AUBF Quetions

GRAFF’S TEXTBOOK OF URINALYSIS 7. The glucose renal threshold is 160–180 mg/dL.
nal threshold is 160–180 mg/dL. Match urine preservatives with their description: 3. Testing specimens that contain high levels of
This represents the: A. Boric acid ascorbate may effect the reading of all of these
AND BODY FLUIDS a. concentration of glucose in the vasa recta B. Chorohexidine EXCEPT:
b. maximum rate of glucose reabsorption in the C. Formalin a. bilirubin
CHAPTER 1
renal tubule D. Refrigeration b. glucose
URINALYSIS CLINICAL LABORATOEY OPERATIONS
c. plasma concentration above which glucose is E. Thymol c. nitrite
excreted in the urine 14. ________ preserves urine sediment d. urobilinogen
1. All are reasons for participating in a proficiency
d. plasma level at the commencement of glucose 15. ________most commonly used
testing program except:
reabsorption in the nephron 16. ________ preserves many constituents 4. A high specific gravity will affect all of the
a. to ensure the best quality of laboratory results
17. ________ culture and sensitivity following reactions EXCEPT:
b. to compare your laboratory’s results with other
8. Which of these is not a mechanism to maintain 18. ________ routine analysis within 72 hours a. glucose
laboratories’ results
blood pH through the kidney? b. leukocytes
c. it is mandated by CLIA ’88
a. excretion of acetic acid 19. Refractive index compares the velocity of light c. nitrite
d. it will justify higher charges for laboratory
b. excretion of hydrogen ions in urine to the velocity of light in: d. protein
analyses
c. excretion of ammonium ions a. air
d. reabsorption of bicarbonate b. oil 5. Which of the following tests does not have a
2. This government agency is responsible for
c. saline negative reading on reagent strip color charts?
oversight of employee safety:
9. Which of these urinary structures is involved in d. water a. blood
a. HHS
the countercurrent exchange mechanism? b. glucose
b. HIPAA
a. the afferent arteriole 20. Which principle is used in the determination of c. ketone
c. OSHA
b. the efferent arteriole specific gravity by reagent strip methods? d. urobilinogen
d. CMC
c. the vasa recta a. The pKa of a polyelectrolyte is altered by the
d. the juxtaglomerular apparatus urine’s ionic strength. 6. Purple colors are observed in the positive
3. CLIA ’88 delineates the following categories of
b. Cations are chelated by a color-changing ligand. reactions for:
laboratory testing except:
10. Aldosterone is involved in the reabsorption of: c. Ions catalyze the oxidation of a chromogen. a. blood and glucose
a. waived testing
a. potassium d. Solutes release H ions to change the pKa. b. ketone and leukocytes
b. high-complexity testing
b. sodium c. bilirubin and urobilinogen
c. low-complexity testing
c. bicarbonate Although not routinely reported, urine odor may be d. protein and nitrite
d. physician-performed microscopy
d. hydrogen ion a significant observation. Match urine odor with
their causative constituent. 7. The ketone most detectable by all reagent strips
4. A control sample should be all of the following
CHAPTER 3 A. Fishy is:
except:
COLLECTION AND PHYSICAL EXAMINATION OF B. Fruity a. acetoacetic acid
a. material of the same matrix as your test samples
URINE C. Fusty b. acetone
b. used to calibrate the test
D. Pungent c. -hydroxybutyric acid
c. have an established acceptable range
Match the type of urine collection with its most E. Sweaty feet d. phenylketone
d. be run along with your test samples and
appropriate use: F. Syrupy
monitored statistically
A. Clean-catch B. Early afternoon 21. ________ Ammonia 8. A false-positive protein may be produced by:
C. First morning D. Postprandial 22. ________ Bacteria a. albumin
5. TLVs are:
E. Random F. Three-glass 23. ________ Butyric acid b. alkaline pH
a. exposure levels permitted for employees
1. ________ routine analysis 24. ________ Hypermethioninemia c. ascorbic acid
b. tracing lower volume
2. ________ diabetic screening 25. ________ Ketones d. run-over effect
c. a biohazard risk
3. ________ urobilinogen quantitation 26. ________ Leucine and isoluecine
d. threshold limit values
4. ________ screening for infection 27. ________ Phenylalanine 9. Positive bilirubin reactions should be confirmed
5. ________ most concentrated specimen by:
CHAPTER 2
6. ________ diagnosis of prostate infections CHAPTER 4 a. Acetest
RENAL ANATOMY. PHYSIO, URINE FORMATION
CHEMICAL ANALYSIS OF URINE b. Clinitest
Match urine appearance with its listed cause: c. Foam Test
5. Patients with diabetes typically have higher urine
A. Amber and clear 1. Specimens for urine chemistry analysis must be d. Ictotest
output volumes; this is referred to as:
B. Brown and cloudy well mixed to ensure an accurate reading of:
a. oliguria
C. Colorless and clear a. pH and specific gravity 10. The principle of “protein error of indicators” is
b. anuria
D. Orange b. blood and leukocytes based on:
c. polyuria
E. Red and clear c. glucose and ketones a. protein changing the pH of the specimen.
d. pyuria
F. Red and cloudy d. bilirubin and urobilinogen b. protein changing the pKa of the specimen.
G. Yellow and clear c. protein accepting hydrogen from the indicator.
6. The glomerular filtration barrier is composed of:
7. ________ normal urine appearance 2. Timing of reagent strip readings is especially d. protein giving up hydrogen to the indicator.
a. the capillary endothelium, basement membrane,
8. ________ concentrated urine critical for:
and juxtaglomerular apparatus
9. ________ very dilute urine a. diazo compound formation
b. capillary endothelium, podocytes, and basement
10. ________ medications b. dye-binding reactions
membrane
11. ________ red blood cells c. enzymatic reactions
c. podocytes, hilum, and basement membrane
12. ________ old specimen with RBCs d. protein error of indicators
d. capillary endothelium, podocytes, and
13. ________ porphyrins
juxtaglomerular apparatus
1 | |not for the exams, but for the time when the patients’ only chance is you| Compiled by: ayejayyyyy
Match the reagents listed below to the test in which 6. In what part of the nephron does cast formation 2. A urinalysis and blood work performed on a 13- 7. Renal failure would most likely not be associated
they are used. NOT take place? yearold girl yield the following results: with which of these:
a. bilirubin b. blood a. collecting tubules a. Systemic shock with drop in blood pressure
c. glucose d. ketone b. distal convoluted tubule Specific gravity 1.015 WBC/HPF 5–10 b. Transfusion reaction
e. leukocytes f. nitrite c. distal portion in loop of Henle pH 7.0 RBC/HPF 25–50 c. Urine with a high specific gravity
g. Ph h. protein d. proximal convoluted tubule Protein 2 Casts/LPF d. ↓GFR
i. urobilinogen Glucose Negative Hyaline 0–2
11. ________ arsanilic acid 7. Casts are classified on the basis of their: Ketones Negative RBC 1–5 8. This disease is one of the most common
12. ________ bromthymol blue a. color Bilirubin Negative Epithelial 0–1 aminoacidurias with urine that has a “mousy” odor:
13. ________ cumene hydroperoxide b. contents Blood 3 Coarse granular 0–1 a. Indicanuria
14. _______ dichloroanaline c. length Nitrite Negative b. Melaninuria
15. ________ dimethylaminobenzaldehyde d. site of formation Bacteria: rare Leukocyte Positive c. Phenylketonuria
16. ________ indoxylcarbonic acid ester Uric acid crystals: moderate d. Fanconi disease
17. ________methyl red 8. The order of cast degradation is: Urobilinogen 0.1 Ehrlich units/dL
18. ________ potassium iodide a. cellular granular waxy Blood tests: Anti-Streptolysin O titer elevated 9. Which of the following diseases results in the
19. ________ sodium nitroprusside b. cellular hyaline waxy production and excretion of large amounts of
20. ________ tetrabromphenol blue c. hyaline cellular waxy The above are MOST consistent with: homogentisic acid?
21. ________ tetrachlorophenol- d. hyaline granular waxy a. yeast infections a. Melanuria
tetrabromsulfophthalein b. pyelonephritis b. Tyrosyluria
22. ________ tetrahydroquinoline 9. Crystals in the urine are NOT: c. acute glomerulonephritis c. Alkaptonuria
23. ________ tetramethylbenzine a. confirmed by reagent strip tests d. renal failure d. Maple syrup urine disease
b. dependent upon pH and temperature
CHAPTER 5 c. formed during pathologic processes 3. Which of the following casts is more associated 10. The ill effects of this condition involving
MICROSCOPIC EXAMINATION OF URINARY d. observed in normal specimens with a chronic glomerulonephritis than with an metabolism of milk sugar can be lessened by
SEDIMENT acute glomerulonephritis: dietary control if caught early enough in an infant’s
10. Parasites seen in the urine are: a. WBC cast life:
1. Which of the following methods is NOT a. confirmed by reagent strip tests b. RBC cast a. Diabetes insipidus
commonly performed in the microscopic b. confused for red blood cells c. Waxy cast b. Maple syrup urine disease
examination of urine sediment? c. unstainable with Sternheimer-Malbin d. Hyaline cast c. Galactosemia
a. Bright field with the use of stains d. usually fecal or vaginal contaminants d. Fructosuria
b. Differential interference contrast 4. Which of these systemic diseases contribute to
c. Phase contrast microscopy Match these crystals to their associated pH. kidney damage and disease? CHAPTER 8
d. Polarized and compensated light A. Acid a. Diabetes mellitus INTRODUCTION TO BODY FLUIDS
B. Alkaline b. Systemic lupus erythematosis
2. What changes in urine sediment can take place 11. ________ ammonium biurate c. Hypertension Match types of body fluid analysis with the
over time if the urine is not examined as soon after 12. ________ ammonium magnesium phosphate d. Amyloidosis laboratory section that performs it.
collection as possible? (Select all that apply.) 13. ________ bilirubin e. All of the above A. Chemistry B. Hematology
a. Bacteria lyse b. Casts dissolve 14. ________ calcium carbonate C. Microbiology
c. Crystals dissolve d. Crystals form 15. ________ calcium oxalate 5. WBC casts are more likely to be indicative of 1. ________ blood cell counts
e. Erythrocytes crenate f. Microoganisms multiple 16. ________ cystine which of these? 2. ________ chemical detection
17. ________ hippuric acid a. Cystitis 3. ________ identification of infectious agents
3. How will erythrocytes appear in hypertonic 18. ________ leucine b. Urethritis
urine? 19. ________ tyrosine c. Pyelonephritis 4. Water enters various body systems through
a. biconcave discs 20. ________ uric acid d. Aminoaciduria a. consumption of water
b. crenated b. consumption of food
c. lysed 6. A 3-year-old girl has edema that is noticeable in c. cellular metabolic processes
d. swollen her eyelids. Urinalysis and blood tests reveal the d. all of these
following results:
4. Glitter cells are: a. Serum albumin: decreased 5. The main function of body fluids is
a. crenated erythrocytes CHAPTER 7 b. Serum cholesterol: elevated a. cushioning interfaces b/n body cavities & organs
b. infected tubular cells URINARY AND METABOLIC DISEASES AND c. Serum urea nitrogen: elevated b. creating a barrier between organ systems
c. macrophages with inclusions RELATED URINALYSIS FINDINGS d. Urinalysis: protein c. providing hydration for organs
d. swollen leukocytes d. all of these
1. The following urinary tests are most helpful in This is most compatible with:
5. Prime conditions for cast formation include examining patients with diabetes for kidney a. acute poststreptococcal glomerulonephritis Match the hydrodynamic force with its direction of
(select all that apply): disease: b. minimal change glomerular disease fluid movement.
a. marked decrease in urine flow a. microalbumin c. acute pyelonephritis A. fluid into the capillary
b. acidic pH b. GFR d. diabetes mellitus B. fluid out of the capillary
c. alkaline pH c. Creatinine 6. ________ capillary colloidal osmotic pressure
d. high solute concentration d. All of the above are helpful 7. ________ capillary hydrostatic pressure
e. presence of abnormal ions 8. ________ tissue colloidal osmotic pressure
9. ________ tissue hydrostatic pressure
Match body fluid with the procedure used to obtain 4. A small amount of CSF is formed by the: 13. The presence of siderophages in CSF indicates: 4. Fluid: serum protein ratio .5
A. Lumbar puncture B. Paracardiocentesis a. cerebral ventricles capillaries a. a normal finding 5. Protein 3.06/dL
C. Paracentesis D. Thoracentesis b. dura mater and pia mater b. meningitis 6. High fibrinogen
10. ________ ascites fluid c. ependymal lining cells c. old hemorrhage 7. LDH 200 1U
11. ________ cerebral spinal fluid d. ventricular choroid plexuses d. traumatic tap 8. Cell count 1000/cc
12. ________ paracardial fluid
13. ________ pleural fluid 5. Water-soluble substances that rapidly diffuse 14. The presence of nucleated red blood cells in CSF 9. Serous body cavities are lined with cells derived
across the blood–brain barrier include (select all indicates: from the:
Match the appearance with the probable cause that apply): a. a normal finding a. endothelium
A. Milky B. Oily a. alcohol b. meningitis b. epithelium
C. Purulent D. Sanguinous b. chloride c. old hemorrhage c. mesothelium
E. Xanthochromic F. Yellow–green c. glucose d. traumatic tap
14. ________ high number of red blood cells d. protein 10. Intestinal perforation can be diagnosed by
15. ________ high number of white blood cells 15. The presence of which cell may be the only testing the level(s) of in ascites.
16. ________ indicates the degradation of 6. Pellicle formation in CSF requires: abnormality a. alkaline phosphatase
hemoglobin a. centrifugation in multiple sclerosis? b. amylase and lipase
17. ________ high amounts of fat may be present b. culture a. choroidal cells c. blood urea nitrogen
c. refrigeration b. eosinophils d. glucose and protein
18. Body fluid cell counts normally need to be d. staining c. macrophages
performed using which dilution? d. plasma cells 11. Chronic liver disease can cause fluid to
a. 1:1 7. CSF may appear oily if the patient has: accumulate in the:
b. 1:2 a. a hemorrhage 16. Malignant cells seen in CSF: a. pericardium
c. 1:10 b. had a myelogram a. can be of CNS origin b. peritoneum
d. 1:20 c. multiple sclerosis b. can be leukemia cells c. pleural cavity
d. normal CSF c. metastasize from other sites
19. The preferred method of performing differential d. may be all of these 12. Removal of more than 1000 mL of ascites can
cell counts on body fluids uses: 8. Typically, the protocol for the performance of cause:
a. an automated cell counter CSF analysis when three tubes are collected is 17. CSF protein levels are: a. edematous extremities
b. concentration of the specimen by sedimentation which order for cell counts, chemistries, a. higher than serum levels b. great relief for the patient
c. cytocentrifugation of the specimen microbiology? b. independent of puncture site c. hypovolemia and shock
d. stain added to the hemocytometer count a. 1, 2, 3 c. decreased in hyperthyroidism d. increased lymphatic absorption
b. 2, 1, 3 d. increased in young adults
20. The crystal property of birefringence is c. 3, 1, 2 13. Which procedure is rarely performed because of
observed using d. 3, 2, 1 18. A myelin basic protein level of 2 ng/mL indicates the risk involved?
a. bright light a. brain hypoxia a. paracardiocentesis
b. compensated light 9. A cranial hemorrhage is indicated by CSF that is b. head trauma b. paracentesis
c. fluorescent light colored: c. myelopathy c. peritoneal lavage
d. polarized light a. pink d. normal results d. thoracentesis
b. red
CHAPTER 9 c. xanthochromic 19. Meningitis results in: 14. In a pleural effusion caused by bacterial
CEREBROSPINAL FLUID ANALYSIS d. all of these a. decreased CSF glucose and decreased CSF protein infection, the glucose level would be:
b. decreased CSF glucose and increased CSF protein a. equal to that of the serum
1. A lumbar puncture should NOT be performed if 10. The concentration of proteins found in CSF is: c. increased CSF glucose and decreased CSF protein b. 30 mg/dL or more higher than serum
the patient has: a. equal to that of serum d. increased CSF glucose and increased CSF protein c. 30 mg/dL or more less than serum
a. dementia or acute states of acute confusion b. greater than that of serum
b. infection such as encephalitis or meningitis c. less than that of serum 15. A chylous effusion would have a:
c. inflammation over or near the puncture site 20. If only a small amount of CSF is obtained, which a. cholesterol level lower than serum
d. unexplained seizures or multiple sclerosis 11. Cells that are normally seen in CSF include is the most important procedure to perform first? b. triglyceride level higher than serum
(select all that apply): a. cell count c. milky appearance
2. Which of the following is NOT a membrane a. erythrocytes b. chemistries d. pH that is alkaline
surrounding the brain? b. lymphocyte c. immunology
a. arachoidea c. monocytes d. microbiology CHAPTER 11
b. dura mater d. neutrophils SYNOVIAL FLUID
c. pia mater CHAPTER 10
d. subarachnoid 12. Cells that may be seen in clusters resembling SEROUS BODY FLUIDS 1. The word synovial means resembling:
tumor cells may be: a. an oval
3. Central nervous system epithelial cells include a. CNS lining cells Match laboratory findings with type of effusion. b. egg albumin
(select all that apply): b. macrophages A. Exudate c. lipids
a. choroidal cells c. nucleated RBCs B. Transudate d. serum
b. endothelial cells d. none of these 1. Clear fluid
c. ependymal cells 2. Purulent fluid
d. pia-arachnoid mesothelial cells 3. Specific gravity 1.015
2. Aspiration of joint fluid is indicated for any Match the crystals with their clinical significance. 10. Which semen pH is within normal limits? 5. An advantage of the guaiac tests over the other
patient with: A. apatite B. calcium pyrophosphate a. 6.8 fecal occult blood tests is that they are:
a. edematous joints C. corticosteroid D. monosodium urate b. 7.0 a. not overly sensitive
b. inflamed joints 17. ________ gout c. 7.6 b. the most sensitive
c. painful joints 18. ________ injections d. 8.0 c. the most specific
d. all of these 19. ________ osteoarthritis d. do not need special diet
20. ________ pseudogout 11. Which of the following describes a normal
3. Normal joint fluid is: spermatozoa head? 6. Even a few fecal leukocytes indicate:
a. colorless and clear CHAPTER 12 a. constricted near the acrosome a. steatorrhea
b. red and cloudy SEMEN ANALYSIS b. elongated and tapered b. invasion of the intestinal wall by microbes
c. white and hazy c. flattened oval c. malabsorption
d. yellow and hazy 1. Over half the volume of semen is produced in d. round and small
the: 7. Steatorrhea is present in:
4. A firm mucin clot of synovial fluid indicates the a. epididymis 12. Viable sperm appear using the eosin-nigrosin a. colorectal cancer
presence of: b. prostate gland stain. b. fetal hemoglobin
a. arthritis c. seminal vesicles a. black c. bacterial invasion of the intestine
b. fibrinogen d. vasa deferentia b. orange d. Giardiasis
c. hyaluronate c. red
d. inflammation 2. Fructose is contained in the portion of semen d. white 8. Which of the following types of fats stains with
produced by the: Sudan III without heat or acid?
5. No formation of a “string” when dispensing a. bulbourethral glands 13. Which statement is NOT true concerning semen a. soaps
synovial fluid from a syringe indicates that: b. epididymis fructose? b. fatty acids
a. collection was traumatic c. prostate gland a. Dec fructose levels indicate androgen deficiency. c. neutral fats (triglycerides)
b. fibrinogen levels are low d. seminal vesicles b. Fructose levels are independent of testosterone d. carbohydrates
c. inflammation is present levels.
d. the fluid is normal 3. The process of spermatozoa formation is under c. Fructose comprises 99% of semen reducing 9. Clinitest is used to detect this substance in
control of all of these hormones EXCEPT: sugars. newborn feces:
6. A cloudy synovial fluid demonstrating poor a. human chorionic gonadotropin d. Fructose levels are assessed in cases of a. fatty acids
viscosity with decreased glucose levels and a WBC b. luteinizing hormone azospermia. b. meat fibers
count of 180,000 (90% neutrophils) is most likely c. follicle-stimulating hormone c. fetal blood
from a patient with which process? d. testosterone CHAPTER 13 d. carbohydrates
a. crystal-induced FECAL ANALYSIS
b. hemorrhagic 4. Semen analysis plays an important role in: 10. Who should be screened annually for occult
c. noninflammatory a. determining the effectiveness of a vasectomy 1. All of the following are mechanisms of diarrhea blood?
d. septic or inflammatory b. establishing a cause for infertility EXCEPT: a. infants and pediatric patients
c. forensic studies of suspected rape a. increased osmotically active compounds such as b. adults older than age 50
Match the char of synovial fluid w/ Group category. d. all of these carbohydrates causing increased fecal water and c. cystic fibrosis patients
A. Normal B. Group I C. Group II D. Group III electrolytes d. all adults
E. Group IV F. Group V 5. What is the optimal place and method for b. increased secretions leading to increased fluid
7. ________ colorless, clear, 57 WBCs, 10% collection of a semen specimen? presented to the large intestine CHAPTER 14
neutrophils c. decreased osmosis MISCELLANEOUS BODY FLUIDS
8. ________ milky, 80,000 WBCs, 40% neutrophils, 6. What type of container should be provided for d. intestinal hypermotility
monosodium urate crystals the collection of a semen specimen ? 1. Reasons for analyzing amniotic fluid include the
9. ________ red, cloudy, 210,000 RBCs, 15,000 2. All of these are seen with malabsorption, following EXCEPT:
WBCs, 45% neutrophils 7. If semen collection occurs at the physician’s maldigestion, or hypermotility, EXCEPT: a. to diagnose genetic and congenital neural tube
10. ________ yellow, cloudy, 80,000 WBCs, 85% office or patient’s home, what care should be taken a. steatorrhea disorders
neutrophils during transport? b. creatorrhea b. to assess fetal liver maturity
11. ________ yellow, purulent, 220,000 WBCs, 98% c. positive APT test c. to assess fetal lung maturity
neutrophils 8. Normal semen color(s) includes (select all that d. increased fecal carbohydrates d. to detect fetal distress from hemolytic disease of
12. ________ xanthochromic, 10,000 WBCs, 30% apply): the newborn
neutrophils, erythrophagocytosis a. clear 3. Bright red blood and mucus in feces are most
b. gray often seen with: 2. The following is true about amniotic fluid
Match the cell with its description. c. white a. malabsorption specimen collection and handling:
A. LE cell B. RA cell d. yellow b. dysentery a. Fifty milliliters of amniotic fluid is typically
C. Reiter cell D. Tart cell c. creatorrhea collected
13. ________ macrophage containing a neutrophil 9. Which semen volume is within normal limits? d. upper GI tract bleeding b. Glass containers are used for cytogenetic studies
14. ________ monocyte containing nuclear material a. .5 mL c. Typical amniotic fluid is colorless to pale yellow
15. ________ neutrophil containing antibody- b. 1.5 mL 4. Eosinophils are often seen with: and slightly cloudy
altered nucleus c. 4.0 mL a. colorectal cancer d. Amniotic fluid is always refrigerated
16. ________ neutrophil containing immune d. 6.0 mL b. creatorrhea
complexes c. fecal carbohydrates
d. parasites such as amebas
3. The fern test: STRASINGER 8. An acceptable disinfectant for blood and body 17. The system used by firefighters when a fire
a. distinguishes amniotic fluid from maternal urine fluid decontamination is: occurs in the laboratory is:
b. is performed on vaginal secretions
URINALYSIS AND BODY FLUIDS (5TH) A. Sodium hydroxide A. MSDS
c. is run on the spectrophotometer B. Antimicrobial soap B. RACE
CHAPTER 1
d. is a wet mount C. Hydrogen peroxide C. NFPA
SAFETY IN CLINICAL LABORATORY
D. Sodium hypochlorite D. PASS
4. Bilirubin is detected spectrophotometrically in
1. In the urinalysis laboratory the primary source in
amniotic fluid at: 9. Proper handwashing includes all of the following 18. A class ABC fire extinguisher contains:
the chain of infection would be:
a. 365 nm except: A. Sand
A. Patients
b. 550 nm A. Using warm water B. Water
B. Needlesticks
c. 410 nm B. Rubbing to create a lather C. Dry chemicals
C. Specimens
d. 450 nm C. Rinsing hands in a downward position D. Acid
D. Biohazardous waste
D. Turning on the water with a paper towel
5. The most common cause of death in the 19. The first thing to do when a fire is discovered is
2. The best way to break the chain of infection is:
premature newborn: 10. Centrifuging an uncapped specimen may to:
A. Handwashing
a. hemolytic disease of the newborn produce a biological hazard in the form of: A. Rescue persons in danger
B. Personal protective equipment
b. neural tube defects A. Vectors B. Activate the alarm system
C. Aerosol prevention
c. respiratory distress syndrome B. Sharps contamination C. Close doors to other areas
D. Decontamination
d. excess lamellar bodies C. Aerosols D. Extinguish the fire if possible
D. Specimen contamination
3. Standard Precautions differ from Universal
6. All of these phospholipids have a role in fetal lung 20. If a red rash is observed after removing gloves,
Precautions and body substance isolation by
maturity EXCEPT: 11. An employee who accidently spills acid on his the employee:
requiring:
a. lecithin arm should immediately: A. May be washing her hands too often
A. Wearing face shields and gloves whenever blood
b. sphingomyelin A. Neutralize the acid with a base B. May have developed a latex allergy
may be encountered
c. phosphatidyl glycerol B. Hold the arm under running water for 15 minutes C. Should apply cortisone cream
B. Wearing gloves when encountering any moist
d. lamellar bodies C. Consult the MSDSs D. Should not rub the hands so vigorously
body fluid
7. A ΔA450 value that falls into zone I indicates: D. Wrap the arm in gauze and go to the emergency
C. Washing hands after removing gloves if visual
a. a normal finding without significant hemolysis room 21. Pipetting by mouth is:
contamination is present
b. moderate hemolysis A. Acceptable for urine but not serum
D. Wearing gloves when exposed to moist body
c. severe hemolysis 12. When combining acid and water, ensure that: B. Not acceptable without proper training
fluids and washing hands after glove removal
d. high fetal risk A. Acid is added to water C. Acceptable for reagents but not specimens
B. Water is added to acid D. Not acceptable in the laboratory
4. An employee who is accidentally exposed to a
8. This cell is an abnormal finding indicating C. They are added simultaneously
possible blood-borne pathogen should
bacterial vaginosis: 22. The NPFA classification symbol contains
immediately:
a. Trichomonas 13. An employee can learn the carcinogenic information on all of the following except:
A. Report to a supervisor
b. white blood cells potential of potassium chloride by consulting the: A. Fire hazards
B. Flush the area with water
c. Pneumocystis jiroveci A. Chemical hygiene plan B. Biohazards
C. Clean the area with disinfectant
d. clue cell B. Material safety data sheets C. Reactivity
D. Receive HIV propylaxis
C. OSHA standards D. Health hazards
9. In bacterial vaginosis, in trichomoniasis, and in D. Urinalysis procedure manual
5. Personnel in the urinalysis laboratory should
postmenopausal women, the vaginal pH is: 23. The classification of a fire that can be
wear lab coats that:
a. above 4.5 14. Employees should not work with radioisotopes extinguished with water is:
A. Do not have buttons
b. between 3.8 and 4.5 if they are: A. Class A
B. Are fluid-resistant
c. below 3.8 A. Wearing contact lenses B. Class B
C. Have short sleeves
d. it is above 4.5 in some of these and below 3.8 in B. Allergic to iodine C. Class C
D. Have full-length zippers
others C. Sensitive to latex D. Class D
D. Pregnant
6. All of the following should be discarded in
10. Which of these specimens is best for the 24. Employers are required to provide free
biohazardous waste containers except:
detection of Pneumocystis jiroveci? 15. All of the following are safe to do when immunization for:
A. Urine specimen containers
a. bronchoalveolar lavage removing the source of an electric shock except: A. HIV
B. Towels used for decontamination
b. vaginal secretions A. Pulling the person away from the instrument B. HTLV-1
C. Disposable lab coats
c. bronchial washings B. Turning off the circuit breaker C. HBV
D. Blood collection tubes
d. amniotic fluid C. Using a glass container to move the instrument D. HCV
D. Unplugging the instrument
7. An employer who fails to provide sufficient
25. A possible physical hazard in the hospital is:
gloves for the employees may be fined by the:
16. The acronym PASS refers to: A. Wearing closed-toed shoes
A. CDC
A. Presence of vital chemicals B. Not wearing jewelry
B. NFPA
B. Operation of a fire extinguisher C. Having short hair
C. OSHA
C. Labeling of hazardous material D. Running to answer the telephone
D. FDA
D. Presence of radioactive substances D. Water is slowly added to acid
CHAPTER 2 10. All of the following are reabsorbed by active 19. The largest source of error in creatinine 28. After controlled fluid intake, the urine-to-serum
RENAL FUNCTION transport in the tubules except: clearance tests is: osmolarity ratio should be at least:
A. Urea A. Secretion of creatinine A. 1:1
1. The type of nephron responsible for renal B. Glucose B. Improperly timed urine specimens B. 2:1
concentration is the: C. Sodium C. Refrigeration of the urine C. 3:1
A. Cortical B. Juxtaglomerular D. Chloride D. Time of collecting blood sample D. 4:1
2. The function of the peritubular capillaries is: 11. Which of the tubules is impermeable to water? 20. Given the following information, calculate the 29. Calculate the free water clearance from the
A. Reabsorption A. Proximal convoluted tubule creatinine clearance: following results: urine volume in 6 hours: 720 mL;
B. Filtration B. Descending loop of Henle 24-hour urine volume: 1000 mL; serum creatinine: urine osmo: 225 mOsm; plasma osmo: 300 mOsm
C. Secretion C. Ascending loop of Henle 2.0 mg/dL; urine creatinine: 200 mg/dL
D. Both A and C D. Distal convoluted tubule 30. To provide an accurate measure of renal blood
21. Values for creatinine clearance tests on children flow, a test substance should be completely:
3. Blood flows through the nephron in the following 12. Glucose will appear in the urine when the: are corrected for: A. Filtered by the glomerulus
order: A. Blood level of glucose is 200 mg/dL A. Body size B. Reabsorbed by the tubules
A. Efferent arteriole, peritubular capillaries, vasa B. Tm for glucose is reached B. Urine volume C. Secreted when it reaches the distal conv. tub.
