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CM Flashcards

1
Q

CHECK 4 BOXES: Variables in the Cockroft and Gault formula.

Urine ceatinine
Serum creatinine
Age
Race
Gender
Body weight in kilograms
BUN
Albumin

A

Serum creatinine
Age
Gender
Body weight in kilograms

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2
Q

CHECK 6 BOXES: Variables in the MODIFICATION OF DIET IN RENAL DISEASE (MDRD) formula.

Urine ceatinine
Serum creatinine
Age
Race
Gender
Body weight in kilograms
BUN
Albumin

A

Serum creatinine
Age
Race
Gender
BUN
Albumin

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3
Q

In the urinalysis laboratory the primary source in the chain of infection would be:

Patients
Needlesticks
Specimens
Biohardous wastes

A

Specimens

In the clinical laboratory, the most direct contact with a source of infection is through contact with patient specimens, although contact with patients and infected objects also occurs.

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4
Q

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

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

A

Urine specimen containers

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5
Q

An acceptable disinfectant for blood and body fluid decontamination is:

Sodium hydroxide
Antimicrobial soap
Hydrogen peroxide
Sodium hypochlorite

A

Sodium hypochlorite

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6
Q

Centrifuging an uncapped specimen may produce a biologic hazard in the form of:

Vectors
Sharps contamination
Aerosols
Specimen contamination

A

Aerosols

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7
Q

The first thing to do when a fire is discovered is to:

Rescue person in danger
Activate the alarm system
Close doors to other areas
Extinguish the fire if possible

A

Rescue person in danger

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8
Q

If a red rash is observed after removing gloves, the employee:

May be washing her hands too often
May have developed a latex allergy
Should apply cortisone cream
Should not rub the hands so vigorously

A

May have developed a latex allergy

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9
Q

The classification of a fire that can be extinguished with water is:

Class A
Class B
Class C
Class D

A

Class A

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10
Q

Employers are required to provide free immunization for:

HIV
HTLV-1
HBV
HCV

A

HBV

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11
Q

The current routine infection control policy developed by CDC and followed in all health-care settings is:

Universal precautions
Isolation precautions
Blood and body fluid precautions
Standard precations

A

Standard precations

In 1987 the CDC instituted Universal Precautions (UP). Under UP all patients are considered to be possible carriers of bloodborne pathogens.

In 1996 the CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC) combined the major features of UP and blood safety isolation (BSI) guidelines and called the new guidelines Standard Precautions.

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12
Q

Which of the following would be least affected in a specimen that has remained unpreserved at room temperature for more than 2 hours?

Urobilinogen
Ketones
Protein
Nitrite

A

Protein

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13
Q

Which of the tubules is impermeable to water?

Proximal convoluted tubule
Descending loop of Henle
Ascending loop of Henle
Distal convoluted tubule

A

Ascending loop of Henle

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14
Q

Decreased production of ADH: (two possible answers)

Produces a large volume of urine
Produces high urine volume
Increases ammonia excretion
Affects active transport of sodium

A

Produces a large volume of urine

Two possible answers:
In diabetes insipidus: deficiency of ADH
High or large urine volume
Decreased urine specific gravity

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15
Q

The largest source of error in creatinine clearance tests is:

Secretion of creatinine
Improperly timed urine specimens
Refrigeration of the urine
Time of collecting blood sample

A

Improperly timed urine specimens

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16
Q

Variables that are included in the MDRD-IDSM estimated creatinine clearance calculations include all of the following except:

Serum creatinine
Weight
Age
Gender

A

Weight

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17
Q

A patient with a viscous orange specimen may have been:

Treated for urinary tract infection
Taking vitamin B
Eating fresh carrots
Taking antidepressants

A

Treated for urinary tract infection

Phenazopyridine (Pyridium)
Drug commonly administered for urinary tract infections

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18
Q

Orange in alkaline urine, colorless in acid urine.

Phenazopyridine (Pyridium)
Phenindione
Methyldopa
Metronidazole (Flagyl)

A

Phenindione

PHENINDIONE
Anticoagulant, orange in alkaline urine, colorless in acid urine

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19
Q

The principle of refractive index is to compare:

Light velocity in solutions with light velocity in solids
Light velocity in air with light velocity in solutions
Light scattering by air with light scattering by solutions
Light scattering by particles in solution

A

Light velocity in air with light velocity in solutions

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20
Q

A specimen with a specific gravity of 1.001 would be considered:

Hyposthenuric
Not urine
Hypersthenuric
Isosthenuric

A

Not urine

Specimens measuring lower than 1.002 probably are not urine.
Most random specimens fall between 1.015 and 1.030.

