

No temperature correction

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132
Q

A specimen with a specific gravity of 1.001 would be considered:
A. Hyposthenuric
B. Not urine
C. Hypersthenuric
D. Isosthenuric

A

B. Not urine

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133
Q

Which of the following will react in the reagent strip
specific gravity test?
A. Glucose
B. Radiographic dye
C. Protein
D. Chloride

A

D. Chloride

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134
Q

A patient with uncontrolled diabetes mellitus will most likely have:

A. Pale urine with 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

A. Pale urine with high specific gravity

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135
Q

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. white blood cells
c. urates
d. phosphates

A

d. phosphates

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136
Q

A patient urine sample has an increased protein and a 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

a. osmolality

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137
Q

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

A

C. Small volume of urine and compensates for temperature

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138
Q

To prepare a solution appropriate for quality control of the refractometer, a technician should use:
A. Urea with SG of 1.040
B. Water with SG of 1.005
C. NaCl with a specific gravity of 1.022.
D. Calcium chloride with an osmolarity of 460

A

C. NaCl with a specific gravity of 1.022.

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139
Q

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

A

C. Have an infection with Proteus spp.

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140
Q

Leaving excess urine on the reagent strip after removing
it from the specimen will:
A. Cause run-over between reagent pads
B. Alter the color of the specimen
C. Cause reagents to leach from the pads
D. Not affect the chemical reactions

A

A. Cause run-over between reagent pads

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141
Q

Failure to mix a specimen before inserting the reagent
strip will primarily affect the:
A. Glucose reading
B. Blood reading
C. Leukocyte reading
D. Both B and C

A

D. Both B and C

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142
Q

The principle of the reagent strip test for pH is the:
A. Protein error of indicators
B. Greiss reaction
C. Dissociation of a polyelectrolyte
D. Double indicator reaction

A

D. Double indicator reaction

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143
Q

A urine specimen with a pH of 9.0:
A. Indicates metabolic acidosis
B. Should be recollected
C. May contain calcium oxalate crystals
D. Is seen after drinking cranberry juice

A

B. Should be recollected

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144
Q

In the laboratory, a primary consideration associated
with pH is:
A. Identifying urinary crystals
B. Monitoring vegetarian diets
C. Determining specimen acceptability
D. Both A and C

A

D. Both A and C

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145
Q

A patient with a 2+ protein reading in the afternoon is asked to submit a first morning specimen. The second specimen has a negative protein reading. This patient is:
A. Positive for orthostatic proteinuria
B. Negative for orthostatic proteinuria
C. Positive for Bence Jones protein
D. Negative for clinical proteinuria

A

A. Positive for orthostatic proteinuria

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146
Q

A patient with a normal blood glucose and a positive
urine glucose should be further checked for:
A. Diabetes mellitus
B. Renal disease
C. Gestational diabetes
D. Pancreatitis

A

B. Renal disease

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147
Q

All of the following may produce false-negative glucose
reactions except:
A. Detergent contamination
B. Ascorbic acid
C. Unpreserved specimens
D. Low urine temperature

A

A. Detergent contamination

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148
Q

A speckled pattern on the blood pad of the reagent strip
indicates:
A. Hematuria
B. Hemoglobinuria
C. Myoglobinuria
D. All of the above

A

A. Hematuria

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149
Q

The principle of the reagent strip test for bilirubin
is the:
A. Diazo reaction
B. Ehrlich reaction
C. Greiss reaction
D. Peroxidase reaction

A

A. Diazo reaction

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150
Q

Screening tests for urinary infection combine the leukocyte esterase test with the test for:
A. pH
B. Nitrite
C. Protein
D. Blood

A

B. Nitrite

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151
Q

The principle of the leukocyte esterase reagent strip test
uses a:
A. Peroxidase reaction
B. Double indicator reaction
C. Diazo reaction
D. Dye-binding technique

A

C. Diazo reaction

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152
Q

All of the following can be detected by the leukocyte
esterase reaction except:
A. Neutrophils
B. Eosinophils
C. Lymphocytes
D. Basophils

A

C. Lymphocytes

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153
Q

A positive nitrite test and a negative leukocyte esterase
test is an indication of a:
A. Dilute random specimen
B. Specimen with lysed leukocytes
C. Vaginal yeast infection
D. Specimen older than 2 hours

A

D. Specimen older than 2 hours

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154
Q

A test are of a urine reagent strip is impregnated with only sodium nitroprusside. This section will react with:
A. Acetoacetic (diacetic) acid
B. Leukocyte esterase
C. Beta-hydroxybutyric acid
D. Ferric chloride

A

A. Acetoacetic (diacetic) acid

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155
Q

A reagent strip area impregnated with stabilized, diazotized 2,4-dichloroaniline will yield a positive reaction with:
A. Bilirubin
B. Hemoglobin
C. Ketones
D. Urobilinogen

A

A. Bilirubin. The student should memorize the chemical reactions for each of the dipstick biochemicals. Diazo reagent is used for bilirubin.

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156
Q

Excess urine on the reagent test strip can turn a normal pH result into a falsely acidic pH when which of the following reagents runs into the pH pad?
A. Tetrabromphenol blue
B. Citrate buffer
C. Glucose oxidase
D. Alkaline copper sulfate

A

B. Citrate buffer

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157
Q

Microscopic analysis of a urine specimen yields a moderate amount of RBCs in spite of a negative result for occult blood using a reagent strip. The technologist should determine if this patient has taken:
A. Vitamin C
B. A diuretic
C. High blood pressure medicine
D. Antibiotics

A

A. Vitamin C

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158
Q

A urine tested with Clinitest exhibits a passthrough reaction and is diluted by adding 2 drops of urine to 10 drops of water. This is a dilution of:
A. 1:4
B. 1:5
C. 1:6
D. 1:8

A

C. 1:6

Dilution: solute/ solution
Ratio: solute/ solvent

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159
Q

A woman in her ninth-month of pregnancy has a urine sugar that is negative with the urine reagent strip but gives a positive reaction with the copper reduction method. The sugar most likely responsible for these results is:
A. Maltose
B. Galactose
C. Glucose
D. Lactose

A

D. Lactose

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160
Q

A urinalysis performed on a 2-week old infant with diarrhea shows a negative reaction with the glucose oxidase reagent strip. A copper reduction tablet test should be performed to check the urine sample for the presence of:
A. Glucose
B. Galactose
C. Bilirubin
D. Ketones

A

B. Galactose

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161
Q

Variations in the microscopic analysis of urine include all
of the following except:
A. Preparation of the urine sediment
B. Amount of sediment analyzed
C. Method of reporting
D. Identification of formed elements

A

D. Identification of formed elements

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162
Q

When using the glass slide and cover-slip method, which of the following might be missed if the cover slip is overflowed?
A. Casts
B. RBCs
C. WBCs
D. Bacteria

A

A. Casts

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163
Q

Initial screening of the urine sediment is performed using
an objective power of:
A. 4×
B. 10×
C. 40×
D. 100×

A

B. 10×

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164
Q

Which of the following are reported as number per lpf?
A. RBCs
B. WBCs
C. Crystals
D. Casts

A

D. Casts

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165
Q

Which of the following lipids is/are stained by Sudan III?
A. Cholesterol
B. Neutral fats
C. Triglycerides
D. Both B and C

A

D. Both B and C - orange-red

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166
Q

Which of the following lipids is/are capable of polarizing
light?
A. Cholesterol
B. Neutral fats
C. Triglycerides
D. Both A and B

A

A. Cholesterol - maltese cross formation

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167
Q

Differentiation among RBCs, yeast, and oil droplets may
be accomplished by all of the following except:
A. Observation of budding in yeast cells
B. Increased refractility of oil droplets
C. Lysis of yeast cells by acetic acid
D. Lysis of RBCs by acetic acid

A

C. Lysis of yeast cells by acetic acid

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168
Q

A finding of dysmorphic RBCs is indicative of:
A. Glomerular bleeding
B. Renal calculi
C. Traumatic injury
D. Coagulation disorders

A

A. Glomerular bleeding

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169
Q

Leukocytes that stain pale blue with Sternheimer-Malbin
stain and exhibit brownian movement are:
A. Indicative of pyelonephritis
B. Basophils
C. Mononuclear leukocytes
D. Glitter cells

A

D. Glitter cells

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170
Q

A clinically significant squamous epithelial cell is the:
A. Cuboidal cell
B. Clue cell
C. Caudate cell
D. Columnar cell

A

B. Clue cell

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171
Q

A primary characteristic used to identify renal tubular
epithelial cells is:
A. Elongated structure
B. Centrally located nucleus
C. Spherical appearance
D. Eccentrically located nucleus

A

D. Eccentrically located nucleus

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172
Q

The predecessor of the oval fat body is the:
A. Histiocyte
B. Urothelial cell
C. Monocyte
D. Renal tubular cell

A

D. Renal tubular cell

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173
Q

A person submitting a urine specimen following a strenuous exercise routine can normally have all of the following in the sediment except:
A. Hyaline casts
B. Granular casts
C. RBC casts
D. WBC casts

A

D. WBC casts - infection

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174
Q

All of the following contribute to urinary crystals formation except:
A. Protein concentration
B. pH
C. Solute concentration
D. Temperature

A

A. Protein concentration - CAST

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175
Q

All of the following are true about waxy casts except they:
A. Represent extreme urine stasis
B. May have a brittle consistency
C. Require staining to be visualized
D. Contain degenerated granules

A

C. Require staining to be visualized

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176
Q

Observation of broad casts represents:
A. Destruction of tubular walls
B. Dehydration and high fever
C. Formation in the collecting ducts
D. Both A and C

A

D. Both A and C

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177
Q

All of the following can cause false-negative microscopic
results except:
A. Braking the centrifuge
B. Failing to mix the specimen
C. Dilute alkaline urine
D. Using midstream clean-catch specimens

A

D. Using midstream clean-catch specimens

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178
Q

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

A

C. Rheostat

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179
Q

Nuclear detail can be enhanced by:
A. Prussian blue
B. Toluidine blue
C. Acetic acid
D. Both B and C

A

D. Both B and C

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180
Q

The purpose of the Hansel stain is to identify:
A. Neutrophils
B. Renal tubular cells
C. Eosinophils
D. Monocytes

A

C. Eosinophils - Using eosin Y and methylene blue

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181
Q

Crenated RBCs are seen in urine that is:
A. Hyposthenuric
B. Hypersthenuric
C. Highly acidic
D. Highly alkaline

A

B. Hypersthenuric

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182
Q

When pyuria is detected in a urine sediment, the slide
should be carefully checked for the presence of:
A. RBCs
B. Bacteria
C. Hyaline casts
D. Mucus

A

B. Bacteria

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183
Q

Transitional epithelial cells are sloughed from the:
A. Collecting duct
B. Vagina
C. Bladder
D. Proximal convoluted tubule

A

C. Bladder

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184
Q

A structure believed to be an oval fat body produced a
Maltese cross formation under polarized light but does not
stain with Sudan III. The structure:
A. Contains cholesterol
B. Is not an oval fat body
C. Contains neutral fats
D. Is contaminated with immersion oil

A

A. Contains cholesterol

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185
Q

The finding of yeast cells in the urine is commonly associated with:
A. Cystitis
B. Diabetes mellitus
C. Pyelonephritis
D. Liver disorders

A

B. Diabetes mellitus

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186
Q

Cylindruria refers to the presence of:
A. Cylindrical renal tubular cells
B. Mucus-resembling casts
C. Hyaline and waxy casts
D. All types of casts