recta, afferent arteriole C. Renal threshold for glucose is exceeded C. Activity level D. Cleared on each contact with functional renal
B. Peritubular capillaries, afferent arteriole, vasa D. All of the above D. Diet tissue
recta, efferent arteriole
C. Afferent arteriole, peritubular capillaries, vasa 13. The countercurrent mechanism takes place in 22. Given the data serum creatinine: 1.1 mg/dL; 31. Given the following data, calculate the effective
recta, efferent arteriole the: age: 50 years, and weight: 72 kg, the estimated renal plasma flow: urine volume in 2 hours: 240 mL;
D. Efferent arteriole, vasa recta, peritubular A. Juxtaglomerular nephrons creatinine clearance using the Cockcroft-Gault urine PAH: 150 mg/dL; plasma PAH: 0.5 mg/dL
capillaries, afferent arteriole B. Proximal convoluted tubule formula is:
C. Cortical nephrons A. 46 32. Renal tubular acidosis can be caused by the:
4. Filtration of protein is prevented in the D. Both A and C B. 62 A. Production of excessively acidic urine due to
glomerulus by: C. 82 increased filtration of hydrogen ions
A. Hydrostatic pressure 14. ADH regulates the final urine concentration by D. 127 B. Production of excessively acidic urine due to
B. Oncotic pressure controlling: increased secretion of hydrogen ions
C. Renin A. Active reabsorption of sodium 23. Variables that may be included in estimated C. Inability to produce an acidic urine due to
D. Capillary pores B. Tubular permeability creatinine clearance calculations include all of the impaired production of ammonia
C. Passive reabsorption of urea following except: D. Inability to produce an acidic urine due to
5. Renin is secreted by the nephron in response to: D. Passive reabsorption of chloride A. Serum creatinine increased production of ammonia
A. Low systemic blood pressure B. Urine creatinine
B. High systemic blood pressure 15. When the body is dehydrated: C. Age 33. Tests performed to detect renal tubular acidosis
C. Oncotic capillary pressure A. ADH production is decreased D. Blood urea nitrogen after administering an ammonium chloride load
D. Increased water retention B. ADH production is increased include all of the following except:
C. Urine volume is increased 24. Advantage to using cystatin C to monitor GFR is: A. Urine ammonia
6. The primary chemical affected by the D. Both A and C A. It does not require urine collection B. Arterial pH
reninangiotensin- aldosterone system is: B. It is not secreted by the tubules C. Urine pH
A. Chloride 16. Bicarbonate ions filtered by the glomerulus are C. It can be measured by immunoassay D. Titratable acicity
B. Sodium returned to the blood: D. All of the above
C. Potassium A. In the proximal convoluted tubule CHAPTER 3
D. Hydrogen B. Combined with hydrogen ions 25. Solute dissolved in solvent will: INTRODUCTION TO URINALYSIS
C. By tubular secretion A. Decrease vapor pressure
7. Secretion of renin is stimulated by: D. All of the above B. Lower the boiling point 1. The primary chemical constituents of normal
A. Juxtaglomerular cells C. Decrease the osmotic pressure urine are:
B. Angiotensin I and II 17. If ammonia is not produced by the distal D. Lower the specific gravity A. Protein, sodium, and water
C. Macula densa cells convoluted tubule, the urine pH will be: B. Urea, water, and protein
D. Circulating angiotensin-converting enzyme A. Acidic 26. Substances that may interfere with C. Urea, chloride, and water
B. Basic measurement of urine and serum osmolarity D. Urea, bilirubin, and glucose
8. The hormone aldosterone is responsible for: include all of the following except:
A. Hydrogen ion secretion 18. Place the appropriate letter in front of the A. Ethanol 2. An unidentified fluid is received in the laboratory
B. Potassium secretion following clearance substances: B. Lactic acid with a request to determine if the fluid is urine or
C. Chloride retention A. Exogenous C. Sodium another body fluid. Using routine laboratory tests,
D. Sodium retention B. Endogenous D. Lipids what tests would determine that the fluid is most
____ inulin probably urine?
9. The fluid leaving the glomerulus has a specific ____ creatinine 27. The normal serum osmolarity is: A. Glucose and ketones
gravity of: ____ cystatin C A. 50–100 mOsm B. Urea and creatinine
A. 1.005 ____ 125I-iothalmate B. 275–300 mOsm C. Uric acid and amino acids
B. 1.010 C. 400–500 mOsm D. Protein and amino acids
C. 1.015 D. 3 times the urine osmolarity
D. 1.020
3. A person exhibiting oliguria would have a daily 11. What is the method of choice for preservation 7. Specimens from patients receiving treatment for
urine volume of: of routine urinalysis samples? 21. What type of urine specimen should be urinary tract infections frequently appear:
A. 200–400 mL A. Boric acid collected from a patient who complains of painful A. Clear and red
B. 600–1000 mL B. Formalin urination and the physician has ordered a routine B. Viscous and orange
C. 1000–1500 mL C. Refrigeration urinalysis and urine culture? C. Dilute and pale yellow
D. Over 1500 mL D. Sodium fluoride A. Random D. Cloudy and red
B. First morning
4. A patient presenting with polyuria, nocturia, 12. For best preservation of urinary sediments, the C. Fasting 8. Fresh normal urine is usually clear; however, if
polydipsia, and a high urine specific gravity is preservatives of choice are: D. Midstream clean-catch alkaline, white turbidity may be present due to:
exhibiting symptoms of what disorder? A. Boric acid and thymol A. Amorphous phosphates and carbonates
A. Diabetes insipidus B. Formalin and sodium fluoride CHAPTER 4 B. Uroerythrin
B. Diabetes mellitus C. Toluene and freezing PHYSICAL EXAMINTION OF URINE C. WBCs
C. Urinary tract infection D. Chloroform and refrigeration D. Yeast
D. Uremia 1. The concentration of a normal urine specimen
13. What chemical can be used to preserve a can be estimated by which of the following? 9. Microscopic examination of a clear urine that
5. True or False: Disposable containers with a specimen for a culture and a routine urinalysis? A. Color produces a pink precipitate after refrigeration will
capacity of 50 mL are recommended for the A. Boric acid B. Clarity show:
collection of specimens for routine urinalysis. B. Formalin C. Foam A. Amorphous urates
C. Sodium fluoride D. Odor B. Porphyrins
6. The correct mX for labeling urine specimen: D. Thymol C. Red blood cells
A. Attach the label to the lid 2. The normal yellow color of urine is produced by: D. Triple phosphate crystals
B. Attach the label to the bottom 14. True or False: A properly labeled urine specimen A. Bilirubin
C. Attach the label to the container for routine urinalysis delivered to the laboratory in B. Hemoglobin 10. Under what conditions will a port-wine urine
D. Use only a wax pencil for labeling a gray-top blood collection tube can be tested. C. Urobilinogen color be observed in a urine specimen?
D. Urochrome A. The patient has eaten Clorets.
7. A urine specimen for routine urinalysis would be 15. What is the specimen of choice for routine UA? B. Melanin is present.
rejected by the laboratory because: A. Fasting specimen 3. A yellow-brown specimen that produces a yellow C. Urine contains porphyrins.
A. The specimen had been refrigerated B. First morning specimen foam when shaken can be suspected of containing: D. The patient has a Pseudomonas infection.
B. More than 50 mL was in the container C. Random specimen A. Bilirubin
C. The specimen and accompanying requisition did D. 24-Hour specimen B. Carrots 11. Which of the following specific gravities would
not match C. Hemoglobin be most likely to correlate with a dark yellow urine?
D. The label was placed on the side of the container 16. Quantitative urine tests are performed on: D. Rhubarb A. 1.005
A. First morning specimens B. 1.010
8. An unpreserved specimen collected at 8 a.m. and B. Timed specimens 4. A urine that turns black after standing may C. 1.020
remaining at room temperature until the afternoon C. Midstsream clean-catch specimens contain: D. 1.030
shift arrives can be expected to have: D. Suprapubic aspirations A. Homogentisic acid
1. Decreased glucose and ketones B. Melanin 12. True or False: Urine specific gravity is equally
2. Increased bacteria and nitrite 17. Three types of urine specimens that would be C. Methemoglobin influenced by the presence of glucose and sodium.
3. Decreased pH and turbidity acceptable for culture to diagnose a bladder D. All of the above
4. Increased cellular elements infection include all of the following except: 13. In what circumstance might a sediment be
A. Catheterized 5. Specimens that contain intact RBCs can be slightly warmed prior to microscopic examination?
A. 1, 2, and 3 B. Midstream clean-catch visually distinguished from those that contain A. To hemolyze RBCs
B. 1, 2, and 4 C. Random hemoglobin because: B. To dissolve amorphous urates
C. 1 and 2 only D. Suprapubic aspiration A. Hemoglobin produces a much brighter red color C. To increase the specific gravity
D. 4 only B. Hemoglobin produces a cloudy, pink specimen D. To correct for temperature in determining the
18. A negative urine pregnancy test performed on a C. RBCs produce a cloudy specimen specific gravity
9. A specimen containing precipitated amorphous random specimen may need to be repeated using a: D. RBCs are quickly converted to hemoglobin
urates may have been preserved using: A. Clean-catch specimen 14. A urine specific gravity measured by
A. Boric acid B. Fasting specimen 6. After eating beets purchased at the local farmers’ refractometer is 1.029, and the temp of the urine is
B. Chloroform C. First morning specimen market, Mrs. Williams notices that her urine is red, 14C. The specific gravity should be reported as:
C. Formalin D. 24-Hour specimen but Mr. William’s urine remains yellow. The A. 1.023
D. Refrigeration Williamses should: B. 1.027
19. Cessation of urine flow is termed: A. Be concerned because red urine always indicates C. 1.029
10. What changes will affect results of the A. Anuria the presence of blood D. 1.032
microscopic exam of urine if not tested w/in 2 hrs? B. Azotemia B. Not be concerned because all women produce
A. Decreased bacteria, decreased red blood cells, C. Diuresis red urine after eating beets 15. Refractive index compares:
decreased casts D. Dysuria C. Be concerned because both of them should have A. Light velocity in solutions with light velocity in
B. Increased bacteria, increased red blood cells,
red urine if beets are the cause solids
increased casts
C. Increased bacteria, decreased red blood cells, 20. Persons taking diuretics can be expected to D. Not be concerned because only Mrs. Williams is B. Light velocity in air with light velocity in solutions
decreased casts produce: genetically susceptible to producing red urine from C. Light scattering by air with light scattering by
D. Decreased bacteria, increased red blood cells, A. Oliguria B. Polyuria beets solutions
increased casts C. Proteinuria D. Pyuria D. Light scattering by particles in solution
16. Refractometers are calibrated using: 25. The microscopic of a cloudy amber urine is 7. The principle of the reagent strip test for pH is :
A. Distilled water and protein reported as rare WBCs and epithelial cells. What A. Protein error of indicators 15. All of the following are true for the Micral-Test
B. Distilled water and blood does this suggest? B. Greiss reaction for microalbumin except:
C. Distilled water and sodium chloride A. Urinary tract infection C. Dissociation of a polyelectrolyte A. It is run on first morning specimens
D. Distilled water and urea B. Dilute random specimen D. Double indicator reaction B. It contains an antibody-enzyme conjugate
C. Precipitated amorphous urates C. Two blue bands are formed on the strip
17. A correlation exists between a specific gravity of D. Possible mix-up of specimen and sediment 8. A urine specimen with a pH of 9.0: D. Unbound antibody attaches to immobilized
1.050 and a: A. Is indicative of metabolic acidosis Albumin
A. 2glucose 26. A specimen with a strong ammonia odor and a B. Should be recollected
B. 2protein heavy white precipitate when it arrives in the C. May contain calcium oxalate crystals 16. All of the following are true for the Immunodip
C. First morning specimen laboratory may require: D. Is seen after drinking cranberry juice test for microalbumin except:
D. Radiographic dye infusion A. Collection of a fresh specimen A. Unbound antibody migrates farther than bound
B. Centrifugation 9. In the laboratory, a primary consideration antibody
18. An alkaline urine turns black upon standing, C. Dilution for specific gravity associated with pH is: B. Blue latex particles are coated with antibody
develops a cloudy white precipitate, and has a D. Testing under a hood A. Identification of urinary crystals C. Bound antibody migrates further than unbound
specific gravity of 1.012. The major concern about B. Monitoring of vegetarian diets antibody
this specimen would be: CHAPTER 5 C. Determination of specimen acceptability D. It utilizes an immumochromographic principle
A. Color CHEMICAL EXAMINATION OF URINE D. Both A and C
B. Turbidity 17. The principle of the protein-low reagent pad on
C. Specific gravity 1. Leaving a reagent strip in the specimen for too 10. Indicate the source of the following proteinurias the Multistix Pro is the:
D. All of the above long will: by placing a 1 for prerenal, 2 for renal, or 3 for A. Binding of albumin to sulphonphtalein dye
A. Cause runover between reagent pads postrenal in front of the condition. B. Immunologic binding of albumin to antibody
19. The reading of distilled water by the B. Alter the color of the specimen A. ____Microalbuminuria C. Reverse protein error of indicators reaction
refractometer is 1.003. You should: C. Cause reagents to leach from the pads B. ____Acute phase reactants D. Enzymatic reaction between albumin and dye
A. Subtract 1.003 from each specimen reading D. Not affect the chemical reactions C. ____Pre-eclampsia
B. Add 1.003 to each specimen reading D. ____Vaginal inflammation 18. The principle of the creatinine reagent pad on
C. Use a new refractometer 2. Failure to mix a specimen prior to inserting the E. ____Multiple myeloma microalbumin reagent strips is the:
D. Adjust the set screw reagent strip will primarily affect the: F. ____Orthostatic proteinuria A. Double indicator reaction
A. Glucose reading G. ____Prostatitis B. Diazo reaction
20. A urine specimen with a specific gravity of 1.008 B. Blood reading C. Pseudoperoxidase reaction
has been diluted 1:5. The actual specific gravity is: C. Nitrite reading 11. The principle of the protein error of indicators D. Reduction of a chromogen
A. 1.008 D. Ph reading reaction is that:
B. 1.040 A. Protein changes the pH of the urine 19. The purpose of performing an
C. 1.055 3. Testing a refrigerated specimen that has not B. Albumin accepts hydrogen ions from the albumin:creatinine ratio is to:
D. 5.040 warmed to room temperature will adversely affect: indicator A. Estimate the glomerular filtration rate
A. Enzymatic reactions C. The indicator accepts ions for albumin B. Correct for hydration in random specimens
21. The method for determining a urine specific B. Dye-binding reactions D. Albumin changes the pH of the urine C. Avoid interference for alkaline urines
gravity that is based on the principle that the freq C. The sodium nitroprusside reaction D. Correct for abnormally colored urines
of a sound wave entering a solution changes in D. Diazo reactions 12. All of the following will cause false-positive
proportion to the density of the solution is: protein reagent strip values except: 20. A patient with a normal blood glucose and a
A. Colorimetric 4. The reagent strip reaction that requires the A. Proteins other than albumin positive urine glucose should be further checked
B. Harmonic oscillation densitometry longest reaction time is the: B. Highly buffered alkaline urines for:
C. Refractometry A. Bilirubin C. Delay in removing the reagent strip from the A. Diabetes mellitus
D. Urinometry B. pH specimen B. Renal disease
C. Leukocyte esterase D. Contamination by quartenary ammonium C. Gestational diabetes
22. A specimen with a specific gravity of 1.005 D. Glucose compounds D. Pancreatitis
would be considered:
A. Isosthenuric 5. Quality control of reagent strips is performed: 13. A patient with a 1 protein reading in the 21. The principle of the reagent strip tests for
B. Hyposthenuric A. Using positive and negative controls afternoon is asked to submit a first morning glucose is the:
C. Hypersthenuric B. When results are questionable specimen. The second specimen also has a 1 A. Peroxidase activity of glucose
D. Not urine C. At least once every 24 hours protein. This patient is: B. Glucose oxidase reaction
D. All of the above A. Positive for orthostatic proteinuria C. Double sequential enzyme reaction
23. True or False: Specific gravity is of more B. Negative for orthostatic proteinuria D. Dye-binding of glucose and chromogen
diagnostic value than osmolarity in evaluating renal 6. All of the following are important to protect the C. Positive for Bence Jones protein
concentration ability. integrity of reagent strips except: D. Negative for clinical proteinuria 22. All of the following may produce false-negative
A. Removing the desiccant from the bottle glucose reactions except:
24. A strong odor of ammonia in a urine specimen B. Storing in an opaque bottle 14. Testing for microalbuminuria is valuable for A. Detergent contamination
could indicate: C. Storing at room temperature monitoring patients with: B. Ascorbic acid
A. Ketones D. Resealing the bottle after removing a strip A. Hypertension C. Unpreserved specimens
B. Normal B. Diabetes mellitus D. Low urine temperature
C. Phenylketonuria C. Cardiovascular disease risk
D. Urinary tract infection D. All of the above
23. A positive Clinitest and a negative reagent strip 31. The principle of the reagent strip test for blood 40. In the Watson-Schwartz differentiation test, the 49. A specific gravity of 1.030 would produce the
glucose are indicative of: is based on the: substance(s) not extracted into butanol is/are: reagent strip color:
A. Low levels of glucose A. Binding of heme and a chromogenic dye A. Urobilinogen A. Blue
B. Nonglucose reducing substances B. Peroxidase activity of heme B. Porphobilinogen B. Green
C. High levels of glucose C. Reaction of peroxide and chromogen C. Ehrlich reactive substances C. Yellow
D. Both A and B D. Diazo activity of heme D. All of the above D. Red
24. Primary reason for performing a Clinitest is to: 32. A speckled pattern on the blood pad of the 41. The Hoesch test is used to monitor or screen 50. Reagent strip–specific gravity readings are
A. Check for high ascorbic acid levels reagent strip indicates: patients for the presence of: affected by:
B. Confirm a positive reagent strip glucose A. Hematuria B. Hemoglobinuria A. Urobilinogen A. Glucose
C. Check for newborn galactosuria C. Myoglobinuria D. All of the above B. Nitrite B. Radiographic dye
D. Confirm a negative glucose reading C. Porphobilinogen C. Alkaline urine
33. List the following products of hemoglobin D. Leukocyte esterase D. All of the above
25. The three intermediate products of fat degradation in the corrct order by placing numbers
metabolism include all of the following except: 1–4 in front of them. 42. The reagent strip test for nitrite used the: CHAPTER 6
A. Acetoacetic acid A. ___Conjugated bilirubin A. Greiss reaction MICROSCOPIC EXAMINATION OF URINE
B. Ketoacetic acid B. ___Urobilinogen and stercobiligen B. Hoesch reaction
C. Beta-hydroxybutyric acid C. ___Urobilin C. Peroxidase reaction 1. Macroscopic screening of urine specimens is used
D. Acetone D. ___Unconjugated bilirubin D. Pseudoperoxidase reaction to:
A. Provide results as soon as possible
26. The most significant reagent strip test that is 34. The principle of the reagent strip test for 43. All of the following can cause a negative nitrite B. Predict the type of urinary casts present
associated with a positive ketone result is: bilirubin is the: reading except: C. Increase cost-effectiveness of urinalysis
A. Glucose A. Diazo reaction A. Gram-positive bacteria D. Decrease the need for polarized microscopy
B. Protein B. Ehrlich reaction B. Gram-negative bacteria
C. pH C. Greiss reaction C. Random urine specimens 2. Variations in the microscopic analysis of urine
D. Specific gravity D. Peroxidase reaction D. Heavy bacterial infections include all of the following except:
A. Preparation of the urine sediment
27. The primary reagent in the reagent strip test for 35. An elevated urine bilirubin with a normal 44. A positive nitrite test and a negative leukocyte B. Amount of sediment analyzed
ketones is: urobilinogen is indicative of: esterase test is an indication of a: C. Method of reporting
A. Glycine A. Cirrhosis of the liver A. Dilute random specimen D. Identification of formed elements
B. Lactose B. Hemolytic disease B. Specimen with lyzed leukocytes
C. Sodium hydroxide C. Hepatitis C. Vaginal yeast infection 3. All of the following can cause false-negative
D. Sodium nitroprusside D. Biliary obstruction D. Specimen older than 2 hours microscopic results except:
A. Braking the centrifuge
28. Ketonuria may be caused by all of the following 36. The primary cause of a false-negative bilirubin 45. All of the following can be detected by the B. Failing to mix the specimen
except: reaction is: leukocyte esterase reaction except: C. Dilute alkaline urine
A. Bacterial infections A. Highly pigmented urine A. Neutrophils D. Using midstream clean-catch specimens
B. Diabetic acidosis B. Specimen contamination B. Eosinophils
C. Starvation C. Specimen exposure to light C. Lymphocytes 4. The two factors that determine relative
D. Vomiting D. Excess conjugated bilirubin D. Basophils centrifugal force are:
46. Screening tests for urinary infection combine A. Radius of rotor head and rpm
29. Urinalysis on a patient with severe back and 37. The purpose of the special mat supplied with the leukocyte esterase test with the test for: B. Radius of rotor head and time of centrifugation
abdominal pain is frequently performed to check the Ictotest tablets is that: A. pH C. Diameter of rotor head and rpm
for: A. Bilirubin remains on the surface of the mat. B. Nitrite D. RPM and time of centrifugation
A. Glucosuria B. Proteinuria B. It contains the dye needed to produce color. C. Protein
C. Hematuria D. Hemoglobinuria C. It removes interfering substances. D. Blood 5. When using the glass slide and coverslip method,
D. Bilirubin is absorbed into the mat. which of the following might be missed if the
30. Place the appropriate number or numbers in 47. The principle of the leukocyte esterase reagent coverslip is overflowed?