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21
Q

Leaving excess urine on the reagent strip after removing it from the specimen will:

Cause run-over between reagent pads
Alter the color of the specimen
Cause reagents to leach from the pads
Not affect the chemical reactions

A

Cause run-over between reagent pads

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22
Q

Testing a refrigerated specimen that has not warmed to room temperature will adversely affect:

Enzymatic reactions
Dye-binding reactions
Sodium nitroprusside reaction
Diazo reactions

A

Enzymatic reactions

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23
Q

Quality control of reagent strips is performed:

Using positive and negative controls
When results are questionable
At least once every 24 hours
All of the above

A

All of the above

Quality Control: REAGENT STRIP TESTING
1. Test open bottles of reagent strips with known positive and negative controls every 24 hours.
2. Resolve control results that are out of range by further testing.
3. Test reagents used in backup tests with positive and negative controls.
4. Perform positive and negative controls on new reagents and newly opened bottles of reagent strips.
5. Record all control results and reagent lot numbers.

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24
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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25
Q

A urine specimen with a pH of 9.0:

Indicates metabolic acidosis
Should be recollected
May contain calcium oxalate crystals
Is seen after drinking cranberry juice

A

Should be recollected

A pH above 8.5 is associated with an improperly preserved specimen and indicates that a fresh specimen should be obtained to ensure the validity of the analysis.

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26
Q

The principle of the protein error of indicators reaction is that:

Protein keeps the pH of the urine constant
Albumin accepts hydrogen ions from the indicator
Indicator accepts hydrogen ions from albumin
Albumin changes the pH of the urine

A

Albumin accepts hydrogen ions from the indicator

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27
Q

Testing for microalbuminuria is valuable for early detection of kidney disease and monitoring patients with:

Hypertension
Diabetes mellitus
Cardiovascular disease risk
All of the above

A

All of the above

Microalbuminuria
The development of diabetic nephropathy leading to reduced glomerular filtration and eventual renal failure is a common occurrence in persons with both type 1 and type 2 diabetes mellitus. Onset of renal complications can first be predicted by detection of microalbuminuria, and the progression of renal disease can be prevented through better stabilization of blood glucose levels and control of hypertension. The presence of microalbuminuria is also associated with an increased risk of cardiovascular disease.

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28
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

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29
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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30
Q

An elevated urine bilirubin with a normal urobilinogen is indicative of:

Cirrhosis
Hemolytic disease
Hepatitis
Biliary obstruction

A

Biliary obstruction

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31
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

Possible bacterial contamination

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32
Q

Initial screening of the urine sediment is performed using an objective power of:

4x
10x
40x
100x

A

10x LPO

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33
Q

Crenated RBCs are seen in urine that is:

Hyposthenuric
Hypersthenuric
Highly acidic
Highly alkaline

A

Hypersthenuric

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34
Q

Differentiation among RBCs, yeast, and oil droplets maybe accomplished by all of the following except:

Observation of budding in yeast cells
Increased refractility of oil droplets
Lysis of yeast cells by acetic acid
Lysis of RBCs by acetic acid

A

Lysis of yeast cells by acetic acid

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35
Q

When pyuria is detected in a urine sediment, the slide should be carefully checked for the presence of:

RBCs
Bacteria
Hyaline casts
Mucus

A

Bacteria

An increase in urinary WBCs is called pyuria and indicates the presence of an infection or inflammation in the genitourinary system.

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36
Q

The largest cells in the urine sediment are:

Squamous epithelial cells
Urothelial epithelial cells
Cuboidal epithelial cells
Columnar epithelial cells

A

Squamous epithelial cells

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37
Q

Following an episode of hemoglobinuria, RTE cells may contain:

Bilirubin
Hemosiderin granules
Porphobilinogen
Myoglobin

A

Hemosiderin granules

Following episodes of hemoglobinuria (transfusion reactions, paroxysmal nocturnal hemoglobinuria, etc.), the RTE cells may contain the characteristic yellow-brown hemosiderin granules. The granules may also be seen free-floating in the urine sediment.

Confirmation of the presence of hemosiderin is performed by staining the urine sediment with Prussian blue.

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38
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:

Contains cholesterol
Is not an oval fat body
Contains neutral fats
Is contaminated with immersion oil

A

Contains cholesterol

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39
Q

The finding of yeast cells in the urine is commonly associated with:

Cystitis
Diabetes mellitus
Pyelonephritis
Liver disorders

A

Diabetes mellitus

Yeast cells, primarily Candida albicans, are seen in the urine of diabetic patients, immunocompromised patients, and women with vaginal moniliasis. The acidic, glucose-containing urine of patients with diabetes provides an ideal medium for the growth of yeast.

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40
Q

All of the following contribute to urinary crystals formation except:

Protein concentration
pH
Solute concentration
Temperature

A

Protein concentration

Crystals are formed by the precipitation of urine solutes, including inorganic salts, organic compounds, and medications (iatrogenic compounds). Precipitation is subject to changes in temperature, solute concentration, and pH, which affect solubility.