A

D. All types of casts

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187
Q

The most valuable initial aid for identifying crystals in a
urine specimen is:
A. pH
B. Solubility
C. Staining
D. Polarized microscopy

A

A. pH

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188
Q

Crystals associated with severe liver disease include all of
the following except:
A. Bilirubin
B. Leucine
C. Cystine
D. Tyrosine

A

C. Cystine

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189
Q

Increased transitional cells are indicative of:
A. Catheterization
B. Malignancy
C. Pyelonephritis
D. Both A and B

A

D. Both A and B

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190
Q

A microscopic examintion of urine sediment reveals ghost cells. Thes red blood cells are seen urine with a:
A. >2% glucose concentration
B. Specific gravity of <1.007
C. Large amount of ketone bodies
D. Neutral pH

A

B. Specific gravity of <1.007

191
Q

The centrifuge tube was not discarded and the urine sediment was reevaluated microscopically 5 hours after the above results were reported. A second technologist reported the same results, except 2+ bacteria and no hyaline casts were found. The most probable explanation for the second technologist’s findings is:
A. Sediment was not agitated before preparing the microscopic slide
B. Cast dissolved due to decrease in urine pH
C. Cast dissolved due to increase in urine pH
D. Cast were never present in the specimen

A

C. Cast dissolved due to increase in urine pH

192
Q

Which of the following aids in differentiating a spherical transitional cell from a round renal tubular cell?
A. Spherical transitional cell is larger
B. Eccentrically-placed nucleus in the renal tubular cell
C. Eccentrically placed nucleus in the spherical transitional cell
D. Round renal tubular cell is larger

A

B. Eccentrically-placed nucleus in the renal tubular cell

193
Q

To distinguish between a clump of WBCs and WBC cast, it is important to observe:
A. The presence of free-floating WBCs
B. A positive leukocyte reaction
C. A positive nitrite reaction
D. The presence of a cast matrix

A

D. The presence of a cast matrix

194
Q

In a specimen with a large amount of bilirubin, which of the following sediment constituents would be most noticeable bile-stained:
A. Squamous epithelial cells
B. WBC cast
C. Cystine crystals
D. Renal tubular epithelial cell casts

A

D. Renal tubular epithelial cell casts

195
Q

After warming, a cloudy urine clears. This is due to the presence of:
A. Urates
B. Phosphates
C. WBCs
D. Bacteria

A

A. Urates

196
Q

Tiny, colorless, dumbell-shaped crystals were found in an alkaline urine sediment. They most likely are:
A. Calcium oxalate
B. Calcium carbonate
C. Calcium phosphate
D. Amorphous phosphate

A

B. Calcium carbonate

197
Q

Polarized light can often be used to differentiate between:
A. Fibers and mucous clumps
B. Hyaline and Waxy Cast
C. Squamous and Transitional epithelial cells
D. Red blood cells and White blood cells

A

A. Fibers and mucous clumps

198
Q

Most glomerular disorders are caused by:
A. Sudden drops in blood pressure
B. Immunologic disorders
C. Exposure to toxic substances
D. Bacterial infections

A

B. Immunologic disorders

199
Q

Dysmorphic RBC casts would be a significant finding with
all of the following except:
A. Goodpasture syndrome
B. Acute glomerulonephritis
C. Chronic pyelonephritis
D. Henoch-Schönlein purpura

A

C. Chronic pyelonephritis - WBC cast

200
Q

Antiglomerular basement membrane antibody is seen with:
A. Wegener granulomatosis
B. IgA nephropathy
C. Goodpasture syndrome
D. Diabetic nephropathy

A

C. Goodpasture syndrome

201
Q

Antineutrophilic cytoplasmic antibody is diagnostic for:
A. IgA nephropathy
B. Wegener granulomatosis
C. Henoch-Schönlein purpura
D. Goodpasture syndrome

A

B. Wegener granulomatosis

202
Q

The highest levels of proteinuria are seen with:
A. Alport syndrome
B. Diabetic nephropathy
C. IgA nephropathy
D. Nephrotic syndrome

A

D. Nephrotic syndrome

203
Q

An inherited disorder producing a generalized defect in
tubular reabsorption is:
A. Alport syndrome
B. Acute interstitial nephritis
C. Fanconi syndrome
D. Renal glycosuria

A

C. Fanconi syndrome

204
Q

The only protein produced by the kidney is:
A. Albumin
B. Uromodulin
C. Uroprotein
D. Globulin

A

B. Uromodulin/ Tamm horsefall protein

205
Q

Differentiation between cystitis and pyelonephritis is aided
by the presence of:
A. WBC casts
B. RBC casts
C. Bacteria
D. Granular casts

A

A. WBC casts

206
Q

The most common composition of renal calculi is:
A. Calcium oxalate
B. Magnesium ammonium phosphate
C. Cystine
D. Uric acid

A

A. Calcium oxalate - 80%

207
Q

Urinalysis on a patient with severe back pain being evaluated for renal calculi would be most beneficial if it
showed:
A. Heavy proteinuria
B. Low specific gravity
C. Uric acid crystals
D. Microscopic hematuria

A

D. Microscopic hematuria

208
Q

The best specimen for early newborn screening is a:
A. Timed urine specimen
B. Blood specimen
C. First morning urine specimen
D. Fecal specimen

A

B. Blood specimen

209
Q

A urine that turns black after sitting by the sink for
several hours could be indicative of:
A. Alkaptonuria
B. MSUD
C. Melanuria
D. Both A and C

A

D. Both A and C

210
Q

Hartnup disease is a disorder associated with the metabolism of:
A. Organic acids
B. Tryptophan
C. Cystine
D. Phenylalanine

A

B. Tryptophan

211
Q

Blue diaper syndrome is associated with:
A. Lesch-Nyhan syndrome
B. Phenylketonuria
C. Cystinuria
D. Hartnup disease

A

D. Hartnup disease

212
Q

The classic urine color associated with porphyria is:
A. Dark yellow
B. Indigo blue
C. Pink
D. Port wine

A

D. Port wine

213
Q

Which of the following specimens can be used for
porphyrin testing?
A. Urine
B. Blood
C. Feces
D. All of the above

A

D. All of the above

214
Q

Hurler, Hunter, and Sanfilippo syndromes are hereditary
disorders affecting metabolism of:
A. Porphyrins
B. Purines
C. Mucopolysaccharides
D. Tryptophan

A

C. Mucopolysaccharides

215
Q

Many uric acid crystals in a pediatric urine specimen may
indicate:
A. Hurler syndrome
B. Lesch-Nyhan disease
C. Melituria
D. Sanfilippo syndrome

A

B. Lesch-Nyhan disease

216
Q

Homocystinuria is caused by failure to metabolize:
A. Lysine
B. Methionine
C. Arginine
D. Cystine

A

B. Methionine

217
Q

Elevated urinary levels of 5-HIAA are associated with:
A. Carcinoid tumors
B. Hartnup disease
C. Cystinuria
D. Platelet disorders

A

A. Carcinoid tumors

218
Q

5-HIAA is a degradation product of:
A. Heme
B. Indole
C. Serotonin
D. Melanin

A

C. Serotonin

219
Q

Urine from a newborn with MSUD will have a
significant:
A. Pale color
B. Yellow precipitate
C. Milky appearance
D. Sweet odor

A

D. Sweet odor

220
Q

False-positive levels of 5-HIAA can be caused by a diet
high in:
A. Meat
B. Carbohydrates
C. Starch
D. Bananas

A

D. Bananas

221
Q

Match the metabolic urine disorders with their classic
urine abnormalities.
____ PKU
____ Indicanuria
____ Cystinuria
____ Alkaptonuria
____ Lesch-Nyhan disease
____ Isovaleric acidemia

A. Sulfur odor
B. Sweaty feet odor
C. Orange sand in diaper
D. Mousy odor
E. Black color
F. Blue color

A

D, F, A, E, C, B

222
Q

Which of the following is not a function of amniotic fluid?
A. Allows movement of the fetus
B. Allows carbon dioxide and oxygen exchange
C. Protects fetus from extreme temperature changes
D. Acts as a protective cushion for the fetus

A

B. Allows carbon dioxide and oxygen exchange - placenta

223
Q

What is the primary cause of the normal increase in amniotic fluid as a pregnancy progresses?
A. Fetal cell metabolism
B. Fetal swallowing
C. Fetal urine
D. Transfer of water across the placenta

A

C. Fetal urine

224
Q

Why might a creatinine level be requested on an amniotic
fluid?
A. Detect oligohydramnios
B. Detect polyhydramnios
C. Differentiate amniotic fluid from maternal urine
D. Evaluate lung maturity

A

C. Differentiate amniotic fluid from maternal urine - estimate for fetal age

225
Q

How are specimens for FLM testing delivered to and stored in the laboratory?
A. Delivered on ice and refrigerated
B. Immediately centrifuged
C. Kept at room temperature
D. Delivered in a vacuum tube

A

A. Delivered on ice and refrigerated

226
Q

Why are amniotic specimens for cytogenetic analysis incubated at 37°C prior to analysis?
A. To detect the presence of meconium
B. To differentiate amniotic fluid from urine
C. To prevent photo-oxidation of bilirubin to biliverdin
D. To prolong fetal cell viability and integrity

A

D. To prolong fetal cell viability and integrity

227
Q

Which of the following is not a reason for decreased
amounts of amniotic fluid?
A. Fetal failure to begin swallowing
B. Increased fetal swallowing
C. Membrane leakage
D. Urinary tract defects

A

A. Fetal failure to begin swallowing

228
Q

A significant rise in the OD of amniotic fluid at 450 nm
indicates the presence of which analyte?
A. Bilirubin
B. Lecithin
C. Oxyhemoglobin
D. Sphingomyelin

A

A. Bilirubin

229
Q

Plotting the amniotic fluid OD on a Liley graph represents
the severity of hemolytic disease of the newborn. A value
that is plotted in zone II indicates what condition of the
fetus?
A. No hemolysis
B. Mildly affected fetus
C. Moderately affected fetus that requires close monitoring
D. Severely affected fetus that requires intervention

A

C. Moderately affected fetus that requires close monitoring

230
Q

The presence of a fetal neural tube disorder may be
detected by:
A. Increased amniotic fluid bilirubin
B. Increased maternal serum alpha-fetoprotein
C. Decreased amniotic fluid phosphatidyl glycerol
D. Decreased maternal serum acetylcholinesterase

A

B. Increased maternal serum alpha-fetoprotein

231
Q

True or False: An AFP MoM value greater than two times
the median value is considered an indication of a neural
tube disorder

A

True

232
Q

When severe HDN is present, which of the following tests
on the amniotic fluid would the physician not order to
determine whether the fetal lungs are mature enough to
withstand a premature delivery?
A. AFP levels
B. Foam stability index
C. Lecithin/sphingomyelin ratio
D. Phosphatidyl glycerol detection

A

A. AFP levels

233
Q

When performing an L/S ratio by thin-layer chromatography,
a mature fetal lung will show:
A. Sphingomyelin twice as concentrated as lecithin
B. No sphingomyelin
C. Lecithin twice as concentrated as sphingomyelin
D. Equal concentrations of lecithin and sphingomyelin

A

C. Lecithin twice as concentrated as sphingomyelin

234
Q

Does the failure to produce bubbles in the Foam Stability
Index indicate increased or decreased lecithin?
A. Increased
B. Decreased

