Medical Laboratory Science Review: Urine and Body Fluids
Urinalysis and Body Fluids Review for final exam or review class
Terms in this set (1293)
All of the following are considered normal functions of the kidney
regulating body hydration, elimination of nitrogenous wastes, regulating electrolyte balance
The approximate number of nephrons contained in each kidney is:
The order of blood flow through the nephron is:
afferent arteriole, efferent arteriole, peritubular capillaries, vasa recta
The total renal blood flow is approximately:
The total renal plasma flow is approximately
The glomerular filtrate is described as a:
protein-free ultrafiltrate of plasma
Increased production of aldosterone causes:
increased plasma sodium levels
The primary chemical affected by the renin-angiotensin-aldosterone system is:
The specific gravity of the glomerular ultrafiltrate is:
All of the following are reabsorbed from the glomerular filtrate by active transport
glucose, sodium and amino acids
For active transport to occur, a chemical:
must combine with a carrier protein to create electrochemical energy
Water is passively reabsorbed in all parts of the nephron except the:
ascending loop of Henle
Most of the sodium filtered by the glomerulus is reabsorbed in the:
proximal convoluted tubule
The enzyme renin is produced by the kidney:
in response to low plasma sodium levels
Concentration of the tubular filtrate by the countercurrent mechanism is dependent on all of the following
high salt concentration in the medulla, water-impermeable walls of the ascending loop of Henle, reabsorption of sodium and chloride from the ascending loop of Henle
The osmotic gradient of the medulla:
affects sodium reabsorption in the proximal convoluted tubule
Aldosterone regulates sodium reabsorption in the:
distal convoluted tubule
Decreased production of vasopressin:
produces a high urine volume
Production of antidiuretic hormone is controlled by the:
state of body hydration
Substances removed from the blood by tubular secretion include primarily:
protein-bound substances, hydrogen, and potassium
Kidneys with impaired production of ammonia will consistently produce urine with a:
To enhance the excretion of hydrogen ions, ammonia is produced by the cells of the:
distal convoluted tubule
To maintain the buffering capacity of the blood, hydrogen ions combine with:
filtered bicarbonate ions
Clearance tests used to determine the glomerular filtration rate must measure substances that are:
neither reabsorbed or secreted by the tubules
Results for glomerular filtration tests are reported in:
milliliters per minute
All of the following are endogenous clearance test substances
urea, creatinine, and beta 2 microglobulin
Performing a clearance test using radionucleotides
eliminates the need to collect urine, provides visualization of the filtration
If a substance is completely filtered by the glomerulus and then completely reabsorbed by the tubules, the clearance of that substance will be:
The most routinely used laboratory method for measuring the glomerular filtration rate is the:
The most common error in measuring the glomerular filtration rate using the creatinine clearance is:
inaccurate timing of urine collection
All of the following could cause falsely decreased creatinine clearance results
consumption of a heavy meat during urine collection, noncreatinine plasma substances reacting in the chemical test, maintaining urine specimens at room temperature
The body surface of the average person in square meters is:
An additional calculation that may be required in the creatinine clearance is a correction for:
Calculate the creatinine clearance for a patient of average size from the following data: Urine volume: 720 mL for 12 hours, Urine creatinine: 120 mg/dL, Serum creatinine: 1.5 mg/dL
Performing a creatinine clearance is helpful for determining:
the feasibility of administering medications
John White donates one of his two healthy kidneys to his twin brother. His glomerular filtration rate can be expected to:
remain within a normal range
The renal function that is most frequently the first affected by early renal disease is:
For accurate evaluation of renal tubular concentrating ability, patient preparation should include:
Measurement of urine osmolarity is a more accurate measure of renal concentrating ability than specific gravity because:
osmolarity is influenced equally by small and large molecules
Solute dissolved in solvent will:
decrease the freezing point
Vapor pressure osmometers are based on the principle that:
increased solute lowers the vapor pressure of a solution
Clinical osmometers use NaCl as a reference solution because:
NaCl is partially ionized similar to the composition of urine
Substances that can interfere with serum osmolarity readings include all of the following
lipids, lactic acid, and ethanol
The results of a serum osmolarity performed by both freezing-point and vapor-pressure osmometry do not agree. A possible cause of this discrepancy would be:
A technical error that could cause a discrepancy between freezing-point and vapor-pressure osmometry readings is:
evaporation of the sample
The normal serum osmolarity is:
275 to 300 mOsm
The extent to which the kidney concentrates the glomerular filtrate can be determined by measuring:
urine and serum osmolarity
Following fluid deprivation, a patient has a serum osmolarity of 276 mOsm and a urine osmolarity of 1000 mOsm. This patient:
has normal concentration ability
The test that provides information similar to specific gravity is the:
The serum osmolarity of a patient with hyponatremia:
should be lower than 275 mOsm
Following injection of ADH, a patient has a serum osmolarity of 290 mOsm and a urine osmolarity of 450 mOsm. The patient:
lacks tubular response to ADH
To determine the amount of water that must be cleared to produce urine with the same osmolarity as the ultrafiltrate, one should perform:
a Mosenthal test
To determine the ability of the kidneys to respond to filtrate osmolarity, one should perform a:
free water clearance
A free water clearance of -2.5 could be indicative of:
A patient with insufficient production of ADH would have which of the following results?
Urine volume—5 mL/min; osmolar clearance—2 mL/min
The PAH test is used to measure:
renal blood flow
To provide an accurate measure of renal blood flow, a test substance should be:
cleared on each contact with functional renal tissues
PAH is secreted by the:
proximal convoluted tubule
A PAH test result showing a renal plasma flow of 400 mL/min:
may be falsely decreased from impaired tubular secretion
Which of the following is not associated with the elimination of hydrogen ions?
Renal tubular acidosis can be caused by the:
inability to produce an acid urine due to impaired production of ammonia
Tests to measure the tubular secretion of hydrogen ions include all of the following except:
Following administration of oral ammonium chloride, a patient with renal tubular acidosis will produce
urine with a high pH
Total acidity of a urine specimen is a combination of:
titratable acidity and ammonium ion
Which of the following clearance substances does not require urine collection?
A 12-hour urine specimen with a volume of 360 mL is collected for a creatinine clearance. What is the volume (V) used to calculate the clearance?
Using the following values, calculate the creatinine clearance: urine volume—1200 mL/12h, urine creatinine—60 mg/dL, and serum creatinine—0.8 mg/dL
Can a patient with the following results be given a nephrotoxic medication: urine volume—720 mL/24 h, urine creatinine—100 mg/dL, and serum creatinine—2.5 mg/dL?
No, clearance is 20 mL/min
Given the following information, calculate the osmolar clearance: urine volume—720 mL in 24 hours, urine osmolarity—700 mOsm, and plasma osmolarity—300 mOsm.
Given the following information, calculate the patient's free water clearance: urine volume—360 mL in 12 hours, urine osmolarity—1400 mOsm, and plasma osmolarity—275 mOsm.
Following a 2-hour infusion of p-aminohippuric acid, during which 200 mL of urine is collected, the urine PAH is 260 mg/dL, and the patient's plasma PAH is 0.8 mg/dL. Calculate the renal plasma volume.
Can a 40-year-old male weighing 72 kg with a serum creatinine of 0.9 mg/dL be given a nephrotoxic medication?
Yes, clearance is 111 mL/min
What is the physical property measured by a vapor pressure osmometer?
Dew point temperature
All of the following are parts of the routine urinalysis
Physical examination, chemical examination and microscopic examination
Early Egyptian physicians examined urine for all of the following
glucose, color and odor
To determine if a specimen is urine, measure the concentrations of:
urea and creatinine
The average daily volume of urine produced by a normal adult is approximately:
A person exhibiting oliguria would have a urine volume of:
200 to 500 mL
Which of the following terms is correctly matched with urine output?
Polyuria: 3000 mL in 24 hours
The polyuria associated with diabetes mellitus is caused by:
the presence of excess glucose in the urine
Urine from a patient with diabetes insipidus has:
increased volume and decreased specific gravity
Urine from a patient with polyuria has a high specific gravity. The patient should be evaluated for:
Persons taking diuretics can be expected to produce:
A urine specimen may be rejected by the laboratory for all of the following reasons except:
the container uses a screw-top lid
An unpreserved urine specimen left at room temperature overnight will have decreased:
glucose and ketones
Which of the following will be least affected in an unpreserved specimen left at room temperature overnight?
Red blood cells will disintegrate more rapidly in urine that is:
dilute and alkaline
The primary cause of the changes that take place in unpreserved urine is:
Which urine chemicals will deteriorate when exposed to air and light?
Ketones, Urobilinogen and Bilirubin
Which of the following is least likely to occur if a urine specimen stands at room temperature for more than 2 hours?
All of the following can be used to preserve a urine reagent strip glucose analysis
refrigeration, boric acid and commercial tablets
A urine specimen containing a large amount of precipitated amorphous material may have been preserved using
The preferred method of urine preservation in the laboratory is
A specimen for routine urinalysis and culture can be preserved using:
All of the following are good preservatives of urinary cellular elements
boric acid, formalin and thymol
Before analysis, a refrigerated urine specimen must be:
returned to room temperature
The recommended specimen for routine urinalysis testing is the:
first morning specimen
For quantitative analysis of urinary constituents the required specimen is the:
A first morning specimen is frequently requested to confirm:
The first morning specimen from a patient with no history of symptoms of diabetes is positive for glucose. The patient should:
collect the second morning specimen
The first morning urine is the specimen of choice for routine urinalysis because it:
is more concentrated to better detect abnormalities
Acceptable specimens for urine culture are
catheterized specimen, suprapubic aspiration or midstream clean-catch specimen
Quantitation of a substance that varies with daily activities should be performed on a
Failure to empty the bladder before beginning the collection of a timed urine specimen will:
cause falsely increased results
An alternative to the catheterized specimen is the:
midstream clean-catch specimen
The least contaminated specimen for bacterial culture is the:
The three glass collection is used for the diagnosis of:
Documentation of appropriate handling of specimens for drug analysis is provided by the:
chain of custody form
Which organ of the body breaks down protein to form urea?
What is the term meaning an increase in urine production during the night?
Where should labels on urine specimen containers be placed?
Increased turbidity in urine that remains at room temperature is usually caused by:
What is the maximum length of time a urine specimen should remain unpreserved at room temperature before testing?
Which specimen(s) from a three-glass collection does not have to be examined microscopically?
The temperature of a specimen for drug testing is 25oC when measured within 4 minutes of collection.
The second sample of a three-glass collection has a positive urine culture.
A patient is deprived of fluids during a 6-hour timed urine collection.
Aliquots from 24-hour specimens are being obtained before measuring and mixing the sample
What derivatives found in certain intravenous medications produce green urine on oxidation?
A correlation exists between a specific gravity of 1.050 and a:
Radiographic dye infusion
A strong odor of ammonia in a urine specimen could indicate:
Urinary tract infection
A urine specific gravity measured by refractometer is 1.029, and the temperataure of the urine is 14°C. The specific gravity should be reported as:
1.029 (temperature does not matter with refractometer
A urine that turns black after standing may contain:
Homogentisic acid, Melanin, Methemoglobin
A yellow-brown specimen that produces a yellow foam when shaken can be suspected of containing:
After eating beets purchased at the local farmers' market, Mrs. Williams notices that her urine is red, but Mr. William's urine remains yellow. The Williamses should:
Not be concerned because only Mrs. Williams is genetically susceptible to producing red urine from beets
In what circumstance might a sediment be slightly warmed prior to microscopic examination?
To dissolve amorphous urates
Microscopic examination of a clear urine that produces a pink precipitate after refrigeration will show:
Refractometers are calibrated using:
Distilled water and sodium chloride
Specimens from patients receiving treatment for urinary tract infections frequently appear:
viscous and orange
Specimens that contain intact RBCs can be visually distinguished from those that contain hemoglobin because:
RBCs produce a cloudy specimen
The method for determining a urine specific gravity that is based on the principle that the frequency of a sound wave entering a solution changes in proportion to the density of the solution is:
Harmonic oscillation densitometry
The microscopic of a cloudy amber urine is reported as rare WBCs and epithelial cells. What does this suggest?
Possible mix-up of specimen and sediment
The reading of distilled water by the refractometer is 1.003. You should:
Adjust the set screw (distilled water will have a reading of 1.000. If necessary, the instrument contains a zero set screw to adjust the distilled water reading p. 48)"
True or False: Urine specific gravity is equally influenced by the presence of glucose and sodium
Specific gravity is influenced by their present but not equally
Under what conditions will a port-wine urine color be observed in a urine specimen?
Urine contains porphyrins
Which of the following specific gravities would be most likely to correlate with a dark yellow urine?