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41
Q

Casts and fibers can usually be differentiated using:

Solubility characteristics
Patient history
Polarized light
Fluorescent light

A

Polarized light

Examination under polarized light can frequently differentiate between fibers and casts. Fibers often polarize, whereas casts, other than fatty casts, do not polarize.

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42
Q

Three-dimensional images:

Bright-field microscope
Phase contrast microcope
Interference contrast microscope
Fluorescent microscope

A

Interference contrast microscope

Interference-contrast microscopy provides a three-dimensional image showing very fine structural detail by splitting the light ray so that the beams pass through different areas of the specimen.

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43
Q

Anti-neutrophilic cytoplasmic antibody is diagnostic for:

IgA nephropathy
Wegener granulomatosis
Henoch-Schönlein purpura
Goodpasture syndrome

A

Wegener granulomatosis

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44
Q

The only protein produced by the kidney is:

Albumin
Uromodulin
Uroprotein
Globulin

A

Uromodulin

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45
Q

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

Acute interstitial nephritis
Chronic glomerulonephritis
Minimal change disease
Acute tubular necrosis

A

Acute tubular necrosis

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46
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

Urine specimens from patients suspected of passing or being in the process of passing renal calculi are frequently received in the laboratory. The presence of microscopic hematuria resulting from irritation to the tissues by the moving calculus is the primary urinalysis finding.

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47
Q

False-positive levels of 5-HIAA can be caused by a diet high in:

Meat
Carbohydrates
Starch
Bananas

A

Bananas

Patients must be given explicit dietary instructions before collecting any sample to be tested for 5-HIAA, because serotonin is a major constituent of foods such as bananas, pineapples, and tomatoes.

Medications, including phenothiazines and acetanilids, also interfere with results. Patients should be directed to withhold medications for 72 hours before specimen collection.

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48
Q

Which type of urine sample is needed for a D-xylose absorption test on an adult patient?

24-hour urine sample collected with 20 mL of 6N HCl
2-hour timed postprandial urine preserved with boric acid
5-hour timed urine kept under refrigeration
Random urine preserved with formalin

A

5-hour timed urine kept under refrigeration

The D-xylose absorption test is used to distinguish pancreatic insufficiency from intestinal malabsorption.

The test requires a blood sample taken 2 hours after oral administration of 25 g of D-xylose, and a 5-hour timed urine sample.

D-xylose is absorbed without the aid of pancreatic enzymes, and is not metabolized by the liver. Therefore, deficient absorption (denoted by a plasma level < 25 mg/dL and urine excretion of < 4g/5hours) points to malabsorption syndrome.

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49
Q

In automated microscopy, Sysmex UF series, the DNA within the cells is stained by the orange dye:

Carbocyanine
Phenathridine
Eosin
Bromcresol green

A

Phenathridine

The DNA within the cells is stained by the orange dye, phenathridine; the nuclear membranes, mitochondria, and negatively charged cell membranes are stained with a green dye, carbocyanine.

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50
Q

In automated microscopy, Sysmex UF series, the nuclear membranes, mitochondria, and negatively charged cell membranes are stained with a green dye:

Carbocyanine
Phenathridine
Eosin
Bromcresol green

A

Carbocyanine

The DNA within the cells is stained by the orange dye, phenathridine; the nuclear membranes, mitochondria, and negatively charged cell membranes are stained with a green dye, carbocyanine.

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51
Q

The UF-100 and UF-50 use laser-based flow cytometry along with:

Impedance detection
Imedance detection and forward light scatter
Impedance detection and fluorescence
Impedance detection and forward light scatter
Impedance detection, forward light scatter and fluorescence

A

Impedance detection, forward light scatter and fluorescence

The UF-100 and UF-50 use laser-based flow cytometry along with impedance detection, forward light scatter, and fluorescence to identify the individual characteristics and stained urine sediment particles in a flowing stream.

52
Q

Graphic display of size distribution of any small sediment particles (ranging from 1 to 6 um2) found during the microscopic examination; helps to decide whether bacteria are present in these small ranges or if the detected particles are small crystals or amorphous.

Near-infrared reflectance spectroscopy
Reflectance photomtery
Small-particle histogram
Mass gravity meter

A

Small-particle histogram

IRIS SLIDELESS MICROSCOPE
Small particle histograms are graphic display of size distribution of f any small sediment particles (ranging from 1 to 6 um2) found during the microscopic examination. The histograms help to decide whether bacteria are present in these small ranges or if the detected particles are small crystals or amorphous.

53
Q

The functions of the CSF include all of the following except:

Removing metabolic wastes
Producing an ultrafiltrate of plasma
Supplying nutrients to the CNS
Protecting the brain and spinal cord

A

Producing an ultrafiltrate of plasma

54
Q

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

Hematology
Chemistry
Microbiology
Serology

A

Hematology

55
Q

The presence of xanthochromia can be caused by all of the following except:

Immature liver function
RBC degradation
A recent hemorrhage
Elevated CSF protein

A

A recent hemorrhage

56
Q

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

Tubercular meningitis
Multiple sclerosis
Primary CNS malignancy
Viral meningitis

A

Tubercular meningitis

57
Q

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.