A

B. Decreased

235
Q

A lamellar body count of 50,000 correlates with:
A. Absent phosphatidyl glycerol and L/S ratio of 1.0
B. L/S ratio of 1.5 and absent phosphatidyl glycerol
C. OD at 650 nm of 1.010 and an L/S ratio of 1.1
D. OD at 650 nm of 0.150 and an L/S ratio of 2.0

A

D. OD at 650 nm of 0.150 and an L/S ratio of 2.0

236
Q

The functions of the CSF include all of the following
except:
A. Removing metabolic wastes
B. Producing an ultrafiltrate of plasma
C. Supplying nutrients to the CNS
D. Protecting the brain and spinal cord

A

B. Producing an ultrafiltrate of plasma

237
Q

Substances present in the CSF are controlled by the:
A. Arachnoid granulations
B. Blood–brain barrier
C. Presence of one-way valves
D. Blood–CSF barrier

A

B. Blood–brain barrier

238
Q

What department is the CSF tube labeled 3 routinely
sent to?
A. Hematology
B. Chemistry
C. Microbiology
D. Serology

A

A. Hematology

239
Q

The presence of xanthochromia can be caused by all of
the following except:
A. Immature liver function
B. RBC degradation
C. A recent hemorrhage
D. Elevated CSF protein

A

C. A recent hemorrhage

240
Q

Given the following information, calculate the CSF WBC
count: cells counted, 80; dilution, 1:10; large Neubauer
squares counted, 10.
A. 8
B. 80
C. 800
D. 8000

A

C. 800

WBC ct = cd/ad – 80x10/ 10x0.1

241
Q

A CSF WBC count is diluted with:
A. Distilled water
B. Normal saline
C. Acetic acid
D. Hypotonic saline

A

C. Acetic acid

242
Q

A total CSF cell count on a clear fluid should be:
A. Reported as normal
B. Not reported
C. Diluted with normal saline
D. Counted undiluted

A

D. Counted undiluted

243
Q

The purpose of adding albumin to CSF before cytocentrifugation is to:
A. Increase the cell yield
B. Decrease the cellular distortion
C. Improve the cellular staining
D. Both A and B

A

D. Both A and B

244
Q

The primary concern when pleocytosis of neutrophils and
lymphocytes is found in the CSF is:
A. Meningitis
B. CNS malignancy
C. Multiple sclerosis
D. Hemorrhage

A

A. Meningitis

245
Q

Macrophages appear in the CSF after:
A. Hemorrhage
B. Repeated spinal taps
C. Diagnostic procedures
D. All of the above

A

D. All of the above

246
Q

After a CNS diagnostic procedure, which of the following
might be seen in the CSF?
A. Choroidal cells
B. Ependymal cells
C. Spindle-shaped cells
D. All of the above

A

D. All of the above

247
Q

The integrity of the blood–brain barrier is measured using
the:
A. CSF/serum albumin index
B. CSF/serum globulin ratio
C. CSF albumin index
D. CSF IgG index

A

A. CSF/serum albumin index

248
Q

Given the following results, calculate the IgG index: CSF IgG, 50 mg/dL; serum IgG, 2 g/dL; CSF albumin, 70 mg/dL; serum albumin, 5 g/dL.
A. 0.6
B. 6.0
C. 1.8
D. 2.8

A

C. 1.8

IgG index = C/S IgG | C/S Alb – 50/2 | 70/5 – 25/14
Synthesis of IgG in the CNS (> 0.70)

249
Q

A CSF glucose of 15 mg/dL, WBC count of 5000,
90% neutrophils, and protein of 80 mg/dL suggests:
A. Fungal meningitis
B. Viral meningitis
C. Tubercular meningitis
D. Bacterial meningitis

A

D. Bacterial meningitis

250
Q

A patient with a blood glucose of 120 mg/dL would have
a normal CSF glucose of:
A. 20 mg/dL
B. 60 mg/dL
C. 80 mg/dL
D. 120 mg/dL

A

C. 80 mg/dL

CSF glucose = 60-70%

251
Q

All of the following statements are true about cryptococcal
meningitis except:
A. An India ink preparation is positive
B. A starburst pattern is seen on Gram stain
C. The WBC count is over 2000
D. A confirmatory immunology test is available

A

C. The WBC count is over 2000

252
Q

The test of choice to detect neurosyphilis is the:
A. RPR
B. VDRL
C. FAB
D. FTA-ABS

A

B. VDRL

253
Q

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

A

B. Pleocytosis of mixed cellularity

254
Q

Nucleated RBCs are seen in the CSF as a result of:
A. Elevated blood RBCs
B. Treatment of anemia
C. Severe hemorrhage
D. Bone marrow contamination

A

D. Bone marrow contamination

255
Q

CSF can be differentiated from serum by the presence of:
A. Albumin
B. Globulin
C. Prealbumin
D. Tau transferrin

A

D. Tau transferrin

256
Q

The finding of oligoclonal bands in the CSF and not in
the serum is seen with:
A. Multiple myeloma
B. CNS malignancy
C. Multiple sclerosis
D. Viral infections

A

C. Multiple sclerosis

257
Q

Measurement of which of the following can be replaced by
CSF glutamine analysis in children with Reye syndrome?
A. Ammonia
B. Lactate
C. Glucose
D. α -Ketoglutarate

A

A. Ammonia

258
Q

CSF lactate will be more consistently decreased in:
A. Bacterial meningitis
B. Viral meningitis
C. Fungal meningitis
D. Tubercular meningitis

A

B. Viral meningitis

259
Q

Before performing a Gram stain on CSF, the specimen
must be:
A. Filtered
B. Warmed to 37°C
C. Centrifuged
D. Mixed

A

C. Centrifuged

260
Q

Maturation of spermatozoa takes place in the:
A. Sertoli cells
B. Seminiferous tubules
C. Epididymis
D. Seminal vesicles

A

C. Epididymis

261
Q

If the first portion of a semen specimen is not collected, the semen analysis will have which of the following?
A. Decreased pH
B. Increased viscosity
C. Decreased sperm count
D. Decreased sperm motility

A

C. Decreased sperm count

262
Q

Failure of laboratory personnel to document the time a
semen sample is collected primarily affects the interpretation of semen:
A. Appearance
B. Volume
C. pH
D. Viscosity

A

D. Viscosity

263
Q

A semen specimen delivered to the laboratory in a condom has a normal sperm count and markedly decreased sperm motility. This indicates:
A. Decreased fructose
B. Antispermicide in the condom
C. Increased semen viscosity
D. Increased semen alkalinity

A

B. Antispermicide in the condom

264
Q

Given the following information, calculate the sperm concentration: dilution, 1:20; sperm counted in five RBC
squares on each side of the hemocytometer, 80 and 86;
volume, 3 mL.
A. 80 million/mL
B. 83 million/mL
C. 86 million/mL
D. 169 million/µ L

A

B. 83 million/mL

Sperm conc = 83x20 / 0.2x0.1 – 83000 x 1000

265
Q

The primary reason to dilute a semen specimen before
performing a sperm concentration is to:
A. Immobilize the sperm
B. Facilitate the chamber count
C. Decrease the viscosity
D. Stain the sperm

A

A. Immobilize the sperm

266
Q

When performing a sperm concentration, 60 sperm are
counted in the RBC squares on one side of the hemocytometer and 90 sperm are counted in the RBC squares on the other side. The specimen is diluted 1:20. The:
A. Specimen should be rediluted and counted
B. Sperm count is 75 million/mL
C. Sperm count is greater than 5 million/mL
D. Sperm concentration is abnormal

A

A. Specimen should be rediluted and counted

267
Q

Additional parameters measured by Kruger’s strict morphology include all of the following except:
A. Vitality
B. Presence of vacuoles
C. Acrosome size
D. Tail length

A

A. Vitality

268
Q

If 5 round cells per 100 sperm are counted in a sperm morphology smear and the sperm concentration is 30 million, the concentration of round cells is:
A. 150,000
B. 1.5 million
C. 300,000
D. 15 million

A

B. 1.5 million

Round cell ct. = NxS/ 100 – 5x30M/ 100 = 1.5M

269
Q

Following a negative postvasectomy wet preparation, the
specimen should be:
A. Centrifuged and reexamined
B. Stained and reexamined
C. Reported as no sperm seen
D. Both A and B

A

A. Centrifuged and reexamined

270
Q

Enzymes for the coagulation and liquefaction of semen are produced by the:
A. Seminal vesicles
B. Bulbourethral glands
C. Ductus deferens
D. Prostate gland

A

D. Prostate gland

271
Q

An increased semen pH may be caused by:
A. Prostatic infection
B. Decreased prostatic secretions
C. Decreased bulbourethral gland secretions
D. All of the above

A

D. All of the above

272
Q

Following an abnormal sperm motility test with a normal
sperm count, what additional test might be ordered?
A. Fructose level
B. Zinc level
C. MAR test
D. Eosin-nigrosin stain

A

D. Eosin-nigrosin stain

273
Q

Follow-up testing for a low sperm concentration would
include testing for:
A. Antisperm antibodies
B. Seminal fluid fructose
C. Sperm vitality
D. Prostatic acid phosphatase

A

B. Seminal fluid fructose

274
Q

Measurement of α -glucosidase is performed to detect a
disorder of the:
A. Seminiferous tubules
B. Epididymis
C. Prostate gland
D. Bulbourethral glands

A

B. Epididymis

275
Q

The functions of synovial fluid include all of the following
except:
A. Lubrication for the joints
B. Removal of cartilage debris
C. Cushioning joints during jogging
D. Providing nutrients for cartilage

A

B. Removal of cartilage debris

276
Q

The primary function of synoviocytes is to:
A. Provide nutrients for the joints
B. Secrete hyaluronic acid
C. Regulate glucose filtration
D. Prevent crystal formation

A

B. Secrete hyaluronic acid

277
Q

Which of the following is not a frequently performed test
on synovial fluid?
A. Uric acid
B. WBC count
C. Crystal examination
D. Gram stain

A

A. Uric acid

278
Q

Normal synovial fluid resembles:
A. Egg white
B. Normal serum
C. Dilute urine
D. Lipemic serum

A

A. Egg white

Synovial = ‘Ovum’ or egg

279
Q

Before testing, very viscous synovial fluid should be
treated with:
A. Normal saline
B. Hyaluronidase
C. Distilled water
D. Hypotonic saline

A

B. Hyaluronidase

280
Q

Which of the following could be the most significantly
affected if a synovial fluid is refrigerated before testing?
A. Glucose
B. Crystal examination
C. Mucin clot test
D. Differential

A

B. Crystal examination

281
Q

The highest WBC count can be expected to be seen with:
A. Noninflammatory arthritis
B. Inflammatory arthritis
C. Septic arthritis
D. Hemorrhagic arthritis

A

C. Septic arthritis

282
Q

All of the following are abnormal when seen in synovial
fluid except:
A. Neutrophages
B. Ragocytes
C. Synovial lining cells
D. Lipid droplets

A

C. Synovial lining cells

283
Q

Synovial fluid crystals that occur as a result of purine
metabolism or chemotherapy for leukemia are:
A. Monosodium urate
B. Cholesterol
C. Calcium pyrophosphate
D. Apatite

A

A. Monosodium urate

284
Q

Synovial fluid for crystal examination should be examined
as a/an:
A. Wet preparation
B. Wright’s stain
C. Gram stain
D. Acid-fast stain

A

A. Wet preparation

285
Q

In an examination of synovial fluid under compensated
polarized light, rhomboid-shaped crystals are observed.
What color would these crystals be when aligned parallel
to the slow vibration?
A. White
B. Yellow
C. Blue
D. Red