A black urine that has been sitting on a shelf in the bathroom for several hours may contain:
A clear, red specimen most likely contains (hemoglobin/red blood cells)
A cloudy red specimen most likely contains (hemoglobin/red blood cells)
Red blood cells that are fully intact will create a cloudy, red urine
A dark yellow urine producing a yellow foam most likely contains
A pale yellow urine would have a (higher/lower) specific gravity than a dark yellow urine
A patient who had diabetes mellitus will have a (high/low) volume of urine and a (high/low) specific gravity
high volume of urine with a high specific gravity (due to increased glucose in urine)
A urine specimen with a specific gravity of 1.008 has been diluted 1:5. The actual specific gravity is:
1.040 (.008 X 5) To calculate you take everything after the colon and multiply by numbers to the right of the decimal
A yellor-orange urine specimen may be caused by the administration of
phenazopyridine (pyridium) or azo- gantrisin compounds (medicine for UTI)
"Amorphous phosphates have a _________ precipitate?
"Amorphous urates have a ______________ precipitate?
An ADH deficiency can be correlated to (hydration/dehydration) and you will see a (high/low) specific gravity in that patient
Biliruben can cause the urine to be which colors:
Dark yellow (usally), amber, or yellow orange Photo oxidation of
the bilirubin imparts a yellow-green color
Black urine can be associated with (organic chemicals)
melanin or homogentisic acid
Blue or green urine is associated with
bacterial infections (Pseudomonas)
Fresh urine containing _______ frequently exhibits a reddish-brown color?
If a patient has hepatitus, what colors can they urine be?
amber or dark yellow (if shaken it will have a yellow foam)
In what circumstances might a sediment be slightly warmed prior to microscopic examination?
to dissolve amorphous urates
Methemoglobin will cause a urine (colors)
brown (due to oxidation of hemoglobin)
Name 3 things that can contribute to the color of a urine specimen that contains blood:
1. amount of blood
2. pH of urine
3. length of contact (blood oxidizes)
Pigment responsible for normal urine color is
RBCs remaining in an (acidic/alkaline) urine for several hours produce a brown or black urine due to
acidic/oxidation of hemoglobin to methemaglobin
Specific gravity is a measure of
The concentration of a normal urine specimen can be estimated by (color, clarity, foam, color)
The presence of ______ will produce a pink pigment in refrigerated urine specimens
The presence of white turbidity in a freshly voided urine can be caused by :
amorphous phosphates and carbonates in ALKALINE urine (Excess phosphate crystals have the ability to build up in your urine. These crystals will then precipitate, making your urine cloudy)
Upon arriving at work, a technologist notices that a urine specimen left beside the sink by personnel on the night shift has a black color. The initial report describes the specimen as yellow. If the original specimen was reported to be red and to contain RBCs, what is a possible cause of the black color?
RBCs remaining in acidic urine for several hours produce a brown urine due to oxidation of hemoglobin to methemoglobin
Upon arriving at work, a technologist notices that a urine specimen left beside the sink by personnel on the night shift has a black color. The initial report describes the specimen as yellow. If the specimen had an initial pH of 6.0 and now has a pH of 8.0, what is the most probable cause of the black color?
Homogentisic acid is a metabolite of phenylalanine and imparts a black color to alkaline urine with persons who have alkaptonurua (in-born error of metabolism)
Upon arriving at work, a technologist notices that a urine specimen left beside the sink by personnel on the night shift has a black color. The initial report describes the specimen as yellow. If the specimen has a pH of 6.0 and was sitting uncapped, what is the most probable cause of the black color?
Melanin is an oxidation product of the colorless pigment melanogen which is produced in excess when malignant melanoma is present. By leaving this specimen uncapped it provided the necessary oxidative environment
Urine specimens containing ______ may appear red resulting from the oxidation of porphobilinogen to _____?
What causes the formation of myoglobin
The breakdown of skeletal muscle
_____ and _____ may lower the sensitivity of the test for bilirubin because they combine with the diazonium salt and prevent its reaction with bilirubin.
High concentrations of ascorbic acid and nitrite
_____ does not appear in the urine because it is passed directly from the liver into the bile duct and on to the intestine.
_____ is converted to urobilin
______ should be performed on newborns for ____
Clinitest (copper reduction test) / galactosuria (inborn error of metabolism)
Galactose in the urine of a newborn represents an ""inborn error of metabolism"" in which lack of the enzyme galactose-1-phosphate uridyl transferase prevents breakdown of ingested galactose and results in failure to thrive and other complications, including death. All newborns should be screened for galactosuria because early detection followed by dietary restriction control the condition.
_______ is the pigment responsible for the characteristic brown color of feces.
________ bound to haptoglobin remains in the plasma and imparts a red color.
Hemoglobin bound to haptoglobin remains in the plasma and imparts a red color
_______are the leukocytes most frequently associated with bacterial infections.
______appears in the urine when the normal degradation cycle is disrupted by obstruction of the bile duct or when the integrity of the liver is damaged, allowing leakage of ______ into the circulation.
conjugated bilirubin/ conjugated bilirubin
_____cannot determine the absence of
urobilinogen, which is significant in biliary obstruction
Reagent strip tests
4 examples of renal proteinuria:
1. glomerular proteinuria
2. tubular proteinuria
3. orthostatic (postural) proteinuria
A positive LE test result is most frequently accompanied by the presence of bacteria, which may or may not produce a positive nitrite reaction. Infections caused by Trichomonas, Chlamydia, yeast, and inflammation of renal tissues produce ______ without ______
leukocyturia without bacteriuria
A primary example of prerenal proteinuria is _____
secretion of Bence Jones protein by persons with multiple myeloma
A protein that precipitates at 60 degrees F and dissolves at 100 degrees is associated with _____
A trace reaction on a reagent strip and a high Clinitest reaction is observed. What could cause this to happen?
In this case, these two reactions would indicate the presence of glucose and other reducing substances. However, there are several explanations for the finding of conflicting results between the two glucose tests. The Clinitest is not as sensitive as the glucose oxidase test, so the finding of a 1+ reagent strip reading and a negative Clinitest should not be surprising. A strongly positive reagent strip and a negative Clinitest, however, should cause concern about possible contamination by strong oxidizing agents. The most significant discrepancy is the negative reagent strip with a positive Clinitest. Although interfering substances affecting either test may cause this problem, the most frequent cause is the presence of other reducing sugars in the urine. As a nonspecific test for reducing substances, Clinitest is subject to interference from other reducing sugars, including galactose, lactose, fructose, maltose, pentoses, ascorbic acid, certain drug metabolites, and antibiotics such as the cephalosporins. Therefore, Clinitest does not provide a confirmatory test for glucose.
A urine specimen from a diabetic whose glucose is not under control will probably contain:
3. an increased specific gravity
Ketonuria shows a deficiency in insulin, indicating the need to regulate dosage. It is often an early indicator of insufficient insulin dosage in type 1 diabetes. Increased accumulation of ketones in the blood leads to electrolyte imbalance, dehydration, and, if not corrected, acidosis and eventual diabetic coma.
A urine with a high pH is (acidic/alkaline)
alkaline (low concentration of hydrogen ions)
Although it cannot be determined by reagent strip, the absence of ______ in the urine and feces is also diagnostically significant and represents an obstruction of the bile duct that prevents the normal passage of bilirubin into the intestine.
As the specific gravity increases (using reagent strip) the indicator changes from ______ to _______ to ______
blue to green to yellow
As the specific gravity increases, the indicator changes from blue (1.000 [alkaline]), through shades of green, to yellow (1.030 [acid]). Readings can be made in 0.005 intervals by careful comparison with the color chart.
Ascorbic acid will negatively affect the results of which tests on the reagent strip?
Because of its higher sensitivity, an_____ may be requested to detect early stages of liver disease.
"Bilirubin becomes conjugated in the _____"
Bilirubin combines with _____ in an acid medium to produce a colored azodye
diazonium salt / colored azo-dye
Bilirubin is an unstable compound that is rapidly photo-oxidized to ______ when exposed to light.
Chemical tests for _____ provide the most accurate means for determining the presence of blood
Because any amount of blood greater than five cells per microliter of urine is considered clinically significant, visual examination cannot be relied upon to detect the presence of blood. Microscopic examination of the urinary sediment shows intact red blood cells, but free hemoglobin produced either by hemolytic disorders or lysis of red blood cells is not detected.
Chemical tests for blood use the _____ to catalyze a reaction between hydrogen peroxide and the chromogen tetramethylbenzidine to produce an oxidized chromogen, which has a green-blue color.
pseudoperoxidase acptivity of hemoglobin
Diabetic nephropathy leads to ___
reduced glomerular filtration and eventual renal failure
Explain conflicting results between the Glucose Oxidase and Clinitest
"The Clinitest is not as sensitive as the glucose oxidase test, so the finding of a 1+ reagent strip reading and a negative Clinitest should not be surprising. A strongly positive reagent strip and a negative Clinitest, however, should cause concern about possible contamination by strong oxidizing agents. The most significant discrepancy is the negative reagent strip with a positive Clinitest. Although interfering substances affecting either test may cause this problem, the most frequent cause is the presence of other reducing sugars in the urine. Commonly found reducing sugars include galactose, fructose, pentose, and lactose, of which galactose is the most clinically significant.
Explain the phenomenon known as "pass through" that can happen with Clinitest
When conducting a Clinitest, care must be taken to observe the reaction closely as it is taking place, because at high glucose levels, a phenomenon known as "pass through" may occur. When this happens, the color produced passes through the orange/red stage and returns to a green-brown color, and if not observed, a high glucose level may be reported as negative.
Explain the steps to a glucose oxidase reaction:
"Reagent strips employ the glucose oxidase testing method by impregnating the testing area with a mixture of glucose oxidase, peroxidase, chromogen, and buffer to produce a double sequential enzymereaction.
Step 1: glucose oxidase catalyzes a reaction between glucose and room air to produce gluconic acid and peroxide.
Step 2: peroxidase catalyzes the reaction between peroxide and chromogen to form an oxidized colored compound that represents the presence of glucose.
Failure to blot the reagent strip will cause runover of reagents on the pads. This will affect ____ the most
Galactose will react on the _____ test
Clinitest (Chemstrip and multistix are specific for glucose. Both of these tests use a glucose oxidase reaction. Clinitest uses the copper reduction method)
Glucosuria (sugar in urine) not in conjunction with hyperglycemia (excess blood glucose) is a symptom of:
Glycosuria during a cerebrovascular trauma may be caused by:
epinephrine inhibiting insulin and producing glycogenolysis.
Epinephrine is a strong inhibitor of insulin secretion and is increased when the body is subjected to severe stress, which accounts for the glucosuria seen in conjunction with cerebrovascular trauma and myocardial infarction.
A primary function of insulin is to convert glucose to glycogen for storage (glycogenesis), these opposing hormones cause the breakdown of glycogen to glucose (glycogenolysis), resulting in increased levels of circulating glucose.
Hemoglobin is broken down becoming bilirubin where it is released into the circulation as ______. It then binds with ______ and in the liver and becomes conjugated bilirubin.
unconjugated bilirubin / albumin
Hemoglobinuria produces ______ granules in urinary sediments.
How are the quantities of leukocytes measured?
The LE reagent test is not designed to measure the concentration of leukocytes, and the manufacturers recommend that quantitation be done by microscopic examination.
How does the reagent strip for specific gravity work?
A polyelectrolyte ionizes, and releases hydrogen ions in proportion to the number of ions in the solution. The higher the concentration of urine, the more hydrogen ions are released, thereby lowering the pH. This change is measured by bromthymol blue on the reagent pad
How does the reagent test (LE test) work?
The LE (leukocyte esterase) test detects the presence of esterase in the granulocytic white blood cells (neutrophils,eosinophils, and basophils) and monocytes. Esterases also are present in Trichomonas and histiocytes.
If you have a negative reagent strip reaction with a positive Clinitest, what might this indicate?
The most significant discrepancy between these two tests is the negative reagent strip with a positive Clinitest. Although interfering substances affecting either test may cause this discrepancy, the most frequent cause is the presence of other reducing sugars in the urine with the detection of galactose being the most clinically significant. Galactose in the urine of a newborn represents an "inborn error of metabolism" in which lack of the enzyme galactose-1-phosphate uridyl transferase prevents breakdown of ingested galactose and results in failure to thrive and other complications, including death. All newborns should be screened for galactosuria because early detection followed by dietary restriction control the condition.
In ______ a reagent strip will test positive for blood, however, red blood cells will not be seen on a microscopic examination.
In a glucose reagent strip, what will cause a false negative:
1. ascorbic acid (high levels)
2. ketones (high levels)
3. High specific gravity
4. Low temperatures
5. Improperly preserved specimen
In a glucose reagent strip, what will cause a false positive:
Contamination by oxidizing agents (peroxide)
In a reagent strip test for keytones, what are th names of the reagents?
sodium nitroprusside and glycine
In a reagent test for ketones, what is being detected?
The presence of acetoacetic acid and acetone (It will only detect the presence of acetone if glycine s present)
In hemoglobinuria, lysis of the red blood cells in the urine shows up as ____.
a mixture of hemoglobin and hematuria
In tests for bilirubin, false-positive reactions are primarily due to _____
In the laboratory, a primary consideration associated with pH is:
The precipitation of inorganic chemicals dissolved in the urine forms urinary crystals and renal calculi. This precipitation depends on urinary pH and can be controlled by maintaining the urine at a pH that is incompatible with the precipitation of the particular chemicals causing the calculi formation.