58
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.

59
Q

A total CSF cell count on a clear fluid should be:

Reported as normal
Not reported
Diluted with normal saline
Counted undiluted

A

Counted undiluted

Clear specimens may be counted undiluted, provided no overlapping of cells is seen during the microscopic examination. When dilutions are required, calibrated automatic pipettes, not mouth pipetting, are used.

60
Q

The purpose of adding 30% albumin to CSF before cytocentrifugation is to:

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

A

Increase cell yield and decrease cellular distortion

As little as 0.1 mL of CSF combined with one drop of 30% albumin produces an adequate cell yield when processed with the cytocentrifuge. Adding albumin increases the cell yield and decreases the cellular distortion frequently seen on cytocentrifuged specimens.

61
Q

Neutrophils with pyknotic nuclei may be mistaken for:

Lymphocytes
Nucleated RBCs
Malignant cells
Spindle-shaped cells

A

Nucleated RBCs

Neutrophils with pyknotic nuclei indicate degenerating cells. They may resemble nucleated red blood cells (NRBCs) but usually have multiple nuclei.

62
Q

Macrophages appear in the CSF after:

Hemorrhage
Repeated spinal taps
Diagnostic procedures
All of the above

A

All of the above

The purpose of macrophages in the CSF is to remove cellular debris and foreign objects such as RBCs. Macrophages appear within 2 to 4 hours after RBCs enter the CSF and are frequently seen following repeated taps. They tend to have more cytoplasm than monocytes in the peripheral blood (PB). The finding of increased macrophages indicates a previous hemorrhage.

63
Q

Nucleated RBCs are seen in the CSF as a result of:

Elevated blood RBCs
Treatment of anemia
Severe hemorrhage
Bone marrow contamination

A

Bone marrow contamination

NRBCs are seen as a result of bone marrow contamination during the spinal tap. This is found in approximately 1% of specimens. Capillary structures and endothelial cells may be seen following a traumatic tap.

64
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

65
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.

66
Q

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

Meningitis
Multiple sclerosis
Fluid leakage
CNS malignancy

A

Fluid leakage

67
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

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.

68
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

Reye syndrome
Acute encephalopathy and liver infiltration seen in children following viral infections

69
Q

Determining CSF ________ provides an indirect test for the presence of excess ammonia in the CSF.

Alpha-ketoglutarate
Glucose
Glutamine
Lactate

A

Glutamine

Determining CSF glutamine provides an indirect test for the presence of excess ammonia in the CSF.

The normal concentration of glutamine in the CSF is 8 to 18 mg/dL.

70
Q

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

Filtered
Warmed to 37C
Centrifuged
Mixed

A

Centrifuged

The Gram stain is routinely performed on CSF from all suspected cases of meningitis, although its value lies in detecting bacterial and fungal organisms. 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. Use of the cytocentrifuge provides a highly concentrated specimen for Gram stains.

71
Q

Particular attention should be paid to the Gram stain for the CLASSIC STARBURST PATTERN produced by:

Hemophilus influenzae
Neisseria meninigitidis
Cryptococcus neoformans
Coccidioides immitis

A

Cryptococcus neoformans

72
Q

Maturation of spermatozoa takes place in the:

Sertoli cells
Seminiferous tubules
Epidiymis
Seminal vesicles

A

Epidiymis

73
Q

Enzymes for the coagulation and liquefaction of semen are produced by the:

Seminal vesicles
Bulbourethral glands
Ductus deferens
Prostate gland

A

Prostate gland

74
Q

If the first portion of a semen specimen is not collected, the semen analysis will have which of the following?

Decreased pH
Increased viscosity
Decreased sperm count
Decreased sperm motility

A

Decreased sperm count

When a part of the first portion of the ejaculate is missing, the sperm count will be decreased, the pH falsely increased, and the specimen will not liquefy.

When part of the last portion of ejaculate is missing, the semen volume is decreased, the sperm count is falsely increased, the pH is falsely decreased, and the specimen will not clot.

75
Q

A semen specimen delivered to the laboratory in a condom has a normal sperm count and markedly decreased sperm motility. This indicates:

Decreased fructose
Antispermicide in the condom
Increased semen viscosity
Increased semen alkalinity

A

Antispermicide in the condom

Specimens should be collected by masturbation. If this is not possible, only nonlubricant-containing rubber or polyurethane condoms should be used.
Ordinary condoms are not acceptable because they contain spermicides.

76
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.

77
Q

Proteolytic enzymes may be added to semen specimens to:

Increase the viscosity
Dilute the specimen
Decrease the viscosity
Neutralize the specimen

A

Decrease the viscosity

Analysis of the specimen cannot begin until liquefaction (normal is within 30 to 60 minutes) has occurred.
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.