A

B. Yellow

286
Q

If crystals shaped like needles are aligned perpendicular
to the slow vibration of compensated polarized light, what
color are they?
A. White
B. Yellow
C. Blue
D. Red

A

C. Blue

287
Q

The most frequently performed chemical test on synovial
fluid is:
A. Total protein
B. Uric acid
C. Calcium
D. Glucose

A

D. Glucose

288
Q

Serologic tests on patients’ serum may be performed to
detect antibodies causing arthritis for all of the following
disorders except:
A. Pseudogout
B. Rheumatoid arthritis
C. Systemic lupus erythematosus
D. Lyme arthritis

A

A. Pseudogout

289
Q

Crystals that have the ability to polarize light are:
A. Corticosteroid
B. Monosodium urate
C. Calcium oxalate
D. All of the above

A

D. All of the above

290
Q

Synovial fluid crystals associated with inflammation in
dialysis patients are:
A. Calcium pyrophosphate dihydrate
B. Calcium oxalate
C. Corticosteroid
D. Monosodium urate

A

B. Calcium oxalate

291
Q

Crystals associated with pseudogout are:
A. Monosodium urate
B. Calcium pyrophosphate dihydrate
C. Apatite
D. Corticosteroid

A

B. Calcium pyrophosphate dihydrate

292
Q

Synovial fluid cultures are often plated on chocolate agar
to detect the presence of:
A. Neisseria gonorrhoeae
B. Staphylococcus agalactiae
C. Streptococcus viridans
D. Enterococcus faecalis

A

A. Neisseria gonorrhoeae

293
Q

When diluting a synovial fluid WBC count, all of the
following are acceptable except:
A. Acetic acid
B. Isotonic saline
C. Hypotonic saline
D. Saline with saponin

A

A. Acetic acid

294
Q

Addition of a cloudy, yellow synovial fluid to acetic acid
produces a/an:
A. Yellow-white precipitate
B. Easily dispersed clot
C. Solid clot
D. Opalescent appearance

A

B. Easily dispersed clot

295
Q

The primary purpose of serous fluid is to:
A. Remove waste products
B. Lower capillary pressure
C. Lubricate serous membranes
D. Nourish serous membranes

A

C. Lubricate serous membranes

296
Q

During normal production of serous fluid, the slight excess
of fluid is:
A. Absorbed by the lymphatic system
B. Absorbed through the visceral capillaries
C. Stored in the mesothelial cells
D. Metabolized by the mesothelial cells

A

A. Absorbed by the lymphatic system

297
Q

Fluid:serum protein and lactic dehydrogenase ratios are
performed on serous fluids:
A. When malignancy is suspected
B. To classify transudates and exudates
C. To determine the type of serous fluid
D. When a traumatic tap has occurred

A

B. To classify transudates and exudates

298
Q

A milky-appearing pleural fluid indicates:
A. Thoracic duct leakage
B. Chronic inflammation
C. Microbial infection
D. Both A and B

A

D. Both A and B

299
Q

Which of the following best represents a hemothorax?
A. Blood HCT: 42 Fluid HCT: 15
B. Blood HCT: 42 Fluid HCT: 10
C. Blood HCT: 30 Fluid HCT: 10
D. Blood HCT: 30 Fluid HCT: 20

A

D. Blood HCT: 30 Fluid HCT: 20

300
Q

A differential observation of pleural fluid associated with
tuberculosis is:
A. Increased neutrophils
B. Decreased lymphocytes
C. Decreased mesothelial cells
D. Increased mesothelial cells

A

C. Decreased mesothelial cells

301
Q

A significant cell found in pericardial or pleural fluid that
should be referred to cytology is a:
A. Reactive lymphocyte
B. Mesothelioma cell
C. Monocyte
D. Mesothelial cell

A

B. Mesothelioma cell

302
Q

A test performed primarily on peritoneal lavage fluid is
a/an:
A. WBC count
B. RBC count
C. Absolute neutrophil count
D. Amylase

A

B. RBC count

303
Q

The recommended test for determining whether peritoneal fluid is a transudate or an exudate is the:
A. Fluid:serum albumin ratio
B. Serum ascites albumin gradient
C. Fluid:serum lactic dehydrogenase ratio
D. Absolute neutrophil count

A

B. Serum ascites albumin gradient

304
Q

Detection of the CA 125 tumor marker in peritoneal fluid
indicates:
A. Colon cancer
B. Ovarian cancer
C. Gastric malignancy
D. Prostate cancer

A

B. Ovarian cancer

305
Q

Cultures of peritoneal fluid are incubated:
A. Aerobically
B. Anaerobically
C. At 37°C and 42°C
D. Both A and B

A

D. Both A and B

306
Q

Production of serous fluid is controlled by:
A. Capillary oncotic pressure
B. Capillary hydrostatic pressure
C. Capillary permeability
D. All of the above

A

D. All of the above

307
Q

A pleural fluid pH of 6.0 indicates:
A. Esophageal rupture
B. Mesothelioma
C. Malignancy
D. Rheumatoid effusion

A

A. Esophageal rupture

308
Q

Given the following results, classify this peritoneal fluid:
serum albumin, 2.2 g/dL; serum protein, 6.0 g/dL; fluid
albumin, 1.6 g/dL.
A. Transudate
B. Exudate

A

B. Exudate

SAAG
SA- AA = 2.2-1.6 = 0.6
<1.1 = exudate
>1.1 = transudate

309
Q

Plasma cells seen in pleural fluid indicate:
A. Bacterial endocarditis
B. Primary malignancy
C. Metastatic lung malignancy
D. Tuberculosis infection

A

D. Tuberculosis infection

310
Q

Where does the reabsorption of water take place in the
primary digestive process?
A. Large intestine
B. Pancreas
C. Small intestine
D. Stomach

A

A. Large intestine

311
Q

Which of the following tests is not performed to detect
osmotic diarrhea?
A. Clinitest
B. Fecal fats
C. Fecal neutrophils
D. Muscle fibers

A

C. Fecal neutrophils - secretory diarrhea

312
Q

The normal composition of feces includes all of the following except:
A. Bacteria
B. Blood
C. Electrolytes
D. Water

A

B. Blood

313
Q

What is the fecal test that requires a 3-day specimen?
A. Fecal occult blood
B. APT test
C. Elastase I
D. Quantitative fecal fat testing

A

D. Quantitative fecal fat testing

314
Q

The normal brown color of the feces is produced by:
A. Cellulose
B. Pancreatic enzymes
C. Undigested foodstuffs
D. Urobilin

A

D. Urobilin

315
Q

Diarrhea can result from all of the following except:
A. Addition of pathogenic organisms to the normal
intestinal flora
B. Disruption of the normal intestinal bacterial flora
C. Increased concentration of fecal electrolytes
D. Increased reabsorption of intestinal water and
electrolytes

A

D. Increased reabsorption of intestinal water and
electrolytes

316
Q

Which of the following pairings of stool appearance and
cause does not match?
A. Black, tarry: blood
B. Pale, frothy: steatorrhea
C. Yellow-gray: bile duct obstruction
D. Yellow-green: barium sulfate

A

D. Yellow-green: barium sulfate

317
Q

Microscopic examination of stools provides preliminary
information as to the cause of diarrhea because:
A. Neutrophils are present in conditions caused by
toxin-producing bacteria
B. Neutrophils are present in conditions that affect the
intestinal wall
C. Red and white blood cells are present if the cause is
bacterial
D. Neutrophils are present if the condition is of nonbacterial etiology

A

B. Neutrophils are present in conditions that affect the
intestinal wall

318
Q

Large orange-red droplets seen on direct microscopic
examination of stools mixed with Sudan III represent:
A. Cholesterol
B. Fatty acids
C. Neutral fats
D. Soaps

A

C. Neutral fats

319
Q

Microscopic examination of stools mixed with Sudan III
and glacial acetic acid and then heated will show small
orange-red droplets that represent:
A. Fatty acids and soaps
B. Fatty acids and neutral fats
C. Fatty acids, soaps, and neutral fats
D. Soaps

A

A. Fatty acids and soaps

320
Q

A value of 85% fat retention would indicate:
A. Dumping syndrome
B. Osmotic diarrhea
C. Secretory diarrhea
D. Steatorrhea

A

D. Steatorrhea

321
Q

Guaiac tests for detecting occult blood rely on the:
A. Reaction of hemoglobin with hydrogen peroxide
B. Pseudoperoxidase activity of hemoglobin
C. Reaction of hemoglobin with ortho-toluidine
D. Pseudoperoxidase activity of hydrogen peroxide

A

B. Pseudoperoxidase activity of hemoglobin

322
Q

What is the significance of an APT test that remains pink
after addition of sodium hydroxide?
A. Fecal fat is present.
B. Fetal hemoglobin is present.
C. Fecal trypsin is present.
D. Vitamin C is present.

A

B. Fetal hemoglobin is present.

323
Q

A patient whose stool exhibits increased fats, undigested
muscle fibers, and the inability to digest gelatin may
have:
A. Bacterial dysentery
B. A duodenal ulcer
C. Cystic fibrosis
D. Lactose intolerance

A

C. Cystic fibrosis

324
Q

A stool specimen collected from an infant with diarrhea
has a pH of 5.0. This result correlates with a:
A. Positive APT test
B. Negative trypsin test
C. Positive Clinitest
D. Negative occult blood test

A

C. Positive Clinitest

325
Q

Which of the following tests differentiates a malabsorption cause from a maldigestion cause in steatorrhea?
A. APT test
B. D-xylose test
C. Lactose tolerance test
D. Occult blood test

A

B. D-xylose test

326
Q

A black tarry stool is indicative of:
A. Upper GI bleeding
B. Lower GI bleeding
C. Excess fat
D. Excess carbohydrates

A

A. Upper GI bleeding

327
Q

Stool specimens that appear ribbon-like are indicative of
which condition?
A. Bile-duct obstruction
B. Colitis
C. Intestinal constriction
D. Malignancy

A

C. Intestinal constriction

328
Q

Chemical screening tests performed on feces include all
of the following except:
A. APT test
B. Clinitest
C. Pilocarpine iontophoresis
D. Quantitative fecal fats

A

C. Pilocarpine iontophoresis - sweat

329
Q

Secretory diarrhea is caused by:
A. Antibiotic administration
B. Lactose intolerance
C. Celiac sprue
D. Vibrio cholerae

A

D. Vibrio cholerae

330
Q

REPORTING OF SPERMATOZOA IN URINE Present, based on laboratory protocol

A

Noted

331
Q

The concentration of hCG is generally at a particular level in serum about 2 to 3days after implantation. This is the concentration at which most sensitive laboratory assays can give a positive serum hCG result. What is the lowest level of hormone for which most current serum hCG tests can give a positive result?

25 mIU/mL
50 mIU/mL
100 mIU/mL
100, 000 mIU/mL

A

25 mIU/mL

In a normal pregnancy, detectable amounts of about 25 mIU/mL β- hCG are secreted 2 to 3 days (48 to 72 hours) after implantation, or approximately 8 to 10 days after conception or fertilization.

332
Q

The most specific assays for human chorionic gonadotropin (hCG) use antibody reagents against which subunit of hCG?

Alpha
Beta
Gamma
Chorionic

A

Beta

Alpha subunit of HCG - similar to LH, FSH and TSH
Beta subunit is unique for HCG

333
Q

In the card pregnancy test: no band appears at T and a black or gray band is visible at the C position

Positive
Negative
Invalid

A

Negative

CARD PREGNANCY TEST
1. POSITIVE: Two separate black or gray bands, one at T and the other at C, are visible in the results window, indicating that the specimen contains detectable levels of hCG. Although the intensity of the test band may vary with different specimens, the appearance of two distinct bands should be interpreted as a positive result.