front of each of the following statements. Use both 38. The reagent in the Multistix reaction for strip test uses a: A. Casts
numbers for an answer if needed. urobilinogen is: A. Peroxidase reaction B. RBCs
A. A diazonium salt B. Double indicator reaction C. WBCs
1. Hemoglobinuria 2. Myoglobinuria B. Tetramethylbenzidine C. Diazo reaction D. Bacteria
C. p-dimethylaminobenzaldehyde D. Dye-binding technique
A. ____Associated with transfusion reactions D. Hoesch reagent 6. Initial screening of the urine sediment is
B. ____Clear, red urine and pale yellow plasma 48. The principle of the reagent strip test for performed using an objective power of:
C. ____Clear, red urine and red plasma 39. The primary problem with urobilinogen tests specific gravity uses the dissociation constant of A. 4
D. ____Associated with rhabdomylosis using Ehrlich reagent is: a/an: B. 10
E. ____Precipitated by ammonium sulfate A. Positive reactions with porphobilinogen A. Diazonium salt C. 40
F. ____Not precipitated by ammonium sulfate B. Lack of sensitivity B. Indicator dye D. 100
G. ____Produced hemosiderin granules in urinary C. Positive reactions with Ehrlich reactive subs. C. Polyelectrolyte
sediments D. Both A and C D. Enzyme substrate
H. ____Associated with acute renal failure
7. Which of the following should be used to reduce 17. Leukocytes that stain pale blue with 26. Following an episode of hemoglobinuria, RTE 35. WBC casts are primarily associated with:
light intensity in bright-field microscopy? Sternheimer- Malbin stain and exhibit brownian cells may contain: A. Pyelonephritis
A. Centering screws movement are: A. Bilirubin B. Cystitis
B. Aperture diaphragm A. Indicative of pyelonephritis B. Hemosiderin granules C. Glomerulonephritis
C. Rheostat B. Basophils C. Porphobilinogen D. Viral infections
D. Condenser aperture diaphrgam C. Mononuclear leukocytes D. Myoglobin
D. Glitter cells 36. The shape of the RTE cell associated with renal
8. Which of the ff are reported as number per LPF? 27. The predecessor of the oval fat body is the: tubular epithelial casts is primarily:
A. RBCs 18. Mononuclear leukocytes are sometimes A. Histiocyte A. Elongated B. Cuboidal
B. WBCs mistaken for: B. Urothelial cell C. Round D. Columnar
C. Crystals A. Yeast cells C. Monocyte
D. Casts B. Squamous epithelial cells D. Renal tubular cell 37. When observing RTE casts, the cells are
C. Pollen grains primarily:
9. The Sternheimer-Malbin stain is added to urine D. Renal tubular cells 28. A structure believed to be an oval fat body A. Embedded in a clear matrix
sediments to do all of the following except: produced a Maltese cross formation under B. Embedded in a granular matrix
A. Increase visibility of sediment constituents 19. When pyuria is detected in a sediment, the slide polarized light but does not stain with Sudan III. The C. Attached to the surface of a matrix
B. Change the constituents refractive index should be carefully checked for the presence of: structure: D. Stained by components of the urine filtrate
C. Decrease precipitation of crystals A. RBCs A. Contains cholesterol
D. Delineate constituent structures B. Bacteria B. Is not an oval fat body 38. The presence of fatty casts is associated with:
C. Hyaline casts C. Contains neutral fats A. Nephrotic syndrome
10. Nuclear detail can be enhanced by: D. Mucus D. Is contaminated with immersion oil B. Crush injuries
A. Prussian blue B. Toluidine blue C. Diabetes mellitus
C. Acetic acid D. Both B and C 20. Transitional epithelial cells are sloughed from 29. The finding of yeast cells in the urine is D. All of the above
the: commonly associated with:
11. Which of the following lipids is/are stained by A. Collecting duct A. Cystitis 39. Nonpathogenic granular casts contain:
Sudan III? B. Vagina B. Diabetes mellitus A. Cellular lysosomes
A. Cholesterol C. Bladder C. Pyelonephritis B. Degenerated cells
B. Neutral fats D. Proximal convoluted tubule D. Liver disorders C. Protein aggregates
C. Triglycerides D. Gram-positive cocci
D. Both B and C 21. The largest cells in the urine sediment are: 30. The primary component of urinary mucus is:
A. Squamous epithlial cells A. Bence Jones protein 40. All of the following are true about waxy casts
12. Which of the following lipids is/are capable of B. Urothelial epithelial cells B. Microalbumin except they:
polarizing light? C. Cuboidal epithelial cells C. Tamm-horsfall protein A. Represent extreme urine stasis
A. Cholesterol D. Columnar epithelial cells D. Orthostatic protein B. May have a brittle consistency
B. Neutral fats C. Require staining to be visualized
C. Triglycerides 22. A clinically significant squamous epithelial cell is 31. The majority of casts are formed in the: D. Contain degenerated granules
D. Both A and B the: A. Proximal convoluted tubules
13. The purpose of the Hansel stain is to identify: A. Cuboidal cell B. Ascending loop of Henle 41. The observation of broad casts represents:
A. Neutrophils B. Clue cell C. Distal convoluted tubules A. Destruction of tubular walls
B. Renal tubular cells C. Caudate cell D. Collecting ducts B. Dehydraton and high fever
C. Eosinophils D. Columnar cell C. Formation in the collecting ducts
D. Monocytes 32. Cylindroiduria refers to the presence of: D. Both A and C
23. Forms of transitional epithelial cells include all A. Cylindrical renal tubular cells
14. Crenated RBCs are seen in urine that is: of the following except: B. Mucus resembling casts 42. All of the following contribute to the formation
A. Hyposthenuric A. Spherical C. Hyaline and waxy casts of urinary crystals except:
B. Hypersthenuric B. Caudate D. All types of casts A. Protein concentration
C. Highly acidic C. Convoluted B. ph
D. Highly alkaline D. Polyhedral 33. A person submitting a urine specimen following C. Solute concentration
a strenuous exercise routine can normally have all D. Temperature
15. Differentiation among RBCs, yeast, and oil 24. Increased transitional cells are indicative of: of the following in the sediment except:
droplets may be accomplished by all of the A. Catheterization A. Hyaline casts 43. The most valuable initial aid for the
following except: B. Malignancy B. Granular casts identification of crystals in a urine specimen is:
A. Observation of budding in yeast cells C. Pyelonephritis C. RBC casts A. ph B. Solubility
B. Increased refractility of oil droplets D. Both A and B D. WBC casts C. Staining D. Polarized microscopy
C. Lysis of yeast cells by acetic acid
D. Lysis of RBCs by acetic acid 25. A primary characteristic used to identify renal 34. Prior to identifying an RBC cast, all of the 44. Crystals associated with severe liver disease
tubular epithelial cells is: following should be observed except: include all of the following except:
16. The finding of dysmorphic RBCs is indicative of: A. Elongated structure A. Free-floating RBCs A. Bilirubin
A. Glomerular bleeding B. Centrally located nucleus B. Intact RBCs in the cast B. Leucine
B. Renal calculi C. Spherical appearance C. Presence of a cast matrix C. Cystine
C. Traumatic injury D. Eccentrically located nucleus D. A positive reagent strip blood reaction D. Tyrosine
D. Coagulation disorders
45. All of the following crystals routinely polarize ____Interference 6. Detects electrons 16. Match the purpose for developing each of the
except: emitted contrast from 8. A color change that indicates when a patient’s following:
A. Uric acid B. Cholesterol objects specimen or reagent is added correctly would be an 1. Flowcharts
C. Radiographic dye D. Cystine 7. Detects specific example of: 2. Cause-and-effect diagrams
wavelengths of light A. External QC 3. Pareto charts
46. Differentiation between casts and fibers can emitted from objects B. Equivalent QC 4. Run charts
usually be made using: C. Internal QC ____A. Determine cyclic and seasonal differences
A. Solubility char. B. Patient history CHAPTER 7 D. Proficiency testing compared to an average
C. Polarized light D. Fluorescent light QUALITY ASSESMENT AND MGMT IN THE ____B. Break down a process into steps
URINALYSIS LABORATORY 9. What steps are taken when the results of reagent ____C. Identify the major contributors to a
47. Match the following crystals seen in acidic urine strip QC are outside of the stated confidence limits? problem
with their description/identifying characteristics: 1. Quality assessment refers to: A. Check the expiration date of the reagent strip ____D. Determine the cause of a problem
____Amorphous urates 1. Envelopes A. Analysis of testing controls B. Run a new control
____Uric acid 2. Thin needles B. Increased productivity C. Open a new reagent strips container 17. True or False: Most medical errors are the fault
____Calcium oxalate 3. Yellow-brown, C. Precise control results D. All of the above of individuals, not the system.
monhydrate whetstone D. Quality of specimens and patient care CHAPTER 8
____Calcium oxalate 4. Pink sediment 10. When a new bottle of qc material is opened, RENAL DISEASE
dihydrate 5. Ovoid 2. During lab accreditation inspections, procedure what information is placed on the label?
manuals are examined for the presence of: A. The supervisor’s initials 1. The majority of glomerular disorders are caused
48. Match the following crystals seen in alkaline A. Critical values B. The lot number by:
urine with their description/identifying B. Procedure references C. The date and the laboratory worker’s initials A. Sudden drops in blood pressure
characteristics: C. Procedures for specimen preservation D. The time the bottle was opened B. Immunologic disorders
____Triple phosphate D. All of the above C. Exposure to toxic substances
____Amorphous phosphate 11. When a control is run, what information is D. Bacterial infections
____Calcium phosphate 3. Urinalysis procedure manuals are reviewed: documented?
____Ammonium biurate A. By the supervisor on each shift A. The lot number 2. Dysmorphic RBC casts would be a significant
____Calcium carbonate B. Weekly by the pathologist B. Expiration date of the control finding with all of the following except:
C. Only when a procedure is changed C. The test results A. Goodpasture syndrome
1. Yellow granules 2. Thin prisms D. Annually by a designated authority D. All of the above B. Acute glomeruonephritis
3. “Coffin lids” 4. Dumbbell shape C. Chronic pyelonephritis
5. White precipitate 6. Thorny apple 4. As supervisor of the urinalysis laboratory, you 12. State which of the CLIA categories is assigned to D. Henoch-Schönlein purpura
have just adopted a new procedure. You should: each of the following laboratory tests by placing the
49. Match the following abnormal crystals with A. Put the package insert in the procedure manual appropriate number in front of the test. 3. Occassional episodes of macroscopic hematuria
their description/identifying characteristics: B. Put a complete, referenced procedure in the 1. Waived over periods of 20 or more years are seen with:
____Cystine 1. Bundles following manual 2. PPM A. Crescentic glomerulonephritis
refrigeration C. Notify the microbiology department 3. Moderate complexity B. IgA nephropathy
____Tyrosine 2. Highly alkaline pH D. Put a cost analysis study in the procedure manual 4. High complexity C. Nephrotic syndrome
____Cholesterol 3. Bright yellow clumps ____A. Reagent strip urinalysis D. Wegener’s granulomatosis
____Leucine 4. Hexagonal plates 5. Indicate whether each of the following would be ____B. Urine culture
____Ampicillin 5. Flat plates, high specific considered a 1) preanalytical, 2) analytical, or 3) ____C. Complete urinalysis using the Clinitek 500 4. Antiglomerular basement membrane antibody is
gravity postanalytical factor by placing the appropriate ____D. Urine microscopic seen with:
____Radiographic 6. Concentric circles, radial number in the space: ____E. Urine pregnancy test A. Wegener’s granulomatosis
dye striations _____ Reagent expiration date B. IgA nephropathy
____Bilirubin 7. Notched corners _____ Rejection of a contaminated specimen 13. How often does CLIA’ 88 require documentation C. Goodpasture syndrome
8. Fine needles seen in _____ Construction of a Levy-Jennings chart of technical competency? D. Diabetic nephropathy
liver disease _____ Telephoning a positive Clinitest result on a A. Every 6 months
newborn B. Once a year 5. Antineutrophilic cytoplasmic antibody is
50. Match the following types of microscopy with _____ Calibrating the centrifuge C. Twice the first year and then annually diagnostic for:
their descriptions: _____ Collecting a timed urine specimen D. Twice the first year and then every 5 years A. IgA nephropathy
____Bright-field 1. Indirect light is reflected B. Wegener’s granulomatosis
off the object 6. Deionized water used for the preparation of 14. Who are the laboratory’s “customers” in CQI? C. Henoch-Schönlein purpura
____Phase 2. Objects split light into reagents should be checked for: A. Physicians D. Goodpasture syndrome
two beams A. Calcium content B. Patients’ family members
____Polarized 3. Low refractive index B. Bacterial content C. Patients 6. Respiratory and renal symptoms are associated
objects may be C. Filter contamination D. All of the above with all of the following except:
overlooked D. pH, purity, and bacteria A. IgA nephropathy
____Dark-field 4. Three-dimensional 15. What is the primary goal of TQM? B. Wegener’s granulomatosis
images 7. Would a control sample that has accidentally A. Increased laboratory productivity C. Henoch-Schönlein purpura
____Fluorescent 5. Forms halo of light become diluted produce a trend or a shift in the B. Improved patient outcomes D. Goodpasture syndrome
around object Levy-Jennings plot? C. Reliability of test results
A. Trend D. Precise test results
B. Shift
7. Broad and waxy casts are most frequently seen 16. End-stage renal disease is characterized by all of 5. Which of the following disorders is not associated 15. Hartnup disease is a disorder associated with
with: the following except: with the phenylalanine-tyrosine pathway? the metabolism of:
A. Membranoproliferative glomerulonephritis A. Hypersthenuria A. MSUD A. Organic acids
B. Membranous glomerulonephritis B. Isosthenuria B. Alkaptonuria B. Tryptophan
C. Chronic glomerulonephritis C. Azotemia C. Albinism C. Cystine
D. Rapidly progressive glomerulonephritis D. Electrolyte imbalance D. Tyrosinemia D. Phenylalanine
8. The presence of fatty casts is associated with all 17. Broad and waxy casts are most likely associated 6. Urine screening tests for PKU utilize: 16. 5-HIAA is a degradation product of:
of the following except: with: A. Microbial inhibition A. Heme
A. Nephrotic syndrome A. Nephrotic syndrome B. Nitroso-napthol B. Indole
B. Focal segmental glomerulosclerosis B. Chronic renal failure C. Dinitrophenylhydrazine C. Serotonin
C. Nephrogenic diabetes insipidus C. Focal segmental glomerulosclerosis D. Ferric chloride D. Melanin
D. Minimal change disease D. Acute renal failure
18. Postrenal acute renal failure could be caused 7. The least serious form of tyrosylemia is: 17. Elevated urinary levels of 5-HIAA, assoc. with:
9. High levels of proteinuria are early symptoms of: by: A. Immature liver function A. Carcinoid tumors
A. Alport syndrome A. Ischemia B. Type 1 B. Hartnup disease
B. Diabetic nephropathy B. Acute tubular necrosis C. Type 2 C. Cystinuria
C. IgA nephropathy C. Acute interstitial nephritis D. Type 3 D. Platelet disorders
D. Nephrotic syndrome D. Malignant tumors
8. An overflow disorder of the phenylalanine- 18. False-positive levels of 5-HIAA can be caused by
10. Ischemia frequently produces: 19. The most common composition of renal calculi tyrosine pathway that could produce a false- a diet high in:
A. Acute renal tubular necrosis is: positive reaction with the reagent strip test for A. Meat
B. Minimal change disorder A. Calcium oxalate ketones is: B. Carbohydrates
C. Acute renal failure B. Magnesium ammonium phosphate A. Alkaptonuria C. Starch
D. Both A and C C. Cystine B. Melanuria D. Bananas
D. Uric acid C. MSUD
11. A disorder associated with polyuria and low D. Tyrosyluria 19. Place the appropriate letter in front of the
specific gravity is: 20. Urinalysis on a patient being evaluated for renal following statements.
A. Renal glucosuria calculi would be most beneficial if it showed: 9. An overflow disorder that could produce a A. Cystinuria B. Cystinosis
B. Cystitis A. Heavy proteinuria falsepositive reaction with clinitest is: ____IEM
C. Nephrogenic diabetes insipidus B. Calcium oxalate crystals A. Cystinuria ____Inherited disorder of renal tubules
D. Focal segmental glomerulosclerosis C. Macroscopic hematuria B. Alkaptonuria ____Fanconi syndrome
D. Microscopic hematuria C. Indicanuria ____Cystine deposits in the cornea
12. An inherited or accquired disorder producing a D. Porphyrinuria ____Early renal calculi formation
generalized defect in tubular reabsorption is: CHAPTER 9
A. Alport syndrome URINE SCREENING FOR METABOLIC DISORDERS 10. A urine that turns black after sitting by the sink 20. Urine from patients with cystine disorders will
B. Acute interstitial nephritis for several hours could be indicative of: react with:
C. Fanconi syndrome 1. All states require newborn screening for PKU for A. Alkaptonuria A. Dinitrophenylhydrazine
D. Renal glucosuria early: B. MSUD B. Sodium cyanide
A. Modifications of diet C. Melanuria C. Ehrlich reagent
13. The presence of renal tubular epithelial cells B. Administration of antibiotics D. Both A and C D. 1-Nitroso-napthol
and casts is an indication of: C. Detection of diabetes
A. Acute interstitial nephritis D. Initiation of gene therapy 11. Ketonuria in a newborn is an indication of: 21. Blue diaper syndrome is associated with:
B. Chronic glomerulonephritis A. MSUD A. Lesch-Nyhan syndrome
C. Minimal change disease 2. All of the following disorders can be detected by B. Isovaleric acidemia B. Phenylketonuria
D. Acute tubular necrosis newborn screening except: C. Methylmalonic acidemia C. Cystinuria
A. Tyrosyluria D. All of the above D. Hartnup disease
14. Differentiation between cystitis and B. MSUD
pyelonephritis is aided by the presence of: C. Melanuria 12. Urine from a newborn with MSUD will have a 22. Homocystinuria is caused by failure to
A. WBC casts D. Galactosemia significant: metabolize:
B. RBC casts A. Pale color B. Yellow precipitate A. Lysine
C. Bacteria 3. Best specimen for early newborn screening is a: C. Milky appearance D. Sweet odor B. Methionine
D. Granular casts A. Timed urine specimen C. Arginine
B. Blood specimen 13. A substance that reacts with p-nitroaniline is: D. Cystine
15. The presence of WBCs and WBC casts with no C. First morining urine specimen A. Isovaleric acid B. Propionic acid
bacteria seen is indicative of: D. Fecal specimen C. Methylmalonic acid D. Indican 23. Early detection is most valuable for correction
A. Chronic pyelonephritis of:
B. Acute tubular necrosis 4. Abnormal urine screening tests categorized as an 14. Which of the following has a significant odor? A. Homocystinuria
C. Acute interstitial nephritis overflow disorder include all of the following A. Isovaleric acidemia B. Cystinuria
D. Both B and C except: B. Propionic acidemia C. Indicanuria
A. Alkaptonuria B. Galactosemia C. Methylmalonic acidemia D. Porphyrinuria
C. Melanuria D. Cystinuria D. Indicanuria
24. Ehrlich reaction will only detect the presence of: CHAPTER 10 9. Given the following information, calculate the 18. Following a CNS diagnostic procedure, which of
A. Aminolevulinic acid CEREBROSPINAL FLUID CSF WBC count: cells counted, 80; dilution, 1:10; the following might be seen in the CSF?
B. Porphobilinogen large Neubauer squares counted, 10. A. Choroidal cells
C. Coproporphyrin 1. The functions of the CSF include all of the A. 8 B. Ependymal cells
D. Protoporphyrin following except: B. 80 C. Spindle-shaped cells
A. Removal of metabolic wastes C. 800 D. All of the above
25. Acetylacetone is added to the urine prior to B. Producing an ultrafiltrate of plasma D. 8000
performing the Ehrlich test when checking for: C. Supplying nutrients to the CNS 19. Hemosiderin granules and hematoidin crystals
A. Aminolevulinic acid D. Protection of the brain and spinal cord 10. A CSF WBC count is diluted with: are seen in:
B. Porphobilinogen A. Distilled water A. Lymphocytes
C. Uroporphyrin 2. The CSF flows through the: B. Normal saline B. Macrophages
D. Coproporphyrin A. Choroid plexus C. Acetic acid C. Ependymal cells
B. Pia mater D. Methylene blue D. Neutrophils
26. Classic urine color associated with porphyria is: C. Arachnoid space
A. Dark yellow D. Dura mater 11. A total CSF cell count on a clear fluid should be: 20. Myeloblasts are seen in the CSF:
B. Indigo blue A. Reported as normal A. In bacterial infections
C. Pink 3. Substances present in the CSF are contolled by B. Not reported B. In conjunction with CNS malignancy
D. Port wine the: C. Diluted with normal saline C. Following cerebral hemorrhage
A. Arachnoid granulations D. Counted undiluted D. As a complication of acute leukemia
27. Which of the following specimens can be used B. Blood-brain barrier
for porphyrin testing? C. Presence of one-way valves 12. The purpose of adding albumin to CSF before 21. Cells resembling large and small lymphocytes
A. Urine D. Blood-CSF barrier cytocentrifugation is to: with cleaved nuclei represent:
B. Blood A. Increase the cell yield A. Lymphoma cells
C. Feces 4. The CSF tube labeled 3 is sent to: B. Decrease the cellular distortion B. Choroid cells
D. All of the above A. The hematology department C. Improve the cellular staining C. Melanoma cells
B. The chemistry department D. Both A and B D. Medulloblastoma cells
28. The two stages of heme formation affected by C. The microbiology department
lead poisoning are: D. The serology department 13. The primary concern when pleocytosis of 22. The normal value of CSF protein is:
A. Porphobilinogen and uroporphyrin neutrophils and lymphocytes is found in the CSF is: A. 6–8 g/dL
B. Aminolevulinic acid and porphobilinogen 5. The CSF tube that should be refrigerated is: A. Meningitis B. 15–45 g/dL
C. Coproporphyrin and protoporphyrin A. Tube 1 B. CNS malignancy C. 6–8 mg/dL
D. Aminolevulinic acid and protoporphyrin B. Tube 2 C. Multiple sclerosis D. 15–45 mg/dL
C. Tube 3 D. Hemorrhage
29. Hurler, Hunter, and Sanfilippo syndromes are D. Tube 4 23. CSF can be differentiated from plasma by the
hereditary disorders affecting metabolism of: 14. Neutrophils with pyknotic nuclei may be presence of:
A. Porphyrins 6. Place the appropriate letter in front of the mistaken for: A. Albumin
B. Purines statement that best describes CSF specimens in A. Lymphocytes B. Globulin
C. Mucopolysaccharides these two conditions: B. Nucleated RBCs C. Prealbumin
D. Tryptophan C. Malignant cells D. Tau transferrin
A. Traumatic tap D. Spindle-shaped cells
30. Many uric acid crystals in a pediatric urine B. Intracranial hemorrhage 24. In plasma, the second most prevalent protein is
specimen may indicate: _____Even distribution of blood in all tubes 15. The presence of which of the following cells is IgG; in CSF, the second most prevalent protein is:
A. Hurler syndrome _____Xanthochromic supernatant increased when a CNS shunt malfunctions? A. Transferrin
B. Lesch-Nyhan disease _____Concentration of blood in tube 1 is greater A. Neutrophils B. Prealbumin
C. Melituria than in tube 3 B. Macrophages C. IgA
D. Sanfilippo syndrome _____Specimen contains clots C. Eosinophils D. Ceruloplasmin
D. Lymphocytes
31. Deficiency of the GALT enzyme will produce a: 7. The presence of xanthochromia can be caused by 25. Elevated CSF protein values can be caused by all
A. Positive Clinitest all of the following except: 16. Macrophages appear in the CSF following: of the following except:
B. Glycosuria A. Immature liver function A. Hemorrhage A. Meningitis
C. Galactosemia B. RBC degradation B. Repeated spinal taps B. Multiple sclerosis
D. Both A and C C. A recent hemorrhage C. Diagnostic procedures C. Fluid leakage
D. Elevated CSF protein D. All of the above D. CNS malignancy
32. Match the metabolic urine disorders with their
classic urine abonormalities. 8. A web-like pellicle in a refrigerated CSF specimen 17. Nucleated RBCs are seen in the CSF as a result 26. The integrity of the blood-brain barrier is
____PKU A. Sulfur odor is indicative of: of: measured using the:
____Indicanuria B. Sweaty feet odor A. Tubercular meningitis A. Elevated blood RBCs A. CSF/serum albumin index
____Cystinuria C. Orange sand in diaper B. Multiple sclerosis B. Treatment of anemia B. CSF/serum globulin ratio
____Homogentisic acid D. Mousy odor C. Primary CNS malignancy C. Severe hemorrhage C. CSF albumin index
____Lesch-Nyhan disease E. Black color D. Viral meningitis D. Bone marrow contamination D. CSF IgG index
F. Blue color
27. Given the following results, calculate the IgG 36. The test of choice to detect neurosyphilis is the: 9. Proteolytic enzymes may be added to semen 17. The percentage of sperm showing average
index: CSF IgG, 50 mg/dL; serum IgG, 2 gm/dL; CSF A. RPR specimens to: motility that is considered normal is:
albumin, 70 mg/dL; serum albumin, 5 gm/dL. B. VDRL A. Increase the viscosity A. 25%
A. 0.6 C. FTA B. Dilute the specimen B. 50%
B. 6.0 D. FTA-ABS C. Decrease the viscosity C. 60%
C. 1.8 D. Neutralize the specimen D. 75%
D. 2.8 CHAPTER 11
SEMEN 10. The normal sperm concentration is: 18. All of the following are grading criteria for
28. The CSF IgG index calculated in Study Question A. Below 20 million per microliter sperm motility except:
27 is indicative of: 1. Maturation of spermatozoa takes place in the: B. Above 20 million per milliliter A. Rapid straight-line movement
A. Synthesis of IgG in the CNS A. Sertoli cells C. Below 20 million per milliliter B. Rapid lateral movement
B. Damage to the blood-brain barrier B. Seminiferous tubules D. Above 20 million per microliter C. No forward progression
C. Cerebral hemorrhage C. Epididymis D. No movement
D. Lymphoma infiltration D. Seminal vesicles 11. Given the following information, calculate the
sperm concentration: dilution, 1:20; sperm counted 19. The purpose of the acrosomal cap is:
29. The finding of oligoclonal bands in the CSF and 2. Enzymes for the coagulation and liquefaction of in five RBC squares on each side of the A. Ovum penetration
not in the serum is seen with: semen are produced by the: hemocytometer, 80 and 86; volume, 3 mL. B. Protection of the nucleus
A. Multiple myeloma A. Seminal vesicles A. 80 million per milliliter C. Energy for tail movement
B. CNS malignancy B. Bulbourethral glands B. 83 million per milliliter D. Protection of the neckpiece
C. Multiple sclerosis C. Ductus deferens C. 86 million per milliliter
D. Viral infections D. Prostate gland D. 169 million per microliter 20. The sperm part containing a mitochondrial
sheath is the:
30. A CSF glucose of 15 mg/dL, WBC count of 5000, 3. The major component of seminal fluid is: 12. Using the above information, calculate the A. Head
90% neutrophils, and protein of 80 mg/dL is A. Glucose sperm concentration when 80 sperm are counted in B. Neckpiece
suggestive of: B. Fructose 1 WBC square and 86 sperm are counted in another C. Midpiece
A. Fungal meningitis C. Acid phosphatase WBC square. D. Tail
B. Viral meningitis D. Citric acid A. 83 million per milliliter
C. Tubercular meningitis B. 166 million per ejaculate 21. All of the following are associated with sperm
D. Bacterial meningitis 4. If the first portion of a semen specimen is not C. 16.6 million per milliliter motility except the:
collected, the semen analysis will have an D. 50 million per ejaculate A. Head
31. A patient with a blood glucose of 120 mg/dL abnormal: B. Neckpiece
would have a normal CSF glucose of: A. ph 13. The primary reason to dilute a semen specimen C. Midpiece
A. 20 mg/dL B. Viscosity before performing a sperm concentration is to: D. Tail
B. 60 mg/dL C. Sperm concentration A. Immobilize the sperm
C. 80 mg/dL D. Sperm motility B. Facilitate the chamber count 22. Morphologic shape of a normal sperm head is:
D. 120 mg/dL C. Decrease the viscosity A. Round
5. Failure of laboratory personnel to document the D. Stain the sperm B. Tapered
32. CSF lactate will be more consistantly decreased time a semen sample is collected primarily affects C. Oval
in: the interpretation of semen: 14. Performing a sperm conc, 60 sperm counted in D. Amorphous
A. Bacterial meningitis A. Appearance RBC squares on one side and 90 sperm counted in
B. Viral meningitis B. Volume the RBC squares on the other side. The specimen is 23. Normal sperm morphology when using the
C. Fungal meningitis C. ph diluted 1:20. The: WHO criteria is:
D. Tubercular meningitis D. Viscosity A. Specimen should be rediluted and counted A. 30% normal forms
B. Sperm count is 75 million per milliliter B. 30% normal forms
33. Measurement of which of the following can be 6. Liquefaction of a semen specimen should take C. Sperm count is greater than 5 million per C. 15% abnormal forms
replaced by CSF glutamine analysis in children with place within: milliliter D. 15% normal forms
Reye syndrome? A. 1 hour B. 2 hours D. Sperm concentation is abnormal
A. Ammonia B. Lactate C. 3 hours D. 4 hours 24. Additional parameters measured by Kruger
C. Glucose D. -ketoglutarate 15. Sperm motility evaluations are performed: strict morphology include all of the following
7. A semen specimen delivered to the laboratory in A. Immediately after the specimen is collected except:
34. Prior to performing a Gram stain on CSF, the a condom has a normal sperm count and markedly B. Within 1–2 hours of collection A. Viability
specimen must be: decreased sperm motility. This is indicative of: C. After 3 hours of incubation B. Presence of vacuoles
A. Filtered B. Warmed to 37C A. Decreased fructose D. At 6-hour intervals for one day C. Acrosome size
C. Centrifuged D. Mixed B. Antispermicide in the condom D. Tail length
C. Increased semen viscosity 16. Sperm motility is evaluated on the basis of:
35. All of the following statements are true about D. Increased semen alkalinity A. Speed 25. Round cells that are of concern and may be
cryptoccocal meningitis except: B. Direction included in sperm counts and morphology analysis
A. An India Ink preparation is positive 8. An increased semen ph may be caused by: C. Tail movement are:
B. A starburst pattern is seen on Gram stain A. Prostatic infection D. Both A and B A. Leukocytes
C. The WBC count is over 2000 B. Decreased prostatic secretions B. Spermatids
D. A confirmatory immunology test is available C. Decreased bulbourethral gland secretions C. RBCs
D. All of the above D. Both A and B
26. If 5 round cells per 100 sperm are counted in a CHAPTER 12 9. To determine if a fluid is synovial fluid, it should 18. Crystals that have the ability to polarize light
sperm morphology smear and the sperm SYNOVIAL FLUID be mixed with: are:
concentation is 30 million, the concentraton of A. Sodium hydroxide A. Corticosteroid
round cells is: 1. The functions of synovial fluid include all of the B. Hypotonic saline B. Monosodium urate
A. 150,000 following except: C. Hyaluronidase C. Calcium oxalate
B. 1.5 million A. Lubrication for the joints D. Acetic acid D. All of the above
C. 300,000 B. Removal of cartilage debris
D. 15 million C. Cushioning joints during jogging 10. The highest WBC count can be expected to be 19. In an examination of synovial fluid under
D. Providing nutrients for cartilage seen with: compensated polarized light, rhombic-shaped
27. Following an abnormal sperm motility test with A. Noninflammatory arthritis crystals are observed. What color would these
a normal sperm count, what additional test might 2. The primary function of synoviocytes is to: B. Inflammatory arthritis crystals be when aligned parallel to the slow
be ordered? A. Provide nutrients for the joints C. Septic arthritis vibration?