78
Q

The primary reason to dilute a semen specimen before performing a sperm concentration is to:

Immobilize the sperm
Facilitate chamber count
Decrease the viscosity
Stain the sperm

A

Immobilize the sperm

The most commonly used dilution is 1:20 prepared using a mechanical (positive-displacement) pipette.

Dilution of the semen is essential because it immobilizes the sperm before counting.

The traditional diluting fluid contains sodium bicarbonate and formalin, which immobilize and preserve the cells; however, good results can also be achieved using saline and distilled water.

79
Q

For determination of sperm concentration, both sides of the Neubauer hemocytometer are loaded and allowed to settle for 3 to 5 minutes; then they are counted, and the counts should agree within ___%.

Agree within 5%
Agree within 10%
Agree within 20%
Agree within 30%

A

Agree within 10%

Using the Neubauer hemocytometer, sperm are usually counted in the four corner and center squares of the large center square, similar to a manual RBC count.

Both sides of the hemocytometer are loaded and allowed to settle for 3 to 5 minutes; then they are counted, and the counts should agree within 10%. An average of the two counts is used in the calculation. If the counts do not agree, both the dilution and the counts are repeated.

80
Q

The purpose of the acrosomal cap is to:

Penetrate the ovum
Protect the the nucleus
Create energy for tail movement
Protect the neckpiece

A

Penetrate the ovum

81
Q

The sperm part containing a mitochondrial sheath is the:

Head
Neckpiece
Midpiece
Tail

A

Midpiece

The midpiece 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.

82
Q

All of the following are associated with sperm motility except the:

Head
Neckpiece
Midpiece
Tail

A

Head

Abnormalities in head morphology are associated with poor ovum penetration, whereas neckpiece, midpiece, and tail abnormalities affect motility.

83
Q

Additional parameters measured by Kruger’s strict morphology include all of the following except:

Vitality
Presence of vacuoles
Acrosome size
Tail length

A

Vitality

Additional parameters in evaluating sperm morphology include measuring head, neck, and tail size; measuring acrosome size; and evaluating for the presence of vacuoles. Inclusion of these parameters is referred to as Kruger’s strict criteria.

Strict criteria evaluation requires the use of a stage micrometer or morphometry. At present, evaluation of sperm morphology using strict criteria is not routinely performed in the clinical laboratory but is recommended by the WHO. Strict criteria evaluation is an integral part of assisted reproduction evaluations.

84
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

Differentiation and enumeration of round cells (immature sperm and leukocytes) can also be made during the morphology examination.

Peroxidase-positive granulocytes are the predominant form of leukocyte in semen and can be further differentiated from spermatogenic cells and lymphocytes using a peroxidase stain.

85
Q

Following an abnormal sperm motility test with a normal sperm count, what additional test might be ordered?

Fructose level
Zinc level
Mixed agglutination reaction
Eosin-nigrosin stain

A

Eosin-nigrosin stain

Decreased sperm vitality may be suspected when a specimen has a normal sperm concentration with markedly decreased motility. Sperm vitality should be assessed within 1 hour of ejaculation. Vitality is evaluated by mixing the specimen with an eosin-nigrosin stain, preparing a smear, and counting the number of dead cells in 100 sperm using a brightfield or phase-contrast microscope.

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.

86
Q

Follow-up testing for a low sperm concentration would include testing for:

Antisperm antibodies
Seminal fluid fructose
Sperm vitality
Prostatic acid phosphatase

A

Seminal fluid fructose

Low sperm concentration may be caused by lack of the support medium produced in the seminal vesicles, which can be indicated by a low to absent fructose level in the semen.

87
Q

Measurement of alpha-glucosidase is performed to detect a disorder of the:

Seminiferous tubules
Epididymis
Prostate gland
Bulbourethral glands

A

Epididymis

decreased neutral alpha-glucosidase, glycerophosphocholine, and L-carnitine suggest a disorder of the epididymis.

88
Q

A specimen delivered to the laboratory with a request for prostatic acid phosphatase and glycoprotein p30 was collected to determine:

Prostatic infection
Presence of antisperm antibodies
A possible rape
Successful vasectomy

A

A possible rape

On certain occasions, the laboratory may be called on to determine whether semen is actually present in a specimen. A primary example is in cases of alleged rape.

Microscopically examining the specimen for the presence of sperm
may be possible, with the best results being obtained by enhancing the specimen with xylene and examining under phase microscopy.

Seminal fluid contains a high concentration of prostatic acid phosphatase, so detecting this enzyme can aid in determining the presence of semen in a specimen.

A more specific method is the detection of seminal glycoprotein p30
(prostatic specific antigen [PSA]), which is present even in the absence of sperm.

Further information can often be obtained by performing ABO blood grouping and DNA analysis on the specimen.