  1. NEGATIVE: If no band appears at T and a black or gray band is visible at the C position, the test can be considered negative, indicating that a detectable level of hCG is not present.
  2. INVALID: If no band appears at C or incomplete or beaded bands appear at the T or C position, the test is invalid. The test should be
    repeated using another Card Pregnancy Test device.

**If the test band appears very faint, it is recommended that a new sample be collected 48 hours later and tested again using another Card Pregnancy Test device.

334
Q

What department is the CSF tube labeled 3 routinely sent to?

Hematology
Chemistry
Microbiology
Serology

A

Hematology

335
Q

Fourth CSF tube may be drawn for:

Cell counts
Chemical tests
Chemistry and cell counts
Microbiology or additional serologic tests

A

Microbiology or additional serologic tests

336
Q

If only a small amount of CSF is obtained, which is the most important procedure to perform first?

Cell count
Chemistry
Immunology
Microbiology

A

Microbiology

337
Q

A web-like pellicle in a refrigerated CSF specimen indicates:

Tubercular meningitis
Multiple sclerosis
Primary CNS malignancy
Viral meningitis

A

Tubercular meningitis

338
Q

A CSF total cell count is diluted with:

Distilled water
Normal saline
Acetic acid
Hypotonic saline

A

Normal saline

Dilutions for total cell counts are made with normal saline, mixed by inversion, and loaded into the hemocytometer with a Pasteur pipette.

339
Q

A CSF WBC count is diluted with:

Distilled water
Normal saline
Acetic acid
Hypotonic saline

A

Acetic acid

Lysis of RBCs must be obtained before performing the WBC count on either diluted or undiluted specimens. Specimens requiring dilution can be diluted in the manner described previously, substituting 3% glacial acetic acid to lyse the RBCs.

Adding methylene blue to the diluting fluid stains the WBCs, providing better differentiation between neutrophils and mononuclear cells.

340
Q

As little as 0.1 mL of CSF combined with one drop of ________ produces an adequate CELL YIELD when processed with the cytocentrifuge.

10% albumin
30% albumin
1% HCl
3% acetic acid

A

30% albumin

Adding albumin increases the cell yield and decreases the cellular distortion frequently seen on cytocentrifuged specimens.

341
Q

The purpose of adding albumin to CSF before cytocentrifugation is to:

Increase the cell yield
Decrease the cellular distortion
Improve the cellular staining
Increase cell yield and decrease cellular distortion

A

Increase cell yield and decrease cellular distortion

Adding albumin increases the cell yield and decreases the cellular distortion frequently seen on cytocentrifuged specimens.

342
Q

The presence of which of the following cells is increased in a parasitic infection?

Neutrophils
Macrophages
Eosinophils
Lymphocytes

A

Eosinophils

Increased eosinophils are seen in the CSF in association with parasitic infections, fungal infections (primarily Coccidioides immitis), and introduction of foreign material, including medications and shunts, into the CNS.

343
Q

Fungal infection associated with increased eosinophils in CSF:

Blastomyces dermatitidis
Coccidioides immitis
Cryptococcus neoformans
Histoplasma capsulatum

A

Coccidioides immitis

Increased eosinophils are seen in the CSF in association with parasitic infections, fungal infections (primarily Coccidioides immitis), and introduction of foreign material, including medications and shunts, into the CNS.

344
Q

Which of the following may resemble a LYMPHOCYTE in CSF?

Blastoyces
Coccidioides
Cryptococcus
Histoplasma

A

Cryptococcus

345
Q

Nonpathologically significant cells are most frequently seen after DIAGNOSTIC PROCEDURES such as PNEUMOENCEPHALOGRAPHY and in fluid obtained from VENTRICULAR TAPS or during NEUROSURGERY:

Choroidal cells
Ependymal cells
Spindle-shaped cells
All of these

A

All of these

346
Q

Myeloblasts are seen in the CSF:

In bacterial infections
In conjunction with CNS malignancy
After cerebral hemorrhage
As a complication of acute leukemia

A

As a complication of acute leukemia

Lymphoblasts, myeloblasts, and monoblasts in the CSF are frequently seen as a serious complication of acute leukemias.

Nucleoli are often more prominent than in blood smears.

347
Q

The most frequently performed chemical test on CSF:

Glucose determination
Lactate determination
Protein determination
India ink staining

A

Protein determination

The most frequently performed chemical test on CSF is the protein determination.

348
Q

The reference range for CSF protein is:

6 to 8 g/dL
15 to 45 g/dL
6 to 8 mg/dL
15 to 45 mg/dL

A

15 to 45 mg/dL

Reference values for total CSF protein are usually listed as 15 to 45 mg/dL, but are somewhat method dependent, and higher values are found in infants and people over age 40.

This value is reported in milligrams per deciliter and not grams per deciliter, as are plasma protein concentrations.

349
Q

CSF can be differentiated from serum by the presence of:

Albumin
Globulin
Prealbumin
Tau transferrin

A

Tau transferrin

Transferrin is the major beta globulin present; also, a separate carbohydrate-deficient transferrin fraction, referred to as “tau,” is seen in CSF and not in serum.

350
Q

In serum, the second most prevalent protein is IgG; in CSF, the second most prevalent protein is:

Transferrin
Prealbumin
IgA
Ceruloplasmin

A

Prealbumin

351
Q

Elevated CSF protein values can be caused by all of the following except:

Meningitis
Multiple sclerosis
Fluid leakage
CNS malignancy

A

Fluid leakage

Abnormally low values are present when fluid is leaking from the CNS.

The causes of elevated CSF protein include damage to the blood–brain barrier, immunoglobulin production within the CNS, decreased normal protein clearance from the fluid, and neural tissue degeneration. Meningitis and hemorrhage conditions that damage the blood–brain barrier are the most common causes of elevated CSF protein.

352
Q

The integrity of the blood–brain barrier is measured using the:

CSF/serum albumin index
CSF/serum globulin ratio
CSF albumin index
CSF IgG index

A

CSF/serum albumin index

CSF/SERUM ALBUMIN INDEX
An index value less than 9 represents an intact blood– brain barrier. The index increases relative to the amount of damage to the barrier.

353
Q

The finding of oligoclonal bands in the CSF and not in the serum is seen with:

Multiple myeloma
CNS malignancy
Multiple sclerosis
Viral infections

A

Multiple sclerosis

354
Q

Oligoclonal banding in cerebrospinal fluid but not in serum, EXCEPT:

Encephalitis
Multiple myeloma
Neurosyphilis
Guillain-Barre disease

A

Multiple myeloma

The presence of two or more oligoclonal bands in the CSF that are not present in the serum can be a valuable tool in diagnosing multiple sclerosis, particularly when accompanied by an increased IgG index.

Other neurologic disorders including encephalitis, neurosyphilis, Guillain-Barré syndrome, and neoplastic disorders also produce oligoclonal banding that may not be present in the serum.

355
Q

Measurement of which of the following can be replaced by CSF GLUTAMINE analysis in children with Reye syndrome?

Ammonia
Lactate
Glucose
Alpha-ketoglutarate

A

Ammonia

Glutamine is produced from ammonia and alpha-ketoglutarate by the brain cells. This process serves to remove the toxic metabolic waste product ammonia from the CNS.

The normal concentration of glutamine in the CSF is 8 to 18 mg/dL. Elevated levels are associated with liver disorders that result in increased blood and CSF ammonia.

356
Q

Before performing a Gram stain on CSF, the specimen must be:

Filtered
Warmed to 37C
Centrifuged
Mixed

A

Centrifuged

All smears and cultures should be performed on concentrated specimens because often only a few organisms are present at the onset of the disease. The CSF should be centrifuged at 1500 g for 15 minutes, and slides and cultures should be prepared from the sediment.

357
Q

The procedure recommended by the CDC to diagnose neurosyphilis:

RPR
VDRL
MHA-TP
FTA-ABS

A

VDRL

Although many different serologic tests for syphilis are available when testing blood, the procedure recommended by the CDC to diagnose neurosyphilis is the Venereal Disease Research Laboratories (VDRL), even though it is not as sensitive as the fluorescent treponemal antibody-absorption (FTA-ABS) test for syphilis.

The rapid plasma regain (RPR) test is not recommended because it is less sensitive than the VDRL.

358
Q

An elevated maternal serum AFP, may indicate an amniocentesis at:

15 to 18 weeks
20 to 42 weeks

A

15 to 18 weeks

INDICATIONS FOR PERFORMING AMNIOCENTESIS
INDICATED AT 15 TO 18 WEEKS’ GESTATION
 Mother’s age of 35 or older at delivery
 Family history of chromosome abnormalities, such as trisomy 21 (Down syndrome)
 Parents carry an abnormal chromosome rearrangement
 Earlier pregnancy or child with birth defect
 Parent is a carrier of a metabolic disorder
 Family history of genetic diseases such a sickle cell disease, Tay-Sachs disease, hemophilia, muscular dystrophy, sickle cell anemia, Huntington chorea, and cystic fibrosis
 Elevated maternal serum alpha-fetoprotein
 Abnormal triple marker screening test
 Previous child with a neural tube disorder such as spina bifida, or ventral wall defects (gastroschisis)
 Three or more miscarriages

INDICATED LATER IN THE PREGNANCY (20 TO 42 WEEKS)
 Fetal lung maturity
 Fetal distress
 HDN caused by Rh blood type incompatibility
 Infection

359
Q

The amount of amniotic fluid increases in quantity throughout pregnancy, reaching a peak of approximately ____ mL during the third trimester, and then gradually decreases prior to delivery.

100 to 200 mL
200 to 400 mL
400 to 800 mL
800 to 1, 200 mL

A

800 to 1, 200 mL

360
Q

A maximum of ___ mL of amniotic fluid is collected in sterile syringes.

5 mL
10 mL
20 mL
30 mL

A

30 mL

361
Q

Presence of meconium in amniotic fluid:

Colorless
Blood-streaked
Yellow
Dark green
Dark red-brown

A

Dark green

362
Q

Dark red-brown amniotic fluid:

Traumatic tap, abdominal trauma, intra-amniotic hemorrhage
Hemolytic disease of the newborn
Meconium
Fetal death

A

Fetal death

363
Q

Amniotic fluid specimens are placed in amber-colored tubes prior to sending them to the laboratory to prevent the destruction of:

Alpha-fetoprotein
Bilirubin
Cytogenetics
Lecithin

A

Bilirubin

364
Q

Why are amniotic specimens for cytogenetic analysis incubated at 37°C prior to analysis?

To detect the presence of meconium
To differentiate amniotic fluid from urine
To prevent photo-oxidation of bilirubin to biliverdin
To prolong fetal cell viability and integrity

A

To prolong fetal cell viability and integrity

365
Q

How are specimens for FLM testing delivered to and stored in the laboratory?

Delivered on ice and refrigerated
Immediately centrifuged
Kept at room temperature
Delivered in a vacuum tube

A

Delivered on ice and refrigerated

366
Q

Amniotic fluid bilirubin is measured by:

Turbidimetric method
Dye-binding method
Spectrophotometric analysis
Fluorometric analysis

A

Spectrophotometric analysis

Amniotic fluid bilirubin is measured by spectrophotometric analysis using serial dilutions.