A. Fructose level B. Secrete hyaluronic acid D. Hemorrhagic arthritis A. White
B. Zinc level C. Regulate glucose filtration B. Yellow
C. Mar test D. Prevent crystal formation 11. When diluting a synovial fluid WBC count, all of C. Blue
D. Eosin-nigrosin stain the following are acceptable except: D. Red
3. Which of the following is not a frequently A. Acetic acid
28. Follow-up testing for a low sperm concentration performed test on synovial fluid? B. Isotonic saline 20. If crystals shaped like needles are aligned
would include testing for: A. Uric acid C. Hypotonic saline perpendicular to the slow vibration of compensated
A. Antisperm antibodies B. WBC count D. Saline with saponin polarized light, what color are they?
B. Seminal fluid fructose C. Crystal examination A. White
C. Sperm viability D. Gram stain 12. The lowest percentage of neutophils would be B. Yellow
D. Prostatic acid phosphatase seen in: C. Blue
4. Procedure for collection of synovial fluid is called: A. Noninflammatory arthritis D. Red
29. The immunobead test for antisperm antibodies: A. Synovialcentesis B. Inflammatory arthritis
A. Detects the presence of male antibodies B. Arthrocentesis C. Septic arthritis 21. Negative birefringence occurs under
B. Determines the presence of IgG, IgM, and IgA C. Joint puncture D. Hemorrhagic arthritis compensated polarized light when:
antibodies D. Arteriocentesis A. Slow light is impeded more than fast light
C. Determines the location of antisperm antibodies 13. All of the following are abnormal when seen in B. Slow light is less impeded than fast light
D. All of the above 5. Match the following disorders with their synovial fluid except: C. Fast light runs against the molecular grain of the
appropriate group: A. RA cells crystal
30. Measurement of -glucosidase is performed to A. Noninflammatory B. Inflammatory B. Reiter cells D. Both B and C
detect a disorder of the: C. Septic D. Hemorrhagic C. Synovial lining cells
A. Seminiferous tubules ____Gout D. Lipid droplets 22. Synovial fluid cultures are often plated on
B. Epididymis ____N. gonorrhoeae infection chocolate agar to detect the presence of:
C. Prostate gland ____Lupus erythematosus 14. Synovial fluid crystals that occur as a result of A. Neisseria gonorrhoeae
D. Bulbourethral glands ____Osteoarthritis purine metabolism or chemotherapy for leukemia B. Staphylococcus agalactiae
____Hemophilia are: C. Streptococcus viridans
31. A specimen delivered to the laboratory with a ____Rheumatoid arthritis A. Monosodium urate D. Enterococcus faecalis
request for prostatic acid phosphatase and ____Heparin overdose B. Cholesterol
glycoprotein p30 was collected to determine: C. Calcium pyrophosphate 23. Most freq performed chem test on synovial fluid
A. Prostatic infection 6. Normal synovial fluid resembles: D. Apatite A. Total protein
B. Presence of antisperm antibodies A. Egg white B. Uric acid
C. A possible rape B. Normal serum 15. Synovial fluid crystals associated with C. Calcium
D. Successful vasectomy C. Dilute urine inflammation in dialysis patients are: D. Glucose
D. Lipemic serum A. Calcium pyrophosphate
32. Following a negative postvasectomy wet B. Calcium oxalate 24. Serologic tests on patients’ serum may be
preparation, the specimen should be: 7. Powdered anticoagulants should not be used in C. Corticosteroid performed to detect antibodies causing arthritis for
A. Centrifuged and reexamined tubes for synovial fluid testing because it interferes D. Monosodium urate all of the following disorders except:
B. Stained and reexamined with: A. Pseudogout
C. Reported as no sperm seen A. Cell counts 16. Crystals associated with pseudogout are: B. Rheumatoid arthritis
D. Both A and B B. Glucose tests A. Monosodium urate C. Lupus erythematosus
C. Crystal examination B. Calcium pyrophosphate D. Lyme arthritis
33. Standardization of procedures and reference D. Differentials C. Apatite
values for semen analysis is primarily provided by D. Corticosteroid 25. Serologic testing of synovial fluid for fibrinogen
the: 8. Addition of a cloudy, yellow synovial fluid to and C-reactive protein is performed to:
A. Manufacturers of instrumentation acetic acid produces a/an: 17. Synovial fluid for crystal examination should be A. Determine clot formation
B. WHO A. Yellow-white precipitate examined as a/an: B. Determine the amount of inflammation
C. Manufacturers of control samples B. Easily dispersed clot A. Wet preparation C. Detect osteoarthritis
D. Clinical laboratory improvement amendments C. Solid clot B. Wright stain D. Diagnose rheumatoid arthritis
D. Opalescent appearance C. Gram stain
D. Acid-fast stain
CHAPTER 13 9. Which of the following requires the most 19. The test performed on peritoneal lavage fluid is: 3. Which of the following is not a reason for
SEROUS FLUID additional testing? A. WBC count decreased amounts of amniotic fluid?
A. Transudate B. RBC count A. Fetus fails to begin swallowing
1. The primary purpose of serous fluid is: B. Exudate C. Absolute neutrophil count B. Increased fetal swallowing
A. Removal of waste products D. Amylase C. Membrane leakage
B. Lowering of capillary pressure 10. An additional test performed on pleural fluid to D. Urinary tract defects
C. Lubrication of serous membranes classify the fluid as a transudate or exudate is the: 20. The recommended test for determining if
D. Nourishing serous membranes A. WBC count peritoneal fluid is a transudate or an exudate is the: 4. Why might a creatinine level be requested on an
B. RBC count A. Fluid-to–serum albumin ratio amniotic fluid?
2. The membrane that lines the wall of a cavity is C. Fluid-to-cholesterol ratio B. Serum ascites albumin gradient A. Detect oligohydramnios
the: D. Fluid-to–serum protein gradient C. Fluid-to–serum lactic dehydrogenase ratio B. Detect polyhydramnios
A. Visceral D. Absolute neutrophil count C. Differentiate amniotic fluid from maternal urine
B. Peritoneal 11. A milky-appearing pleural fluid is indicative of: D. Evaluate lung maturity
C. Pleural A. Thoracic duct leakage 21. Given the following results, classify this
D. Parietal B. Chronic inflammation peritoneal fluid: serum albumin, 2.2 g/dL; serum 5. Amniotic fluid specimens are placed in
C. Microbial infection protein, 6.0 g/dL; fluid albumin, 1.6 g/dL. ambercolored tubes prior to sending them to the
3. During normal production of serous fluid, the D. Both A and B A. Transudate laboratory to prevent the destruction of:
slight excess of fluid is: B. Exudate A. Alpha fetoprotein B. Bilirubin
A. Absorbed by the lymphatic system 12. Which of the following best represents a C. Cells for cytogenetics D. Lecithin
B. Absorbed through the visceral capillaries hemothorax? 22. Differentiation between bacterial peritonitis
C. Stored in the mesothelial cells A. Blood HCT: 42 Fluid HCT: 15 and cirrhosis is done by performing a/an: 6. How are specimens for FLM testing delivered to
D. Metabolized by the mesothelial cells B. Blood HCT: 42 Fluid HCT: 10 A. WBC count and stored in the laboratory?
C. Blood HCT: 30 Fluid HCT: 10 B. Differential A. Delivered on ice and refrigerated or frozen
4. Production of serous fluid is controlled by: D. Blood HCT: 30 Fluid HCT: 20 C. Absolute neutrophil count B. Immediately centrifuged
A. Capillary oncotic pressure D. Absolute lymphocyte count C. Kept at room temperature
B. Capillary hydrostatic pressure 13. All of the following are normal cells seen in D. Delivered in a vacuum tube
C. Capillary permeability pleural fluid except: 23. Detection of the CA 125 tumor marker in
D. All of the above A. Mesothelial cells B. Neutrophils peritoneal fluid is indicative of: 7. Why are amniotic specimens for cytogenetic
C. Lymphocytes D. Mesothelioma cells A. Colon cancer analysis incubated at 37C prior to analysis?
5.Increase in amount of serous fluid is called a/an: B. Ovarian cancer A. To detect the presence of meconium
A. Exudate 14. A differential observation of pleural fluid C. Gastric malignancy B. To differentiate amniotic fluid from urine
B. Transudate associated with tuberculosis is: D. Prostate cancer C. To prevent photo-oxidation of bilirubin to
C. Effusion A. Increased neutrophils biliverdin
D. Malignancy B. Decreased lymphocytes 24. Chemical tests primarily performed on D. To prolong fetal cell viability and integrity
C. Decreased mesothelial cells peritoneal fluid include all of the following except:
6. Pleural fluid is collected by: D. Increased mesothelial cells A. Lactose dehydrogenase 8. Filtration of amniotic fluid is required to avoid
A. Pleurocentesis B. Glucose decreased values in the test results for:
B. Paracentesis 15. All of the following are characteristics of C. Alkaline phosphatase A. Bilirubin B. Fetal cells
C. Pericentesis malignant cells except: D. Amylase C. Phospholipids D. Urea
D. Thoracentesis A. Cytoplasmic molding
B. Absence of nucleoli 25. Cultures of peritoneal fluid are incubated: 9. Match the following colors in amniotic fluid with
7. Place the appropriate letter in front of the C. Mucin-containing vacuoles A. Aerobically their significance.
following statements describing transudates and D. Increased N:C ratio B. Anaerobically ___A. Colorless 1. Fetal death
exudates. C. At 37C and 42C ___B. Dark green 2. Normal
A. Transudate 16. A pleural fluid pH of 6.0 is indicative of: D. Both A and B ___C. Red-brown 3. Presence of bilirubin
B. Exudate A. Esophageal rupture ___D. Yellow 4. Presence of meconium
____Caused by increased capillary permeability B. Mesothelioma CHAPTER 14
____Caused by increased hydrostatic pressure C. Malignancy AMNIOTIC FLUID 10. A significant rise in the OD of amniotic fluid at
____Caused by decreased oncotic pressure D. Rheumatoid effusion 450 nm indicates the presence of which analyte?
____Caused by congestive heart failure 1. Which of the following is not a function of A. Bilirubin B. Lecithin
____Malignancy related 17. A mesothelioma cell seen in pleural fluid amniotic fluid? C. Oxyhemoglobin D. Sphingomyelin
____Tuberculosis related indicates: A. Allow movement of the fetus
____Nephrotic syndrome related A. Bacterial endocarditis B. Carbon dioxide and oxygen exchange 11. Plotting the amniotic fluid OD on a Liley graph
____Cloudy appearance B. Primary malignancy C. Protect fetus from extreme temperature changes represents the severity of hemolytic disease of the
C. Metastatic lung malignancy D. Protective cushion for the fetus newborn. A value that is plotted in zone II indicates
8. Fluid-to–serum protein and lactic dehydrogenase D. Tuberculosis infection what condition of the fetus?
ratios are performed on serous fluids: 2. What is the primary cause of the normal increase A. No hemolysis
A. When malignancy is suspected 18. Another name for a peritoneal effusion is: in amniotic fluid as a pregnancy progresses? B. Mildly affected fetus
B. To classify transudates and exudates A. Peritonitis A. Fetal cell metabolism C. Moderately affected fetus that requires close
C. To determine the type of serous fluid B. Lavage B. Fetal swallowing monitoring
D. When a traumatic tap has occurred C. Ascites C. Fetal urine D. Severely affected fetus that requires intervention
D. Cirrhosis D. Transfer of water across the placenta
12. The presence of a fetal neural tube disorder 22. The presence of phosphatidyl glycerol in 4. The normal composition of feces includes all of 13. Secretory diarrhea is caused by:
may be detected by: amniotic fluid fetal lung maturity tests must be the following except: A. Antibiotic administration
A. Increased amniotic fluid bilirubin confirmed when: A. Bacteria B. Blood B. Lactose intolerance
B. Increased maternal serum alpha fetoprotein A. Hemolytic disease of the newborn is present C. Electrolytes D. Water C. Celiac sprue
C. Decreased amniotic fluid phosphatidyl glycerol B. The mother has maternal diabetes D. Vibrio cholerae
D. Decreased maternal serum acetycholinesterase C. Amniotic fluid is contaminated by hemoglobin 5. What is the fecal test that requires a 3-day
D. Neural tube disorder is suspected specimen? 14. The fecal osmotic gap is elevated in which
13. True or False: An AFP MoM value greater than A. Fecal occult blood disorder?
two times the median value is considered an 23. Match the following principles with the B. APT test A. Dumping syndrome
indication of a neural tube disorder. appropriate FLM test C. Elastase I B. Osmotic diarrhea
1. Amniostat-FLM D. Quantitative fecal fat testing C. Secretory diarrhea
14. When severe HDN is present, which of the 2. Lamellar body count D. Steatorrhea
following tests on the amniotic fluid would the 3. L /S ratio 6. The normal brown color of the feces is produced
physician not order to determine whether the fetal 4. Microviscosity test by: 15. Microscopic examination of stools provides
lungs are mature enough to withstand a premature ___A. Immunologic agglutination test A. Cellulose preliminary info as to the cause of diarrhea bec:
delivery? ___B. Uses albumin as the internal standard B. Pancreatic enzyme A. Neutrophils are present in conditions caused by
A. AFP levels ___C. Uses the platelet channel on a hematology C. Undigested foodstuffs toxin-producing bacteria
B. Foam stability index instrument D. Urobilin B. Neutrophils are present in conditions that affect
C. Lecithin/sphingomyelin ratio ___D. Uses sphingomyelin as an internal standard the intestinal wall
D. Phosphatidyl glycerol detection 7. Diarrhea can result from all of the following C. Red and white blood cells are present if the cause
24. True or False: An L/S ratio of 2.0 correlates with except: is bacterial
15. The foam or shake test is a screening test for a surfactant/ albumin ratio of 39 mg/g. A. Addition of pathogenic organisms to the normal D. Neutrophils are present if the condition is of
which amniotic fluid substance? intestinal flora nonbacterial etiology
A. Bilirubin 25. A lamellar body count of 50,000 correlates with: B. Disruption of the normal intestinal bacterial flora
B. Lecithin A. Absent phosphatidyl glycerol and TDx-FLM II C. Increased concentration of fecal electrolytes 16. True or False: The presence of fecal neutrophils
C. Alpha fetoprotein ratio of 39 D. Increased reabsorption of intestinal water and would be expected with diarrhea caused by a
D. Creatinine B. L/S ratio of 1.5 and absent phosphatidyl glycerol electrolytes rotavirus.
C. OD at 650 nm of 1.010 and an L/S ratio of 1.1
16. True or False: Prior to 35 weeks’ gestation, the D. OD at 650 nm of 0.150 and an L/S ratio of 2.0 8. Stools from persons with steatorrhea will contain 17. Large orange-red droplets seen on direct
normal L/S ratio is less than 1.6. excess amounts of: microscopic examination of stools mixed with
26. Which test for FLM is least affected by A. Barium sulfate Sudan III represent:
17. When performing an L/S ratio by thin-layer contamination with hemoglobin and meconium? B. Blood A. Cholesterol B. Fatty acids
chromatography, a mature fetal lung will show: A. Amniostat-FLM C. Fat C. Neutral fats D. Soaps
A. Sphingomyelin twice as concentrated as lecithin B. Foam Stability D. Mucus
B. No sphingomyelin C. Lamellar Bodies Count 18. Microscopic examination of stools mixed with
C. Lecithin twice as concentrated as sphingomyelin D. TDx-FLM II 9. Which of the following pairings of stool Sudan III and glacial acetic acid and then heated will
D. Equal concentrations of lecithin and appearance and cause does not match? show small orange-red droplets that represent:
sphingomyelin CHAPTER 15 A. Black, tarry: blood A. Fatty acids and soaps
FECAL ANALYSIS B. Pale, frothy: steatorrhea B. Fatty acids and neutral fats
18. True or False: Phosphatidyl glycerol is present C. Yellow-gray: bile duct obstruction C. Fatty acids, soaps, and neutral fats
with an L/S ratio of 1.1. 1. In what part of the digestive tract do pancreatic D. Yellow-green: barium sulfate D. Soaps
enzymes and bile salts contribute to digestion?
19. A rapid test for FLM that does not require A. Large intestine 10. Stool specimens that appear ribbon-like are 19. When performing a microscopic stool
performance of thin-layer chromatography is: B. Liver indicative of which condition? examination for muscle fibers, the structures that
A. AFP levels C. Small intestine A. Bile-duct obstruction should be counted:
B. Amniotic acetylcholinesterase D. Stomach B. Colitis A. Are coiled and stain blue
C. Aminostat-FLM C. Intestinal constriction B. Contain no visible striations
D. Bilirubin scan 2. Where does the reabsorption of water take place D. Malignancy C. Have two-dimensional striations
in the primary digestive process? D. Have vertical striations and stain red
20. Does the failure to produce bubbles in the Foam A. Large intestine 11. A black tarry stool is indicative of:
Stability Index indicate increased or decreased B. Pancreas A. Upper GI bleeding 20. A value of 85% fat retention would indicate:
lecithin? C. Small intestine B. Lower GI bleeding A. Dumping syndrome
A. Increased D. Stomach C. Excess fat B. Osmotic diarrhea
B. Decreased D. Excess carbohydrates C. Secretory diarrhea
3. Which of the following tests is not performed to D. Steatorrhea
21. Microviscosity of amniotic fluid is measured by: detect osmotic diarrhea? 12. Chemical screening tests performed on feces
A. Thin-layer chromatography A. Clinitest include all of the following except: 21. Which of the following tests would not be
B. Immunologic agglutination B. Fecal fats A. APT test indicative of steatorrhea?
C. Spectrophotometer C. Fecal neutrophils B. Clinitest A. Fecal elastase-I
D. Fluorescence polarization D. Muscle fibers C. Pilocarpine iontophoresis B. Fecal occult blood
D. Trypsin digestion C. Sudan III
D. Van de Kamer
22. Gum guaiac is preferred over ortho-tolidine for 30. A patient whose stool exhibits increased fats, 5. Which parameter(s) will increase with an 12. Microscope lenses should be cleaned or
“occult” blood in mass screening tests because: undigested muscle fibers, and the inability to digest increase in the numerical aperture of an objective polished using
A. There is less interference from dietary gelatin may have: lens? 1. gauze. 2. facial tissue.
hemoglobin A. Bacterial dysentery A. Magnification and resolution 3. lint-free tissues. 4. lens paper.
B. Ortho-tolidine is less sensitive B. A duodenal ulcer B. Field of view and resolution A. 1, 2, and 3 are correct.
C. Gum guaiac reacts equally with formed and C. Cystic fibrosis C. Magnification and field of view B. 1 and 3 are correct.
watery stools D. Lactose intolerance D. Magnification C. 4 is correct.
D. Filter paper is more easily impregnated with gum D. All are correct.
guaiac 31. A stool specimen collected from an infant with 6. Match the microscope component with its
diarrhea has a pH of 5.0. This result correlates w/ a: primary function. 13. When viewing a focused specimen in the
23. The term “occult” blood describes blood that: A. Positive APT test 1. Aperture diaphragm 2. Condenser microscope, the user sees a speck in the field of
A. Is produced in the lower GI tract B. Negative trypsin test 3. Eyepiece 4. Field diaphragm view. The speck remains in view when the objective
B. Is produced in the upper GI tract C. Positive Clinitest 5. Mechanical stage 6. Light source is changed and when the specimen is moved. The
C. Is not visibly apparent in the stool specimen D. Negative occult blood test 7. Objective speck is most likely located on the
D. Produces a black, tarry stool __ A. Produces primary image magnification A. condenser.
32. Which of the following tests differentiates a __ B. Produces secondary image magnification B. eyepiece.
24. What is the recommended number of samples malabsorption cause from a maldigestion cause in __ C. Moves the specimen for viewing C. objective.
that should be tested to confirm a negative occult steatorrhea? __ D. Optimally focuses light onto the specimen D. specimen coverslip.
blood result? A. APT test __ E. Controls the angle of light presented to the
A. One random specimen B. D-xylose test specimen 14. Which type of microscopy converts differences
B. 2 samples taken from different parts of 3 stools C. Lactose tolerance test __ F. Controls the diameter of light rays that strike in refractive index into variations in light intensity
C. Three samples taken from the outermost portion D. Occult blood test the specimen to obtain the specimen image?
of the stool A. Brightfield
D. Three samples taken from different parts of two BRUNZEL 7. Which of the following components should be B. Interference contrast
stools adjusted to decrease the illumination light or field C. Phase-contrast
FUNDAMENTALS OF URINE AND BODY brightness? D. Polarizing
25. Which test is more sensitive to upper GI FLUID ANALYSIS A. Aperture diaphragm B. Condenser
bleeding? C. Field diaphragm D. Light source 15. A birefringent substance is one that
A. Guaic fecal occult blood CHAPTER 1 A. vibrates light in all directions.
B. Hemoquant MICROSCOPY 8. Which lens characteristic is described as the B. vibrates light at two different wavelengths.
C. Immunochemical fecal occult blood ability to keep a specimen image in focus regardless C. refracts light in two different directions.
D. Sudan III 1. In a brightfield microscope, which lens produces of which objective lens is used? D. shifts light one-half wavelength out of phase.
the primary image magnification? A. Parcentered B. Parfocal
26. Annual testing for fecal occult blood has a high A. Condenser C. Chromatic aberration D. Spherical aberration 16. Which type of microscopy is able to produce
predictive value for the detection of: B. Eyepiece (ocular) three dimensional images and perform optical
A. Colorectal cancer C. Numerical aperture 9. To achieve maximal image magnification and sectioning?
B. Malabsorption syndromes D. Objective resolution, the A. Brightfield
C. Pancreatic deficiencies A. condenser should be in its lowest position. B. Interference contrast
D. Ulcers 2. A microscope has a 10× magnification eyepiece B. condenser numerical aperture must be equal to C. Phase-contrast
and a 100× objective lens. What is the total or greater than the objective numerical aperture. D. Polarizing
27. Tests for detection of “occult” blood rely on the: magnification of the specimen when viewed using C. aperture diaphragm should be used to decrease
A. Reaction of hemoglobin with hydrogen peroxide this microscope? field brightness. 17. Principle of fluorescence microscopy is based on
B. Pseudoperoxidase activity of hemoglobin A. 0.1× B. 10× D. field diaphragm should be opened fully. A. subs that cause the rotation of polarized light.
C. Reaction of hemoglobin with ortho-tolidine C. 100× D. 1000× B. differences in the optical light path being
D. Pseudoperoxidase activity of hydrogen peroxide 10. Various inscriptions may be found on an converted to intensity differences.
3. Select the numerical aperture that has the ability objective lens. Select the objective lens inscription C. differences in refractive index being converted
28. What is the significance of an APT test that to distinguish the smallest distance between two that indicates a numerical aperture of 0.25. into variations in light intensity.
remains pink after addition of sodium hydroxide? distinct points, that is, the greatest resolving power A. SPlan40PL 0.65 160/025 D. the absorption of light and its subsequent
A. Fecal fat is present. (R). B. 25 0.10 160/0.17 emission at a longer wavelength.
B. Fetal hemoglobin is present. A. 0.25 C. E10 0.25 160/0.20
C. Fecal trypsin is present. B. 0.65 D. DPlan25 0.10 25/160 18. Converting a brightfield microscope for
D. Vitamin C is present. C. 0.85 polarizing microscopy requires
D. 1.25 11. When a microscope with Köhler illumination is A. two polarizing filters—one placed below the
29. In the Van de Kamer method for quantitative adjusted, the condenser and one placed between the objective
fecal fat determinations, fecal lipids are: 4. The numerical aperture of a lens can be A. condenser is adjusted up or down until the field and the eyepiece.
A. Converted to fatty acids prior to titrating with increased by diaphragm is focused sharply. B. a special condenser, two polarizing filters, and a
sodium hydroxide A. decreasing the angle of light made by the lens. B. field diaphragm is opened until it is slightly Wollaston prism b/n the objective and eyepiece.
B. Homogenized and titrated to a neutral endpoint B. increasing the refractive index of the optical smaller than the field of view. C. an annular diaphragm in the condenser and a
with sodium hydroxide medium. C. illumination intensity is adjusted using the field phase-shifting element in the objective.
C. Measured gravimetrically after washing C. increasing the illumination intensity. and aperture diaphragms. D. a slit aperture below the condenser, a polarizing
D. Measured by spectrophotometer after addition D. decreasing the interpupillary distance. D. aperture diaphragm is opened until 25% of the filter, and a modulator.
of Sudan III field is in view.