89
Q

Following a negative postvasectomy wet preparation, the specimen should be:

Centrifuged and reexamined
Stained and reexamined
Reported as no sperm seen
Detect presence of male antibodies

A

Centrifuged and reexamined

A negative wet preparation is followed by specimen centrifugation for 10 minutes and examination of the sediment.

90
Q

Normal synovial fluid resembles:

Egg white
Normal serum
Dilute urine
Lipemic serum

A

Egg white

The word “synovial” comes from the Latin word for egg, ovum.
Normal viscous synovial fluid resembles egg white.

91
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

Traditional WBC diluting fluid cannot be used because it contains acetic acid that causes the formation of mucin clots.

Normal saline can be used as a diluent. 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.

92
Q

Synovial fluid crystals associated with inflammation in dialysis patients are:

Calcium pyrophosphate dihydrate
Calcium oxalate
Corticosteroid
Monosodium urate

A

Calcium oxalate

Calcium oxalate crystals in renal dialysis patients.

93
Q

Synovial fluid for crystal examination should be examined as a/an:

Wet preparation
Wright’s stain
Gram stain
Acid-fast stain

A

Wet preparation

Fluid is examined as an unstained wet preparation. One drop of fluid is placed on a precleaned glass slide and cover slipped. The slide can be initially examined under low and high power using a regular light microscope.

Crystals may be observed in Wright’s-stained smears; however, this should not replace the wet prep examination and the use of polarized and red-compensated polarized light for identification.

94
Q

The most frequently performed chemical test on synovial fluid is:

Total protein
Uric acid
Calcium
Glucose

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.

95
Q

An increase in the amount of serous fluid is called a/an:

Exudate
Transudate
Effusion
Malignancy

A

Effusion

96
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

97
Q

A differential observation of pleural fluid associated with tuberculosis is:

Increased neutrophils
Decreased lymphocytes
Decreased mesothelial cells
Increased mesothelial cells

A

Decreased mesothelial cells

98
Q

A pleural fluid pH of 6.0 indicates:

Esophageal rupture
Mesothelioma
Malignancy
Rheumatoid effusion

A

Esophageal rupture

A pH value as low as 6.0 indicates an esophageal rupture that is allowing the influx of gastric fluid.

Pleural fluid pH lower than 7.2 may indicate the need for chest-tube drainage, in addition to administration of antibiotics in cases of pneumonia.

In cases of acidosis, the pleural fluid pH should be compared with the blood pH. Pleural fluid pH at least 0.30 degrees lower than the blood pH is considered significant.

99
Q

Plasma cells seen in pleural fluid indicate:

Bacterial endocarditis
Primary malignancy
Metastatic lung malignancy
Tuberculosis infection

A

Tuberculosis infection

100
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.

101
Q

Differentiation between bacterial peritonitis and cirrhosis is done by performing a/an:

WBC count
Differential
Absolute neutrophil count
Absolute lymphocyte count

A

Absolute neutrophil count

Normal PERITONEAL FLUID WBC counts are less than 350 cells/μL, and the count increases with bacterial peritonitis and cirrhosis.

To distinguish between those two conditions, an absolute neutrophil count should be performed. An absolute neutrophil count >250 cells/μL or >50% of the total WBC count indicates infection.

102
Q

Ascitic fluid TRANSUDATE:

Bacterial peritonitis
Cirrhosis
Intestinal perforation, ruptured appendix
Malignancy

A

Cirrhosis

Hepatic disorders such as cirrhosis are frequent causes of ascitic transudates.

Bacterial infections (peritonitis)—often as a result of intestinal perforation or a ruptured appendix—and malignancy are the most frequent causes of exudative fluids.

103
Q

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

Colon cancer
Ovarian cancer
Gastric malignancy
Prostate cancer

A

Ovarian cancer

104
Q

What is the primary cause of the normal increase in amniotic fluid as a pregnancy progresses?

Fetal cell metabolism
Fetal swallowing
Fetal urine
Transfer of water across the placenta

A

Fetal urine

105
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

Fluid for fetal lung maturity (FLM) tests should be placed in ice for delivery o the laboratory and kept refrigerated.

Specimens for bilirubin testing must be immediately protected from light. This can be accomplished by placing the specimens in amber-colored tubes, wrapping the collection tube in foil, or by use of a black
plastic cover for the specimen container.

Specimens for cytogenetic studies or microbial studies must be processed aseptically and maintained at room temperature or body temperature (37°C incubation) prior to analysis to prolong the life of the cells needed for analysis.

106
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

Specimens for cytogenetic studies or microbial studies must be processed aseptically and maintained at room temperature or body temperature (37°C incubation) prior to analysis to prolong the life of the cells needed for analysis.

107
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 that requires close monitoring
Severely affected fetus that requires intervention

A

Moderately affected fetus that requires close monitoring

Notice that the Liley graph plots the A450 against gestational age and is divided into three zones that represent the extent of hemolytic severity.