When bilirubin is present, a rise in OD is seen at 450 nm because this is the wavelength of maximum bilirubin absorption.

367
Q

A significant rise in the OD of amniotic fluid at 450 nm indicates the presence of which analyte?

Bilirubin
Lecithin
Oxyhemoglobin
Sphingomyelin

A

Bilirubin

368
Q

For OD 450, specimens that are contaminated with blood are generally unacceptable because maximum absorbance of oxyhemoglobin occurs at ___ nm and can interfere with the bilirubin absorption peak

Oxyhemoglobin and bilirubin 410 nm
Oxyhemoglobin and bilirubin 450 nm
Oxyhemoglobin 410 nm, bilirubin 450 nm
Oxyhemoglobin 450 nm, bilirubin 410 nm

A

Oxyhemoglobin 410 nm, bilirubin 450 nm

Specimens that are contaminated with blood are generally unacceptable because maximum absorbance of oxyhemoglobin occurs at 410 nm and can interfere with the bilirubin absorption peak.

This interference can be removed by extraction with chloroform if necessary.

369
Q

A ΔA450 value that falls into Zone I indicates:

Normal finding without significant hemolysis
Moderate hemolysis
Severe hemolysis
High fetal risk

A

Normal finding without significant hemolysis

Zone I: no more than a mildly affected fetus

Zone II: moderate hemolysis and require careful monitoring anticipating an early delivery or exchange transfusion upon delivery

Zone III: severe hemolysis and suggests a severely affected fetus; intervention through induction of labor or intrauterine exchange transfusion must be considered

370
Q

Plotting the amniotic fluid OD on a Liley graph represents the severity of hemolytic disease of the newborn. A value that is plotted in ZONE II indicates what condition of the fetus?

No hemolysis
Mildly affected fetus
Moderately affected fetus requiring close monitoring
Severely affected fetus that requires intervention

A

Moderately affected fetus requiring close monitoring

371
Q

In the FOAM OR SHAKE TEST, amniotic fluid is mixed with:

1% NaOH
10% NaOH
70% ethanol
95% ethanol

A

95% ethanol

Amniotic fluid is mixed with 95% ethanol, shaken for 15 seconds, and allowed to sit undisturbed for 15 minutes. At the end of this time, the surface of the fluid is observed for the presence of a continuous line of bubbles around the outside edge.

The presence of bubbles indicates that a sufficient amount of phospholipid is available to reduce the surface tension of the fluid even in the presence of alcohol, an antifoaming agent.

372
Q

Increases the OD of the amniotic fluid at 650 nm:

AFP
Bilirubin
Lamellar bodies
Oxyhemoglobin

A

Lamellar bodies

OD 650 nm: LAMELLAR BODIES (FETAL LUNG MATURITY)
An OD of 0.150 has been shown to correlate well with an L/S ratio of greater than or equal to 2.0 and the presence of phosphatidyl glycerol.

373
Q

When severe HDN is present, which of the following tests on the amniotic fluid would the physician NOT ORDER to determine whether the fetal lungs are mature enough to withstand a premature delivery?

AFP levels
Foam stability index
Lecithin/sphingomyelin ratio
Phosphatidylglycerol detection

A

AFP levels

Neural tube defects (NTD) are one of the most common birth defects. It can be detected by maternal serum alpha-fetoprotein (MSAFP) blood test, high-resolution ultrasound, and amniocentesis. Increased levels of alpha-fetoprotein (AFP) in both the maternal circulation and the amniotic fluid can be indicative of fetal neural tube defects, such as anencephaly and spina bifida.

374
Q

True for SPUTUM:

Green in color
Secreted by the tracheobronchial tree
Healthy individual normally produce sputum
All of these

A

Secreted by the tracheobronchial tree

SPUTUM is the material secreted by the tracheobronchial tree and brought up by coughing. The healthy individual does not normally produce sputum.

375
Q

Formed elements in sputum are best studied by which CYTOLOGICAL techniques?

AFB stain
Gram’s stain
Pap’s stain
Wright’s stain

A

Pap’s stain

Pap’s stain: SPUTUM CYTOLOGY
Wright’s stain: DIFFERENTIATES NEUTROPHILS FROM EOSINOPHILS

376
Q

Which of the following may resemble MYELIN GLOBULE in sputum?

Blastomyces
Coccidioides
Cryptococcus
Histoplasma

A

Blastomyces

Myelin globules: little or no significance but may be mistaken for Blastomyces (yeastlike fungi). They are colorless, round, oval or pea-shaped of various sizes.

377
Q

Dense, crystalline concretions (may be large enough to be grossly visible) may be seen in sputum in:

Bronchial asthma
Broncholithiasis
Pneumonia
Tuberculosis

A

Broncholithiasis

378
Q

Which of the following stimulate the parietal cells to produce hydrochloric acid?

Gastrin
Intrinsic factor
Pepsin
Trypsin

A

Gastrin

379
Q

Gastric tube inserted through the mouth:
Gastric tube inserted through the nose:

Levin tube
Rehfuss tube

A

Rehfuss tube

Levin tube

The gastric juice is obtained by insertion of a gastric tube into the stomach
1. REHFUSS tube (introduced through the mouth)
2. LEVIN tube (inserted through the nose)
3. Disposable plastic tubes are usually employe

380
Q

Normal fasting gastric fluid appears:

Dark red-brown
Clear and pale yellow
Pale yellow with food particles
Pale gray and slightly mucoid

A

Pale gray and slightly mucoid

381
Q

What is the preferred gastric stimulant?

Histamine
Histalog
Insulin
Pentagastrin

A

Pentagastrin
resembles true gastrin.

382
Q

Hypoglycemia is induced with which of the following to test for the completeness of VAGOTOMY?

Histamine
Histalog
Insulin
Pentagastrin

A

Insulin

383
Q

The cell most frequently seen in bronchoalveolar lavage (BAL):

Macrophages
Lymphocytes
Neutrophils
Eosinophils

A

Macrophages

384
Q

In bronchoalveolar lavage (BAL), which cell type is elevated in CIGARETTE SMOKERS, and in cases of bronchopneumonia, toxin exposure, and diffuse alveolar damage:

Macrophages
Lymphocytes
Neutrophils
Eosinophils

A

Neutrophils

385
Q

Normal lymphocyte count in bronchoalveolar lavage (BAL):

Less than 1%
Less than 3%
1 to 15%
56 to 80%

A

1 to 15%

386
Q

The entire process of spermatogenesis takes approximately ___ days.

50 days
70 days
90 days
120 days

A

90 days

When spermatogenesis is complete, the immature sperm (nonmotile) enter the epididymis. In the epididymis, the sperm mature and develop flagella. The entire process takes approximately 90 days.

The sperm remain stored in the epididymis until ejaculation, at which time they are propelled through the ductus deferens (vas deferens) to the ejaculatory ducts.

387
Q

Produce most of the fluid present in semen (60%to 70%):

Testes and epididymis
Seminal vesicles
Prostate gland
Bulbourethral gland

A

Seminal vesicles

Semen is composed of four fractions that are contributed by the testes, epididymis, seminal vesicles, prostate gland, and bulbourethral glands.

The seminal vesicles produce most of the fluid present in semen (60% to 70%), and this fluid is the transport medium for the sperm.

388
Q

Produces milky acidic fluid containing high concentrations of acid phosphatase, citric acid, zinc, and proteolytic enzymes responsible for both the coagulation and liquefaction of the semen following ejaculation:

Testes and epididymis
Seminal vesciles
Prostate gland
Bulbourethral gland

A

Prostate gland

Approximately 20% to 30% of the semen volume is acidic fluid produced by the prostate gland. The milky acidic fluid contains high concentrations of acid phosphatase, citric acid, zinc, and proteolytic enzymes responsible for both the coagulation and liquefaction of the semen following ejaculation.

389
Q

Semen is collected following a period of sexual abstinence of at least___ days to not more than ___ days.

At least 1 day to not more than 3 days
At least 2 days to not more than 7 days
At least 5 days to not more than 7 days
At least 7 days to not more than 10 days

A

At least 2 days to not more than 7 days

Specimens are collected following a period of sexual abstinence of at least 2 days to not more than 7 days.

Specimens collected following prolonged abstinence tend to have higher volumes and decreased motility.

390
Q

Liquefaction of a semen specimen should take place within:

1 hour
2 hours
3 hours
4 hours

A

1 hour

A fresh semen specimen is clotted and should liquefy within 30 to 60 minutes after collection; therefore, recording the time of collection is essential for evaluating semen liquefaction.

Failure of liquefaction to occur within 60 minutes may be caused by a deficiency in prostatic enzymes and should be reported.

391
Q

If after 2 hours, the seminal fluid has not liquefied, which of the following may be added to induce liquefaction?

Dulbecco’s phosphate-buffered saline
Dulbecco’s phosphate-buffered saline and hyaluronidase
Dulbecco’s phosphate-buffered saline, alpha-chymotrypsin and bromelain
Alpha-chymotrypsin and bromelain

A

Dulbecco’s phosphate-buffered saline, alpha-chymotrypsin and bromelain

If after 2 hours the specimen has not liquified, an equal volume of physiologic Dulbecco’s phosphate-buffered saline or proteolytic enzymes such as alpha-chymotrypsin or bromelain may be added to induce liquefaction and allow the rest of the analysis to be performed.

392
Q

Normal seminal fluid volume

2 to 5 mL
3 to 10 mL
10 to 15 mL
15 mL to 20 mL

A

2 to 5 mL

Normal semen volume ranges between 2 and 5 mL. It can be measured by pouring the specimen into a clean graduated cylinder calibrated in 0.1-mL increments.

393
Q

Watery seminal fluid:

Viscosity grade of 0
Viscosity grade of 4

A

Viscosity grade of 0

Ratings of 0 (watery) to 4 (gel-like) can be assigned to the viscosity report.

394
Q

Gel-like seminal fluid:

Viscosity grade of 0
Viscosity grade of 4

A

Viscosity grade of 4

Ratings of 0 (watery) to 4 (gel-like) can be assigned to the viscosity report.

395
Q

Normal pH of semen:

pH of 2.0 to 4.0
pH of 4.5 to 8.0
pH of 7.4 to 7.5
pH of 7.2 to 8.0

A

pH of 7.2 to 8.0

The normal pH of semen is alkaline with a range of 7.2 to 8.0.

Increased pH indicates infection within the reproductive tract.

A decreased pH may be associated with increased prostatic fluid, ejaculatory duct obstruction, or poorly developed seminal vesicles.

396
Q

Increased pH of semen:

Increased prostatic fluid
Ejaculatory duct obstruction
Poorly developed seminal vesicles
Infection within the reproductive tract

A

Infection within the reproductive tract

The normal pH of semen is alkaline with a range of 7.2 to 8.0.

Increased pH indicates infection within the reproductive tract.

A decreased pH may be associated with increased prostatic fluid, ejaculatory duct obstruction, or poorly developed seminal vesicles.

397
Q

SPERM MOTILITY: slower speed, some lateral movement.

SPERM MOTILITY: no forward progression.