Intestinal bacteria reduce bilirubin to ______ which is then oxidized and excreted in the feces in the form of urobilin
Most common false negative reaction for the LE reagent test is:
Not waiting a full 2 minutes before reading
Multistix pro has both protein-low reading and protein-high reading. Protein-low uses a ____ reaction and protein-high uses a ____
Protein-Low - dye binding Protein-high - protein error of indicators
Myoglobinuria may be caused by:
1. extensive overexertion (strenuous exercise)
2. Muscle trauma (crush syndrome)
3. Alcoholism/drug abuse
Name some examples of prerenal proteinuria:
1. multiple myeloma (Bence Jones protein)
2. increased levels of low-molecular- weight plasma proteins such as hemoglobin, myoglobin, and the acute phase reactants associated with infection and inflammation.
Name some reason to get a false negative with the test for biliruben:
1. Light exposure
2. ascorbic acid
Nitrite is detected by the _____, in which nitrite at an acidic pH reacts with sulfanilamide to form a diazonium compound that produces a ______.
Greiss reaction / pink-colored azodye.
Once blood has been detected, the _____ can be used to differentiate between hematuria and hemoglobinuria.
Onset of renal complications can be predicted by testing for ______ and the progression of renal disease can be prevented through better stabilization of _____
microalbuminuria / blood glucose levels
Onset of renal complications can first be predicted by detection of _____
Other than glucose, name another clinically significant reducing sugar
galactose (inborn error of metabolism)
Prerenal proteinuria is caused by conditions affecting the _____ and (is/is not) indicative of renal disease.
the plasma / is not
Prerenal proteinuria is caused by conditions affecting the plasma prior to its reaching the kidney and, therefore, is not indicative of actual renal disease.
Proper care of reagent strips should include:
1. Store with dessicant (amber) in an opaque container (not clear)
2. Do not use past expiration date
3. Do not expose to toxic fumes
4. Store below 30 degrees but do not freeze
Questionable results for bilirubin testing with reagent strips can be repeated using the ____
Reagent strip tests use the sodium nitroprusside reaction to measure ketones. What substance(s) does the reagent strip react with to detect the presence of ketones?
In this reaction, acetoacetic acid in an alkaline medium reacts with sodium nitroprusside to produce a purple color. The test does not measure beta-hydroxybutyric acid and is only slightly sensitive to acetone when glycine is also present.
Routine testing for urinary bilirubin by reagent strip uses the _____ reaction.
Several companies manufacture both positive and negative controls. Distilled water is not recommended as a negative control because ____
reagent strip chemical reactions are designed to perform at ionic concentrations similar to urine
Sodium nitroprusside is used to test for ____
"Stercobilinogen is produced in the ____.
The ____ is used for rapid screening or monitoring of urinary porphobilinogen
The _____ is less subject to interference and is more sensitive to bilirubin than ____
The _____ procedure is a specific test for glucose and the ______ is a general test for glucose and other reducing substances
glucose oxidase / copper reduction method
The _____ test is the most frequent test performed on urine
The albumin:creatinine ratio may be increased in patients with ______
The chemical basis of the nitrite test is the ability of certain bacteria _______ which does not normally appear in the urine.
to reduce nitrate, a normal constituent of urine, to nitrite.
The color ____ is a low pH and the color ____ is a high pH
blue is low and yellow is high
The diagnosis of _____ is usually based on elevated serum levels of the enzymes creatinine kinase and lactic dehydrogenase. The appearance of the patient's plasma can also aid in the differentiation.
The kidneys rapidly clear myoglobin from the plasma, leaving a normal appearing plasma.
The LE test will also detect the presence of:
Trichomonas and histiocytes
The leukocyte esterase reagent strip will detect the presence of :
neutrophils, eosinophils, basophils and monocytes.
The pH of freshly excreted urine does not reach pH ___ in normal or abnormal conditions. A pH of ____ is associated with an improperly preserved specimen and indicates that a fresh specimen should be obtained to ensure the validity of the analysis.
pH 9/pH 9
The principle for the reagent strip test is___
protein error of indicators
Certain indicators change color in the presence of protein even though the pH of the medium remains constant. This is because protein (primarily albumin) accepts hydrogen ions from the indicator. The test is more sensitive to albumin because albumin contains more amino groups to accept the hydrogen ions than other proteins.
The pseudoperoxidate reaction is used in reagent strip tests for:
Creatinine and Blood
The reagent strip test for nitrite provides a rapid screening test for the presence of ______
urinary tract infection
The term ketones represents three intermediate products of fat metabolism. Name them.
2. acetoacetic acid
3. beta-hydroxybutyric acid
The test for protein using the reagent strip is most sensitive for ___
The SSA test is a precipitation test that reacts equally to all forms of protein.
Three tests that can be used to detect microalbuminuria:
2. Micral test
"Urine from vegetarians is more ____ (alkaline or acidic), owing to the formation of bicarbonate following digestion of many fruits and vegetables. An exception to the rule is ______
Acidic / cranberry juice
Persons on high-protein and high-meat diets tend to produce acidic urine, whereas urine from vegetarians is more alkaline, owing to the formation of bicarbonate following digestion of many fruits and vegetables. An exception to the rule is cranberry juice, which produces an acidic urine and has long been used as a home remedy for minor bladder infections.
What are some clinical reasons for increased fat metabolism? (Remember that the presense of ketones signifies increased fat metabolosim)
1. Inability to metabolize carbohydrate, as occurs in diabetes mellitus
2. Increased loss of carbohydrate from vomiting
3. Iinadequate intake of carbohydrate associated with starvation
What are some possible causes of postrenal proteinuria:
1. urinary tract infection
2. Prostatic fluid
3. vaginal secretions
4. menstrual contamination
What are some reagents for a glucose test using copper reduction
What are some reagents for a glucose test using reagent strips
1. glucose oxidase
What can produce a false negative nitrite test:
1. non-reductase containing bacteria
2. Insufficient contact time between bacteria and urinary nitrate
3. ascorbic acid
4. high specific gravity
What causes hemoglobinuria
The lysis of red blood cells
What is the Clinical Significance of Urine Specific Gravity"
1. Monitoring patient hydration and dehydration
2. Loss of renal tubular concentrating ability
3. Diabetes insipidus
4. Determination of unsatisfactory specimens due to low concentration
What is the clinical Significance of Urine Urobilinogen?
1. Early detection of liver disease
2. Hemolytic disorders
What is the most frequent error that causes a false-negative results in biliruben testing
testing using old specimens
What is the normal range of urine pH?
4.5 to 8
What is the principle employed by the pH test using reagent strips?
double indicator reaction
The Multistix and Chemstrip brands of reagent strips measure urine pH in 0.5- or 1-unit increments between pH 5 and 9. To differentiate pH units throughout this wide range, both manufacturers use a doubleindicator system of methyl red and bromthymol blue. Methyl red produces a color change from red to yellow in the pH range 4 to 6, and bromthymol blue turns from yellow to blue in the range of 6 to 9. Therefore, in the pH range 5 to 9 measured by the reagent strips, one sees colors progressing from orange at pH 5 through yellow and green to a final deep blue at pH 9.
What produces the brown color in feces
What type of proteinuria would not be detected by a reagent strip?
When using the reagent strip for protein, false negatives may be caused by:
2. Proteins other than albumin
When using the reagent strip for protein, false positives may be caused by:
1. High alkaline urine
2. High specific gravity
3. Loss of buffer due to prolonged exposure of reagent strip to the specimen
The major source of error with reagent strips occurs with highly buffered alkaline urine that overrides the acid buffer system, producing a rise in pH and a color change unrelated to protein concentration. Likewise, a technical error of allowing the reagent pad to remain in contact with the urine for a prolonged period may remove the buffer. False-positive readings are obtained when the reaction does not take place under acidic conditions.
Why would you find the presence of ketones in the urine?
Normally, measurable amounts of ketones do not appear in the urine, because all the metabolized fat is completely broken down into carbon dioxide and water. However, when the use of available carbohydrate as the major source of energy becomes compromised, body stores of fat must be metabolized to supply energy. Ketones are then detected in urine.
The recommended centrifugation for preparing the urine sediment is
400 RCF for 5 minutes
The number of fields that should be examined when quantitating urinary sediment constituents is:
The predecessor of the standardized urine microscopic examination was the:
The two factors that determine relative centrifugal force are:
radius of rotor head and RPM
A lipid droplet that does not stain with Sudan III may be composed of:
A urine specimen is referred for cytodiagnostic urine testing to detect the presence of:
To calculate the sediment concentration factor, one must know the:
volume of urine centrifuged and volume of sediment
The purpose of scanning the perimeter of urine sediment placed under a conventional glass slide is to:
detect the presence of casts
All of the following are reported as the quantity per high-power field
red blood cells, white blood cells, bacteria
The most probable structures to be stained by the Prussian blue stain are:
renal tubular epithelial cells
The purpose of including glucose as a significant chemical parameter by a laboratory that performs macroscopic screening is to check for the presence of:
10 mL of urine is centrifuged, and 9.5 mL of urine is decanted. The sediment concentration factor is:
Calculation of the number of RBCs per milliliter of urine requires knowledge of all of the following
number of high-power fields per milliliter of urine, number of high-power fields per viewing area, area of a high-power field
A medical technology student consistently obtains lower RBC counts than the instructor. A possible reason for this might be:
failure to centrifuge a mixed specimen, focusing in the wrong plane, failure to recognize crenated cells
Centrifugation of less than the recommended 12 mL of urine for the microscopic examination will:
decrease the number of cellular elements
Substances found in the urinary sediment that can be confirmed using polarized light are:
Using polarized microscopy, which of the following is/are birefringent?
Identification of oval fat bodies can be verified using:
Using a bright-field microscope, the final magnification of a high-power field is:
To detect the presence of casts, the sediment is examined using:
reduced light under low power
Optimal viewing is obtained by performing Köhler illumination adjustment to the:
To increase the probability of detecting urine sediment constituents that have a low refractive index, clinical laboratories often use:
The presence of crenated RBCs in the urine sediment is associated with:
Dilute alkaline urine should be examined carefully for the presence of:
A patient with severe back pain and 15 to 20 RBCs/hpf in the urine sediment may have:
Differentiation among RBCs, yeast, and oil droplets may be accomplished by all of the following
observation of budding in yeast cells, increased refractility of oil droplets, lysis of RBCs by acetic acid
Ghost RBCs most frequently occur with:
high pH, low specific gravity
The presence of hypochromic, irregularly shaped RBCs in the urine sediment indicates:
Glitter cell is a term used to describe a specific type of?
An increase in urinary WBCs is called?
Urine sediments containing increased WBCs should be observed closely for the presence of:
Eosinophils are found in the urine in cases of:
acute interstitial nephritis
Leukocytes that stain pale blue with Sternheimer-Malbin stain and exhibit brownian movement are:
Oval fat bodies are:
renal tubular epithelial cells that contain lipids
The type of cells that line the bladder and ureters are:
Initial microscopic focusing on the urinary sediment is frequently performed by referencing:
squamous epithelial cells
The location of epithelial cells in the urinary tract in ascending order is:
squamous, transitional, renal tubular
Clue cells are derived from:
squamous epithelial cells
The organisms attached to a clue cell are:
Urothelial cells routinely occur in all of the following shapes
spherical, polyhedral, caudate
Which of the following cells found in increased numbers in the urine sediment is only indicative of nephron damage?
renal tubular cells
The type of cell most likely to appear stained with bilirubin is:
Collection of a midstream clean-catch specimen will alleviate contamination by:
squamous epithelial cells
Which of the following structures could be found in both a vaginal wet prep and a urine sediment?
Yeast cell and Clue cell
Spherical transitional epithelial cells can be differentiated from renal tubular epithelial cells by observing the:
centrally located nucleus in transitional cells
The finding of renal tubular epithelial cells containing yellow-brown granules correlates with a positive reagent strip test for:
The primary factor that favors the formation of casts is:
The major constituent of casts is:
Waxy casts are most easily differentiated from hyaline casts by their:
Urinary casts are formed in the:
distal and collecting tubules
Which of the following elements would most likely be found in an acidic concentrated urine that contains protein?
Sediment constituents that are used to differentiate between upper and lower urinary tract infections are:
To differentiate a bacterial cast from a granular cast, a technologist could:
perform a Gram stain
The type of cast most closely associated with tubular damage is the:
epithelial cell cast
The only type of cast capable of polarization is the:
Broad casts may form as a result of:
extreme urinary stasis and tubular destruction
The finding of increased hyaline and granular casts in the urine of an otherwise healthy person may be the result of:
recent strenuous exercise
Hyaline casts may degenerate into:
Hyaline casts are found in the urine sediment
following strenuous exercise
The urinary sediment constituent most closely associated with bleeding within the nephron is the:
Which of the following best differentiates a waxy cast from a fiber?