Values falling in zone I indicate no more than a mildly affected fetus; those in zone II indicate moderate hemolysis and require careful monitoring anticipating an early delivery or exchange transfusion upon delivery, whereas a value in zone III indicates severe hemolysis and suggests a severely affected fetus.

Intervention through induction of labor or intrauterine exchange transfusion must be considered when a D A450 is plotted in zone III.

108
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
Phosphatidyl glycerol detection

A

AFP levels

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.

109
Q

Amniocentesis may be indicated at 15 to 18 weeks’ gestation for the following conditions to determine early treatment or intervention: CHECK FOUR (4) BOXES

Family history of chromosome abnormalities, such as trisomy 21 (Down syndrome)
Earlier pregnancy or child with birth defect
Fetal lung maturity
HDN caused by Rh blood type incompatibility
Elevated maternal serum alpha-fetoprotein
Abnormal triple marker screening test

A

Family history of chromosome abnormalities, such as trisomy 21 (Down syndrome)
Earlier pregnancy or child with birth defect
Elevated maternal serum alpha-fetoprotein
Abnormal triple marker screening test

110
Q

Amniocentesis is indicated later in the pregnancy (20 to 42 weeks) to evaluate: CHECK TWO (2) BOXES

Family history of chromosome abnormalities, such as trisomy 21 (Down syndrome)
Earlier pregnancy or child with birth defect
Fetal lung maturity
HDN caused by Rh blood type incompatibility
Elevated maternal serum alpha-fetoprotein
Abnormal triple marker screening test

A

Fetal lung maturity
HDN caused by Rh blood type incompatibility

111
Q

When performing an L/S ratio by thin-layer chromatography, a mature fetal lung will show:

Sphingomyelin twice as concentrated as lecithin
No sphingomyelin
Lecithin twice as concentrated as sphingomyelin
Equal concentrations of lecithin and sphingomyelin

A

Lecithin twice as concentrated as sphingomyelin

The L/S ratio will rise to 2.0 or higher as the lecithin production increases to prevent alveolar collapse.

112
Q

A rapid immunologic test for FLM that does not require performance of thin-layer chromatography is:

AFP levels
Amniotic acetylcholinesterase
Aminostat-FLM
Bilirubin scan

A

Aminostat-FLM

AMNIOSTAT FLM: IMMUNOLOGIC AGGLUTINATION TEST FOR PHOSPHATIDYLGLYCEROL

113
Q

The presence of phosphatidyl glycerol in amniotic fluid fetal lung maturity tests must be confirmed when:

Hemolytic disease of the newborn is present
The mother has maternal diabetes
Amniotic fluid is contaminated by hemoglobin
Neural tube disorder is suspected

A

The mother has maternal diabetes

The presence of another lung surface lipid, phosphatidyl glycerol (PG), is also essential for adequate lung maturity and can be detected after 35 weeks’ gestation.

The production of PG normally parallels that of lecithin, but its production is delayed in cases of maternal diabetes.

In this circumstance, respiratory distress occurs in the presence of an L/S ratio of 2.0. Therefore, a thin-layer chromatography lung profile must include lecithin, sphingomyelin, and PG to provide an accurate measurement of FLM.

114
Q

OD 650 nm:

Bilirubin
Lamellar bodies
Lecithin
Oxyhemoglobin

A

Lamellar bodies

The presence of lamellar bodies increases the OD of the amniotic fluid. Specimens are centrifuged at 2000 g for 10 minutes and examined using a wavelength of 650 nm.

115
Q

A lamellar body count of 50,000 correlates with:

Absent phosphatidyl glycerol and L/S ratio of 1.0
L/S ratio of 1.5 and absent phosphatidyl glycerol
OD at 650 nm of 1.010 and an L/S ratio of 1.1
OD at 650 nm of 0.150 and an L/S ratio of 2.0

A

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

The number of lamellar bodies present in the amniotic fluid correlates with the amount of phospholipid present in the fetal lungs.

The presence of lamellar bodies increases the OD of the amniotic fluid. Specimens are centrifuged at 2000 g for 10 minutes and examined using a wavelength of 650 nm, which rules out interference from hemoglobin but not other contaminants, such as meconium. 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.

A consensus protocol for noncentrifuged samples considers LBCs greater than 50,000/uL an indication of FLM and values below 15,000/uL as immature.

116
Q

The normal composition of feces includes all of the following except:

Bacteria
Blood
Electrolytes
Water

A

Blood

The normal fecal specimen contains bacteria, cellulose, undigested foodstuffs, GI secretions, bile pigments, cells from the intestinal walls, electrolytes, and water.

117
Q

The normal brown color of the feces is produced by:

Cellulose
Pancreatic enzymes
Undigested foodstuffs
Urobilin

A

Urobilin

118
Q

Stool specimens that appear ribbon-like are indicative of which condition?

Bile duct obstruction
Colitis
Intestinal constriction
Malignancy

A

Intestinal constriction

119
Q

What is the fecal test that requires a 3-day specimen?