SPERM MOTILITY: slow forward progression, noticeable lateral movement

0
1.0
2.0
3.0
4.0
a
b
c
d

A

3.0
0
b

4.0 (a) Rapid, straight-line motility
3.0 (b) Slower speed, some lateral movement
2.0 (b) Slow forward progression, noticeable lateral movement
1.0 (c) No forward progression
0 (d) No movement

398
Q

Included in computer-assisted semen analysis (CASA):

Sperm velocity
Sperm velocity and trajectory
Sperm velocity, trajectory and morphology
Sperm velocity, trajectory, sperm concentration and morphology

A

Sperm velocity, trajectory, sperm concentration and morphology

399
Q

Location of the nucleus of sperm:

No nucleus
Head
Neckpiece
Midpiece
Tail

A

Head

400
Q

Critical to ovum penetration:

Acrosomal cap
Cell membrane
Mitochondria
Tail

A

Acrosomal cap

401
Q

The acrosomal cap should encompass approximately ___ of the head and cover approximately___ of the sperm nucleus.

Half of the head and covers half of the sperm nucleus
Half of the head and covers 2/3 of the sperm nucleus
Two-thirds of the head and covers half of the sperm nucleus
Two-thirds of the head and covers 2/3 of the sperm nucleus

A

Half of the head and covers 2/3 of the sperm nucleus

402
Q

It is surrounded by a mitochondrial sheath that produces the energy required by the tail for motility:

Head
Neckpiece
Midpiece
Flagellum

A

Midpiece

The midpiece is approximately 7.0 μm long and is the thickest part of the tail because it is surrounded by a mitochondrial sheath that produces the energy required by the tail for motility.

403
Q

Round cells that are of concern and may be included in sperm counts and morphology analysis are:

Leukocytes
Spermatids
RBCs
Leukocytes and spermatids

A

Leukocytes and spermatids

Immature sperm and WBCs, often referred to as “round” cells.

Only fully developed sperm should be counted. Immature sperm and WBCs, often referred to as “round” cells, must not be included. However, their presence can be significant, and they may need to be identified and counted separately. Stain included in the diluting fluid aids in differentiating between immature sperm cells (spermatids) and leukocytes, and they can be counted in the same manner as mature sperm.

A count greater than 1 million leukocytes per milliliter is associated with inflammation or infection of the reproductive organs that can lead to infertility.

The presence of more than 1 million spermatids per milliliter indicates disruption of spermatogenesis. This may be caused by viral infections, exposure to toxic chemicals, and genetic disorders.

404
Q

Living sperm cells in the eosin-nigrosin stain:

Green against a yellow background
Purple against a red background
Red against a purple background
Not infiltrated by the dye and remain bluish white

A

Not infiltrated by the dye and remain bluish white

Living cells are not infiltrated by the dye and remain bluish white, whereas dead cells stain red against the purple background.

Normal vitality requires 50% or more living cells and should correspond to the previously evaluated motility.

405
Q

Dead sperm cells in the eosin-nigrosin stain:
Green against a yellow background
Purple against a red background
Red against a purple background
Not infiltrated by the dye and remain bluish white

A

Red against a purple background

Living cells are not infiltrated by the dye and remain bluish white, whereas dead cells stain red against the purple background.

Normal vitality requires 50% or more living cells and should correspond to the previously evaluated motility.

406
Q

Seminal fluid specimens can be screened for the presence of fructose using the resorcinol test that produces an _____ color when fructose is present.

Black
Blue
Green
Orange

A

Orange

407
Q

Specimens for fructose levels should be tested within 2 hours of collection or _____ to prevent fructolysis.

Frozen
Incubated at 37C
Preserved with formalin
Refrigerated

A

Frozen

408
Q

Decreased sperm motility with clumping:

Decreased sperm vitality
Lack of seminal vesicle support medium
Female anti-sperm antibodies
Male anti-sperm antibodies

A

Male anti-sperm antibodies

The presence of antibodies in a male subject can be suspected when clumps of sperm are observed during a routine semen analysis. Sperm-agglutinating antibodies cause sperm to stick to each other in a head-to-head, head-to-tail, or tail to- tail pattern.1 The agglutination is graded as “few,” “moderate,” or “many” on microscopic examination.

Two frequently used tests to detect the presence of antibody-coated sperm are the mixed agglutination reaction (MAR) test and the immunobead test.

409
Q

A decreased neutral alpha-glucosidase suggests a disorder of the:

Epididymis
Seminal vesicles
Prostate gland
Bulbourethral gland

A

Epididymis

Just as decreased fructose levels are associated with a lack of seminal fluid, decreased neutral alpha-glucosidase, glycerophosphocholine, and L-carnitine suggest a disorder of the epididymis.

Decreased zinc, citric acid, glutamyl transpeptidase, and acid phosphatase indicate a lack of prostatic fluid. Spectrophotometric methods are used to quantitate citric acid and zinc.

410
Q

For post-vasectomy semen analysis, specimens are tested:

Beginning 1 month post-vasectomy and continuing until two consecutive monthly specimens show no sperm
Beginning 2 months post-vasectomy and continuing until two consecutive monthly specimens show no sperm
Beginning 3 months post-vasectomy and continuing until two consecutive monthly specimens show no sperm
Beginning 3 months post-vasectomy and continuing until three consecutive monthly specimens show no sperm

A

Beginning 2 months post-vasectomy and continuing until two consecutive monthly specimens show no sperm

411
Q

Before testing, very viscous synovial fluid should be treated with:

Normal saline
Hyaluronidase
Distilled water
Hypotonic saline

A

Hyaluronidase

Very viscous fluid may need to be pretreated by adding one drop of 0.05% hyaluronidase in phosphate buffer per milliliter of fluid and incubating at 37°C for 5 minutes.

412
Q

Normal volume of synovial fluid:

Less than 1.5 mL
Less than 3.5 mL
Less than 7.5 mL
Less than 10.5 mL

A

Less than 3.5 mL

413
Q

A synovial fluid string measuring _____ is considered normal.

0.5 to 1 cm string
1 to 2 cm string
2 to 4 cm string
4 to 6 cm string

A

4 to 6 cm string

414
Q

ROPE’S (MUCIN CLOT) TEST: when added to a solution of 2% to5% acetic acid, normal synovial fluid forms:

No clot
Friable clot
Soft clot
Solid clot

A

Solid clot

Good (solid clot)
Fair (soft clot)
Low (friable clot)
Poor (no clot)

415
Q

Normal synovial fluid WBC count:

Less than 200 cells/uL
Less than 400 cells/uL
Less than 1,000 cells/uL
Less than 2,000 cells/uL

A

Less than 200 cells/uL

RBC COUNT: LESS THAN 2,000 cells/uL
WBC COUNT: LESS THAN 200 cells/uL

SYNOVIAL FLUID WBC COUNT:
WBC counts less than 200 cells/uL are considered normal and may reach 100,000 cells/uL or higher in severe infections.

416
Q

Joint disorder with WBC count of 800/uL:

Group I, non-inflammatory
Group II, inflammatory
Group III, septic
Group IV, hemorrhagic
Normal synovial fluid WBC count

A

Group I, non-inflammatory

SYNOVIAL FLUID WBC COUNT
Normal: less than 200 cells/uL
Noninflammatory: less than 1, 000 cells/uL
Immunologic: 2,000 to 75,000 cells/uL
Crystal-induced: up to 100,000 cells/uL
Septic: 50,000 to 100,000 cells/uL
Hemorrhagic: WBCs equal to blood

417
Q

When diluting a synovial fluid WBC count, all of the following are acceptable except:

Acetic acid
Isotonic saline
Hypotonic saline
Saline with saponin

A

Acetic acid

SYNOVIAL FLUID + ACETIC ACID = CLOT FORMATION
Traditional WBC diluting fluid cannot be used because it contains acetic acid that causes the formation of mucin clots.

If it is necessary to lyse the RBCs, hypotonic saline (0.3%) or saline that contains saponin is a suitable diluent. Methylene blue added to the normal saline stains the WBC nuclei, permitting separation of the RBCs and WBCs during counts performed on mixed specimens.

418
Q

Vacuolated macrophage with ingested neutrophils:

LE cell
Ragocyte
Reiter cell
Rice bodies

A

Reiter cell

419
Q

Neutrophil with dark cytoplasmic granules containing immune complexes:

LE cell
Ragocyte
Reiter cell
Rice bodies

A

Ragocyte

420
Q

Synovial fluid crystals found in cases of gout:

Calcium phosphate (apatite)
Calcium pyrophosphate
Calcium oxalate
Monosodium urate

A

Monosodium urate

Increased serum uric acid resulting from impaired metabolism of purines; increased consumption of high-purine-content foods, alcohol, and fructose; chemotherapy treatment of leukemias; and decreased renal excretion of uric acid are the most frequent causes of gout.

421
Q

Synovial fluid crystals found in cases of pseudogout:

Calcium phosphate (apatite)
Calcium pyrophosphate
Calcium oxalate
Monosodium urate

A

Calcium pyrophosphate

Pseudogout is most often associated with degenerative arthritis, producing cartilage calcification and endocrine disorders that produce elevated serum calcium levels.

422
Q

Synovial fluid crystals found in cases of osteoarthritis:

Calcium phosphate (apatite)
Calcium pyrophosphate
Calcium oxalate
Monosodium urate

A

Calcium phosphate (apatite)

423
Q

Shape of calcium pyrophosphate crystals in synovial fluid:

Envelopes
Flat, variable-shaped plates
Needles
Rhomboid square, rods

A

Rhomboid square, rods

424
Q

Most frequently requested test in synovial fluid:

Gram stain and culture
Glucose
Protein
Uric acid

A

Glucose

The most frequently requested test is the glucose determination, because markedly decreased glucose values indicate inflammatory (group II) or septic (group III) disorders.

425
Q

Required tube for synovial fluid glucose analysis:

Sterile heparinized
Nonanticoagulated
Tube with liquid EDTA
Tube with sodium fluoride

A

Tube with sodium fluoride

Sterile heparinized or SPS: Gram stain and culture
Liquid EDTA or heparin: cell counts
Sodium fluoride: glucose analysis
Non-anticoagulated: all other tests

426
Q

Serous fluid for pH determination must be:

Maintained aerobically and incubated at 37C
Maintained anaerobically and incubated at 37C
Maintained aerobically in ice
Maintained anaerobically in ice

A

Maintained anaerobically in ice

427
Q

Fluid: serum protein and lactic dehydrogenase ratios are performed on serous fluids:

When malignancy is suspected
To classify transudates and exudates
To determine the type of serous fluid
When a traumatic tap has occurred

A

To classify transudates and exudates

Traditionally, a variety of laboratory tests have been used to differentiate between transudates and exudates, including appearance, total protein, lactic dehydrogenase, cell counts, and spontaneous clotting.

However, the most reliable differentiation is usually obtained by determining the fluid: blood ratios for protein and lactic dehydrogenase.

428
Q

If the blood is from a HEMOTHORAX, the fluid hematocrit is ______ of the whole blood hematocrit.

Less than 20% of the whole blood hematocrit
More than 20% of the whole blood hematocrit
Less than 50% of the whole blood hematcrit
More than 50% of the whole blood hematocrit

A

More than 50% of the whole blood hematocrit

429
Q

These cells are increased in pleural effusions resulting from pancreatitis and pulmonary infarction:

Mesothelial cells
Neutrophils
Lymphocytes
Plasma cells

A

Neutrophils

Similar to other body fluids, an increase in pleural fluid neutrophils indicates a bacterial infection, such as pneumonia.

Neutrophils are also increased in effusions resulting from pancreatitis and pulmonary infarction.

430
Q

Adenosine deaminase (ADA) levels higher than 40 U/L are highly indicative of:

Chylous effusion
Pancreatitis
Tuberculosis
Rheumatoid inflammation

A

Tuberculosis

ADENOSINE DEAMINASE (ADA)
ADA levels higher than 40 U/L are highly indicative of tuberculosis. They are also frequently elevated with malignancy.