Waxy casts do not polarize light and fibers do
All of the following may be seen in the urine following strenuous exercise
protein, hyaline casts and granular casts
To distinguish a cellular cast from a clump of cells, the microscopist should:
look carefully for a cast matrix
All of the following are associated with severe urinary stasis
granular casts, waxy casts and broad casts
Identification of crystals is based on shape and:
urine pH and crystal solubility
Urinary crystals that appear yellow to reddish-brown are:
To dissolve amorphous urates, you could:
warm the specimen
Normal crystals found in acidic urine include:
calcium oxalate, uric acid, amorphous urates
All of the following crystals are found in acid urine
cholesterol, tyrosine, cystine
Abnormal crystals are most frequently seen in urine that is
Information that aids in the identification of crystals includes all of the following
urine pH, crystal solubility, crystal birefringence
Which of the following crystals occurs in two very distinct forms?
Normal crystals found in alkaline urine include:
triple phosphate, calcium carbonate, ammonium biurate
Crystals found in the urine that are associated with disease include:
leucine and tyrosine
Which of the following crystals is associated with ethylene glycol ingestion?
A urine specimen refrigerated overnight is cloudy and has a pH of 6. The turbidity is probably due to:
All of the following affect the formation of crystals
urine specific gravity, urine pH, urine temperature
Cystine crystals would most possibly be confused with:
uric acid crystals
Formation of crystals due to medications is most frequently caused by:
Calcium carbonate crystals can be distinguished from bacteria by:
adding acetic acid
Which of the following results should be repeated?
pH 7.0 with uric acid crystals
The significance of bacteria in the urine sediment is increased when:
WBCs are present
Yeast may appear in the urine sediment in all of the following forms
mycelial, oval, budding ovals
Schistosoma haematobium would most likely be found in the urine from a:
Motility by which of the following is most noticeable during the urine sediment examination?
Urine sediment artifacts frequently differ from true sediment constituents by their:
size and refractility
Under polarized light, all of the following will exhibit the Maltese cross formation
starch granules, oval fat bodies, fatty casts
Students may have difficulty differentiating between bacteria and:
Which of the following is most likely to be found in the urine of a diabetic patient?
Specimens containing mucus may be erroneously reported as containing:
Enhance nuclear detail.
Stain oval fat bodies
Stain hemosiderin granules
Focus light on the specimen
Hold the objectives
Increase objective resolution
Regulate interpupillary distance
Diopter adjustment knob
Ammonium biurate crystals
thorny apple appearance
Calcium carbonate crystals
Triple phosphate crystals
coffin lid apearance
Notched corners appearance
Diseases affecting the glomerulus are primarily caused by:
Symptoms of acute glomerular nephritis include all of the following except:
The major cause of the nephrotic syndrome in children is:
minimal change disease
Damage to the glomerulus can occur as a result of all of the following except:
increased filtration of electrolytes
The buildup of crescentic formations on the glomerular capillaries is characteristic of
Rapidly progressive glomerulonephritis
The most common cause of end-stage renal disease is:
A renal disorder associated with heroin abuse is:
Focal segmental glomerulosclerosis
Blood tests to confirm the diagnosis of acute glomerulonephritis detect the presence of
Goodpasture's syndrome and Wegener's granulomatosis are associated with the presence of which of the following in the urine sediment?
Red blood cell casts
The presence of which of the following crystals is associated with the nephrotic syndrome?
A patient with symptoms of hemoptysis and hematuria should be tested for:
antiglomerular basement membrane antibody, antineutrophilic cytoplasmic antibody
Which of the following disorders has the best prognosis?
Glomerular basement membrane thickening occurs in membranous glomerulonephritis as a result of deposition of:
IgG immune complexes
The presence of heavy proteinuria is most characteristic of:
The pronounced edema associated with the nephrotic syndrome is related to the:
Oval fat bodies and fatty casts are characteristic urine sediment constituents in patients with:
A decrease in systemic blood flow affects the renal tubules by producing:
Glucosuria and generalized amino aciduria are characteristics of:
Which of the following renal disorders may be inherited?
Administration of a nephrotoxic antibiotic to a patient with a decreased glomerular filtration rate may cause:
acute tubular necrosis
The presence of increased renal tubular epithelial cell casts would be most indicative of:
acute tubular necrosis
Infection of the bladder is termed:
Cystitis can be differentiated from pyelonephritis by:
the presence of white blood cell casts
In diabetic nephropathy, solid material deposited around the capillary tufts includes:
The finding of bacterial casts is associated with:
acute pyelonephritis and chronic pyelonephritis
The most serious tubulointerstitial disorder is:
Increased urinary eosinophils are diagnostic for:
acute interstitial nephritis
Microscopic urinalysis findings with acute interstitial nephritis include all of the following except:
Acute renal failure may be classified as:
Prerenal, renal and postrenal
In which disorder would waxy and broad casts be most likely to be seen?
Chronic renal failure
Causes of acute renal failure include:
Malignancy, acute tubular necrosis, and renal calculi
The majority of renal calculi are composed of:
Lithotripsy is performed to:
Remove renal calculi
The microscopic hematuria associated with renal lithiasis is caused by:
All of the following may be helpful in preventing the formation of renal calculi:
Increased hydration, dietary restrictions and adjustment of uring pH
Phenylketonuria is caused by:
lack of the enzyme phenylalanine hydroxylase
The Guthrie test is a:
bacterial inhibition test
The abnormal metabolite that is present in the urine in alkaptonuria is:
Which of the following disorders results in the accumulation of large amounts of homogentisic acid in the urine?
All of the following disorders are caused by defects in the phenylalanine-tyrosine pathway:
Initial screening for PKU performed on newborns before their discharge from the hospital uses a blood sample rather than a urine sample because:
increased serum phenylalanine can be detected earlier
A routine urinalysis is performed on a specimen that has turned dark after standing in the laboratory. The urine is acidic and has negative chemical tests except for the appearance of a red color on the ketone area of the reagent strip. One should suspect:
Inhibition of bacterial growth in the Guthrie test should be interpreted as:
the patient lacks phenylalanine hydroxylase
In a positive Guthrie test:
bacterial growth occurs around the positive control disc and the patient disc
The presence of unusually fair complexions is a characteristic of phenylketonuria because:
tyrosine is not available for conversion to melanin
A false-positive reaction for urinary ketones could be present in:
A positive Clinitest reaction is seen in patients with:
Confirmation of maple syrup urine disease is made on the basis of:
A disease that causes large amounts of branched-chain amino acids to be excreted in the urine is:
Urine with an odor of "sweaty feet" and a positive ketone test indicates:
The types of organic acidemias include all of the following:
isovaleric, propionic, methylmalonic
Which of the following reacts with p-nitroaniline to produce an emerald-green color?
The finding of persistent ketonuria in a newborn is:
associated with methylmalonic aciduria
A urinalysis and a DNPH test are performed on an infant who is failing to thrive. If the DNPH test is positive, what result in the urinalysis will also be positive?
The presence of maple syrup urine disease is first suspected by the presence of abnormal urine:
Under normal conditions, tryptophan that is not reabsorbed in the intestine is removed from the body as:
indole in the feces
The presence of argentaffin cell tumors can be detected by the presence in the urine of:
The finding of a "blue diaper" is indicative of a defect in the metabolism of:
Analysis of urine from an infant whose mother reported a blue staining on the diapers showed increased levels of indican and a generalized aminoaciduria. On the basis of these findings, the infant was diagnosed as having:
A false-positive test for 5-HIAA may result if the patient:
does not receive appropriate diet instructions
Abnormal amounts of indigo blue in the urine are indicative of a defect in the metabolism of:
The finding of increased amounts of the serotonin degradation product 5-HIAA in the urine indicates:
argentaffin cell tumors
The silver nitroprusside test detects the presence of:
To differentiate between cystinuria and homocystinuria, the urine should be tested with:
Patients who produce kidney stones at an early age should be tested for the presence of:
Chemical screening tests for cystine produce false-positive results in the presence of urinary ketones because:
the test reagent is nitroprusside
Porphyrins are intermediary compounds in the formation of:
The specimen of choice when testing for protoporphyrin is:
Name all of the primary porphyrins:
Uroporphyrin, protoporphyrin, and coproporphyrin
All of the following porphyrin compounds will exhibit fluorescence under ultraviolet light:
Uroporphyrin, protoporphyrin, and coproporphyrin
The most common cause of acquired porphyria is:
Symptoms of inherited porphyrias include all of the following
neurologic, psychiatric, and photosensitivity
The presence of porphobilinogen in the urine can be suspected when:
acidic urine turns a port wine color after standing
Urine from a child suspected of having lead poisoning has a red fluorescence under Wood's lamp. This finding is:
consistent with lead poisoning because coproporphyrin fluoresces under ultraviolet light
What compound does not react directly with either Ehrlich's reagent or fluorescence?
Porphyrin compounds that can be found in urine are:
aminolevulinic acid, coproporphyrin, uroporphyrin
The concept of vampires is associated with:
The appearance of abnormal metabolites in the urine due to a defect categorized as an "overflow type" may be caused by all of the following:
inborn errors of metabolism, serum concentrations exceeding the Tm, disruption of normal enzyme function by exposure to toxic substances
Characteristic urine odors are associated with all of the following disorders:
Hurler's and Sanfilippo's syndromes present with mental retardation and increased urinary:
The presence of urinary reducing substances is of particular concern in:
All of the following are metabolic rather than renal disorders:
tyrosyluria, maple syrup urine disease, indicanuria
The presence of "orange sand" in an infant's diaper is indicative of:
The acid albumin CTAB and metachromatic spot tests are used to test for:
Fanconi's syndrome is a symptom of:
cystinosis and Hartnup's disease
Mental retardation is a symptom of all of the following:
Hurler's syndrome, galactosuria and PKU
Melituria refers to:
GALT deficiency is a disorder affecting the metabolism of:
True inborn of metabolism
Defective reabsorption of cystine, lysine, ornithine, and arginine
Tendency to form renal calculi
the appropriate screening test result for PKU?
the appropriate screening test result for Tyrosyluria?
the appropriate screening test result for Methylmalonic academia?
the appropriate screening test result for Hemocystinuria?
the appropriate screening test result for Hurler's syndrome?
the characteristic odor for Phenylketonuria?
the characteristic odor for Cystinosis?
the characteristic odor for Isovaleric academia?
the charasteristic odor for maple syrup urine disease?
The functions of the cerebrospinal fluid include all of the following
nutritional enrichment of nervous tissue, removal of metabolic waste products, and protection of neurologic tissue from trauma
Chemical analysis of CSF shows that the fluid contains:
plasma chemicals in concentrations different from those in the plasma
CSF is formed in the _______________ and reabsorbed by the _______________.
choroid plexus, arachnoid granulations
CSF is produced primarily by:
selective filtration of plasma in the choroid plexus
The CSF circulates through the brain and spinal cord in the:
The average volume of CSF in an adult is:
90 to 150 mL
If CSF tubes numbered 2 and 3 can not be analyzed within 1 hour, the correct procedure is to:
refrigerate tube 3 and leave tube 2 at room temperature
A xanthochromic CSF specimen will appear:
yellow and clear
Differential counts on CSF are performed on:
stained smears prepared from a concentrated specimen
A broad spectrum of reactive and nonreactive lymphocytes in the CSF is associated with:
The third tube of CSF collected from a lumbar puncture should be used for:
Cells seen in the CSF following pneumoencephalography are:
The primary disadvantage in using a cytocentrifuge to prepare CSF differential slides is:
Nucleated red blood cells seen in the CSF indicate:
bone marrow contamination from the puncture
White blood cell counts on clear CSF specimens are performed:
on undiluted specimens if there is no cell overlapping
To determine the WBC count on a cloudy CSF specimen that contains both RBCs and WBCs, it is necessary to:
dilute the specimen using glacial acetic acid
WBC counts on CSF specimens collected during a traumatic tap can:
be corrected for WBCs added by the traumatic tap
When using the cytocentrifuge, a daily control slide of saline and albumin is prepared to check:
for bacterial contamination
Three tubes of CSF are submitted to the laboratory. They are numbered 1, 2, and 3 and show blood in all tubes but decreasing in amount as one inspects tubes 1 through 3. This observation should be interpreted as:
a traumatic or bloody tap and, in all likelihood, no pathogenic significance should be attached to the presence of the blood
The presence of hemosiderin containing macrophages in CSF indicates:
A slightly hazy CSF specimen is diluted 1:10 with acetic acid. A total of 50 cells are counted in five large squares on both sides of the Neubauer counting chamber. The count is reported as:
A CSF specimen, in which there is uneven distribution of blood among the three tubes and clots are detected, is an indication of:
The presence of xanthochromia and an increased D-dimer test in the CSF is indicative of:
a cerebral hemorrhage
Examination of a CSF shows 1000 WBCs, of which 75% are lymphocytes and 25% are monocytes. This finding is consistent with:
When choroid plexus cells are present in the CSF, they:
may resemble clusters of malignant cells
Damage to the blood-brain barrier by Mycobacterium tuberculosis may cause the CSF to:
contain a pellicle or clot
Dilution of CSF prior to performing a total cell count should be made using:
Increased CSF eosinophils are associated with:
introduction of foreign material
Melanoma cells in the CSF must be differentiated from:
macrophages containing hemosiderin
The normal CSF protein is:
15 to 45 mg/dL
Conditions that produce elevated CSF protein include all of the following
meningitis, multiple sclerosis, hemorrhage
The Coomassie blue dye-binding method for measuring CSF protein is based on the principle of:
protein error of indicators
The normal CSF glucose is:
60% to 70% of the blood glucose
Myelin basic protein is measured in the CSF to assess the condition of patients with:
If protein electrophoresis was performed on both serum and CSF, which of the following components would have a higher ratio to total protein in the CSF than in the serum?