Fecal occult blood
APT test
Elastase 1
Quantitative fecal fat testing

A

Quantitative fecal fat testing

Quantitative fecal analysis requires the collection of at least a 3-day specimen. The patient must maintain a regulated intake of fat (100 g/d) before and during the collection period.

120
Q

What is the significance of an APT test that remains pink after addition of sodium hydroxide?

Fecal fat is present
Fetal hemoglobin is present
Fecal trypsin is present
Vitamin C is present

A

Fetal hemoglobin is present

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.

121
Q

A patient whose stool exhibits increased fats, undigested muscle fibers, and the inability to digest gelatin may have:

Bacterial dysentery
A duodenal ulcer
Cystic fibrosis
Lactose intolerance

A

Cystic fibrosis

122
Q

A stool specimen collected from an infant with diarrhea has a pH of 5.0. This result correlates with a:

Positive APT test
Negative trypsin test
Positive Clinitest
Negative occult blood test

A

Positive Clinitest

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

123
Q

hat is the recommended number of samples that should be tested to confirm a negative occult blood result?

One random specimen
Two samples taken from different parts of three stools
Three samples taken from the outermost portion of the stool
Three samples taken from different parts of two stools

A

Two samples taken from different parts of three stools

Two samples from three different stools should be tested before a negative result is confirmed.

124
Q

A positive amine (Whiff) test is observed in which of the following syndromes?

Bacterial vaginosis
Vulvovaginal candidiasis
Atrophic vaginitis
Desquamative inflammatory vaginitis

A

Bacterial vaginosis

Amine (Whiff) Test
1. Apply one drop of the saline vaginal fluid suspension to the surface of a clean glass slide.
2. Add one drop of 10% KOH directly to the vaginal sample.
3. Holding the slide in one hand, gently fan above the surface of the slide with the other hand and assess for the presence of a fishy amine odor.
4. Report as positive or negative.
Positive: The presence of a fishy odor after adding KOH.
Negative: The absence of a fishy odor after adding KOH.

125
Q

The presence of fetal fibronectin in vaginal secretions between 24 and 34 weeks’ gestation is associated with

Bacterial vaginosis
Candidiasis
Desquamative inflmmatory vaginitis
Preterm delivery

A

Preterm delivery

The presence of fetal fibronectin in vaginal secretions between 24 and 34 weeks’ gestation is associated with preterm delivery.

126
Q

QUESTIONS FROM CHAPTER 2 OF THE 7th EDITION STRASINGER: URINE AND BODY FLUID ANALYSIS AUTOMATION

  1. The principle most commonly used to measure the concentration of a particular analyte in the CHEMICAL examination of urine is:

A. Reflectance photometry⭐️

B. Digital imaging

C. Flow cytometry

D. Auto particle recognition

  1. In automated urinalysis, the specific gravity is measured by:

A. Light transmittance

B. Light scattering

C. Refractometry⭐️ [refractometry, refractive index]

D. Turbidity

  1. All of the following are true concerning fully automated urine chemistry analyzers, except:

A. They are designed for a high-volume urinalysis laboratory

B. The reagent strip is dipped into the well-mixed urine⭐️

C. The urine moves through the instrument

D. A sample probe aspirates the urine.

  1. The advantages of an automated urine microscopy analyzer over manual microscopy includes:

A. Cost-effective

B. Centrifugation not required

C. Standardized results

D. All of the above⭐️

  1. Which of the following is a complete urinalysis automated urinalysis system?

A. AUTION ELEVEN AE 4022

B. Clinitek Atlas

C. iQ200 Automated Urine Microscopy

D. Clinitek AUWi Pro System⭐️

A
  1. What two technologies are used for urine sediment analysis?

A. Light scattering and refractometry

B. Light scattering and flow cytometry

C. Flow cytometry and digital imaging⭐️

D. Digital imaging and refractometry

  1. Which automated urine particle counter combines urine flow cytometry with digital image analysis?

A. UN-2000⭐️

B. iRICELL

C. UF-100i

D. iQ 200

  1. Which of the following urine sediment particles cannot be autovalidated but will be flagged and must be reviewed by laboratory personnel?

A. RBCs

B. WBCs

C. RTEs⭐️

D. Squamous epithelial cells

  1. Which of the automated body fluid analyzers does not need to dilute or pretreat body fluids before analysis?

A. ADVIA 2120i

B. XN Series⭐️

C. iQ200

D. None of the above

  1. What is a disadvantage of counting body fluid cells using an automated instrument versus a Neubauer hemocytometer?

A. Less labor-intensive and time-consuming

B. More precise

C. Unable to count low WBC numbers and malignant cells⭐️

D. Able to perform a WBC differential

Correct answer is letter C: Body fluids with low cell counts or malignant cells still require a manual differential using a stained cytospin smear.

PROGRESS (10 decks)

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