431
Q

The recommended test for determining whether peritoneal fluid is a transudate or an exudate is the:

Fluid:serum albumin ratio
Serum ascites albumin gradient
Fluid:serum lactic dehydrogenase ratio
Absolute neutrophil count

A

Serum ascites albumin gradient

Differentiation between ascitic fluid transudates and exudates is more difficult than for pleural and pericardial effusions. The serum-ascites albumin gradient (SAAG) is recommended over the fluid:serum total protein and LD ratios to detect transudates of hepatic origin.

Fluid and serum albumin levels are measured concurrently, and the fluid albumin level is then subtracted from the serum albumin level. A difference (gradient) of 1.1 or greater suggests a transudate effusion of hepatic origin, and lower gradients are associated with exudative effusions.

432
Q

Elements containing concentric striations of collagen-like material and can be seen in benign conditions and are also associated with ovarian and thyroid malignancies:

Lipophages
Macrophages
Mesothelial cells
Psammoma bodies

A

Psammoma bodies

433
Q

Detection of the CA 125 tumor marker in peritoneal fluid indicates:

Colon cancer
Ovarian cancer
Gastric malignancy
Prostate cancer

A

Ovarian cancer

The presence of CA 125 antigen with a negative CEA suggests the source is from the ovaries, fallopian tubes, or endometrium.

434
Q

The brown color of feces is due to:

Urochrome
Uroeythrin
Urobilinogen
Urobilin

A

Urobilin

The brown color of the feces results from intestinal oxidation of stercobilinogen to urobilin.

435
Q

Blood that originates from the esophagus, stomach, or duodenum takes approximately ___ day(s) to appear in the stool.

Approximately 1 day to appear in stool
Approximately 3 days to appear in stool
Approximately 7 days to appear in stool
Approximately 10 days to appear in stool

A

Approximately 3 days to appear in stool

436
Q

Bulky and frothy stool:

Upper GI bleeding
Lower GI bleeding
Barium sulfate
Pancreatic disorders

A

Pancreatic disorders

437
Q

Black stool:

Barium sulfate
Bile duct obstruction
Beets and food coloring
Bismuth (antacid), iron therapy

A

Bismuth (antacid), iron therapy

438
Q

Microscopic examination reveals presence of fecal WBCs EXCEPT in diarrhea caused by:

Enteroinvasive E. coli (EIEC)
Salmonella, Shigella
Staphylococcos aureus, Vibrio spp.
Yersinia, Campylobacter

A

Staphylococcos aureus, Vibrio spp.

Microscopic screening is performed as a preliminary test to determine whether diarrhea is being caused by invasive bacterial pathogens including Salmonella, Shigella, Campylobacter, Yersinia, and enteroinvasive E. coli.

Bacteria that cause diarrhea by toxin production, such as Staphylococcus aureus and Vibrio spp., viruses, and parasites usually do not cause the appearance of fecal leukocytes.

439
Q

By far the most frequently performed fecal analysis is the detection of:

Carbohydrates
Fats
Occult blood
pH

A

Occult blood

440
Q

Reagent for the APT test:

1% NaOH
10% NaOH
70% ethanol
95% ethanol

A

1% NaOH

APT Test (Fetal Hemoglobin)
The material to be tested is emulsified in water to release hemoglobin (Hb) and, after centrifugation, 1% sodium hydroxide is added to the pink hemoglobin-containing supernatant.

In the presence of alkali-resistant fetal hemoglobin, the solution remains pink (HbF), whereas denaturation of the maternal hemoglobin (HbA) produces a yellow-brown supernatant after standing for 2 minutes.

441
Q

Normal stool pH:

Between pH 4 and 5
Between pH 5 and 6
Between pH 7 and 8
Between pH 8 and 9

A

Between pH 7 and 8

Normal stool pH is between 7 and 8; however, increased use of carbohydrates by intestinal bacterial fermentation increases the lactic acid level and lowers the pH to below 5.5 in cases of carbohydrate disorders.

442
Q

Which of the following is the urine specimen of choice for cytology studies?
a. First morning specimen
b. Random specimen
c. Midstream “clean catch” collection
d. Timed collection

A

B

Random urine is ideal for cytology studies

With prior hydration of the patient, a random “clean catch” urine specimen is ideal for cytology studies

443
Q

Which of the following can be mistaken as myelin globules in sputum?
a. Blastomyces
b. Cryptococcus
c. Histoplasma
d. Candida

A

A

444
Q

Which of the following may resemble lymphocytes in CSF?
a. Blastomyces
b. Cryptococcus
c. Histoplasma
d. Candida

A

B

445
Q

Larva in sputum:
a. Ascaris
b. Paragonimus
c. Both of these
d. None of these

A

A

Paragonium = Ova
Ascaris = Heart to lung migration = “ASH”

446
Q

Ova in sputum
a. Ascaris
b. Paragonimus
c. Both of these
d. None of these

A

B

Paragonium = Ova
Ascaris = Heart to lung migration = “ASH”

447
Q

Formed elements in sputum are best studied by which CYTOLOGICAL technique?
a. Gram stain
b. Giemsa stain
c. Wright’s stain
d. Pap’s stain

A

D.

Stained
1. Neoplastic cells
2. Bacteria
C. Leukocytes, epithelial cells

Pap’s stain = sputum cytology
Wright’s stain = differentiates neutrophils from eosinophils

448
Q

Fluid: serum protein and lactic dehydrogenase ratios are performed on serous fluids:
a. When malignancy is suspected
b. To classify transudates and exudates
c. To determine the type of serous fluid
d. When a traumatic tap has occurred

A

B

449
Q

The recommended test for determining whether PERITONEAL is a transudate or an exudate is the:
a. Fluid: serum albumin ratio
b. Serum: ascites albumin gradient
c. Fluid: serum lactic dehydrogenase ratio
d. Absolute neutrophil count

A

B

450
Q

Which type of urine sample is needed for a D-xylose absorption test on an adult patient?
a. 24-hour urine sample collected with 20ml of 6N 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

A

C

D-xylose test requires a blood sample taken 5 hours after oral administration of 25 grams of D -xylose, and a 5-hour time urine sample

Differential diagnosis of malabsorption

If <3 grams = enterogenous malabsorption because pancreatic enzymes are not required for absorption of D-xylose

451
Q

Urine SG by URINOMETER = 1.032
Urine temp = 26C
Glucose = 2g/dL

a. 1.022
b. 1.024
c. 1.026
d. 1.028

A

C

26C - 20C = 6C
6C/ 3C = 2
2 X 0.001 = 0.002
1.032 + 0.002 = 1.034
1.034 - [(2)(0.004)] = 1.026

452
Q

iQ 200 preclassifies (autoclassified by the analyzer) the following urine particles EXCEPT:
a. Nonsquamous epithelial cells
b. Unclassified casts
c. Bacteria
d. Uric acid crystals

A

D

453
Q

When performing a sperm concentration, 60 sperms are counted in the RBC squares on one side of the hemocytometer and 90 sperms are counted in the RBC squares on the other side. The specimen is diluted 1:20. The:

a. Specimen should be rediluted and counted
b. Sperm count is 75 million/ml
c. Sperm count is greater than 5 million/mL
d. Sperm concentration is abnormal

A

A

454
Q

Which of the following substances will cause urine to produce red fluorescence when examined with an ultraviolet lamp (360nm)?
a. Myoglobin
b. Porphobilinogen (PBG)
c. Urobilin
d. Coproporphyrin

A

D

Produce red fluorescence = Uro, Copro, Proto

455
Q

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

A

B

456
Q

Urinary preservative that can be used for albumin

A

Boric acid

457
Q

Major organic substance in urine
Major inroganic substance in urine

A

Urea
Chloride

458
Q

Rotting fish odor
Fruity odor
Swimming pool odor
Odorless

A

Trimethylaminuria (galunggong)
Acetone/ Ketone
Hawkinsinuria
Acute tubular necrosis

459
Q

What is equivalent to 1+ grading in reagent strip for protein?

A

30mg

+ = 30mg
++ = 100mg
+++ = 300mg
++++ = 2000 or more mg

460
Q
  1. Albumin-creatinine ratio correlates with
  2. To convert a bright field microscope ____ are needed
  3. A bright field microscope is easily adapted for dark field microscopy by replacing the ____ with a ____ that contains an ______
A
  1. Microalbumin levels
  2. 2 filters
  3. condenser; dark field condenser; opaque disk
461
Q
  1. Simple stain used to enhance nuclear details of epithelial cells in urine
  2. aka Modified Sternheimer Malbin stain; not a simple stain
A
  1. Methylene Blue
  2. Kova’s stain
462
Q

What is the most common urinary crystal found in alkaline urine?

A

Triple phosphate/ struvite

463
Q

Emotional imbalance is related to the finding of abnormal serotonin levels. This is due to the abnormal metabolism of this essential amino acid

A

Tryptophan

464
Q

Urine samples for pregnancy testing should have a specific gravity of at least ______

A

1.015 or higher

465
Q

What is the principle of lamellar body count?

A

Platelet channel of automated hematology analyzer using either OPTICAL or IMPEDANCE method for counting

466
Q

Meninges (lines the brain and spinal cord)
1. Lines the skull and vertebral canal
2. Filamentous inner membrane
3. Lines the surface of the brain and spinal cord

A

‘DAS’
1. Outer - DURA MATER
2. Spider web-like - ARACHNOID MATER
3. Inner - PIA MATER

Subarachnoid space - where the CSF flows

467
Q

Agents of Bacterial Meningitis
1. Birth to 1 month
2. 1 month - 5 years
3. 5 - 24 years
4. > 24 years
5. Infant, Old, Immunocompromised

A
  1. S. agalactiae
  2. H. influenzae
  3. N. meningitidis
  4. S. pneumoniae
  5. L. monocytogenes
468
Q
  1. Mineral fibers encrusted with Ferroproteins seen in Asbestos
  2. Most predomniant cell in BAL
  3. Purpose of Histamine chemicals stimulant in gastric fluid
A
  1. Ferruginous bodies
  2. Macrophage
  3. Induce gastric fluid secretion
469
Q

What is the purpose of flaming wired loops?
A. To prevent cross contamination
B. To sterilize

A

B. To sterilize

It is beneficial to flame the inoculating loop between streaks to each area on the agar surface; avoids over inoculation; ensures individual colonies

470
Q

A specimen positive for Hepatitis A virus spilled. What is the proper disinfectant?
a. Quaternary ammonium compound
b. 90% ethanol
c. Soap and water
d. Hypochlorite

A

D. Hypochlorite - Fresh solution daily

Routinely: 1 minute (60 secs)
HBV: 10 minutes
HIV: 2 minutes

471
Q

Amoeba that can survive harsh environments like chlorinated water but is killed at 70 degrees celsius (both)
a. Naegleria fowleri
b. Acanthamoeba

A

B. Acanthamoeba

Both Naegleria and Acanthamoeba can survive hot temperatures up to 60 to 65 degrees Celsius

472
Q

Sealed bucket centrifuge containing liquid culture media should be unloaded in:
a. Fume hood
b. Biosafety cabinet
c. Disinfected bench tops
d. Standard bench tops

A

B. Biosafety cabinet

473
Q

BSC
1. 70% air is recirculated
2. No recirculation
3. Vertical Laminar flow
4. Routinely used
5. For COVID 19

A
  1. Class IIA
  2. Class IIB2
  3. Class II
  4. Class IIA
  5. Class IIA+

03-2023 (14 decks)

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