19. Which type of microscopy uses a special 6. Why are written procedure manuals necessary? 13. The primary purpose of a Standard Precautions 19. Which of the following is not part of a Chemical
condenser to direct light onto the specimen from A. To assist in the ordering of reagents and supplies policy in the laboratory is to Hygiene Plan?
oblique angles only? for a procedure A. ensure a safe and healthy working environment. A. To identify and label hazardous chemicals
A. Darkfield B. To appropriately monitor the accuracy and B. identify processes (e.g., autoclaving) to be used B. To educate employees about the chemicals
B. Interference contrast precision of a procedure to neutralize infectious agents. they use (e.g., providing material safety data
C. Phase-contrast C. To ensure that all individuals perform the same C. prevent the exposure and transmission of sheets)
D. Polarizing task consistently potentially infectious agents to others. C. To provide guidelines for the handling and use
D. To ensure that the approp test has been ordered D. identify patients with hepatitis B virus, human of each chemical type
20. Match the type of microscopy with the char immunodeficiency virus, and other infectious D. To monitor the handling of biological hazards
1. Brightfield 2. Darkfield 7. Which of the following is not considered to be an diseases.
3. Fluorescence 4. Phase-contrast analytical component of quality assurance? 20. Which of the following information is not found
5. Polarizing 6. Interference Contrast A. Reagents (e.g., water) 14. Which agency is responsible for defining, on a material safety data sheet?
__ A. Is the preferred technique for identifying B. Glassware (e.g., pipettes) establishing, and monitoring safety and health A. Exposure limits
spirochetes. C. Instrumentation (e.g., microscope) hazards in the workplace? B. Catalog number
__ B. Is used often to visualize antigens, antibodies, D. Specimen preservation (e.g., refrigeration) A. Occupational Safety and Health Administration C. Hazardous ingredients
and viruses. B. Centers for Disease Control and Prevention D. Flammability of the chemical
__ C. Enables three-dimensional viewing of 8. Which of the following sources should include a C. Chemical Hygiene Agency
unstained, low-refractile specimens. protocol for the way to proceed when quality D. National Fire Protection Association CHAPTER 3
__ D. Is used to identify negative and positive control results exceed acceptable tolerance limits? URINE SPECIMEN TYPES, COLLECTION, AND
birefringence. A. A reference book 15. Match the mode of transmission with the PREPARATION
__ E. Produces less haloing with thin, flat B. A procedure manual laboratory activity.
specimens. C. A preventive maintenance manual 1. Inhalation 1. Which of the following is the urine specimen of
D. A specimen-processing protocol 2. Ingestion choice for cytology studies?
CHAPTER 2 3. Direct contact A. First morning specimen
QUALITY ASSURANCE AND SAFETY 9. Technical competence is displayed when a B. Random specimen
laboratory practitioner __ A. Not wearing gloves when handling specimens C. Midstream “clean catch” collection
1. Ultimate goal of a quality assurance program is to A. documents reports in a legible manner. __ B. Centrifuging uncovered specimens D. Timed collection
A. maximize the productivity of the laboratory. B. recognizes discrepant test results. __ C. Smoking in the laboratory
B. ensure that patient test results are precise. C. independently reduces the time needed to __ D. Being scratched by a broken beaker 2. Which of the following specimens usually
C. ensure appropriate diagnosis and treatment of perform a procedure (e.g., by decreasing inc times). __ E. Having a specimen splashed into the eyes eliminates contamination of the urine with entities
patients. D. is punctual and timely. __ F. Pipetting by mouth from the external genitalia and the distal urethra?
D. ensure the validity of laboratory results A. First morning specimen
obtained. 10. Quality control materials should have 16. Which of the following is not considered B. Midstream “clean catch” specimen
A. a short expiration date. personal protective equipment? C. Random specimen
2. Which of the following is a preanalytical B. a matrix similar to patient samples. A. Gloves D. 4-hour timed collection
component of a quality assurance program? C. their values assigned by an external and unbiased B. Lab coat
A. Quality control commercial manufacturer. C. Disinfectants 3. Substances that show diurnal variation in their
B. Turnaround time D. the ability to test preanalytical variables. D. Eyeglasses urinary excretion pattern are best evaluated using a
C. Technical competence A. first morning specimen.
D. Preventive maintenance 11. Within one facility, what is the purpose of 17. Which of the following actions represents a B. midstream “clean catch” specimen.
performing duplicate testing of a specimen by two good laboratory practice? C. random specimen.
3. Which of the following is a postanalytical different laboratories (i.e., in-house duplicates)? A. Washing or sanitizing hands frequently D. timed collection.
component of a quality assurance program? A. It provides little information because the results B. Wearing lab coats outside of the laboratory
A. Critical values are already known. C. Removing lab coats from the laboratory for 4. Which of the following will not cause erroneous
B. Procedure manuals B. It saves money by avoiding the need for internal laundering at home in 2% bleach results in a 24-hour timed urine collection?
C. Preventive maintenance quality control materials. D. Wearing the same gloves to perform A. The collection starts and ends in the evening
D. Test utilization C. It provides a means of evaluating the precision venipuncture on two different patients because the B. Two first morning specimens are included in the
of a method. patients are in the same room collection
4. Analytical components of a quality assurance D. It can detect procedural and technical C. Multiple collection containers are not mixed
program are procedures and policies that affect the differences between laboratories. 18. Which of the following is not an acceptable together before specimen testing
A. technical testing of the specimen. disposal practice? D. A portion of the collection is removed before
B. collection and processing of the specimen. 12. Interlaboratory comparison testing as with A. Discarding urine into a sink total volume measurement
C. reporting and interpretation of results. proficiency surveys provides a means to B. Disposing of used, empty urine containers with
D. diagnosis and treatment of the patient. A. identify critical values for timely reporting to nonhazardous waste 5. A 25-year-old woman complains of painful
clinicians. C. Discarding a used, broken specimen transfer urination and is suspected of having a urinary tract
5. The purpose of quality control materials is to B. ensure that appropriate documentation is being pipette with noninfectious glass waste infection.
A. monitor instrumentation to eliminate downtime. performed. D. Discarding blood specimens into a biohazard Which of the following specimens should be
B. ensure the quality of test results obtained. C. evaluate the technical performance of individual container collected for a routine urinalysis and urine culture?
C. assess the accuracy and precision of a method. laboratory practitioners. A. First morning specimen
D. monitor the technical competence of laboratory D. evaluate the performance of a laboratory B. Timed collection
staff. compared with that of other laboratories. C. Midstream “clean catch” specimen
D. Random specimen
6. A 35-year-old diabetic woman is suspected of CHAPTER 4 7. Which of the following is a characteristic of renin, 14. During tubular transport, the movement of a
developing renal insufficiency. Which of the THE KIDNEY an enzyme secreted by specialized cells of the solute against a gradient
following specimens should be obtained to juxtaglomerular apparatus? A. is called passive transport.
determine the amount of creatinine being excreted 1. Beginning with the glomerulus, number the A. Renin stimulates the diffusion of urea into the renal B. requires little to no energy.
in the urine? following structures in the order in which the interstitium. C. involves specific cell membrane–binding sites.
B. Renin inhibits the reabsorption of sodium and water in
A. 2-hour postprandial ultrafiltrate travels for processing and excretion in D. may occur paracellularly, that is, between cells
the nephron.
B. 12-hour timed collection the kidney. C. Renin regulates the osmotic reabsorption of water by the through intercellular spaces.
C. 24-hour timed collection __ A. Bladder collecting tubules.
D. Midstream “clean catch” __ B. Calyces D. Renin causes the formation of angiotensin and the 15. Substances bound to plasma proteins in the
__ C. Collecting tubule secretion of aldosterone. blood can be eliminated in the urine by
7. An unpreserved urine specimen collected at __ D. Distal tubule A. glomerular secretion. B. glomerular filtration.
midnight is kept at room temperature until the __ E. Glomerulus 8. Glomerular filtration barrier is composed of the C. tubular secretion. D. tubular reabsorption.
morning hospital shift. Which of the following __ F. Juxtaglomerular apparatus A. capillary endothelium, basement membrane, and
changes will most likely occur? __ G. Loop of Henle podocytes. 16. Which statement characterizes the ability of the
A. Decrease in urine color and clarity __ H. Proximal tubule B. mesangium, basement membrane, and shield of renal system to regulate blood pH?
B. Decrease in pH and specific gravity __ I. Renal pelvis negativity. A. The renal system has a slow response with
C. Decrease in glucose and ketones __ J. Ureter C. capillary endothelium, mesangium, and complete correction of the pH to normal.
D. Decrease in bacteria and nitrite __ K. Urethra juxtaglomerular apparatus. B. The renal system has a fast response with
D. basement membrane, podocytes, and complete correction of the pH to normal.
8. A urine specimen containing the substance 2. How many nephrons are found in the average juxtaglomerular apparatus. C. The renal system has a slow response with only
indicated is kept unpreserved at room temperature kidney? partial correction of the pH toward normal.
for 4 hours. Identify the probable change to that A. 13,000 9. The ability of a solute to cross the glomerular D. The renal system has a fast response with only
substance. B. 130,000 filtration barrier is determined by its partial correction of the pH toward normal.
__ Bacteria A. Decrease C. 1.3 million 1. molecular size.
__ Bilirubin B. No change D. 13 million 2. molecular radius. 17. The kidneys excrete excess alkali (base) in the
__ Glucose C. Increase 3. electrical charge. urine as
__ Ketones 3. Ultrafiltration of plasma occurs in glomeruli 4. plasma concentration. A. ammonium ions. B. ammonium salts.
__ pH located in the renal A. 1, 2, and 3 are correct. C. sodium bicarbonate. D. titratable acids.
__ Protein A. cortex. B. 1 and 3 are correct.
__ Urobilinogen B. medulla. C. 4 is correct. 18. Which of the following substances is secreted
C. pelvis. D. All are correct. into the tubular lumen to eliminate hydrogen ions?
9. Which of the following is the most common D. ureter. A. Ammonia (NH3)
method used to preserve urine specimens? 10. The epithelium characterized by a brush border B. Ammonium ions (NH4+)
A. Acid addition 4. Which component of the nephron is located owing to numerous microvilli is found in the C. Disodium phosphate (Na2HPO4)
B. Thymol addition exclusively in the renal medulla? A. collecting tubules. B. distal tubules. D. Monosodium phosphate (NaH2PO4)
C. Freezing A. Collecting tubule C. loops of Henle. D. proximal tubules.
D. Refrigeration B. Distal tubule 19. Urine titratable acids can form when the
C. Loop of Henle 11. The kidneys play an important role in the ultrafiltrate contains
10. If refrigeration is used to preserve a urine D. Proximal tubule 1. excretion of waste products. A. ammonia. B. bicarbonate.
specimen, which of the following may occur? 2. regulation of water and electrolytes. C. phosphate. D. sodium.
A. Cellular or bacterial glycolysis will be enhanced. 5. Which of the following is not a vascular 3. maintenance of acid-base
B. Formed elements will be destroyed. characteristic of the kidney? equilibrium. 20. The renal threshold level for glucose is 160 to
C. Amorphous crystals may precipitate. A. The afferent arteriole has a narrower lumen than 4. control of blood pressure and fluid 180 mg/dL. This corresponds to the
D. Bacteria will proliferate. the efferent arteriole. balance. A. rate of glucose reabsorption by the renal
B. The arteries are primarily end arteries, supplying A. 1, 2, and 3 are correct. B. 1 and 3 are correct. tubules.
11. Which of the following urine preservatives is specific areas of tissue, and they do not C. 4 is correct. D. All are correct. B. concn of glucose in the tubular lumen fluid.
acceptable for both urinalysis and urine culture? interconnect. C. plasma concentration above which tubular
A. Boric acid B. Chlorhexidine C. The arterioles subdivide into a capillary network, 12. What percent of the original ultrafiltrate formed reabsorption of glucose occurs.
C. Dowicil 200 D. Formalin rejoin as an arteriole, and subdivide into a second in the urinary space actually is excreted as urine? D. plasma concentration above which glucose is
capillary bed. A. 1% B. 10% excreted in the urine.
12. How much urine is usually required for a D. The vasa recta vessels deep in the renal medulla C. 25% D. 33%
manually performed routine urinalysis? form the beginning of the venous renal circulation. 21. When too much protein is presented to the
A. 5 to 10 mL B. 10 to 15 mL 13. What differentiates tubular reabsorption from renal tubules for reabsorption, it is excreted in the
C. 20 to 30 mL D. 50 to 100 mL 6. Formation of the ultrafiltrate in the glomerulus is tubular secretion in the nephron? urine because
driven by the A. The direction of movement of the substance being A. the renal threshold for protein has not been
absorbed or secreted is different.
13. Which of the following substances is higher in A. hydrostatic blood pressure. exceeded.
B. Reabsorption is an active transport process, whereas
urine than in any other body fluid? B. oncotic pressure of the plasma proteins. secretion is a passive transport process. B. the maximal tubular reabsorptive capacity for
A. Chloride C. osmotic pressure of the solutes in the C. Cell membrane–binding sites are different for the protein has been exceeded.
B. Creatinine ultrafiltrate. reabsorption and secretion of a solute. C. protein is not normally present in the ultrafiltrate
C. Glucose D. pressures exerted by the glomerular filtration D. The location of the epithelium in the nephron determines and cannot be reabsorbed.
D. Protein barrier. which process occurs. D. the glomerular filtration barrier allows only
abnormal proteins to pass.
22. More than 66% of filtered water, sodium, and 29. Antidiuretic hormone regulates the 6. The maximum osmolality that urine can achieve 15. When the body is dehydrated, the kidneys
chloride and 100% of filtered glucose, amino acids, reabsorption of is determined by the A. excrete excess solutes in a constant volume of
and proteins are reabsorbed in the A. water in the collecting tubules. A. quantity of solutes ingested in the diet. urine.
A. collecting tubules. B. sodium in the collecting tubules. B. presence of antidiuretic hormone in the B. excrete solutes in as small a volume of urine as
B. distal tubules. C. sodium in the distal convoluted tubule. collecting tubules. possible.
C. loops of Henle. D. water and sodium in the loop of Henle. C. osmolality of the medullary interstitium. C. decrease the quantity of solutes excreted and
D. proximal tubules. D. osmolality of fluid entering the collecting decrease the urine volume.
30. Which of the following describes the tubular tubules. D. increase the quantity of solutes excreted while
23. Water reabsorption occurs throughout the lumen fluid that enters the collecting tubule holding the urine volume constant.
nephron except in the compared with the tubular lumen fluid in the 7. Serum osmolality remains relatively constant,
A. cortical collecting tubules. proximal tubule? whereas the urine osmolality ranges from 16. The excretion of less than 400 mL of urine per
B. proximal convoluted tubules. A. Hypo-osmotic B. Isosmotic A. one-third to one-half that of serum. day is called
C. ascending limb of the loops of Henle. C. Hyperosmotic D. Counterosmotic B. one-third to equal that of serum. A. anuria. B. hypouria.
D. descending limb of the loops of Henle. C. one to three times that of serum. C. nocturia. D. oliguria.
31. The final concentration of the urine is D. three to five times that of serum.
24. The process solely responsible for water determined within the 17. The ultrafiltrate in the urinary space of the
reabsorption throughout the nephron is A. collecting ducts. 8. Another name for excessive thirst is glomerulus has a specific gravity of
A. osmosis. B. distal convoluted tubules. A. polydipsia. A. 1.005 and a lower osmolality than blood plasma.
B. the urea cycle. C. loops of Henle. B. polyuria. B. 1.010 and same osmolality as the blood plasma.
C. the countercurrent exchange mechanism. D. proximal convoluted tubules. C. hydrophilia. C. 1.015 and higher osmolality than blood plasma.
D. the countercurrent multiplier mechanism. D. hydrostasis. D. 1.035 and a higher osmolality than the blood
CHAPTER 5 plasma.
25. Hypertonicity of the renal medulla is maintained RENAL FUNCTION 9. Specific gravity measurements are not affected
by by 18. All of the following conditions may produce
1. the countercurrent multiplier mechanism. 1. Which of the following solutes are present in the A. temperature. B. solute charge. nocturia except
2. the countercurrent exchange mechanism. largest molar amounts in urine? C. solute mass. D. solute number. A. anuria.
3. the urea cycle. A. Urea, chloride, and sodium B. pregnancy.
4. osmosis. B. Urea, creatinine, and sodium 10. Osmolality is a measure of solute C. chronic renal disease.
A. 1, 2, and 3 are correct. C. Creatinine, uric acid, and ammonium A. density. B. mass. D. fluid intake at night.
B. 1 and 3 are correct. D. Urea, uric acid, and ammonium C. number. D. weight.
C. 4 is correct. 19. Which renal function is assessed using specific
D. All are correct. 2. Renal excretion is not involved in the elimination 11. Which of the following solutes, if added to pure gravity and osmolality measurements?
of water, affects the specific gravity more than it A. Concentrating ability
26. Which of the following is not a feature of the A. electrolytes and water. affects its osmolality? B. Glomerular filtration ability
renal B. normal by-products of fat metabolism. A. Sodium C. Tubular excretion ability
countercurrent multiplier mechanism? C. soluble metabolic wastes (e.g., urea, creatinine). B. Chloride D. Tubular secretion ability
A. The ascending limb of the loop of Henle is D. exogenous substances (e.g., drugs, x-ray contrast C. Potassium
impermeable to water. media). D. Glucose 20. A fluid deprivation test is used to
B. The descending limb of the loop of Henle A. determine renal plasma flow.
passively reabsorbs water. 3. The concentration of which substances provides 12. Occasionally the specific gravity of a urine B. investigate the cause of oliguria.
C. The descending limb of the loop of Henle actively thebest means of distinguishing urine from other specimen exceeds that physiologically possible (i.e., C. assess renal concentrating ability.
reabsorbs sodium and urea. body fluids? >1.040). Which of the following substances when D. measure the glomerular filtration rate.
D. The fluid in the ascending and descending A. Creatinine and urea found in urine could account for such a high value?
limbs of the loop of Henle flows in opposite B. Glucose and protein A. Creatinine 21. A fluid deprivation test involves the
directions. C. Uric acid and ammonia B. Glucose measurement of serum and urine
D. Water and electrolytes C. Mannitol A. density. B. osmolality.
27. The purpose of the renal countercurrent D. Protein C. specific gravity. D. volume.
multiplier mechanism is to 4. What is the definition of the osmolality of a
A. concentrate the tubular lumen fluid. solution? 13. The excretion of large volumes of urine (>3 22. The volume of plasma cleared per minute in
B. increase the urinary excretion of urea. A. The density of solute particles per liter of solvent L/day) is called excess of that required for solute elimination is
C. preserve the gradient hypertonicity in the B. The mass of solute particles per kilogram of A. glucosuria. called the
medulla. solvent B. hyperuria. A. creatinine clearance.
D. facilitate the reabsorption of sodium and C. The number of solute particles per kilogram of C. polydipsia. B. free-water clearance.
chloride. solvent D. polyuria. C. osmolar clearance.
D. The weight of solute particles per liter of solvent D. renal clearance.
28. Which vascular component is involved in the 14. The daily volume of urine excreted normally
renal countercurrent exchange mechanism? 5. The osmolality of a solution containing 1.0 mole ranges from 23. A free-water clearance value of −1.2 would be
A. Afferent arteriole of urea is equal to that of a solution containing A. 100 to 500 mL/day. expected from a patient experiencing
B. Efferent arteriole A. 1.0 mole of HCl. B. 100 to 1800 mL/day. A. polyuria.
C. Glomerulus B. 1.0 mole of H2PO4. C. 500 to 1800 mL/day. B. dehydration.
D. Vasa recta C. 0.5 mole of NaCl. D. 1000 to 3000 mL/day. C. water diuresis.
D. 0.5 mole of glucose. D. excessive fluid intake.
CHAPTER 6 7. Select the urine specimen that does not indicate
24. Calculate the osmolar and free-water clearances 32. Which of the following situations results in an PHYSICAL EXAMINATION OF URINE the possible presence of blood or hemoglobin.
using the following patient data. erroneous creatinine clearance measurement? A. Clear, red urine
Serum osmolality: 305 mOsm/kg A. A 24-hour urine collection from an individual on 1. The color of normal urine is due to the pigment B. Cloudy, brown urine
Urine osmolality: 250 mOsm/kg a vegetarian diet A. bilirubin C. Clear, brown urine
Urine volume: 300 mL/2 hours B. A 24-hour urine collection maintained at room B. urobilin D. Cloudy, amber urine
A. Is this individual excreting more water than is temperature throughout the collection C. uroerythrin
necessary for solute removal? Yes/No C. A plasma sample drawn at the beginning instead D. urochrome 8. A urine that produces a large amount of white
B. Is the osmolar clearance “normal” (i.e., 2.0 to of during the 24-hour urine collection foam when mixed should be suspected to contain
3.0 mL/min)? Yes/No D. Creatinine determinations made using the 2. A single substance can impart different colors to increased amounts of
C. From the free-water clearance result obtained, is nonspecific urine depending on the A. bilirubin.
the urine hypo-osmotic or hyperosmotic? alkaline picrate method (Jaffe reaction) 1. amount of the substance present. B. protein.
2. storage conditions of the urine. C. urobilin.
25. Which of the following is an endogenous subs 33. A 45-year-old female African American had her 3. pH of the urine. D. urobilinogen.
used to measure glomerular filtration rate? serum creatinine determined using a creatinine 4. structural form of the substance.
A. Urea B. Inulin method that is NOT calibrated to an IDMS reference A. 1, 2, and 3 are correct. 9. Which of the following substances can change
C. Creatinine D. p-Aminohippurate method. Her serum creatinine was 1.5 mg/dL; what B. 1 and 3 are correct. the color of a urine and its foam?
is her eGFR using the appropriate MDRD equation? C. 4 is correct. A. Bilirubin
26. Renal clearance is defined as the volume of A. 40 mL/min/1.73 m2 D. All are correct. B. Hemoglobin
A. urine cleared of a substance per minute. B. 48 mL/min/1.73 m2 C. Myoglobin
B. plasma cleared of a substance in a time interval. C. 51 mL/min/1.73 m2 3. Which of the following urine characteristics D. Urobilin
C. plasma flowing through the kidney per minute. D. 54 mL/min/1.73 m2 provides the best rough indicator of urine
D. plasma containing the same amount of concentration and body hydration? 10. The clarity of a well-mixed urine specimen that
substance in 1 mL of urine. 34. The glomerular filtration rate is controlled by A. Color has visible particulate matter and through which
A. the renal blood flow. B. Clarity news print can be seen but not read should be
27. Creatinine is a good substance to use for a renal B. the renal plasma flow. C. Foam described as
clearance test because it C. the countercurrent mechanism. D. Volume A. cloudy.
A. is exogenous. D. hormones (e.g., aldosterone, antidiuretic B. flocculated.
B. is reabsorbed. hormone). 4. Which of the following pigments deposits on C. slightly cloudy.
C. is affected by fluid intake. urate and uric acid crystals to form a precipitate D. turbid.
D. has a constant plasma concentration. 35. For measurement of renal plasma flow, described as “brick dust”?
p-aminohippurate is an ideal substance to use A. Bilirubin 11. Classify each substance that can be present in
28. Which of the following groups would be because it B. Urobilin urine as indicating a
expected to have the greatest 24-hour excretion of A. is easily measured in urine and plasma. C. Uroerythrin (1) pathologic or (2) nonpathologic condition.
creatinine? B. is endogenous and does not require an infusion. D. Urochrome __ A. Bacteria (fresh urine)
A. Infants B. Children C. is secreted completely in its first pass through the __ B. Bacteria (old urine)
C. Women D. Men kidneys. 5. Match the colors to the urine __ C. Fat
D. maintains a constant plasma concentration pigment/substance. __ D. Powder
29. Creatinine clearance results are “normalized” throughout the test. __ E. Radiographic contrast media
using an individual’s body surface area to account __ A. Bilirubin 1. Colorless __ F. Red blood cells
for variations in the individual’s 36. What percentage of the total cardiac output is __ B. Biliverdin 2. Yellow __ G. Renal epithelial cells
A. age. B. sex. received by the kidneys? __ C. Hemoglobin 3. Orange __ H. Spermatozoa
C. dietary intake. D. muscle mass. A. 8% __ D. Myoglobin 4. Red __ I. Squamous epithelial cells
B. 15% __ E. Porphobilinogen 5. Pink __ J. Urate crystals
30. The following data are obtained from a 60-year- C. 25% __ F. Urobilin 6. Purple __ K. White blood cells
old female who is 4′8˝ tall and weighs 88 lb: D. 33% __ G. Urobilinogen 7. Brown __ L. Yeast
Plasma creatinine: 1.2 mg/dL __ H. Urochrome 8. Green
Urine creatinine: 500 mg/L 37. Measuring the quantity of hydrogen ion __ I. Uroerythrin 12. Which of the following urine specimens is
Urine volume: 1440 mL/24 hr excreted as titratable acids and ammonium salts in considered normal?
A. Calculate the creatinine clearance. urine provides a measure of 6. Which of the following criteria should one use to A. A freshly voided urine that is brown and clear
B. Calculate the normalized creatinine clearance. A. tubular secretory function. consistently evaluate urine color and clarity? B. A freshly voided urine that is yellow and cloudy
(Determine the body surface area using Equation B. tubular reabsorptive function. 1. Mix all specimens well. C. A clear yellow urine specimen that changes color
5-6.) C. glomerular filtration ability. 2. Use the same depth or volume of a upon standing
C. Are these results normal for this patient? D. renal concentrating ability. specimen. D. A clear yellow urine specimen that becomes
3. Evaluate the specimens at the same cloudy upon refrigeration
31. A 24-hour urine collection is preferred for 38. The oral ammonium chloride test evaluates the temp
determination of creatinine clearance because of ability of the tubules to secrete 4. View the specimens against a dark 13. A white or beige precipitate in a “normal”
diurnal variation in the A. ammonium and chloride. background with good lighting. alkaline urine most likely is caused by
A. glomerular filtration rate. B. phosphate and sodium. A. 1, 2, and 3 are correct. A. amorphous phosphates.
B. plasma creatinine. C. bicarbonate and chloride. B. 1 and 3 are correct. B. amorphous urates.
C. creatinine excretion. D. ammonia and hydrogen. C. 4 is correct. C. uric acid crystals.
D. urine excretion. D. All are correct. D. radiographic contrast media.
14. Match the urine odor to the condition or 21. Refractometry is preferred for specific gravity 27. The freezing point of a urine specimen is 5. Which of the following is not a source of
substance that can cause it. You may select more measurements because it determined to be −0.90° C. What is the osmolality erroneous results when reagent strips are used?
than one odor for a condition. 1. uses a small amount of sample. of the specimen? A. Testing a refrigerated urine specimen
__ A. Diabetes mellitus 1. Ammonia-like 2. is fast and easy to perform. A. 161 mOsm/kg B. Timing using a clock without a second hand
__ B. Normal urine 2. Bleach 3. automatically compensates for temperature. B. 484 mOsm/kg C. Allowing excess urine to remain on the reagent
__ C. Old, improperly 3. Faintly aromatic 4. measures only ionic solutes. C. 597 mOsm/kg strip
stored urine D. 645 mOsm/kg D. Dipping the reagent strip briefly into the urine
__ D. Specimen 4. Pungent, fetid A. 1, 2, and 3 are correct. specimen.
adulteration B. 1 and 3 are correct. 28. Which of the following will not influence the
__ E. Starvation 5. Sweet, fruity C. 4 is correct. volume of urine produced? 6. Select the primary reason why tablet (e.g.,
__ F. Urinary tract infection D. All are correct. A. Diarrhea Ictotest) and chemical tests (e.g., sulfosalicylic acid
B. Exercise precipitation test) generally are performed.
15. Which of the following methods used to 22. The principle of the reagent strip method for C. Caffeine ingestion A. They confirm results suspected about the
determine the specific gravity of urine does not measuring specific gravity is based on D. Carbohydrate ingestion specimen.
detect the presence of urine protein or glucose? A. the pKa of a polyelectrolyte dec in proportion to B. They are alternative testing methods for highly
A. Harmonic oscillation densitometry the ionic concentration of the specimen. CHAPTER 7 concentrated urines.
B. Reagent strip B. the pH of a polyelectrolyte dec in proportion to CHEMICAL EXAMINATION OF URINE C. Their specificity differs from that of the reagent
C. Refractometry the ionic concentration of the specimen. strip test.
D. Urinometry C. the pKa of a polyelectrolyte increasing in 1. To preserve the integrity of reagent strips, it is D. They are more sensitive to the chemical
proportion to the ionic concentration of the necessary that they are constituents in urine.