An IgG index greater than 0.77 is indicates:
synthesis of IgG within the CNS
Measurement of CSF lactate is useful in monitoring cases of:
The CSF/serum albumin index is performed to determine:
the integrity of the blood-brain barrier
To determine if IgG is being produced within the central nervous system, the laboratory must calculate the:
The lowest levels of CSF lactate are found with:
Normal CSF protein differs from serum protein by the:
absence of fibrinogen
Crystals with a bright yellow color seen in macrophages are called:
CSF electrophoresis to confirm the diagnosis of multiple sclerosis would be expected to show:
increased IgG with oligoclonal bands not seen on serum electrophoresis
To determine if fluid draining from the ear of a patient with a severe head injury is CSF, the fluid should be:
electrophoresed for the presence of transferrin isoforms
The primary cause of decreased CSF glucose in bacterial meningitis is
alteration of blood-brain glucose transport
Measurement of CSF lactate levels is a valuable aid for all of the following
preliminary diagnosis of tubercular meningitis, preliminary diagnosis of viral meningitis, monitoring the effects of antibiotic treatment
A CSF protein report of 32 g/dL
is an erroneous report
The presence of increased glutamine in the CSF is indicates
An unknown fluid can be identified as CSF by determining the
presence of "tau" transferrin
Oligoclonal bands are significant in the diagnosis of multiple sclerosis when:
they are seen in the CSF and not in the serum
The IgG index is a comparison between the
CSF/serum albumin index and CSF/serum IgG index
An IgG index of 1.10 would most probably be seen in a patient diagnosed with
The CSF glucose in a patient with a blood glucose of 90 mg/dL is 60 mg/dL. These results are representative of:
A CSF glutamine level is an indirect measure of CSF
Gram's stains performed on CSF specimens are of value in the
detection of bacterial and fungal meningitis
Specimens from patients suspected of having fungal meningitis should be tested with:
Gram's stain and India ink
Which of the following cells are seen following neurological diagnostic procedures?
Choroidal, Ependymal, Spindle
India ink preparations are useful in the diagnosis of
When a CSF specimen is received in the microbiology laboratory, the first thing the technologist should do is:
centrifuge the specimen
A questionable India ink preparation on the CSF from an immunocompromised patient should be further tested using:
a cryptococcal antigen test
Which of the following structures contain(s) one-way valves?
A report of many gram-positive cocci on a clear CSF sample with a normal cell count may be the result of:
precipitated stain mistaken for bacteria, use of contaminated albumin in the cytocentrifuge
A positive cryptococcal antigen test with a negative India ink preparation may indicate:
the presence of rheumatoid factor
A positive FTA-ABS and a positive CSF VDRL indicate:
A false-positive CSF serologic test for neurosyphilis in a treated patient can occur if:
fluid from a traumatic tap is tested by the FTA-ABS test
A positive serum FTA-ABS and a negative VDRL on CSF indicate:
successfully treated syphilis
Semen analysis on postvasectomy patients should be performed
until two consecutive monthly specimens show no sperm
To determine if a questionable specimen is semen, the specimen should be tested for:
Absence of a normal sperm acrosome:
affects ovum penetration
Yellow color in a semen specimen may be caused by all of the following
urine, medications, prolonged abstinence
Normal semen should liquefy
within 1 hour
An increased amount of prostatic fluid in a semen specimen will
lower the pH
Which parameter of the semen analysis is most critically affected if the first portion of the ejaculation is not collected?
Semen viscosity is most closely related to:
Proper collection of a semen specimen should include all of the following except collection:
at the laboratory followed by 1 hour of refrigeration
Abnormal sperm morphology is determined by:
head and tail morphology and size
Before analysis semen specimens should be:
allowed to liquefy
Sperm motility after 1 hour should be at least:
Prior to reporting a postvasectomy specimen as negative for the presence of sperm, the specimen must be:
Sperm can be immobilized before performing a sperm concentration using all of the following
heat, sodium bicarbonate, tap water
Evaluation of sperm motility includes:
determining slow and fast movement, differentiation between forward and lateral movement
Computer-assisted semen analysis determines all of the following
sperm count, trajectory of sperm motion, velocity of sperm motility
When performing sperm morphology analysis, the minimum number of sperm that should be evaluated is:
When using routine morphology criteria, the normal value is greater than:
30% normal forms
When using Kruger's strict morphology criteria, the normal value is greater than:
14% normal forms
Semen specimens should be analyzed:
The normal sperm concentration is:
20 to 160 million/mL
A yellow semen specimen with a normal sperm concentration and decreased motility may contain:
Using a 1:20 dilution and the 5 RBC counting squares of the Neubauer counting chamber, an average of 54 sperm is counted. The sperm concentration is:
When performing sperm morphology analysis on a semen specimen with a sperm concentration of 20 million, 10 spermatids are seen. This result is:
indicative of abnormal sperm maturation
A sperm motility report graded 2.0 is interpreted as:
slow forward motility with noticeable lateral movement
While performing a sperm morphology examination, a technologist counts 10 neutrophils per 100 mature sperm. To determine if this observation is significant, the technologist must also know the:
The finding of 3 million neutrophils per milliliter in a semen specimen is:
Indicative of infection
The purpose of diluting semen specimens with sodium bicarbonate and formalin before counting is to:
immobilize and preserve the sperm
The motility component of a sperm analysis includes all of the following except evaluation of the:
motility of normal and abnormal sperm
Using a 1:20 dilution of semen, a student counts 70 sperm in the five RBC squares on one side of the Neubauer hemocytometer and 82 sperm on the other side. The student should:
make a new dilution, repeat the count
The sugar of interest in cases of infertility is:
Development of male antisperm antibodies can be caused by all of the following
vasovasostomy, infection, trauma
The immunobead test detects:
male antisperm antibodies
All of the following chemicals are decreased in the semen when there is a lack of prostatic fluid
Zinc, Citrate, Acid phosphatase
The type of microscopy recommended for use when examining a specimen for the presence of sperm is:
Sperm function tests include all of the following
hamster egg penetration assay, cervical mucus penetration test, in vitro acrosome reaction
All of the following can be used to evaluate continued infertility with a normal sperm count
eosin-methylene blue stain, plasma and semen agglutination, immunobead test
A semen specimen in which clumping of sperm is observed should be further tested using the:
Which of the following parameters directly relates to and provides a check on the sperm motility evaluation?
When an abnormally low sperm count is encountered in a fertility examination, the follow-up test of choice is:
female agglutination studies
Which of the following is a normal finding in an eosin-nigrosin stain?
75% of the cells appear bluish white
Normal semen analyses accompanied by continued infertility would most probably be caused by:
female antisperm antibodies
Spermatogenesis takes place in the:
Using a 1:20 dilution of a specimen with a volume of 3 mL, an average of 86 sperm are counted in the five RBC counting squares of the Neubauer hemocytometer.
86 million/mL and 258 million/specimen
Using a 1:20 dilution of a specimen with a volume of 4 mL, 30 sperm are counted in two large squares (WBC) of the Neubauer hemocytometer.
1.5 million/mL and 6 million/specimen
Using a 1:10 dilution of a specimen with a volume of 2 mL, 400 sperm are counted in four large squares (WBC) of the Neubauer hemocytometer.
10 million/mL and 20 million/specimen
Maturation of sperm occurs in the
Provides energy for sperm motility.
Neutralized vaginal acidity.
Propels sperm through the urethra
All of the following statements on synovial fluid are true, that it:
surrounds all joints in the body, acts as a lubricant, supplies nourishment to cartilage
Which of the following descriptions of synovial fluid does not match?
Sepsis: Uniform blood
Crystals found in synovial fluid during attacks of gout are:
In gout, both serum and synovial fluid will have increased levels of:
Synovial fluid is produced by:
ultrafiltration of plasma
The concentration of which of the following chemicals found in synovial fluid differs most noticeably from the plasma concentration?
A turbid synovial fluid with yellow-green color is indicates:
The primary cells seen in normal synovial fluid include all of the following
macrophages, monocytes, synovial tissue cells
All of the following can cause crystals to be present in the synovial fluid
metabolic disorders, degeneration of cartilage, injection of medications
A cloudy, yellow-green synovial fluid with 100,000 WBCs, a predominance of neutrophils, and a decreased glucose is classified as:
An arthrocentesis performed on a patient with lupus erythematosus produces a cloudy yellow fluid with 2000 WBCs, of which 55% is neutrophils. This fluid is classified as:
A clear, pale yellow synovial fluid with good viscosity and a WBC count of 1000 is calssified as?
To determine if an unknown fluid is synovial fluid, the fluid can be tested:
by adding acetic acid and observing clot formation
A milky-appearing synovial fluid is associated with the presence of:
monosodium urate crystals
Which of the following crystals would most likely be present in conjunction with calcium pyrophosphate crystals in synovial fluid?
The recommended diluting fluid for synovial fluid cell counts is:
Neutrophils that contain precipitated rheumatoid factor in their cytoplasm are called:
The most frequently performed tests on synovial fluid include all of the following
Gram's stain, WBC count and differential
Vacuolated macrophages containing ingested neutrophils seen in synovial fluid are called:
Before performing a cell count on highly viscous synovial fluid, it may be necessary to incubate the fluid with:
In the Ropes' or mucin clot test, normal synovial fluid:
forms a solid clot when added to glacial acetic acid
Synovial fluid for crystal examination should be:
examined unstained under direct and compensated polarized light
Examination of synovial fluid under direct polarized light reveals intracellular needle-shaped crystals that appear white against the black background. When a red compensator is added and the crystals are aligned with the slow vibration, they appear yellow against the red background. These crystals are:
monosodium urate showing negative birefringence
Crystals that appear to be rhombic-shaped and are blue when aligned with the slow vibration of compensated polarized light are:
Delayed analysis of synovial fluid affects the results of all of the following tests
glucose, crystal examination, WBC count
The presence of neutrophils containing dark granules in the synovial fluid is associated with:
Crystals frequently seen with chronic inflammation are:
In addition to routine culture media, synovial fluid cultures should include:
All of the following diseases are frequently associated with joint disorders
Lyme disease, lupus erythematosus, rheumatoid arthritis
A synovial fluid with a normal WBC count from a patient with a normal serum uric acid contains extracellular birefringent crystals under polarized light. A possible reason for this finding is that the:
specimen was collected in powdered EDTA
Crystals seen in the synovial fluid from a patient previously diagnosed with gout exhibit positive birefringence when observed under compensated polarized light. The most probable cause of this discrepancy is:
aligning the crystals perpendicular to the slow vibration
Vacuolated macrophages containing ingested neutrophils are called:
Fat droplets seen in synovial fluid are associated with:
crush injuries, chronic inflammation
Synovial fluid crystals seen in patients undergoing renal dialysis most commonly are:
Peritoneal lavage is performed to:
detect intra-abdominal bleeding
Exudate fluids usually result from:
inflammation of the serous membrane
The pathological accumulation of fluid in a body cavity is termed a/an:
Which of the following is most often associated with the formation of a transudate?
Congestive heart failure
The cells lining the pleural cavities are primarily:
The function of serous fluid is to:
provide lubrication for the serous membranes
Production of serous fluid is controlled by all of the following
hydrostatic pressure, oncotic pressure, capillary permeability
Peritoneal fluid is collected by a procedure called:
Serous fluid effusions may result from all of the following
Congestive heart failure, hypoalbuminemia, increased capillary permeability
A pleural fluid delivered to the laboratory in ice would be accompanied by a requisition to test for:
Pleural fluid can be better classified as to transudative or exudative origin by performing a:
fluid-to-serum cholesterol ratio and fluid-to-serum total bilirubin ratio
A decrease in the number of mesothelial cells seen on a pleural fluid differential indicates:
All of the following are unique characteristics of malignant cells
hyperchromatic nucleoli, cytoplasmic molding and abnormal nuclear to cytoplasm ratios
Elevated pleural fluid amylase can be indicative of all of the following
pancreatitis, esphageal rupture, malignancy
A blood-streaked pericardial exudate with an increased amount of neutrophils is indicative of:
Structures seen in peritoneal fluid that may be associated with either benign or malignant conditions are:
A fluid obtained by thoracentesis has a cholesterol of 100 mg/dL. This would be classified as a/an
Differentiation between a hemothorax and a hemorrhagic effusion on a bloody pleural fluid is done by:
performing a hematocrit value, because a hemothorax will give a value close to that of blood
A pleural fluid pH of less than 6.0 is indicative of:
Requests for amylase and alkaline phosphatase determinations on ascitic fluid are received in suspected cases of:
What best describes a pleural fluid as an exudate rather than a transudate?
Fluid-to-serum cholesterol ratio >0.3
What test is valuable in the diagnosis of esophageal rupture?