16. A small ion and a large uncharged molecule specimen. A. humidified adequately.
have the same effect when urine concentration is D. the pH of a polyelectrolyte increasing in B. stored in a refrigerator. 7. In a patient with chronic renal disease, in whom
determined by proportion to the ionic concentration of the C. stored in a tightly capped container. the kidneys can no longer adjust urine
A. urinometry. B. osmolality. specimen. D. protected from the dark. concentration, the urine specific gravity would be
C. reagent strip. D. refractometry. A. 1.000. B. 1.010.
23. Ionic specific gravity (SGionic) measurements 2. Using quality control materials, one should check C. 1.020. D. 1.030.
17. Which of the following specific gravity values is obtained using reagent strips provide useful clinical reagent strip performance
physiologically impossible? information because 1. at least once daily. 8. Urine pH normally ranges from
A. 1.000 B. 1.010 A. all of the urinary solutes present are measured. 2. when a new bottle of strips or tablets is opened. A. 4.0 to 9.0. B. 4.5 to 7.0.
C. 1.020 D. 1.030 B. the quantity of nonionic solutes in urine relative 3. when a new lot number of strips or tablets in C. 4.5 to 8.0. D. 5.0 to 6.0.
to ionic solutes is significant. placed into use.
18. Match the principle to the appropriate specific C. excretion of nonionic solutes (e.g., urea, glucose, 4. once each shift by each laboratorian performing 9. Urine pH can be modified by all of the following
gravity method. A principle can be used more than protein) does not reflect renal dysfunction. urinalysis testing. except
once. D. the ability of the kidneys to concentrate urine is A. diet.
1. Density reflected in the reabsorption and secretion of A. 1, 2, and 3 are correct. B. increased ingestion of water.
2. Refractive index ionic solutes. B. 1 and 3 are correct. C. ingestion of medications.
3. pKa changes C. 4 is correct. D. urinary tract infections.
__ A. Harmonic oscillation 24. Which of the following as described is not a D. All are correct.
__ B. Reagent strip colligative property? 10. The double-indicator system used by
__ C. Refractometry A. Boiling point elevation 3. Which of the following is not checked by quality commercial reagent strips to determine urine pH
__ D. Urinometry B. Freezing point depression control materials? uses which two indicator dyes?
C. Osmotic pressure depression A. The technical skills of the personnel performing A. Methyl orange and bromphenol blue
19. Which of the following methods is an indirect D. Vapor pressure depression the test B. Methyl red and bromthymol blue
measure of specific gravity? B. The integrity of the specimen, that is, that the C. Phenol red and thymol blue
25. An advantage of freezing point osmometry over specimen was collected and stored properly D. Phenolphthalein and litmus
1. Reagent strip vapor pressure osmometry is its C. The test protocol, that is, that the procedure was
2. Urinometry A. increased turnaround time. performed according to written guidelines 11. All of the following can result in inaccurate urine
3. Refractometry B. use of a smaller volume of sample. D. The functioning of the equipment used, for pH measurements except
4. Harmonic oscillation densitometry C. ability to detect volatile substances. example, the refractometer and the reagent strip A. large amounts of protein present in the urine.
D. decreased interference from plasma lipids. readers B. double-dipping of the reagent strip into the
A. 1, 2, and 3 are correct. B. 1 and 3 are correct. specimen.
C. 4 is correct. D. All are correct. 26. Osmolality measurements are considered to be 4. Quality control materials used to assess the C. maintaining the specimen at room temperature
a more accurate assessment of solute performance of reagent strips and tablet tests must for 4 hours.
20. Refractive index of a solution is affected by the concentration in body fluids than are specific A. be purchased from a commercial manufacturer. D. allowing excess urine to remain on the reagent
1. wavelength of light used. gravity measurements because B. yield the same results regardless of the strip during the timing interval.
2. size and number of the solutes present. A. all solutes contribute equally. commercial brand used.
3. concentration of the solution. B. heavy molecules do not interfere. C. contain chemical constituents at realistic and 12. Which of the following aids in the
4. temperature of the solution. C. they are not temperature dependent. critical detection levels. differentiation of hemoglobinuria and hematuria?
D. they are less time-consuming to perform. D. include constituents to assess the chemical and A. Urine pH
A. 1, 2, and 3 are correct. B. 1 and 3 are correct. microscopic examinations. B. Urine color
C. 4 is correct. D. All are correct. C. Leukocyte esterase test
D. Microscopic examination
18. Which of the following statements describes the 24. Match each type of proteinuria with its 28. A urine specimen is tested for glucose by a
13. Select the correct statement(s). chemical principle involved in the leukocyte description. reagent strip and by the Clinitest method. The
1. Myoglobin and hemoglobin are reabsorbed esterase pad of commercial reagent strips? 1. Overflow 2. Glomerular reagent strip result is 100 mg/dL, and the Clinitest
readily by renal tubular cells. A. Leukocyte esterase reacts with a diazonium salt 3. Tubular 4. Postrenal result is 500 mg/dL. Which of the following
2. Hemosiderin, a soluble storage form of iron, on the reagent pad to form an azo dye. statements would best account for this
is found in aqueous solutions. B. An ester and a diazonium salt combine to form __ A. Defective protein reabsorption in the discrepancy?
3. When haptoglobin is saturated, free hemoglobin an azo dye in the presence of leukocyte esterase. nephrons A. The Clinitest tablets have expired or were stored
passes through the glomerular filtration barrier. C. An aromatic compound on the reagent pad __ B. Increased urine albumin and mid- to high- improperly.
4. Hemosiderin is found in the urine during a combines with leukocyte esterase to form an azo molecular-weight proteins B. A large amount of ascorbic acid is present in the
hemolytic episode. dye. __ C. Increase in low-molecular-weight proteins in specimen.
A. 1, 2, and 3 are correct. D. Leukocyte esterase hydrolyzes an ester on the urine C. A strong oxidizing agent (e.g., bleach) is
B. 1 and 3 are correct. reagent pad, then an azocoupling reaction results in __ D. Immunoglobulin light chains in the Urine contaminating the specimen.
C. 4 is correct. the formation of an azo dye. __ E. Proteins originating from a bladder tumor D. The reagent strip is exhibiting the pass-through
D. All are correct. __ F. Protein excreted only in an orthostatic phenomenon, which results in a falsely low value.
19. Which of the following conditions most likely position
14. Which statement about hemoglobin and accounts for a negative nitrite result on the reagent __ G. Hemoglobinuria and myoglobinuria 29. Which of the following substances if present in
myoglobin is true? strip despite the presence of large quantities of __ H. Nephrotic syndrome the urine results in a negative Clinitest?
A. They are heme-containing proteins involved in bacteria? __ I. Fanconi’s syndrome A. Fructose
oxygen transport. 1. The bacteria present did not have enough B. Lactose
B. Their presence is suspected when urine and time to convert nitrate to nitrite. 25. Which of the following statements about Bence C. Galactose
serum appear red. 2. The bacteria present are not capable of Jones protein is correct? D. Sucrose
C. Their presence in serum is associated with high converting nitrate to nitrite. A. The protein consists of κ and λ light chains.
creatine kinase values. 3. The patient is not ingesting adequate amounts B. The protein is often found in the urine of patients 30. The glucose reagent strip test is more sensitive
D. They precipitate out of solution when the urine of nitrate in the diet. with multiple sclerosis. and specific for glucose than the Clinitest method
is 80% saturated with ammonium sulfate. 4. The urine is dilute and the level of nitrite C. The protein precipitates when urine is heated to because it detects
present is below the sensitivity of the test. 100° C and redissolves when cooled to 60° C. A. other reducing substances and higher
15. On the reagent strip test for blood, any heme A. 1, 2, and 3 are correct. D. The protein can produce a positive reagent strip concentrations of glucose.
moiety (e.g., hemoglobin, myoglobin) present in B. 1 and 3 are correct. protein test and a negative sulfosalicylic acid B. no other substances and higher concentrations of
urine catalyzes C. 4 is correct. (SSA) precipitation test. glucose.
A. oxidation of the chromogen and hydrogen D. All are correct. C. other reducing substances and lower
peroxide. 26. A urine specimen is tested for protein by concentrations of glucose.
B. reduction of the chromogen in the presence of 20. The chemical principle of the nitrite reagent pad reagent strip and by the SSA test. The reagent strip D. no other substances and lower concentrations of
hydrogen peroxide. is based on the result is negative, and the SSA result is 2+. Which of glucose.
C. reduction of the pseudoperoxidase while the A. pseudoperoxidase activity of nitrite. the following statements best explains this
chromogen undergoes a color change. B. diazotization of nitrite followed by an discrepancy? 31. Which of the following statements about
D. oxidation of the chromogen while hydrogen azocoupling reaction. A. A protein other than albumin is present in the glucose is false?
peroxide is reduced. C. azocoupling action of nitrite with a diazonium urine. A. Glucose readily passes the glomerular filtration
salt to form an azo dye. B. The reagent strip result is falsely negative barrier.
16. Which of the following blood cells will not be D. hydrolysis of an ester by nitrite combined with because the urine has a pH of 8.0. B. Glucose is reabsorbed passively in the proximal
detected by the leukocyte esterase pad because it an azocoupling reaction. C. A large quantity of amorphous urates in the urine tubule.
lacks esterases? caused the false-positive SSA result. C. Glucosuria occurs when plasma glucose levels
A. Eosinophils 21. Which of the following substances or actions D. The time interval for reading the reagent strip exceed 160 to 180 mg/dL.
B. Lymphocytes can produce false-positive nitrite results? pad was exceeded, causing a false-negative result. D. High plasma glucose concentrations are
C. Monocytes A. Ascorbic acid associated with damage to the glomerular filtration
D. Neutrophils B. Vaginal contamination 27. Which of the following statements best barrier.
C. Strong reducing agents describes the chemical principle of the protein
17. Microscopic examination of a urine sediment D. Improper specimen storage reagent strip test? 32. The pass-through phenomenon observed with
revealed an average of 2 to 5 white blood cells per 22. Normally, daily urine protein excretion does not A. The protein reacts with an immunocomplex on the Clinitest method when large amounts of
high-power field, whereas the leukocyte esterase exceed the pad, which results in a color change. glucose are present in the urine is due to
test by reagent strip was negative. Which of the A. 150 mg/day. B. The protein causes a pH change on the reagent A. “carmelization” of the sugar present.
following statements best accounts for this B. 500 mg/day. strip pad, which results in a color change. B. reduction of copper sulfate to green-brown
discrepancy? C. 1.5 g/day. C. The protein accepts hydrogen ions from the cupric complexes.
A. The urine is contaminated with vaginal fluid. D. 2.5 g/day. indicator dye, which results in a color change. C. depletion of the substrate, that is, not enough
B. Many white blood cells are lysed, and their D. The protein causes protons to be released from copper sulfate is present initially.
esterase has been inactivated. 23. Which of the following proteins originates in the a polyelectrolyte, which results in a color change. D. reoxidation of the cuprous oxide formed to
C. Ascorbic acid is interfering with the reaction on urinary tract? cupric oxide and other cupric complexes.
the reagent strip. A. Albumin
D. The amount of esterase present is below the B. Bence Jones protein 33. The glucose specificity of the double sequential
sensitivity of the reagent strip test. C. β2-Microglobulin enzyme reaction used on reagent strip tests is due
D. Uromodulin to the use of
A. gluconic acid. B. glucose oxidase.
C. hydrogen peroxide. D. peroxidase.
34. Which of the following ketones is not detected amount of urobilinogen 49. Which of the following features is/are different 3. The microscopic identification of hemosiderin is
by the reagent strip or tablet test? D. A negative test for bilirubin and a decreased when the Hoesch and Watson-Schwartz tests are enhanced when the urine sediment is stained with
A. Acetone amount of urobilinogen compared? A. Gram stain.
B. Acetoacetate 1. The pH of the reaction mixture B. Hansel stain.
C. Acetone and acetoacetate 42. Which of the following conditions can result in 2. The concentration of the Ehrlich’s reagent used C. Prussian blue stain.
D. β-Hydroxybutyrate false-positive bilirubin results? 3. The volume ratio of urine to Ehrlich’s reagent in D. Sudan III stain.
A. Elevated concentrations of nitrite the reaction mixture
35. Which of the following can cause false-positive B. Improper storage of the specimen 4. The sensitivity and specificity for porphobilinogen 4. When the laboratorian performs the microscopic
ketone results? C. Ingestion of ascorbic acid and urobilinogen examination of urine sediment, which of the
A. A large amount of ascorbic acid in urine D. Ingestion of certain medications A. 1, 2, and 3 are correct. following are enumerated using low-power
B. Improper storage of the urine specimen B. 1 and 3 are correct. magnification?
C. Drugs containing free sulfhydryl groups 43. Urobilinogen is formed from the C. 4 is correct. A. Bacteria
D. A large amount of glucose (glucosuria) A. conjugation of bilirubin in the liver. D. All are correct. B. Casts
B. reduction of conjugated bilirubin in bile. C. Red blood cells
36. Which of the following will not cause ketonemia C. reduction of bilirubin by intestinal bacteria. 50. Which of the following reagent strip tests can D. Renal tubular cells
and ketonuria? D. oxidation of urobilin by anaerobic intestinal be affected by ascorbic acid, resulting in falsely low
A. An inability to use carbohydrates bacteria. or false-negative results? 5. A urine sediment could have which of the
B. Inadequate intake of carbohydrates 1. Blood 2. Bilirubin following formed elements and still be considered
C. Increased metabolism of carbohydrates 44. Which of the following statements about 3. Glucose 4. Nitrite “normal”?
D. Excessive loss of carbohydrates urobilinogen is true? A. 1, 2, and 3 are correct. A. Two or fewer hyaline casts
A. Urobilinogen is not normally present in urine. B. 1 and 3 are correct. B. Five to 10 red blood cells
37. The ketone reagent strip and tablet tests are B. Urobilinogen excretion usually is decreased C. 4 is correct. C. A few bacteria
based on the reactivity of ketones with following a meal. D. All are correct. D. A few yeast cells
A. ferric chloride. B. ferric nitrate. C. Urobilinogen excretion is an indicator of renal
C. nitroglycerin. D. nitroprusside. function. 51. Which of the following best describes the 6. Which of the following statements about red
D. Urobilinogen is labile and readily photo-oxidizes mechanism of ascorbic acid interference? blood cells in urine is true?
38. Which of the following statements about to urobilin. A. Ascorbic acid inhibits oxidation of the chromogen. A. Red blood cells crenate in hypotonic urine.
bilirubin is true? B. Ascorbic acid inactivates a reactant, promoting color B. Red blood cell remnants are called “ghost cells.”
development.
A. Conjugated bilirubin is water insoluble. 45. The classic Ehrlich’s reaction is based on the C. Alkaline and hypotonic urine promotes red blood
C. Ascorbic acid removes a reactant from the intended
B. Bilirubin is a degradation product of heme reaction of urobilinogen with reaction sequence. cell disintegration.
catabolism. A. diazotized dichloroaniline. D. Ascorbic acid interacts with the reactants, producing a D. Dysmorphic red blood cells often are associated
C. Unconjugated bilirubin readily passes through B. p-aminobenzoic acid. color that masks the results. with renal tubular disease.
the glomerular filtration barrier. C. p-dichlorobenzene diazonium salt.
D. The liver conjugates bilirubin with albumin to D. p-dimethylaminobenzaldehyde. CHAPTER 8 7. Hemoglobin is a protein and will
form conjugated bilirubin. 46. Which of the following chemical principles is MICROSCOPIC EXAMINATION OF URINE SEDIMENT A. not react in the protein reagent strip test.
most specific for the detection of urobilinogen? B. interfere with the protein reagent strip test,
39. The bilirubin reagent strip and tablet tests are A. Azocoupling reaction 1. Which of the following are not standardized producing erroneous results.
based on B. Ehrlich’s reaction when commercial systems are used for the C. always contribute to the protein reagent strip
A. Ehrlich’s aldehyde reaction. C. Hoesch test processing and microscopic examination of urine result, regardless of the amount of hemoglobin
B. the oxidation of bilirubin to biliverdin. D. Watson-Schwartz test sediment? present.
C. the reduction of bilirubin to azobilirubin. A. Microscopic variables, such as the number of D. contribute to the protein reagent strip result only
D. the coupling of bilirubin with a diazonium salt. 47. Which of the following statements about focal planes when large concentrations of hemoglobin are
porphobilinogen is true? B. The concentration and volume of the urine present.
40. Which of the following are characteristic urine A. Porphobilinogen is red and fluoresces. sediment prepared
findings from a patient with hemolytic jaundice? B. Normally, only trace amounts of porphobilinogen C. The volume of the urine sediment dispensed for 8. Which urinary sediment component(s) when
are formed.
A. A positive test for bilirubin and an increased microscopic viewing observed microscopically can resemble red blood
C. Porphobilinogen is an intermediate product in
amount of urobilinogen bilirubin formation. D. Identification and enumeration of formed cells?
B. A positive test for bilirubin and a decreased D. Porphobilinogen production is the rate-limiting elements in the urine sediment 1. Yeasts 2. Air bubbles
amount of urobilinogen step in heme synthesis. 3. Oil droplets 4. Calcium oxalate crystals
C. A negative test for bilirubin and an increased 2. When urine sediment is viewed, stains and A. 1, 2, and 3 are correct.
amount of urobilinogen 48. A Watson-Schwartz test is performed on a urine various microscopic techniques are used to B. 1 and 3 are correct.
D. A negative test for bilirubin and a decreased specimen. The following results are seen: 1. enhance the observation of fine detail. C. 4 is correct.
amount of urobilinogen chloroform tube—red color in the bottom layer; 2. confirm the identity of suspected components. D. All are correct.
butanol tube: red color in the top layer. These 3. differentiate formed elements that look alike.
41. Which of the following results show results indicate the presence of 4. facilitate the visualization of low-refractile 9. Which of the following is not a characteristic of
characteristic urine findings from a patient with an A. urobilinogen components. neutrophils found in the urine sediment?
obstruction of the bile duct? B. porphobilinogen A. 1, 2, and 3 are correct. A. They are approximately 10 to 14 μm in diameter.
A. A positive test for bilirubin and an increased C. urobilinogen and other Ehrlich’s reactive B. 1 and 3 are correct. B. They form “ghost cells” in hypotonic urine.
amount of urobilinogen substances C. 4 is correct. C. They shrink in hypertonic urine but do not
B. A positive test for bilirubin and a decreased D. porphobilinogen and other Ehrlich’s reactive D. All are correct. crenate.
amount of urobilinogen substances D. As they disintegrate, vacuoles and blebs form
C. A negative test for bilirubin and an increased and their nuclei fuse.
10. How do increased numbers of leukocytes 17. Which of the following does not contribute to 24. The formation of urinary crystals is associated 29. Which of the following is not a distinguishing
usually get into the urine? the size, shape, or length of a urinary cast? with a specific urine pH. Match the urine pH that characteristic of yeast in the urine sediment?
A. Through a renal bleed A. The concentration of protein in the core matrix facilitates crystalline formation with the A. Motility
B. By passive movement through pores in the of the cast appropriate crystal type. More than one number B. Budding forms
vascular epithelium B. The configuration of the tubule in which the cast (pH) can be used. C. Hyphae formation
C. By active ameboid movement through tissues is formed D. Colorless ovoid forms
and epithelium C. The diameter of the tubular lumen in which the __ A. Ammonium biurate 1. Acid
D. Through damage to the integrity of the normal cast is formed __ B. Amorphous urates 2. Neutral 30. Fat can be found in the urine sediment in all of
vascular barrier D. The duration of time the cast is allowed to form __ C. Amorphous phosphates 3. Alkaline the following forms except
in the tubule __ D. Calcium oxalate A. within casts.
11. Which statement regarding lymphocytes found __ E. Cholesterol B. within cells.
in urine sediment is correct? 18. All of the following enhance urinary cast __ F. Cystine C. as free-floating globules.
A. They are not normally present in the urine. formation except __ G. Radiographic contrast media D. within hemosiderin granules.
B. They produce a positive leukocyte esterase test. A. an alkaline pH. __ H. Sulfonamides
C. Their number is increased in patients with drug B. urinary stasis. __ I. Triple phosphate 31. Which of the following statements regarding
hypersensitivity. C. an increase in the solute concentration of the __ J. Tyrosine the characteristics of urinary fat is true?
D. Their number is increased in patients ultrafiltrate. __ K. Uric acid A. Cholesterol droplets stain with Sudan III stain.
experiencing kidney transplant rejection. D. an increase in the quantity of plasma proteins in B. Triglyceride/ neutral fat stains w/ Oil Red O stain.
the ultrafiltrate 25. Match the crystal composition with the C. Cholesterol droplets do not form a Maltese cross
12. Which of the following urinary tract structures is microscopic description that best characterizes it. pattern under polarized light.
not lined with transitional epithelium? 19. When the laboratorian is using brightfield 1. Ammonium biurate 2. Amorphous urates D. Triglycerides and neutral fat are anisotropic and
A. Bladder B. Nephrons microscopy, a urinary cast that appears 3. Amorphous phosphates form a Maltese cross pattern under polarized light.
C. Renal pelves D. Ureters homogeneous with well-defined edges, blunt ends, 4. Calcium 5. Cholesterol
and cracks is most likely a 6. Cystine 7. Sulfonamides 32. Which of the following statements regarding
13. Match the number of the epithelial cell type A. fatty cast. B. granular cast. 8. Triple phosphate 9. Uric acid the microscopic examination of urine sediment is
with its characteristic feature. Only one type is C. hyaline cast. D. waxy cast. false?
correct for each feature. __ A. Colorless “coffin lid” form A. If large numbers of leukocytes are present
1. Collecting tubular cell 20. All of the following can be found incorporated __ B. Colorless hexagonal plates microscopically, then bacteria are present.
B. If urinary fat is present microscopically, then the
2. Distal tubular cell into a cast matrix except __ C. Colorless “envelope” form
chemical test for protein should be positive.
3. Proximal tubular cell A. bacteria. __ D. Colorless rectangular plates with notched C. If large numbers of casts are present microscopically, then
4. Squamous epithelial cell B. crystals. corners oxalate the chemical test for protein should be positive.
__ A. Large and flagstone; can be anucleated C. transitional epithelial cells. __ E. Yellow-brown “thorny apple” form D. If large numbers of red blood cells are present
__ B. Oblong or cigar shaped; small eccentric D. white blood cells. __ F. Colorless to yellow; diamondshaped or microscopically, then the chemical test for blood should be
nucleus rhombic-; can formlayers positive.
__ C. Polygonal; large nucleus 21. Which of the following urinary casts are __ G. Yellow-brown sheaves of wheat
__ D. Oval to round; small nucleus that is centered diagnostic of glomerular or renal tubular damage? 33. The following are initial results obtained during
or slightly eccentric A. Bacterial casts 26. Which of the following crystals, when found in a routine urinalysis. Which results should be
__ E. Round, pear-shaped, orcolumnar with a small B. Red blood cell casts the urine sediment, most likely indicates an investigated further?
oval to round nucleus C. Renal tubular cell casts abnormal metabolic condition? A. Negative protein; 2 to 5 waxy casts
D. White blood cell casts A. Bilirubin B. Sulfonamides B. Cloudy, brown urine; 2 to 5 red blood cells
14. Which of the following can be observed in the C. Triple phosphate D. Uric acid C. Urine pH 7.5; ammonium biurate crystals
urine sediment as an intact fragment or sheet of 22. Which of the following characteristics best D. Clear, colorless urine; specific gravity 1.010
cells? differentiates waxy casts from fibers that may 27. During the microscopic examination of a urine
1. Collecting tubular epithelium contaminate urine sediment? sediment, cystine crystals are found. The 34. The following are initial results obtained during
2. Distal tubular epithelium A. Waxy casts do not polarize light; fibers do. laboratorian should perform which of the following a routine urinalysis. Which results should be
3. Transitional epithelium B. Waxy casts are more refractile than fibers. before reporting the presence of these crystals? investigated further?
4. Proximal tubular epithelium C. Waxy casts have rounded ends; fibers do not. 1. Perform a confirmatory chemical test A. Negative protein; 0 to 2 hyaline casts
A. 1, 2, and 3 are correct. D. Waxy casts are thicker at their margins; fibers are 2. Ensure that the urine specimen has an acid pH B. Urine pH 6.0; calcium oxalate crystals
B. 1 and 3 are correct. thicker in the middle. 3. Assess the number of crystals per high-power C. Cloudy, yellow urine; specific gravity 1.050
C. 4 is correct. field D. Amber urine with yellow foam; negative bilirubin
D. All are correct. 23. Which of the following does not affect the 4. Check the current medications that the patient is by reagent strip; positive Ictotest
formation of urinary crystals within nephrons? taking
15. Urinary casts are formed in A. The pH of the ultrafiltrate A. 1, 2, and 3 are correct. 35. Which of the following when found in the urine
A. the distal and collecting tubules. B. The diameter of the tubular lumen B. 1 and 3 are correct. sediment from a female patient is not considered a
B. the distal tubules and the loops of Henle. C. The flow of urine through the tubules C. 4 is correct. vaginal contaminant?