Pleural fluid pH
Which of the following sets of results most closely indicates an exudate?
Cloudy, fluid-to-serum LD ratio: 0.8; fluid-to-serum protein ratio: 0.7; WBC count: 2500/mL
A milky pleural fluid that stains strongly positive with Sudan III indicates:
thoracic duct leakage
A milky, green-tinged pleural fluid:
stains weakly with Sudan III
A pericardial exudate from a patient diagnosed with AIDS might be tested with:
an acid-fast stain and an adenosine deaminase assay
Differentiation between an ascitic fluid transudate or exudate is most accurately made using the:
serum-ascites albumin gradient
The test performed on peritoneal lavage fluid is the:
An ascitic fluid absolute neutrophil count of 1000/mL is most indicative of:
A screening test performed on a cloudy, green ascitic fluid would be a/an:
A peritoneal fluid with a positive CEA and a negative CA 125 indicates:
Increased serous fluid can be caused by all of the following
lymphatic obstruction, inflammation, increased hydrostatic pressure
The finding of a mesothelioma cell in pericardial fluid is indicative of:
Amniotic fluid is formed by all of the following
fetal urine, fetal cell metabolism, transfer of water across the placenta
A dark green amniotic fluid is associated with?
A primary function of amniotic fluid is to?
provide protection for the fetus
The volume of amniotic fluid increases after the first trimester as a result of:
production of fetal urine
Amniotic fluid for fetal lung maturity testing should be preserved:
in the refrigerator
A dark yellow amniotic fluid is caused by:
Measurement of amniotic fluid creatinine levels can be used to:
determine approximate fetal age and differentiate between amniotic fluid and maternal urine
A technical error that could produce a falsely low fetal lung maturity test is:
centrifuging the specimen at too high a speed
To differentiate between maternal and fetal blood in blood-streaked amniotic fluid, the fluid is tested for:
The presence of a fetal neural tube disorder may be detected by:
increased maternal serum alpha fetoprotein
An increased level of alpha fetoprotein in amniotic fluid should be further tested for:
Hemolytic disease of the newborn is caused by:
Analysis of amniotic fluid bilirubin levels is performed using:
Alpha fetoprotein is produced by the fetal:
An amniocentesis is performed on a woman whose last two pregnancies have resulted in stillbirths due to hemolytic disease of the newborn. A screening test performed at the hospital is positive for bilirubin, and the specimen is sent to a reference laboratory for a bilirubin scan. Doctors are concerned when the report comes back negative, and they question if the:
specimen was exposed to light
The purpose of plotting amniotic fluid bilirubin on a Liley graph is to:
determine further treatment
Hemolytic disease of the newborn endangers the fetus by:
destroying fetal RBCs
The A450 of an amniotic fluid is plotted in zone 3 of a Liley graph. The physician should:
request testing for fetal lung maturity
Interference with the amniotic fluid bilirubin analysis on centrifuged fluid is most likely caused by:
Which of the following alpha fetoprotein results would be of concern?
3.0 MoM in amniotic fluid
The foam, or shake, test is a screening test for amniotic fluid:
Microviscosity of amniotic fluid is measured by:
Amniotic fluid tests for fetal maturity include:
L/S ratio and microviscosity
Decreased levels of phosphatidyl glycerol in amniotic fluid are associated with:
hyaline membrane disease
The test for amniotic fluid lamellar bodies uses:
an automated cell counter
The Amniostat agglutination test is performed on amniotic fluid from pregnant women to detect the presence of:
The most frequent concern of premature delivery is underdevelopment of the:
The principle of the shake test and foam stability index is that phospholipids:
reduce the surface tension of an alcoholic solution
Lamellar bodies contain:
When performing an L/S ratio by thin-layer chromatography, a mature fetal lung will show:
lecithin twice as concentrated as sphingomyelin
The method of choice for testing amniotic fluid contaminated with hemoglobin for fetal lung maturity is:
The test of choice for testing amniotic fluid from a diabetic patient for fetal lung maturity is the:
Which of the following fetal lung maturity test results correlate?
L/S ratio: 2.2, surfactant/albumin ratio: 75
An amniotic fluid optical density at 650 nm of 0.180 correlates with:
a lamellar body count over 32,000/L
A fern test is performed to differentiate between:
urine and amniotic fluid
Failure of the fetus to begin swallowing will result in:
The normal brown color of the feces is produced by:
Stools from persons with steatorrhea contain excess amounts of:
A black, tarry stool is indicative of:
upper GI bleeding
A pale, frothy stool is indicative of:
All of the following are secreted into the small intestine by the pancreas
chymotrypsin, lipase, elastase 1
The recommended specimen for quantitative fecal testing is a:
72 hour specimen
The presence of amebic dysentery may be suspected when a stool:
is coated with blood-streaked mucus
The unpleasant odor associated with fecal analysis is caused primarily by:
Diarrhea can result from all of the following
disruption of the normal intestinal bacterial flora, addition of pathogenic organisms to the normal intestinal flora, increased concentration of fecal electrolytes
Large orange-red droplets seen on direct microscopic examination of stools mixed with Sudan III represent:
Microscopic examination of stools mixed with Sudan III and glacial acetic acid and then heated will show small orange-red droplets that represent:
fatty acids, soaps, and neutral fats
When performing microscopic examination of a stool for muscle fibers, the structures that are counted:
have vertical and horizontal striations
Crystals seen in a stool after it has been mixed with acetic acid and Sudan III and heated may be composed of:
Wet preparations for the detection of fecal neutrophils are stained with:
Microscopic examination of stools for fecal cells provides preliminary information as to the cause of diarrhea because:
neutrophils are present in conditions that affect the intestinal wall
Increased neutrophils in a stool may indicate:
A positive lactoferrin latex agglutination test indicates :
enteroinvasive Escherichia coli
The term occult blood describes blood that:
is not visibly apparent in the stool specimen
Chemical screening tests performed on feces include all of the following
Apt test, trypsin digestion, Clinitest
The presence of a negative trypsin test indicates:
To prevent false-positive fecal occult blood tests, patients should avoid eating all of the following for 3 days before testing
horseradish, melons, red meat
Before and during collection of a sample for quantitative fecal fats, a patient should:
consume 100 g of fat per day
The coefficient of fat retention should be at least:
The most sensitive fecal enzyme test for the diagnosis of pancreatic insufficiency measures:
A bloody stool from a neonate should be emulsified in water, centrifuged, and the supernatant tested with:
Tests for the detection of occult blood rely on the:
pseudoperoxidase activity of hemoglobin
Gum guaiac is preferred over ortho-tolidine for occult blood in mass screening tests because:
there is less interference from dietary hemoglobin
In the Van de Kamer method for quantitative fecal fat determinations, fecal lipids are:
converted to fatty acids before titrating with sodium hydroxide
A patient whose stool exhibits increased fats, undigested muscle fibers, and the inability to digest gelatin may have:
A stool pH of 5.0 correlates with a:
A bloody stool produced by a newborn should:
have an Apt test performed on it
False-negative results for upper gastrointestinal bleeding can be caused by:
degradation of hemoglobin to porphyrin and ingestion of Vitamin C
When performing the Apt test, a pink color that remains in the supernatant during testing indicates:
the presence of fetal hemoglobin
Tests for quantitative fecal fats include all of the following
Van de Kamer, near-infrared reflectance spectrophotometry, acid steatocrit test
After reviewing a 24 hour urine for quantitative total protein analysis, the technician must first
measure the total volume
False results in urobilinogen testing may occur if the urine specimen is
exposed to light
A clean catch urine is submitted to the laboratory for routine urinalysis and culture. The routine urinalysis is done first, and 3 hours later, the specimen is sent to the microbiology department for culture. The specimen should:
be rejected due to time delay
with time delay, bacteria is multiplying which is not giving an accurate reading for when culture is done
Which of the following urine results is most apt to be changed by prolonged exposure to light
Urine samples should be examined within 1 hour of voiding because
bacterial contamination will cause alkalinization of the urine
The following results were obtained on a urine specimen at 8 AM
If this urine specimen was stored uncapped at 5C without preservation and retested at 2PM, which of the following test results would be changed due to these storage conditions
being uncapped can cause the ketones to evaporate
A urine specimen comes to the laboratory 7 hours after it is obtained. It is acceptable for culture only if the specimen has been stored:
Which of the following would be affected by allowing a urine specimen to remain at room temperature for 3 hours before analysis
A 24 hour urine from a man who had no evidece of kidney impairment was sent to the laboratory for hormone determination. The volume was 600 mL but there was some question as to the completeness of the 24 hour collection. The next step would be to:
check the creatinine level; if it is >1g, do the procedure
Failure to observe RBC casts in urine specimen can be caused by
centrifuging an unmixed specimen
eGFR calculated by the MDRD formula takes into account the age, BUN, race, albumin, and what else for its calculations?
The creatinine clearance is reported in
Microalbumin can be measured by a random urine collection. An increased microalbumin is predictive of
A patient with uncontrolled diabetes mellitus will most likely have
pale urine and high specific gravity
While performing an analysis of a baby's urine, the technologist notices the specimen to have a "mousy" odor. Of the following substances that may be excreted in urine, the one that MOST characteristically produces this odor is:
An ammonia-like odor is characteristically associated with urine from patients who
have an infection with proteus spp.
Urine that develops a port wine color after standing may contain
Acid urine that contains hemoglobin will darken on standing due to the formation of
Urine from a 50 year old man was noted to turn dark red on standing. This change is caused by
The clarity of a urine sample should be determined
following thorough mixing of the specimen
Milky urine from a 24 year old woman would most likely contain
many white blood cells
A brown-black urine would most likely contain
The yellow colorof urine is primarily due to
Red urine may be due to
A urine specimen collected on an apparently healthy 25 year old man shortly after he finished eating lunch was cloudy but showed normal results on a multiple reagent strip analysis. The most likely cause of the turbidity is
In which of the following metabolic diseases will urine turn dark brown to black upon standing
Urine osmolality is related to
Urine specific gravity is an index of the ability of the kidney to
concentrate the urine
Osmolality is a measure of
dissolved particles, including ions
A patient urine sample has an increased protein and a high specific gravity. Which of the following would be a more accurate measure of urine concentration
To prepare a solution appropriate for quality control of the refractometer, a technician should use
sodium chloride with a specific gravity of 1.022
A urine's specific gravity is directly proportional to its
Isosthenuria is associated with a specific gravity which is usually
fixed around 1.010
The fluid leaving the glomerulus normally has a specific gravity of
An antidiuretic hormone deficiency is associated with a
low specific gravity
Use of a refractometer over a urinometer is preferred due to the fact that the refractometer uses
small volume of urine and compensates for temperature
Calibration of refractometer is done by measuring for specific gravity of distilled water and
The method of choice for performing a specific gravity measurement of urine following administration of x-ray contrast dyes is
Which of the following urinary parameters are measured during the course of concentration and dilution tests to assess renal tubular function
osmolality and specific gravity
Refractive index is a comparison of
light velocity in air to light velocity in solutions
Which of the following can give a false-negative urine protein reading
very dilute urine
the pH of a urine specimen measured the
free hydrogen ions
Upon standing at room temperature, a urine pH typically
Urine reagent strips should be stored in a(n)
cool dry area
The principle of the reagent strip test for urine protein depends on:
proper error of indicators
The protein section of the urine reagent strip is MOST sensitive to
Routine screening of urine samples for glycosuria is performed primarily to detect
Which of the following reagents is used to react with ketones in the urine
A test area of a urine reagent strip is impregnated with only sodium nitroprussise. This section will react with
acetoacetic (diacetic) acid
A reagent strip area impregnated with stabilized, diazotized 2,4-dichloroaniline will yield a positive reaction with
Which of the following factors will NOT interfere with the reagent strip test for leukocytes
Excess urine on the reagent strip can turn a normal pH result into a falsely acidi pH when which of the following reagents runs into the pH pad
When employing the urine reagent strip method, a false-positive protein result may occur in the presence of
highly alkaline urine
A 17-year old girl decided to go on a starvation diet. After week 1 of starving herself, what substance would most likely be found in her urine
A 2year old child had a positive urine ketone. This would most likely be caused by
A patient's urinalysis revealed a positive bilirubin and a decreased urobilinogen level. these results are associated with
A urine specimen with an elevated urobilinogen and a negative bilirubin may indicate
Microscopic analysis of a urine specimen yields a moderate amount of red blood cells in spite of a negative result for occult blood using a reagent strip. The technologist should determine if this patient has taken
The purpose for routinely screening diabetes mellitus patients for microalbuminuria is to monitor the development of
The principle of the reagent strip test for microalbuminuria is
a dye-binding reaction
The reason that an albumin creatinine ratio can be run on a random specimen is
creatinine corrects for over or under body hydration
To prepare the reagent used in confirmatory protein testing, a technician would
dissolve 3 g sulfosalicylic acid in 100 mL of water
A positive result for bilirubin on a reagent strip should be followed up by
performing an ictotest
Ammonia sulfate was added to red urine. The urine had a positive reaction for blood, but no RBC's were seen on microscopic examination. After centrifugation the supernatant fluid is red. The abnormal color is caused by
A urine tested with clinitest exhibits a pass through reaction and is diluted by adding 2 drops of urine to 10 drops of water. This is a dilution of
When performing a routine urinalysis, the technologist notes a 2+ protein result. He should:
confirm with the acid precipitation test
The confirmatory test for a positive protein result by the reagent strip methoduses
A urine specimen is analyzed for glucose by a glucose oxidase reagent strip and a copper reduction test. If both results are positive, which of the following interpretations is correct
glucose is present
A woman in her ninth month of pregnancy has a urine sugar which is negative with the urine reagent strip, but gives a positive reaction with the copper reduction method. The sugar most likely responsible for these results is
A urinalysis performed on a 2-week-old infant with diarrhea shows a negative reaction with the glucose oxidase reagent strip. A copper reduction tablet test should be performed to check the urine sample for the presence of
When using the sulfosalicylic acid test, false-positive protein results may occur in the presence of
radiographic contrast media
Which of the following is the primary reagent in the copper reduction tablet
In most compound light microscopes, the ocular lens has a magnification of
The best way to lower the light intensity of the microscope is to
lower the rheostat
The advantage to using phase microscopy in urinalysis is to
enhance to using phase microscopy in urinalysis is to
The presence of leukocytes in urine is known as
Oval fat bodies are
renal tubular epithelial cells that contain lipids
A microscopic examination of urine sediment reveals ghost cells. These RBCs seen in urine with a
specific gravity <1.007
Glitter cells are a microscopic finding of
WBC's in hypotonic urine
Granules in the WBCs exhibit Brownian movement
What cell is MOST commonly associated with vaginal contamination
A reagent strip test for blood has been reported positive. Microscopic examination fails to yield RBCs. This patient's condition can be called
Ghost RBC are seen in urine that is
alkaline and dilute
The possibility of detecting glitter cells is associated with urine that is
An eosinophil count may be requested on urine from a patient with suspected
acute interstitial nephritis
Clue cells are a form of
Squamous epithelial cell
Which of the following cells is most likely to be seen in the urine sediment following a catheterization procedure
A patient admitted following an accident involving massive crush injuries has the following urinalysis results
color: red brown
specific gravity: 1.011
renal tubular epithelial 5-10
renaltubular cell casts 1-2
The discrepancy between the large amount of blood and the absence of RBCs on microscopy is caused by
The presence of myoglobin in the urine specimen
What is the most likely diagnosis given this microscopic finding
Identify the formed elements in this photomicrograph
All casts typically contain
Tubular casts are usually found
under subdued light
Which of the following casts is most likely to be found in healthy people
which of the following casts is most indicative of end stage renal disease
A technologist performed a STAT microscopic urinalysis and reported the following
Hyaline casts 5-7
The centrifuge tube was not discarded and the urine sediment was reevaluated microscopically 5 hours after the above results were reported. A second technologist reported the same results, except 2+ bacteria and no hyaline casts were found. The most probable explanation for the second technologist's findings is
casts dissolved due to increase in urine pH
Which of the following aids in differentiating a spherical transitional cell from a round renal tubular cell
eccentrically-placed nucleus in the renal tubular cell
The urine microscopic constituents that best differentiate between cystitis and pyelonephritis are
Epithelial cell casts are most indicative of
Granular casts found in the urine of a football player admitted to the hospital with a broken leg occurring during the game can be a result of
which of the following casts most frequently appears to have a brittle consistency
To distinguish between a clump of WBCs and WBC cast, it is important to observe
the presence of a cast matrix
Spherical urothelial cells may be confused with
renal tubular epithelial cells
Prior to reporting a red blood cell cast, it is important to observe
In a specimen with a large amount of bilirubin, which of the following sediment constituents would be most noticeable bile-stained
renal tubular epithelial cell casts
What is the most likely diagnosis given this microscopic finding
A white precipitate in a urine specimen with a pH of 7.5 would most probably be causes by
Which of the following is an abnormal crystal described as a hexagonal plate
The primary component of most urinary calculi is
After warming, a cloudy urine clears. This is due to the presence of
Tiny, colorless, dumbell-shaped crystals were found in an alkaline urine sediment. They most likely are
Which of the following crystals may be found in acidic urine
Using polarized light microscopy, which of the following urinary elements are birefringent
Which of the following crystals appear as fine, silky needles
Which of the following crystals is seen in an amber urine with a positive bilirubin
Following ingestion of ethylene glycol (antifreeze) numerous crystals are found in the urine. The shape of these crystals is
cholesterol crystals will most likely be observed in urine that contains
The finding of a large amount of uric acid crystals in a urine specimen from a 6 month old boy:
could indicate Lesch-Nyhan syndrome
The following crystal is found in
alkaline pH and nonpathologic
Identify this crystal
This crystal has many shapes, the main is barrel
alkaline urine showed this microscopic finding
(overcrowded with amorphous phosphates)
dissolve with acetic acid
Polarized light can often be used to differentiate between
fibers and mucous clumps
Which of the following contaminants has a dimpled center and will polarize
The presence of this element in urine indicates the presence of
Identify the formed element in this photomicrograph
triple phosphate crystals next to a highly refractile strand
A technologist is having trouble differentiating between red blood cells, oil droplets, and yeast cells on a urine microscopy. Acetic acid should be added to the sediment to
lyse the red blood cells
A urine specimen is tested and has the following results
many yeast cells
This is indicative of
When identifying urinary crystals, which reagent strip result is most important
Bacteria are considered significant in the urine sediment when the
leukocytes is positive
Which of the following exhibits rapid motolity in urine sediment
Which of the following positive chemical reactions is most closel associated with the presence of yeast in the urine sediment
What of the following is consistent with this urine microscopic finding
A21-year-old woman had glucose in her urine with a normal blood sugar. These findings are most consistent with
A 59-year-oldman is evaluated for back pain. Urine studies (urinalysis by multiple reagent strip) include
rare epithelial cells
Urine protein electrophoresis
monoclonal spike in gamma globulin region
Which of the following statements best explains these results
urine protein is falsely negative because the method is not sensitive for bence-jones protein
The results of a urinalysis on a first morning specimen are
specific gravity 1.024
uric acid crystals
The next step would be to repeat the
pH and microscopic examination
*uric acid crystals are in acidic urine
The following urinalysis results were obtained from an 18 year old woman in labor
protein 30 mg/dL
specific gravity 1.025
Which of the following is the MOST likely explanation for the patient's positive copper reduction test
copper reduction test 1.0 g/dL
glucose and possibly other reducing substances/sugars are present
The following urine results were obtained on a 25 year old female.
specific gravity 1.015
WBC casts 0-3/lpf
These results are most compatible with
*because of the casts
A urinalysis performed on a 27 year old woman yields the following results
specific gravity 1.008
casts/lpf hyaline (5-7), RBC (2-5), granular (2-3)
uric acid crystalks, moderate
These findings are MOST consistent with
glomerulonephritis (rbc casts)
A 62 year old patient with hyperlipoproteinemia has a large amount of protein in his urine. Microscopic analysis yields moderate to many fatty, waxy, granular, and cellular casts. Many oval fat bodies are also noted. This is most consistent with
A patient has 2 separate urinalysis reports, which contain the following data
specific gravity A 1.004; B 1.017
pH A 5.5; B 7.0
protein A negative; B 1+
glucose A negative; B negative
blood A negative; B small
microscopy A rare epis; B 1-2 granular casts, 2-3 hyaline casts, moderate epis
Which of the following statements best explains these results
protein, glucose and microscopy of A are false negatives because of specific gravity
A 4 year old girl develops edema following a recent immunization. Laboratory studies reveal:
serum albumin 1.8g/dL
serum cholesterol 450 mg/dL
serum urea nitrogen 20 mg/dL
urinalysis protein 4+; hyaline, granular and fatty casts
These findings are most compatible with:
minimal change disease
*often follows immunizations or allergic reactions
Aspecimen with a negative nitrate reaction and a positive leukocytes reaction that has WBCs, WBC casts, and no bacteria in the sediment will be seen in cases of
acute interstitial nephritis
urinalysis results on a female patient who brings a urine specimen to the physician's office for her annual physical are:
specific gravity 1.020
urobilinogen 0.2 mg/dL
What action should be taken
ask the patient to collect another specimen at the office
A patient with lupus erythematosus has the following urinalysis results:
specific gravity 1.011
urobilinogen 1.0 mg/dL
casts/lpf hyaline 2-4; rbc 3-5
The sediment of a urine specimen with a reagent strip glucose of 250 mg/dL and a pH of 5.5 is ideal for the presence of
A patient with severe back pain has the following urinalysis results
color dark yellow
specific gravity 1.030
urobilinogen 0.4 mg/dL
squamous epis moderate
calcium oxalate crystals moderate
In addition to the presence of blood, what other reagent strip result relates to the patient symptoms
The normal renal threshold for glucose in the adult is approximately
The volume of urine excreted in 24 hour period by an adult patient was 300 mL. This condition would be termed
normal is 1200
A patient has glucosuria, hyperglycemia, and polyuria. These findings are most consistent with
The normal glomerular filtration rate is
normal urine primarily consists of
water, urea, sodium chloride
An abdominal fluid is submitted from surgery. The physician wants to determine if this fluid could be urine. The technologist should
test for urea and creatinine
Antidiuretic hormones regulates the reabsorption of
Which of the following components are present in serum but NOT present in the glomerular filtrate
large molecular weight proteins
Polyuria is usually correlated with
Cessation of urine flow is defined as
The reason for performing a Clinitest on a newborn urine is to check for
Ketones in urine are due to
incomplete fat emtabolism
Reagent strip tests for ketones measure primarily
bilirubinuria may be associated with
Myoglobinuria is MOST likely to be noted in urine specimens from patients with which of the following disorders
*due to muscle deterioration
A patient with renal tubular acidosis would most likely excrete a urine with a
Glycosuria may be due to
renal tubular dysfunction
The area of the nephron that is impermeable to water is the
ascending loop of henle
the urinary tract structures responsible for renal concentration are the
The most accurate test to determine renal concentration is
Failure of the nephron to produce ammonia will result in urine with a
To avoid falsely elevated spinal fluid cell counts
select an aliquot from the last tube collected
A turbid cerebrospinal fluid is most commonly caused by increased
The normal concentration of proteins in CSF, relative to serum protein, is
To prepare the reagent used for mucin clot determination of synovial fluid, water is mixed with
glacial acetic acid
In addition to the sperm count in a fertility study, analysis of seminal fluid should also include
time of liquification, estimation of motility, morphology
The following lab values were obtained on a body fluid sample
protein 3 g/dL
albumin 2.1 g/dL
hyaluronate 0.4 g/dL
glucose 80 mg/dL
lactate 10 mg/dL
The sample is
urine and CSF are ruled out because of the high protein value. they have values in the mg/dL range not g/dL. Hyaluronate is part of synovial fluid and not pleuralfluid
A physician attempts to aspirate a knee joint and obtains 0.1mL of slightly bloody fluid. Addition of acetic acid results in turbidity and a clot. This indicates that
the fluid is synovial fluid
hyaluronic acid clots in the presence of acetic acid.
hyaluronic acid is part of synovial fluid
Synovial fluid is analyzed with a polarizing microscope. Strongly birefringent needles are seen. This most likely indicates
monosodium urate crystals
A sperm count is diluted 1:20 and 50 sperm are counted in 2 large squares of the Neubauer counting chamber. The sperm count in mLs is
cells x dilution x 10
divided by the number of secondary squares
(50 x 20 x 10)/2= 5,000 x 1000 (to make it in mLs)= 5,000,000
microliters needs to be converted to mLs
The principle mucin in synovial fluid is
The synovial fluid easily forms small drops from the aspirating syringe. This viscosity is
associated with inflammation
*normal will form strand 4-6cm when expressed from the synringe
Pleural transudates differ from pleural exudates in that transudates have
relatively low cell counts
*exudates have higher everything than transudates
Pleural fluid from a patient with congestive heart failure would be expected to
appear clear and pale yellow
Monosodium urate and calcium pyrophosphate dehydrate crystals can be distinguished by using red compensator in a polarizing microscope. When the crystal is aligned with the slow vibration of the compensator, which is true?