C. the proximal and distal tubules. D. The concentration of solutes in the ultrafiltrate D. All are correct. A. Fat
D. the proximal tubules and the loops of Henle. B. Clue cells
28. Mucous threads can be difficult to differentiate C. Spermatozoa
16. Urinary casts are formed with a core matrix of from D. Trichomonads
A. albumin. B. Bence Jones protein. A. fibers. B. hyaline casts.
C. transferrin. D. uromodulin. C. pigmented casts. D. waxy casts.
CHAPTER 9 8. Which of the following disorders is the major 16. Which formed element in urine sediment is 24. Eosinophiluria, fever, and skin rash are
RENAL AND METABOLIC DISEASE cause of the nephrotic syndrome in adults? characteristic of toxic acute tubular necrosis and characteristic clinical features of
A. IgA nephropathy aids in its differentiation from ischemic acute A. acute pyelonephritis.
1. Which of the following statements about renal B. Membranoproliferative glomerulonephritis tubular necrosis? B. acute interstitial nephritis.
diseases is true? C. Membranous glomerulonephritis A. Collecting tubular cells C. acute glomerulonephritis.
A. Glomerular renal diseases are usually immune D. Rapidly progressive glomerulonephritis B. Granular casts D. chronic glomerulonephritis.
mediated. C. Proximal tubular cells
B. Vascular disorders induce renal disease by 9. Which of the following glomerular diseases is D. Waxy casts 25. Cessation of the administration of a drug is the
increasing renal perfusion. the major cause of the nephrotic syndrome in fastest and most effective treatment for
C. All structural components of the kidney are children? 17. Which of the following disorders is A. acute pyelonephritis.
equally susceptible to disease. A. IgA nephropathy characterized by the urinary excretion of large B. acute interstitial nephritis.
D. Tubulointerstitial renal diseases usually result B. Minimal change disease amounts of arginine, cystine, lysine, and ornithine? C. acute glomerulonephritis.
from antibody-antigen and complement C. Membranous glomerulonephritis A. Cystinosis D. chronic glomerulonephritis.
interactions. D. Rapidly progressive glomerulonephritis B. Cystinuria
C. Lysinuria 26. Yeast is considered part of the normal flora in
2. In glomerular diseases, morphologic changes in 10. Which of the following statements regarding IgA D. Tyrosinuria each of the following locations except in the
the glomeruli include all of the following except nephropathy is true? A. gastrointestinal tract.
A. cellular proliferation. A. It often follows a mucosal infection. 18. Generalized loss of proximal tubular function is B. oral cavity.
B. erythrocyte congestion. B. It is associated with the nephrotic syndrome. a characteristic of C. urinary tract.
C. leukocyte infiltration. C. It is characterized by leukocyte infiltration of the A. Fanconi’s syndrome. D. vagina.
D. glomerular basement membrane thickening. glomeruli. B. nephrotic syndrome.
D. It often occurs secondary to systemic lupus C. renal glucosuria. 27. Acute renal failure can be caused by all of the
3. When all renal glomeruli are affected by a erythematosus. D. renal tubular acidosis. following except
morphologic change, this change is described as A. hemorrhage.
A. diffuse. 11. Eighty percent of patients who develop chronic 19. Which of the following changes is not B. acute tubular necrosis.
B. focal. glomerulonephritis previously had some type of associated with renal tubular acidosis? C. acute pyelonephritis.
C. differentiated. glomerular disease. Which of the following A. Decreased glomerular filtration rate D. urinary tract obstruction.
D. segmental. disorders is implicated most frequently in the B. Decreased renal tubular secretion of hydrogen
development of chronic glomerulonephritis? ions 28. Which of the following statements about
4. In glomerular renal disease, glomerular damage A. IgA nephropathy C. Decreased proximal tubular reabsorption of chronic renal failure is true?
results from B. Membranous glomerulonephritis bicarbonate A. It can be reversed by appropriate treatment
A. deposition of infectious agents. C. Poststreptococcal glomerulonephritis D. Increased back-diffusion of hydrogen ions in the regimens.
B. a decrease in glomerular perfusion. D. Rapidly progressive glomerulonephritis distal tubules B. It eventually progresses to end-stage renal
C. changes in glomerular hemodynamics. disease.
D. toxic substances induced by immune complex 12. Chronic renal failure often develops in each of 20. Which of the following disorders is considered a C. It is monitored by periodic determinations of
formation. the following diseases except lower urinary tract infection? renal blood flow.
A. amyloidosis. A. Cystitis D. Its onset involves a sudden decrease in the
5. Clinical features that are characteristic of B. diabetes mellitus. B. Glomerulonephritis glomerular filtration rate.
glomerular damage include all of the following C. diabetes insipidus. C. Pyelitis
except D. systemic lupus erythematosus. D. Pyelonephritis 29. Isosthenuria, significant proteinuria, and
A. edema. numerous casts of all types describes the urinalysis
B. hematuria. 13. Which of the following features characterize the 21. Most urinary tract infections are caused by findings from a patient with
C. proteinuria. nephrotic syndrome? A. yeast, such as Candida spp. A. acute renal failure.
D. polyuria. 1. Proteinuria 2. Edema B. gram-negative rods. B. acute tubular necrosis.
3. Hypoalbuminemia 4. Hyperlipidemia C. gram-positive rods. C. chronic renal failure.
6. Which of the following disorders frequently A. 1, 2, and 3 are correct. D. gram-positive cocci. D. renal tubular acidosis.
occurs following a bacterial infection of the skin or B. 1 and 3 are correct.
throat? C. 4 is correct. 22. Which of the following formed elements when 30. Approximately 75% of the renal calculi that
A. Acute glomerulonephritis D. All are correct. present in urine sediment is most indicative of an form in patients contain
B. Chronic glomerulonephritis upper urinary tract infection? A. calcium.
C. Membranous glomerulonephritis 14. When a patient has the nephrotic syndrome, A. Bacteria B. cystine.
D. Rapidly progressive glomerulonephritis microscopic examination of their urine sediment B. Casts C. oxalate.
often reveals C. Erythrocytes D. uric acid.
7. Which of the following disorders is characterized A. granular casts. B. leukocyte casts. D. Leukocytes
by cellular proliferation into Bowman’s space to C. red blood cell casts. D. waxy casts. 31. The formation of renal calculi is enhanced by
form cellular “crescents”? 23. The most common cause of chronic A. an increase in urine flow.
A. Chronic glomerulonephritis 15. Which of the following has not been associated pyelonephritis is B. the natural “acid-alkaline tide” of the body.
B. Membranous glomerulonephritis with acute tubular necrosis? A. cystitis. C. increases in protein in the urine ultrafiltrate.
C. Minimal change disease A. Antibiotics B. bacterial sepsis. D. increases in chemical salts in the urine
D. Rapidly progressive glomerulonephritis B. Galactosuria C. drug-induced nephropathies. ultrafiltrate.
C. Hemoglobinuria D. reflux nephropathies.
D. Surgical procedures
32. An overflow mechanism is responsible for the 40. Which of the following features is not a 6. Intestinal motility is stimulated by each of the 14. Which of the following types of fat readily stain
aminoaciduria present in characteristic of diabetes insipidus? following except with Sudan III or Oil Red O stain?
A. cystinosis. B. cystinuria. A. Polyuria A. castor oil. 1. Fatty acids
C. tyrosinuria. D. phenylketonuria. B. Polydipsia B. dietary fiber. 2. Cholesterol
C. Increased production of antidiuretic hormone C. intestinal distention. 3. Soaps (fatty acid salts)
33. Which of the following hereditary diseases D. Urine with a low specific gravity D. sympathetic nerve activity. 4. Neutral fats (triglycerides)
results in the accumulation and excretion of large A. 1, 2, and 3 are correct. B. 1 and 3 are correct.
amounts of homogentisic acid? 41. Porphyria is characterized by 7. Which of the following conditions is C. 4 is correct. D. All are correct.
A. Alkaptonuria A. increased heme degradation. characterized by the excretion of greasy, pale, foul-
B. Melanuria B. increased heme formation. smelling feces? 15. Which of the following types of fat require
C. Phenylketonuria C. decreased globin synthesis. A. Steatorrhea acidification and heat before they stain with Sudan
D. Tyrosinuria D. decreased iron catabolism. B. Osmotic diarrhea III or Oil Red O stain?
C. Secretory diarrhea 1. Fatty acids
34. Which of the following substances oxidizes with 42. Which of the following statements regarding D. Intestinal hypermotility 2. Cholesterol
exposure to air, causing the urine to turn brown or porphyrin and porphyrin precursors is true? 3. Soaps (fatty acid salts)
black? 1. Porphyria can be inherited or induced. 8. The daily amount of fat excreted in the feces is 4. Neutral fats (triglycerides)
A. Melanin 2. Porphyrin precursors are neurotoxins. normally less than A. 1, 2, and 3 are correct. B. 1 and 3 are correct.
B. Porphyrin 3. Porphyrins can be dark red or purple. A. 0.7 g. B. 7.0 g. C. 4 is correct. D. All are correct.
C. Tyrosine 4. Porphyrin precursor accumulation causes C. 70 g. D. 700 g.
D. Urobilinogen skin photosensitivity. 16. With the two-slide qualitative fecal fat
9. Which of the following tests is used to diagnose determination, the first slide produces a normal
35. Which of the following diseases is related to A. 1, 2, and 3 are correct. steatorrhea? amount of staining fat present, whereas the second
tyrosine production or metabolism? B. 1 and 3 are correct. A. Fecal fat slide, following acid addition and heat, produces an
1. Tyrosinuria 2. Melanuria C. 4 is correct. B. Fecal carbohydrates abnormally increased amount of fat. These results
3. Phenylketonuria 4. Alkaptonuria D. All are correct. C. Fecal occult blood indicate
A. 1, 2, and 3 are correct. D. Fecal osmolality A. malabsorption.
B. 1 and 3 are correct. CHAPTER 10 B. maldigestion.
C. 4 is correct. FECAL ANALYSIS 10. Which of the following statements about feces C. parasitic infestation.
D. All are correct. is TRUE? D. disaccharidase deficiency.
1. Which of the following substances is not a A. The normal color of feces is primarily due to
36. Which of the following diseases can result in component of normal feces? urobilinogens. 17. Mass screening in adults for fecal occult blood is
severe mental retardation if not detected and A. Bacteria B. Blood B. The amount of feces produced in 24 hours performed primarily to detect
treated in the infant? C. Electrolytes D. Water correlates poorly with food intake. A. ulcers. B. hemorrhoids.
1. Phenylketonuria C. The normal odor of feces is usually due to C. colorectal cancer. D. esophageal varices.
2. Maple syrup urine disease 2. All of the following actions can result in watery or metabolic by-products of intestinal protozoa.
3. Galactosuria diarrheal stools except D. The consistency of feces is primarily determined 18. Which of the following dietary substances can
4. Alkaptonuria A. decreased intestinal motility. by the amount of fluid intake. cause a false-negative guaiac-based fecal occult
B. inhibition of water reabsorption. blood slide test?
A. 1, 2, and 3 are correct. C. inadequate time allowed for water reabsorption. 11. Fecal specimens may be tested for each of the A. Fish B. Red meat
B. 1 and 3 are correct. D. an excessive volume of fluid presented for following except C. Ascorbic acid D. Fruits and vegetables
C. 4 is correct. reabsorption. A. fat.
D. All are correct. B. blood. 19. Which of the following actions can cause a
3. Lactose intolerance caused by the lack of C. bilirubin. falsepositive guaiac-based fecal occult blood slide
37. Which of the following is a characteristic feature sufficient lactase primarily presents with D. carbohydrates. test?
of type 2 diabetes mellitus? A. steatorrhea. A. Rehydration of the specimen on the slide before
A. Daily insulin injections are necessary. B. osmotic diarrhea. 12. Which of the following substances is responsible testing
B. Onset of the disease is usually sudden. C. secretory diarrhea. for the characteristic color of normal feces? B. Degradation of hemoglobin to porphyrin
C. Strong tendency to develop ketoacidosis. D. intestinal hypermotility. A. Bilirubin C. Storage of fecal specimens before testing
D. The disease usually presents after 40 years of B. Hemoglobin D. Storage of slides with the specimen already
age. 4. Which of the following tests assists most in the C. Urobilins Applied
differentiation of secretory and osmotic diarrhea? D. Urobilinogens
38. Which of the following abnormalities is not a A. Fecal fat 20. Select the true statement about fecal occult
clinical feature of an infant with galactosuria? B. Fecal carbohydrates 13. Which of the following statements about fecal blood tests (FOBTs)?
A. Cataract formation C. Fecal occult blood tests is true? A. Guaiac-based FOBTs are more specific than
B. Liver dysfunction D. Fecal osmolality A. A fecal fat determination identifies the cause of immunochemical-based FOBTs.
C. Mental retardation steatorrhea. B. Guaiac-based FOBTs are more expensive than
D. Polyuria 5. The inability to convert dietary foodstuffs into B. A fecal leukocyte determination aids in immunochemical-based FOBTs.
readily absorbable substances is called intestinal differentiating the cause of diarrhea. C. Dietary restrictions are not required when
39. Galactose is produced in the normal metabolism A. inadequacy. C. A fecal Clinitest identifies the enzyme deficiency immunochemical-based FOBTs are used.
of B. hypermotility. that prevents sugar digestion. D. Hemoglobin from nonhuman sources (e.g., red
A. fructose. B. glucose. C. malabsorption D. A fecal blood screen aids in differentiating meat) can cause false-positive results when
C. lactose. D. sucrose. D. maldigestion. bacterial from parasitic infestations. immunochemical-based FOBTs are used.
21. Which of the following conditions can result in 3. Which of the following structures performs an 10. Which of the following statements regarding 17. The concentration of which of the following
the excretion of small amounts of occult blood in endocrine and an exocrine function? sperm concentration is true? substances can be used to positively identify a fluid
the feces? A. Testes B. Epididymis A. Sperm concentration within a single individual is as seminal fluid?
1. Hemorrhoids C. Prostate gland D. Seminal vesicles usually constant. A. Acid phosphatase
2. Bleeding gums B. Sperm concentration depends solely on the B. Citric acid
3. Peptic ulcers 4. The primary function of semen is to period of abstinence. C. Fructose
4. Intake of iron supplements A. nourish the spermatozoa. C. In a normal ejaculate, sperm concentration D. Zinc
A. 1, 2, and 3 are correct. B. coagulate the ejaculate. ranges from 20 to 250 million per milliliter.
B. 1 and 3 are correct. C. transport the spermatozoa. D. For fertility purposes, sperm concentration is CHAPTER 12
C. 4 is correct. D. stimulate sperm maturation. more important than sperm motility. AMNIOTIC FLUID ANALYSIS
D. All are correct.
5. Match the number of the structure to the feature 11. Which of the following statements regarding 1. Which of the following is not a function of the
22. Which of the following statements regarding that best describes it. Only one structure is correct sperm morphology is true? amniotic fluid surrounding a developing fetus?
the test for fetal hemoglobin in feces (the Apt test) for each feature. A. Sperm morphology is usually evaluated using a A. Amniotic fluid provides protection of the fetus.
is TRUE? 1. Bulbourethral testosterone gland peroxidase stain. B. Amniotic fluid enables fetal movement.
A. Any adult hemoglobin present should resist 2. Ejaculatory duct B. Stained smears of fresh semen can be used to C. Amniotic fluid is a medium for oxygen exchange.
alkali treatment. 3. Epididymis evaluate sperm morphology. D. Amniotic fluid is a source of water and solute
B. The Apt test is used to differentiate various 4. Interstitial cells of Leydig C. Sperm morphology is evaluated using 400× (high- exchange.
hemoglobinopathies in the newborn. 5. Prostate gland power) magnification.
C. Hemoglobin degraded to hematin usually 6. Seminal vesicles D. Normal semen contains at least 80% sperm with 2. Amniocentesis is usually performed at 15 to 18
produces a positive test result. 7. Seminiferous tubules normal morphology. weeks’ gestation to determine which of the
D. A pink color following alkali treatment indicates 8. Vas deferens following conditions?
the presence of fetal hemoglobin. __ A. Produces and secretes 12. Which of the following parameters directly A. Fetal distress
__ B. Site of spermatogenesis relates to and provides a check of the sperm B. Fetal maturity
23. Which of the following are clinical __ C. Concentrates and stores sperm motility evaluation? C. Genetic disorders
manifestations of a disaccharidase deficiency? __ D. Secretes fluid rich in zinc A. Agglutination evaluation D. Infections in the amniotic fluid
1. A positive fecal Clinitest __ E. Secretes fluid high in fructose B. Concentration determination
2. Constipation and gas __ F. Transports sperm to the ejaculatory duct C. Morphology assessment 3. Through which of the following mechanism(s)
3. A fecal pH of 5.0 D. Vitality assessment does solute and water exchange occur between the
4. A positive fecal occult blood test 6. Which of the following is a requirement when fetus and the amniotic fluid?
A. 1, 2, and 3 are correct. collecting semen specimens? 13. Microscopically, immature spermatogenic cells 1. Fetal swallowing of the amniotic fluid
B. 1 and 3 are correct. A. The patient should abstain from sexual inter course for at are often difficult to distinguish from 2. Transudation across the fetal skin
C. 4 is correct. least 2 days following the collection. A. bacteria. 3. Fetal urination into the amniotic fluid
B. Only complete collections of the entire ejaculate are
D. All are correct. B. erythrocytes. 4. Respiration of amniotic fluid into the fetal
acceptable for analysis.
C. A single semen specimen is sufficient for the evaluation of C. leukocytes. pulmonary system
24. Which of the following tests can differentiate male fertility. D. epithelial cells.
inadequate carbohydrate metabolism from D. Semen specimens must be evaluated within 3 hours A. 1, 2, and 3 are correct.
inadequate carbohydrate absorption? following collection. 14. A semen pH greater than 7.8 is associated with B. 1 and 3 are correct.
A. Fecal Clinitest A. premature ejaculation. C. 4 is correct.
B. Xylose absorption test 7. Which of the following conditions adversely B. obstruction of the vas deferens. D. All are correct.
C. Oral carbohydrate tolerance tests affects the quality of a semen specimen? C. abnormal seminal vesicle function.
D. Carbohydrate thin-layer chromatography A. The use of Silastic condoms D. infection of the male reproductive tract. 4. Select the term used to describe a decreased
B. The time of day the collection is obtained volume of amniotic fluid present in the amniotic
CHAPTER 11 C. Collection of the specimen in a glass container 15. Fructose in semen assists in the evaluation of sac.
SEMINCAL FLUID ANALYSIS D. The storage of the specimen at refrigerator which of the following? A. Anhydramnios
temperatures 1. The secretory function of the seminal vesicles B. Hydramnios
1. Seminal fluid analysis is routinely performed to 2. The functional integrity of the epididymis C. Oligohydramnios
evaluate which of the following? 8. Which of the following statements regarding 3. The functional integrity of the vas deferens D. Polyhydramnios
A. Prostate cancer B. Postvasectomy status semen is true? 4. The secretory function of the prostate gland
C. Penile implant status D. Premature ejaculation A. Semen usually coagulates within 30 minutes after 5. Amniotic fluid specimens are immediately
ejaculation.
A. 1, 2, and 3 are correct. protected from light to preserve which of the
B. For semen to liquefy before 60 minutes is abnormal.
2. Which of the following structures contribute(s) C. Following liquefaction, the viscosity of normal semen is B. 1 and 3 are correct. following substances?
secretions to semen? similar to that of water. C. 4 is correct. A. Bilirubin B. Fetal cells
1. Epididymis D. Following liquefaction, the presence of particulate matter D. All are correct. C. Meconium D. Phospholipids
2. Prostate gland is highly indicative of a bacterial infection.
3. Seminal vesicles 16. Which of the following substances can be used 6. Which of the following substances, when present
4. Seminiferous tubules 9. Which of the following statements regarding the to evaluate the secretory function of the prostate in amniotic fluid, is affected adversely by
A. 1, 2, and 3 are correct. manual evaluation of sperm motility is not true? gland? refrigeration?
B. 1 and 3 are correct. A. Sperm motility most often is graded subjectively. A. Carnitine A. Bilirubin
B. Sperm motility is affected adversely by temperature.
C. 4 is correct. B. Fructose B. Fetal cells
C. Sperm motility assesses speed and forward progression.
D. All are correct. D. Sperm motility should be evaluated initially and at 2 C. pH C. Protein
hours after collection. D. Zinc D. Phospholipids
7. When processing amniotic fluid, high 8. All of the following can cause xanthochromia in 17. Which of the following proteins in the CSF is
centrifugation speeds are used to clear the fluid of CHAPTER 13 CSF except used to monitor the integrity of the blood-brain
turbidity for CEREBROSPINAL FLUID ANALYSIS A. high concentrations of protein. barrier?
A. bilirubin analysis. B. high concentrations of bilirubin. A. Albumin B. Transthyretin
B. culturing of fetal cells. 1. Cerebrospinal fluid (CSF) is produced primarily C. increased numbers of leukocytes. C. Transferrin D. Immunoglobulin G
C. meconium detection. from D. erythrocytes from a traumatic tap.
D. phospholipid analysis. A. secretions by the choroid plexus. 18. An immunoglobulin G index greater than 0.70
B. diffusion from plasma into the central nervous 9. In CSF, which of the following findings indicates a indicates
8. Analysis for which of the following substances system. traumatic puncture? A. intrathecal synthesis of immunoglobulin G.
can aid in the differentiation of amniotic fluid from C. ultrafiltration of plasma in the ventricles of the A. The presence of erythrophagocytic cells in the B. a compromised blood-brain barrier.
urine? brain. CSF C. active demyelination of neural proteins.
1. Urea 2. Glucose D. excretions from ependymal cells lining the brain B. Hemosiderin granules within macrophages in the D. increased transport of immunoglobulin G from
3. Creatinine 4. Protein and spinal cord. CSF sediment plasma into the CSF.
A. 1, 2, and 3 are correct. C. An uneven distribution of blood in the CSF
B. 1 and 3 are correct. 2. Cerebrospinal fluid is found between the collection tubes 19. An unknown fluid can be positively identified as
C. 4 is correct. A. arachnoid and dura mater. D. A xanthochromic supernatant following CSF CSF by determining the
D. All are correct. B. arachnoid and pia mater. centrifugation A. lactate concentration.
C. pia mater and dura mater. B. albumin concentration.
9. Which of the following statements about D. pia mater and choroid plexus. 10. How many leukocytes are normally present in C. presence of oligoclonal banding on
amniotic fluid is true? the CSF obtained from an adult? electrophoresis.
A. Amniotic fluid is normally clear and colorless. 3. Which of the following statements regarding CSF A. 0 to 5 cells/mL D. presence of carbohydrate-deficient transferrin
B. Normally amniotic fluid contains fetal hair, cells, is true? B. 0 to 10 cells/mL on electrophoresis.
and vernix. A. Cerebrospinal fluid is constantly produced. C. 0 to 20 cells/mL
C. Amniotic fluid and urine can be differentiated by B. Cerebrospinal fluid is reabsorbed into the blood D. 0 to 30 cells/mL 20. Which of the following statements about
a physical examination of the fluid. at the choroid plexus. oligoclonal bands is false?
D. When contaminated with meconium, amniotic C. Cerebrospinal fluid is essentially composed of 11. Which of the following cells can be present in A. In the CSF, these bands indicate increased
fluid takes on a yellow or amber coloration. diluted plasma. small numbers in normal CSF? intrathecal
D. Cerebrospinal fluid circulates through the brain A. Erythrocytes B. Lymphocytes concentrations of immunoglobulin G.
10. Which of the following is not a test to evaluate and spinal cord because of active and passive C. Macrophages D. Plasma cells B. The bands usually correlate with the stage of
the surfactants present in the fetal pulmonary diffusion processes. disease and can be used to predict disease
system? 12. Which of the following cell types predominate progression.
A. ΔA450 4. Which of the following substances does not in CSF during a classic case of bacterial meningitis? C. The bands are often present in the CSF and
B. Lecithin/sphingomyelin ratio normally pass through the blood-brain barrier? A. Lymphocytes B. Macrophages serum of individuals with a lymphoproliferative
C. Phosphatidylglycerol detection A. PO2 C. Monocytes D. Neutrophils disease.
D. Foam stability index B. Albumin D. The bands are often present in the CSF but
C. Glucose 13. Which of the following cell types predominate not in the serum of individuals with multiple
11. Which of the following test results would D. Fibrinogen in CSF during a classic case of viral meningitis? sclerosis.
indicate fetal lung immaturity? A. Lymphocytes B. Macrophages
1. A lecithin/sphingomyelin ratio of less than 2.0 5. During a lumbar puncture procedure, the first C. Monocytes D. Neutrophils 21. Which of the following statements about CSF
2. A lecithin/sphingomyelin ratio of more than 2.0 collection tube of CSF removed should be used for glucose is false?
3. A lecithin/sphingomyelin ratio of more than 2.0, A. chemistry tests. 14. When choroid plexus cells and ependymal cells A. Increased CSF glucose values are diagnostically
with phosphatidylglycerol absent B. cytologic studies. are present in CSF, they significant.
4. A lecithin/sphingomyelin ratio of less than 2.0, C. hematologic tests. A. are often clinically significant. B. Glucose enters the CSF by active transport and
with phosphatidylglycerol present D. microbiological studies. B. represent the demyelination of nerve tissue. simple diffusion.
C. can closely resemble clusters of malignant cells. C. Decreased CSF glucose values reflect a defective
A. 1, 2, and 3 are correct. 6. Which of the following is not an analytical D. indicate breakdown of the blood-brain barrier. blood-brain barrier and increased glycolysis.
B. 1 and 3 are correct. concern when the processing and testing of CSF are D. CSF glucose values reflect the plasma glucose
C. 4 is correct. delayed? 15. All of the following proteins are normally concentration 30 to 90 minutes preceding
D. All are correct. A. The viability of microorganisms present in the CSF except collection.
B. The lability of the immunoglobulins A. albumin.
12. Which of the following conditions can cause C. The lysis of leukocytes and erythrocytes B. fibrinogen. 22. Normal CSF lactate levels (less than 25 mg/dL)
erythroblastosis fetalis? D. Alterations in the chemical composition C. transthyretin. are commonly found in patients with
A. Immaturity of the fetal liver D. transferrin. A. bacterial meningitis. B. fungal meningitis.
B. Decreased amounts of amniotic fluid 7. Pleocytosis is a term used to describe C. tuberculous meningitis D. viral meningitis.
C. Inadequate fetal pulmonary surfactants A. an increased number of cells in the CSF. 16. Which of the following events does not result in
D. Maternal immunization by fetal antigens B. a pink, orange, or yellow CSF specimen. an increased CSF total protein? 23. Which of the following procedures frequently
C. an increased protein content in the CSF caused A. A traumatic puncture procedure provides a rapid presumptive diagnosis of bacterial
13. A ΔA450 value that falls into zone III indicates by cellular lysis. B. Alterations in the blood-brain barrier meningitis?
that the fetus is experiencing D. inflammation and sloughing of cells from the C. Trauma to the central nervous system, resulting A. A blood culture
A. no hemolysis. B. mild hemolysis. choroid plexus. in fluid loss B. A CSF culture
C. moderate hemolysis. D. severe hemolysis. D. Decreased reabsorption of CSF into the C. A CSF Gram stain
peripheral blood D. Immunologic tests on CSF for microbial antigens
24. India ink preparations and microbial antigen 8. A synovial fluid specimen has a high cell count 15. Which of the following findings provides a 3. Which of the following conditions enhances the
tests on CSF can aid in the diagnosis of and requires dilution to be counted. Which of the definitive diagnosis of a specific joint condition? formation of serous fluid in a body cavity?
A. bacterial meningitis. following diluents should be used? A. Staphylococcal bacteria identified by Gram stain A. Increased lymphatic absorption
B. fungal meningitis. A. Normal saline B. Corticosteroid crystals identified during the B. Increased capillary permeability
C. tuberculous meningitis. B. Dilute acetic acid (2%) microscopic examination C. Increased plasma oncotic pressure
D. viral meningitis. C. Dilute methanol (1%) C. A plasma–synovial fluid glucose difference D. Decreased capillary hydrostatic pressure
D. Phosphate buffer solution (0.050 mol/L) exceeding 20 mg/dL
CHAPTER 14 D. Greater than 25 WBCs/μL observed during the 4. The pathologic accumulation of fluid in a body
SYNOVIAL FLUID ANALYSIS 9. Which of the following results from synovial fluid microscopic examination cavity is called
analysis indicates a joint disease process? A. an abscess. B. an effusion.
1. Which of the following tasks is a function of A. A few synoviocytes present in the fluid 16. Analysis of a synovial fluid specimen reveals the C. pleocytosis. D. paracentesis.
synovial fluid? B. A WBC count lower than 200 cells/mL following:
1. Providing lubrication for a joint C. An RBC count lower than 2000 cells/mL • Cloudy, yellow-green fluid of low viscosity 5. Paracentesis and serous fluid testing are
2. Assisting in the structural support of a joint D. A differential count showing greater than 25% • Total leukocyte count of 98,000 cells/μL performed to
• Plasma–synovial fluid glucose difference of 47 mg/dL
3. Transporting nutrients to articular cartilage neutrophils 1. remove serous fluids that may be compressing a
Based on the information provided and Table
4. Synthesizing hyaluronate and degradative 14-2, this specimen most likely would be classified as vital organ.
enzymes 10. Differentiation of synovial fluid crystals, based A. noninflammatory. B. inflammatory. 2. determine the pathologic cause of an effusion.
on their birefringence, is achieved using C. septic. D. hemorrhagic. 3. identify an effusion as a transudate or an
A. 1, 2, and 3 are correct. B. 1 and 3 are correct. A. transmission electron microscopy. exudate.
C. 4 is correct. D. All are correct. B. phase-contrast microscopy. 17. An analysis of a synovial fluid specimen reveals 4. prevent volume depletion caused by the
C. direct polarizing microscopy. the following: accumulation of fluid in body cavities.
2. Which of the following statements is a D. compensated polarizing microscopy. • Yellow fluid of high viscosity
characteristic of normal synovial fluid? • Total leukocyte count of 300 cells/μL A. 1, 2, and 3 are correct.
A. Synovial fluid is viscous. 11. The microscopic examination of synovial fluid • Plasma–synovial fluid glucose difference of B. 1 and 3 are correct.
B. Synovial fluid is slightly turbid. for crystals can be difficult because 17 mg/dL C. 4 is correct.
C. Synovial fluid is dark yellow. 1. numerous artifacts are also birefringent. D. All are correct.
Based on the information provided and Table
D. Synovial fluid forms small clots on standing. 2. few crystals may be present.
3. free-floating crystals can become enmeshed 14-2, this specimen would most likely be classified
as 6. Thoracentesis refers specifically to the removal of
or hidden in fibrin.
3. Which of the following components is not 4. different crystals can closely resemble each A. noninflammatory. B. inflammatory. fluid from the
normally present in synovial fluid? other morphologically. C. septic. D. hemorrhagic. A. abdominal cavity. B. pericardial cavity.
A. Fibrinogen B. Neutrophils A. 1, 2, and 3 are correct. C. peritoneal cavity. D. pleural cavity.
C. Protein D. Uric acid B. 1 and 3 are correct. CHAPTER 15
C. 4 is correct. PLEURAL, PERICARDIAL AND PERITONEAL FLUID 7. Which of the following parameters best identifies
4. Which of the following substances will not D. All are correct. ANALYSIS a fluid as a transudate or an exudate?
increase the turbidity of synovial fluid? A. Color and clarity
A. Fat B. Crystals 12. Which of the following crystals characteristically 1. Which of the following statements about serous B. Leukocyte and differential counts
C. Hyaluronate D. WBCs occurs in patients with gout? fluid–filled body cavities is true? C. Total protein and specific gravity measurements
A. Cholesterol crystals 1. A parietal membrane is attached firmly to the D. Total protein ratio and lactate dehydrogenase
5. Abnormally decreased viscosity in synovial fluid B. Hydroxyapatite crystals body cavity wall. ratio
results from C. Monosodium urate crystals 2. Serous fluid acts as a lubricant between
A. mucin degradation by leukocytic lysosomes. D. Calcium pyrophosphate dihydrate crystals opposing membranes. 8. Chylous and pseudochylous effusions are
B. overproduction of synovial fluid by synoviocytes. 3. A serous membrane is composed of a single differentiated by their
C. autoimmune response of synoviocytes in joint 13. In synovial fluid, which of the following crystals layer of flat mesothelial cells. A. physical examinations.
disease. is not birefringent? 4. The visceral and parietal membranes of B. cholesterol concentrations.
D. depolymerization of hyaluronate by neutrophilic A. Cholesterol crystals an organ are actually a single continuous C. triglyceride concentrations.
enzymes. B. Hydroxyapatite crystals membrane. D. leukocyte and differential counts.
C. Monosodium urate crystals
6. A synovial fluid specimen is received in the D. Calcium pyrophosphate dihydrate crystals A. 1, 2, and 3 are correct. B. 1 and 3 are correct. 9. Which of the following conditions is most often
laboratory 2 hours after collection. Which of the C. 4 is correct. D. All are correct. associated with the formation of a transudate?
following changes to the fluid will most likely have 14. Assuming that a patient is fasting, which of the A. Pancreatitis
taken place? following analytes is normally present in the 2. Which of the following mechanisms is B. Surgical procedures
A. The specimen will have clotted. synovial fluid in essentially the same concentration responsible for the formation of serous fluid in C. Congestive heart failure
B. The uric acid concentration will have decreased. as in the blood plasma? body cavities? D. Metastatic neoplasm
C. Crystals may have precipitated or dissolved. 1. Glucose 2. Lactate A. Ultrafiltration of circulating blood plasma
D. The lactate concentration will have decreased 3. Uric acid 4. Protein B. Selective absorption of fluid from the lymphatic 10. Match the type of serous effusion most often
because of anaerobic glycolysis. A. 1, 2, and 3 are correct. system associated with each pathologic condition.
B. 1 and 3 are correct. C. Diuresis of solutes and water across a __ A. Neoplasms 1. Exudate
7. Which of the following anticoagulants does not C. 4 is correct. concentration gradient __ B. Hepatic cirrhosis 2. Transudate
have the potential to precipitate out in crystalline D. All are correct. D. Active secretion by mesothelial cells that line the __ C. Infection
form when used for synovial fluid specimens? serous membranes __ D. Rheumatoid arthritis
A. Sodium citrate B. Sodium heparin __ E. Trauma
C. Lithium heparin D. Potassium oxalate __ F. Nephrotic syndrome
11. Which of the following laboratory findings on an 3. Which range of pH values is associated with 11. Which of the following substances is responsible 4. Select the TRUE statement regarding semi-
effusion does not indicate a specific diagnosis? secretions from a healthy vagina? for the foul, fishy odor obtained when the “whiff” automated urine chemistry analyzers.
A. LE cells found during the microscopic exam A. 3.8 to 4.5 test is performed on vaginal secretions? A. Results cannot be automatically transmitted to
B. A serous fluid glucose concentration <60 mg/dL B. 4.5 to 5.8 A. Lactic acid B. Polyamine an LIS.
C. Microorganisms identified by Gram or acid-fast C. 5.8 to 6.5 C. Trimethylamine D. Hydrogen peroxide B. Specific gravity is usually determined by
stain D. 7.0 to 7.4 refractive index.
D. Malignant cells identified during the microscopic 12. Select the condition that correlates best with C. Urine color and clarity are manually determined
or cytologic examination 4. Which of the following elements is considered the following vaginal secretion results: and entered into the analyzer.
abnormal when present in vaginal secretions? pH: 5.9 Amine test: positive D. Well-mixed uncentrifuged urine is placed onto
12. An abnormally low fluid pH value is useful when A. Bacteria B. Pseudohyphae KOH examination: negative the intake platform for analysis.
evaluating conditions associated with C. Yeast D. White blood cells Wet mount examination: bacteria: mixed bacterial
A. pleural effusions. Flora WBC: 4+ 5. The benefits of performing automated urine
B. pleural and pericardial effusions. 5. Which of the following organisms and substances A. Normal, indicating a healthy vagina microscopy include all of the following EXCEPT
C. pericardial and peritoneal effusions. is responsible for the normal pH of the vagina? B. Bacterial vaginosis A. Increases precision of microscopy results
D. pleural, pericardial, and peritoneal effusions. A. Gardnerella vaginalis and its metabolic by- C. Candidiasis B. Decreases exposure to urine, a potential
product succinic acid D. Trichomoniasis biohazard
13. A pleural or peritoneal fluid amylase level two B. Lactobacilli spp. and their metabolic by-product C. Increases the time required for the microscopic
times higher than the serum amylase level can be lactic acid 13. Select the condition that correlates best with examination
found in effusions resulting from C. Mobiluncus spp. and their metabolic by-product the following vaginal secretion results: D. Decreases manual entry and potential
A. pancreatitis. acetic acid pH: 4.6 transcription errors
B. hepatic cirrhosis. D. Prevotella spp. and their metabolic by-product Amine test: negative
C. rheumatoid arthritis. phenylacetic acid KOH examination: negative 6. Which of the following statements about the
D. lymphatic obstruction. Wet mount examination: bacteria: large rods iQ200 microscopy analyzer is TRUE?
6. Which of the following statements best describes predominate A. Particle analysis is performed using flow
14. A glucose concentration difference greater than a clue cell? WBC: 1+ cytometry.
30 mg/dL between the serum and an effusion is A. Degenerating squamous epithelial cells with A. Normal, indicating a healthy vagina B. Urine particles are automatically classified into
associated with distinctive keratohyalin granulation B. Bacterial vaginosis 12 categories.
A. pancreatitis. B. Budding yeast (e.g., blastoconidia) with small C. Candidiasis C. Concentrated urine sediments must be prepared
B. hepatic cirrhosis. coccobacilli adhering to their surfaces D. Trichomoniasis before analysis by the analyzer.
C. rheumatoid arthritis. C. Squamous epithelial cells with numerous bacteria D. It cannot be used as a standalone instrument
D. lymphatic obstruction. adhering to their outer cell membranes CHAPTER 17 (i.e., it must be attached to a urine chemistry
D. White blood cells with numerous bacteria AUTOMATION OF URINE AND BODY FLUID analyzer for use).
15. Which of the following actions can adversely completely covering them such that they appear as ANALYSIS
affect the chances of obtaining a positive stain or floating spherical orbs of bacteria 7. Which of the following statements about the UF-
culture when performing microbiological studies on 1. When semi-automated urine chemistry analyzers 100 and UF-1000i urine particle analyzers is TRUE?
infectious serous fluid? 7. Which of the following vaginal secretion results are used, the color that develops on the reaction A. A separate channel is used to detect bacteria.
A. Using a large vol of serous fluid for the inoculum correlate with health? pads is measured by B. Digital images of each urine particle are available
B. Storing serous fluid specimens at ref temp A. pH 3.9; white blood cells, 3+ A. spectrophotometry. for review and archival storage.
C. Using an anticoagulant in the serous fluid B. pH 4.2; white blood cells, 1+ B. reflectance photometry. C. The analyzers can specifically identify pathologic
collection container C. pH 4.8; white blood cells, rare C. fluorescence photometry. casts and renal epithelial cells.
D. Concentrating the serous fluid before preparing D. pH 5.5; white blood cells, 2+ D. comparing reaction pads with a color chart. D. Impedance technology is the primary method by
smears for staining which these analyzers detect and categorize
8. Which of the following statements best describes 2. What is the purpose of the color compensation particles.
CHAPTER 16 the microbial flora of a healthy vagina? pad on reagent strips?
ANALYSIS OF VAGINAL SECRETIONS A. Large gram-positive rods predominate. A. To compensate for the effect of specific gravity on urine 8. Which of the following statements is NOT an
B. Large gram-positive cocci predominate. color issue for the instruments used to perform body
B. To calibrate the instrument for color assessment of
1. Which of the following devices should be used to C. Small gram-negative rods predominate. fluid analysis?
reaction pads
collect a sample of vaginal secretions? D. Small gram-variable coccobacilli predominate. C. To account for the contribution of urine color to the A. Unable to perform five-part WBC differentials
A. Cervical brush on a teflon shaft colors on the reaction pads B. Have difficulty detecting and enumerating RBCs
B. Cotton-tipped swab on a wooden shaft 9. Which of the following tests is most helpful in D. To detect substances (e.g., phenazopyridine) that mask C. Unable to detect and specifically identify
C. Polyester-tipped swab on a plastic shaft differentiating red blood cells from yeast in vaginal color development on the reaction pads malignant cells
D. Wool-tipped swab on a wooden shaft secretions? D. Unable to perform accurate and precise counting
A. pH 3. Select the TRUE statement regarding reflectance of low WBC numbers (<20 cells/μL).
2. Which of the following organisms is adversely B. Amine test photometry.
affected if a vaginal secretions specimen is C. Wet mount examination A. The amount of light that is absorbed is detected
refrigerated? D. KOH preparation and examination and measured.
A. Chlamydia trachomatis B. The same wavelength of light is used to evaluate
B. Candida albicans 10. Which of the following vaginal secretion all reaction pads.
C. Gardnerella vaginalis findings is most diagnostic for bacterial vaginosis? C. The intensity of light reflected from a polished
D. Trichomonas vaginalis A. pH 5.0 B. Clue cells surface is quantified.
C. Pseudohyphae D. Parabasal cells D. The relationship between reflectance and
concentration is not linear.
ANSWER 13. b 16. E 17. D 17. C 8. C 18. C 26. B 12. C 16. D 5. B, C, B, A,
KEY 14. a 17. A 18. C 18. C 9. D 19. B 27. D 13. D 17. D D, B, D
15. i 18. a 19. A 19. A 10. C 20. B 28. A 14. A 18. D 6. A
GRAFF 16. e 19. c 20. B 20. B 11. C 21. C 29. B 15. A 19. B 7. C
17. g 20. b 21. D 12. A 22. A 30. C 16. A 20. D 8. B
Chapter 1 18. c Chapter 12 22. B 13. A 23. B 31. C 17. B 21. A 9. D
1. d 19. d Chapter 9 1. c 23. A 14. False 24. C 32. D 18. D 22. D 10. C
2. c 20. h 1. c 2. d 24. C 15. B 25. B 33. D 19. A 23. D 11. A
3. c 21. h 2. d 3. a 25. D 16. B 26. A 34. B 20. D 24. B 12. A
4. b 22. f 3. a, c, d 4. d 17. C 27. D 35. A 25. C 13. C
5. d 23. b 4. c Chapter 2 18. C 28. A 36. C Chapter 9 26. A 14. A
5. b, c 8. b, c 1. B 19. A 29. C 37. C 1. A 27. C 15. B
Chapter 2 Chapter 5 6. c 9. c 2. D 20. B 30. 1, 2, 1, 38. D 2. C 28. A 16. B
5. c 1. b 7. b 10. c 3. C 21. D 2, 1, 2, 1, 1, 39. A 3. B 29. C 17. A
6. b 2. b, c, d, f 8. c 11. c 4. D 2 40. C 4. D 30. D 18. D
7. c 3. b 9. d 12. d 5. A Chapter 4 31. B 41. D 5. A 31. C 19. C
8. a 4. d 10. c 13. b 6. B 1. A 32. A 42. A 6. D 32. B 20. C
9. c 5. a, b d, e 11. b, c 7. C 2. D 33. 2, 3, 4, 1 43. A 7. A 33. A 21. D
10. b 6. d 12. a Chapter 13 8. D 3. A 34. A 44. C 8. B 34. C 22. A
7. b 13. c 1. c 9. B 4. D 35. D 45. D 9. B 35. C 23. D
Chapter 3 8. a 14. d 2. c 10. A 5. C 36. C 46. C 10. D 36. B 24. A
1. E 9. a 15. d 3. b 11. C 6. D 37. A 47. 4, 3, 5, 1 11. D 25. B
2. D 10. d 16. d 4. d 12. D 7. B 38. C 48. 3, 5, 2, 12. D Chapter 11
3. B 11. B 17. c 5. a 13. A 8. A 39. D 6, 4 13. C 1. C Chapter 13
4. A 12. B 18. d 6. b 14. B 9. A 40. B 49. 4, 8, 7, 14. A 2. D 1. C
5. C 13. A 19. b 7. d 15. B 10. C 41. C 6, 1, 5, 3 15. B 3. B 2. D
6. F 14. B 20. d 8. c 16. D 11. D 42. A 50. 3, 5, 2, 16. C 4. C 3. A
7. G 15. A 9. d 17. B 12. False 43. B 1, 7, 4 17. A 5. D 4. D
8. A 16. A Chapter 10 10. b 18. A – 13. B 44. D 18. D 6. A 5. C
9. C 17. A 1. B Inulin, 14. B 45. C Chapter 7 19. B, A, B, 7. B 6. D
10. D 18. A 2. A Chapter 14 B – Cre 15. B 46. B 1. D B, A 8. D 7. B, A, A, A,
11. F 19. A 3. B 1. b atinine, 16. C 47. C 2. D 20. B 9. C B, B, A, B
12. B 20. A 4. B 2. c B – Cystatin 17. D 48. C 3. D 21. D 10. B 8. B
13. E 5. A 3. a C, 18. A 49. C 4. B 22. B 11. B 9. B
14. C Chapter 7 6. A 4. d A – 125 I- 19. D 50. C 5. 2, 1, 2, 3, 23. A 12. C 10. C
15. D 1. d 7. A 5. c iothalmate 20. B 2, 1 24. B 13. A 11. D
16. E 2. c 8. B 6. b 19. B 21. B Chapter 6 6. D 25. A 14. A 12. D
17. A 3. c 9. c 7. a 20. 69 22. B 1. C 7. B 26. D 15. B 13. D
18. B 4. e 10. a 8. d mL/min 23. False 2. D 8. C 27. D 16. D 14. C
19. a 5. c 11. b 9. a 21. A 24. D 3. D 9. D 28. D 17. B 15. B
20. a 6. b 12. c 10. a 22. C 25. D 4. C 10. C 29. C 18. B 16. A
21. D 7. c 13. a 23. B 26. A 5. A 11. D 30. B 19. A 17. B
22. D 8. c 14. c STRASINGE 24. D 6. B 12. 1, 4, 3, 31. D 20. C 18. C
23. E 9. c 15. d R 25. A Chapter 5 7. C 2, 1 32. D, F, A, 21. A 19. B
24. A 10. c 26. C 1. C 8. D 13. C E, C 22. C 20. B
25. B Chapter 11 Chapter 1 27. B 2. B 9. C 14. D 23. A 21. B
26. F Chapter 8 1. b 1. C 28. C 3. A 10. D 15. B Chapter 10 24. A 22. C
27. C 1. B 2. c 2. A 29. +0.5 4. C 11. D 16. 4, 1, 3, 2 1. B 25. D 23. B
2. A 3. a 3. D 30. D 5. D 12. A 17. False 2. C 26. B 24. A
Chapter 4 3. C 4. c 4. A 31. 600 6. A 13. C 3. B 27. D 25. D
1. b 4. d 5. c 5. B mL/min 7. D 14. B Chapter 8 4. A 28. B
2. c 5. a 6. d 6. A 32. C 8. B 15. C 1. B 5. C 29. D Chapter 14
3. d 6. A 7. A 7. C 33. B 9. D 16. A 2. C 6. B, B, A, A 30. B 1. B
4. d 7. B 8. E 8. D 10. 2, 1, 2, 17. D 3. B 7. C 31. C 2. C
5. d 8. B 9. F 9. D Chapter 3 3, 1, 2, 3 18. D 4. C 8. A 32. A 3. A
6. b 9. A 10. C 10. C 1. C 11. B 19. B 5. B 9. C 33. B 4. C
7. a 10. C 11. D 11. B 2. B 12. A 20. C 6. A 10. C 5. B
8. b 11. A 12. F 12. A 3. A 13. B 21. A 7. C 11. D Chapter 12 6. A
9. d 12. B 13. C 13. B 4. B 14. D 22. B 8. C 12. D 1. B 7. D
10. c 13. D 14. D 14. D 5. True 15. C 23. C 9. D 13. A 2. B 8. C
11. f 14. D 15. A 15. A 6. C 16. C 24. D 10. D 14. B 3. A 9. 2, 4, 1, 3
12. g 15. C 16. B 16. B 7. C 17. A 25. D 11. C 15. C 4. B 10. A
11. C D2 8. C 8. A 6. A 13. B B3 19. A 6. B 8. A 4. D
12. B E1 A 9. B 7. D 14. A C1 20. A 7. D 9. D 5. B
13. True F4 A 10. C 8. B 15. D D2 21. B 8. C 10. D 6. C
14. A 7. D A 11. D 9. A 16. B E5 22. B 9. D 11. D 7. D
15. B 8. B C 12. C 10. A 17. D 14. B 23. D 10. C 12. C 8. B
16. True 9. B 9. D 13. D 11. A 1 18. D 15. A 24. B 11. B 13. B
17. C 10. C 10. C 14. C B2 19. D 16. D 25. B 12. D 14. B
18. True 11. A 11. A 15. B C1 20. B 17. A 26. C 13. C 15. A
19. C 12. C 12. B 16. D D2 21. D 18. A 27. C 14. D 16. C
20. B 13. B 13. B 17. B E2 22. A 19. D 28. B 15. B 17. A
21. D 14. C 18. A F1 23. D 20. C 29. C 16. D
22. B 15. C CHAPTER 4 19. A G1 24. A 3 21. B 30. A 17. A CHAPTER 15
23. 1, 4, 2, 3 16. B 1. A 10 20. C H2 B2 22. A 31. D 1. D
24. False 17. D B7 21. B I2 C3 23. B 32. C CHAPTER 12 2. A
25. D 18. A C6 22. B J2 D1 24. A 3 33. A 1. C 3. B
26. A 19. A D5 23. B K1 E4 B 1 (2) 34. A 2. C 4. B
20. A 2 E1 24. A. Yes L1 F2 C 3 (2) 35. D 3. D 5. A
Chapter 15 B3 F4 B. Yes 12. D G1 D 1, 2, 3 36. A 4. C 6. D
1. C C6 G3 C. Hypo- 13. A H2 E1 37. D 5. A 7. D
2. A D5 H2 osmotic 14. A 5 I3 F 1 (2, 3) 38. D 6. B 8. C
3. C E4 I8 25. C B3 25. A G1 39. C 7. A 9. C
4. B J9 26. B C1 26. A H1 40. C 8. D 10. A 1
5. D CHAPTER 2 K 11 27. D D 1, 2 27. C I 3 (2) 41. B 9. B B2
6. D 1. D 2. C 28. D E5 28. B J1 42. A 10. A C1
7. D 2. B 3. A 29. D F 1, 4 29. D K1 11. B D1
8. C 3. A 4. C 30. A. 42 15. B 30. D 25. A 8 CHAPTER 10 12. D E1
9. D 4. A 5. A mL/min 16. B 31. B B6 1. B 13. D F2
10. C 5. C 6. A (Note that 17. A 32. D C4 2. A 11. B
11. A 6. C 7. D the plasma 18. A 1 33. B D5 3. B CHAPTER 13 12. A
12. C 7. D 8. A and urine B3 34. D E1 4. D 1. A 13. A
13. D 8. B 9. A creatinine C2 35. C F9 5. D 2. B 14. C
14. B 9. B 10. D results must D1 36. C G7 6. D 3. A 15. B
15. B 10. B 11. D first be 19. B 37. D 26. A 7. A 4. D
16. False 11. D 12. A converted 20. D 38. B 27. A 8. B 5. A CHAPTER 16
17. C 12. D 13. A to the same 21. A 39. D 28. B 9. A 6. B 1. C
18. C 13. C 14. C units.) 22. A 40. C 29. A 10. B 7. A 2. D
19. C 14. A 15. C B. 58 23. D 41. B 30. D 11. C 8. C 3. A
20. D 15. A 3 16. A mL/min 24. C 42. D 31. B 12. C 9. C 4. B
21. B B1 17. C C. Yes 25. C 43. C 32. A 13. B 10. A 5. B
22. A C2 18. A 31. A 26. A 44. D 33. A 14. C 11. B 6. C
23. C D3 19. C 32. B 27. B 45. D 34. C 15. B 12. D 7. B
24. B E3 20. D 33. B 28. D 46. A 35. A 16. A 13. A 8. A
25. B F2 21. B 34. A Case 6-1 47. B 17. C 14. C 9. D
26. A 16. C 22. D 35. C 1. B 48. A CHAPTER 9 18. C 15. B 10. B
27. B 17. A 23. C 36. C 2. D 49. D 1. A 19. A 16. C 11. C
28. B 18. C 24. A 37. A Case 6-2 50. D 2. B 20. C 17. A 12. D
29. A 19. D 25. B 38. D 1. D 51. C 3. A 21. D 18. A 13. A
30. C 20. B 26. C 2. C 4. D 22. D 19. D
31. C Case 2-1 27. C CHAPTER 6 CHAPTER 8 5. D 23. B 20. B CHAPTER 17
32. B 1. E 28. D 1. D CHAPTER 7 1. D 6. A 24. B 21. A 1. B
2. C 29. A 2. D 1. C 2. D 7. D 22. D 2. C
BRUNZEL 30. B 3. A 2. A 3. C 8. C CHAPTER 11 23. C 3. D
CHAPTER 3 31. A 4. C 3. B 4. B 9. B 1. B 24. B 4. C
CHAPTER 1 1. B 5. A 2, 3 4. C 5. A 10. A 2. D 5. C
1. D 2. B CHAPTER 5 B8 5. D 6. C 11. D 3. A CHAPTER 14 6. B
2. D 3. D 1. A C 4, 7 6. C 7. D 12. C 4. C 1. B 7. A
3. D 4. A 2. B D 7 (4) 7. B 8. D 13. D 5. A 4 2. A 8. B
4. B 5. C 3. A E 6 (4) 8. C 9. B 14. D B7 3. A
5. A 6. A 4. C F 3, 7 9. B 10. C 15. B C3 4. C CHAPTER 18
6. A 7 B 5. C G1 10. B 11. D 16. C D5 5. D 1. C
B3 A 6. C H2 11. A 12. B 17. B E6 6. C 2. D
C5 7. C 7. C I5 12. D 13. A 4 18. A F8 7. B 3. C

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What are the main components of the glomerular filtration barrier?

What is the glucose renal threshold and what does it represent?

GRAFF’S TEXTBOOK OF URINALYSIS 7. The glucose renal threshold is 160–180 mg/dL.

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