MSU are yellow
uric acid produces a yellow color when the crystal is aligned with the compensator but the color is blue when it is perpendicular to the compensator
False-positive results can occur for fecal occult blood due to the ingestion of
*as well as brocccoli, radishes, melons; foods that produce peroxidase
The chromogen for the fecal occult blood test is
A build up of fluid in a body cavity is called
A fluid sample was collected by thoracentesis. A serum sample was collected immediately afterward. The LD fluid to serum ratio was 0.9. there were 5,000 WBC/uL, with 75% PMNs.Which of the following describes this fluid
pleural effusion exudate
Exudate= fluid/serum ratio is >0.6 and the PMNs are> 1000
Ascites is collected by
Amniotic fluid is tested for the concentration of lamellar bodies. This test determines
fetal lung maturity (FLM)
Amniocentesis should be performed to
confirm a high maternal serum alpha-fetoprotein (MSAFP)
A sweat chloride >60 mEq/L (60mmol/L) is indicative of
The most common genetic defect associated with cystic fibrosis is called
The presence of oligoclonal bands in the CSF but not in the serum is associated with
Normal CSF has a relative abundance of which of the following proteins when compared to serum
A CSF was collected from a 5-year-old with a fever, and 3 tubes were transported to the lab. Tube 1 has 50,000RBC/mL and 48WBC/mL. Tube 3 had 10 RBC and 0 WBC/mL. What is the most likely explanation for the discrepancy
An increased IgG index indicates
synthesis of IgG in the CNS
The appearance of normal CSF is
colorless and clear
A CSF was hazy and the WBC was too high to perform undiluted. The technologist took 50 mL of samples and added 500 mL of saline. The cell count on the diluted sample was 200 WBC/mL. This should be multiplied by
The finding of hemosiderin laden macrophage in a CSF sample indicates
Which CSF results are most consistent with bacterial meningitis
Sample Glucose Protein Lactate
A; 20, 50, increased
B; 75, 20, increased
C; 20, 45, decreased
D; 75, 120, decreased
Sample A; 20 glucose, 50 protein, increased lactate
*glucose is decreased in bacterial meningitis
Which of the following is the best indicator of Reye syndrome for CSF
The tau isoform of transferrin is a carbohydrate deficient protein found only in
Which markercan be used to identify a body fluid as semen
Which stain is used to measure sperm viability
*differentiates between live and dead stain
The dimensions of a hemacytometer are
Rapid forward progression of sperm is rated as
Laboratory characteristics of malabsorption syndrome due to pancreatic insufficiently include
increased fecal fat
Pilocarpine iontophoresis refers to the specific process of
During sweat collection, a consideration that can result in a falsely high result is
Methods used as screening tests for cystic fibrosis include
Which pair does not match with respect to amniotic fluid
dark red brown; fetal death
dark green; HDFN
blood streaked; traumatic tap
dark green; HDFN
*dark green is meconium which indicates the fetus' first bowel movement
Amniotic fluid is evaluated using a Liley graph and change in absorbance at 450 nm. What is being evaluated, and why
bilirubin, which increases in HDFN
This is also known as Delta-OD 450
Which assay for fetal lung maturity using amniotic fluid gives a ratio of surfactant to albumin
Triglycerides (chyle) can be identified in body fluids by their ability to
stain with Sudan III
Peritoneal lavage is used to
detect intra-abdominal bleeding in blunt injury
Tumor markers that can be measured on body fluids include allexcept
*not a tumormarker. This is for syphilis.
Which semen result is normal
motility of 1.0
Increased CSF lactate is found in
Decreased CSF protein can be found in
What calculation is used to determine if there is a breach in the blood brain barrier (BBB)
CSF/serum albumin index
Ascaris Lumbricoudes (parasite)
Renal Tubular Epithelial
Renal Tubular Epithelial
Renal Tubular Epithelial
Renal Tubular Epithelial
Epithelial Cast (PCT)
Renal Epithelial Cells
Renal Tubular Cells
Renal Tubular Epithelial Cast
Squamous Epithelial Cells
Squamous Epithelial Cells
Squamous Epithelial CElls
Squamous Epithelial Cell
Sulfonamides (Sulfa Crystals)
Sulfonamides (Sulfa Crystals)
Transitional Epithelial Cells
Transitional Epithelial Cells
Transitional Epithelial Cells
Transitional Epithelial Cells
What is the major functional unit of the kidney?
>2500 mL per day
Clinical significance of polyuria
Diabetes insipidus, diabetes mellitus, diuretics, caffeine, alcohol
<500 mL per day
Clinical significance of Oliguria
Dehydration, vomiting, diarrhea, burns, perspiration
Metabolic waste product produced in the liver from breakdown of protein.
Other organic solids in urine
uric acid and creatine
chloride, sodium, potassium
increases rate of sodium reabsorption
Arginine vasopressin source
posterior pituitary gland
Arginine vasopressin action
reabsorption of water from the distal tubules. Deficiency-diabetes insipidus
stimulates production of erythrocytes
midstream clean catch
Effects of prolonged sitting of specimens
high nitrite (bacterial growth, high pH, turbidity, lower glucose, lower ketones, lower bilirubin, lower urobilinogen, lower cells and casts.
What gives urine it's yellow color?
normal pH of urine
pH 6, random - pH 4.5-8
Hemoglobin, red cells, myoglobin, porphyrin, uroerythin
hemoglobin, red cells., myoglobin
yellow-brown, amber-yellow-green urine
bilirubin, urobilin, pyridium (drug)
bright yellow urine
Dark yellow urine
concentrated specimen, bilirubin, urobilin
methemoglobin, homogentisic acid, melanin
Indican (tryptophane Metabolic Disorder)
Old urine, pseudomonas
Port wine urine
Why would urine be alkaline?
sitting at room temp for too long or right after eating (vegetarian)
why would urine be acidic?
metabolic or respiratory acidosis, high protein diet, cranberry juice
simplest way to check the concentration function of the tubules
Specific gravity range
1.002 - 1.035
High specific gravity
large amounts of glucose, dilute 1:2 with distilled water
low insulin, polyuria, polydipsia, high SG, high Ketones
low ADH, polyuria, polydipsia, low SG, normal glucose, normal ketones
0.1 EU - normal, high in hemolytic disease, high in liver disease, and negative in obstruction.
normal - 0, 0 in hemolytic disease, 0 or high in liver disease, high in obstruction
2 indicators. Alkaline urine may have sat too long or collected after eating.
Error if pH is too high, or there is high salt. High protein is the first indicator of disease and can be high in strenuous exercise.
Glucose oxidase method. False positive with bleach. False negative with ketones, high SG, low pH, and ascorbic acid. Diabetes Mellitus
Sodium nitroprusside and ketones make a purple color. False positive with highly pigmented urine. False negative with ascorbic acid and high SG. Uncontrolled diabetes mellitus, high protein diet, dehydration
peroxide and blood yields O2, O2 makes a color change. false positive with bleach. False negative with ascorbic acid, ketones, high SG with low pH. Myoglobin, hemoglobinuria, hematuria.
diazonium salt and bilirubin make a bluish color. False positive with medication color. False negative with ascorbic acid, high SG, and nitrites. Indictates bile duct obstruction and liver damage.
Ehrlich's Reaction. Peach to pink color. False positive with highly pigmented urine. False negative with nitrites. Indicates liver damage or hemolytic anemias.
nitrite + amine reagent = diazo compound
Diazo compound + 3-hydroxy-1,2,3,4 Tetrahyrdobez-(h)-quinolin = pink color. False positive with medication color. False negative with ascorbic acid. Indicates bacteria
leukocyte esterase splits ester to form pyrole compound. Pyrole compound + diazo reagent = purple color. False positive with bleach. False negative with Glucose, protein, high SG, and some antibiotics. Indicates WBC in urine.
Specific gravity dipstick
pKa change of polyelectrolyte. False positive with protein. False negative with alkaline urine. Indicates diabetes insipidus and radiopaque dye.
Sudan III or Oil Red O- confirms the presence of fat or triglyceride
Normal urine sediment constituents
0-2 hyaline casts/lpf
Abnormal urine constituents
Red cells- glomerular damage or menstrual contamination
White Cells- May indicate inflammation or infection (pyuria)
Casts- formed in the lumen of the distal convoluted tubule and collecting duct. Uromodulin.
Factors that influence cast formation
high solute conc
primarily uromodulin protein
red cell cast
indicates bleeding from the nephron. solid mass of tightly packed red cells. Intrinsic renal disease.
white cell cast
inflammation or infection of the nephron. Associated with pyelonephritis.
disintegration of cellular casts
waxy cast- older hyaline cast
indicates prolonged urinary stasis, considered renal failure casts
breakdown of epithelial cell casts that contain oval fat bodies
Form in collecting ducts that have become dilated. All types of cast can be broad casts.
How are crystals formed?
by the precipitation of urine solutes subjected to a change in pH, temperature and concentration.
Normal Crystals acidic urine
Calcium oxalate (may be seen in antifreeze poisoning)
Normal Crystals alkaline urine
Amorphous phosphates- White
Triple phosphate (coffin lid)
Calcium carbonate (dumbbell)
Bilirubin- small clusters of fine needles
Cystine- colorless hexagonal plates
Cholesterol- rectangular plates with notched corners
Leucine- yellow-brown spheres with concentric circles
Tyrosine- fine, delicate needles
Sulfonomide- needles or brown spheres
Radiographic dye- plates
Conditions that may contain inclusion bodies
Herpes, Rubella, CMV (Large intranuclear inclusions), lead poisoning, hemosiderin, hemochromatosis
What does hCG stand for?
Human Chorionic Gonadotropin
What is hCG?
a glycoprotein composed of alpha and beta subunits, is secreted by the placenta. Confirms pregnancy.
Renal function tests
used to test for glomerular filtration and tubular function.
Tests for glomerular function
clearance tests, B2 microglobin, cystatin C
Creatinine clearance test
assesses glomerular filtration rate. 24 hr urine.
Normal range for CC
120 ml/min for adults. Decreases with age.
useful marker of renal tubular function. Increased plasma concentrations indicate reduces GFR
May provide an equal or better detection of adverse changes in GFR, higher cost
Reasons for analysis of CSF
meningitis, encephalitis, syphilis, brain abcess/tumor, intracranial hemorrhage, leaukemia/lymphoma with CNS involvement.
Distribution of CSF tubes
Tube #1- Chemistry and serology
Tube #2- microbiology
Tube #3- Hematology
Lab results for bacterial meningitis
Really High protein, low glucose, Neutrophils, and high lactate
Lab results for viral meningitis
High protein, normal glucose, lymphocytes, normal lactate
Lab results for fungal meningitis
High protein, normal to low glucose, lymphocytes and monocytes, high lactate
Characteristics of a traumatic tap
first tube has more blood, supernatant is clear, clots due to fibrinogen
Characteristics of cranial hemorrhage
all tubes have blood, supernatant is xanthochromic, no clots
Reasons for semen analysis
infertility, post vasectomy, forensic medicine (presence of acid phosphatase confirms semen)
Reasons to analyze serous fluid
Sepsis, malignancy, systemic disease
Reasons to analyze synovial fluid
sepsis, hemorrhage, crystal induced inflammation (gout or pseudogout)
Characteristics of Transudate
Colorless, Clear, Watery, SG <1.015, Protein < 3g/dl, Lactic dehydrogenase < 200UL, Cell Count <1000/ul, High associated with congestive heart failure, changes is hydrostatic pressure
Characteristics of exudate
Yellow-white, red-brown, yellow-brown, milky green. Cloudy, viscous. SG > 1.015. Protein > 3 g/dl. lactic dehydrogenase > 200 IU. Cell count > 1000/ul. High associated with infections and malignancies.
build up of fluid in a body cavity due to a pathologic process
Reasons to analyze amniotic fluid
fetal well-being, fetal lung maturity
Fetal lung maturity tests
Lecithin/sphingomyelin (L/S) ratio measures the phospholipids lecithin and sphingomyelin to assess fetal lung maturity. Ratio is > 2.0, fetal lungs are usually mature
Lipid component of pulmonary surfactants. Detected at 35 weeks gestation. Absence does not rule out mature lungs.
Lamellar body counts
Secreted into alveolar lumen at 20-24 weeks of gestation. Amniotic fluid is analyzed on instrument using platelet count.
High is associated with neural tube disorders such as spina bifida
Amniotic fluid test for bilirubin
Reliable estimate of fetal red cell distruction due to maternal antibody.
High sodium and chloride confirms diagnosis of cystic fibrosis
Which statements regarding renal function is true?
Glomeruli are far more permeable to H2O and salt than other capillaries
Which statement regarding normal salt and h2o handling by the nephron is correct?
The ascending limb of the tubule is highly permeable to salt but not H2O
Which statement concerning renal tubular function is true?
In salt deprivation, the kidneys will conserve sodium at the expense of potassium
Which of the following is inappropriate when collecting urine for routine bacteriologic culture?
The sample may be held at 2 degrees for up to 48 hours prior to plating
Which statement about sample collection for routine urinanalysis is true?
Samples may be stored at room temperature for up to 2 hrs
Which urine color is correctly correlated with the pigment-producing substance?
Deep yellow urine and yellow foam with bilirubin
which of the following conditions is associated with normal urine color but produces red fluorescence when urine is examined with an ultraviolet lamp?
Which statement regarding porphyria is accurate?
serum, urine, and fecal tests may be needed for diagnosis
Which is the most common form of porhyria?
Porphyria cutanea tarda
Which of the following methods is the least sensitive and specific for measuring PBG in urine?
A brown or black pigment in urine can be caused by
Urine that is dark red or port wine in color may be caused by
Porphyria cutanea tarda
Which of the following tests is affected least by standing or improperly stored urine
Which type of urine sample is needed for a D-xylose absorption test on an adult patient?
5-hour timed urine kept under refrigeration
Which of the following is inappropriate when collecting a 24 hour urine sample for catecholamines?
Ten mL of 1N sodium hydroxide should be added to the ocntainer before collection
Urine production of less than 400 mL/day is
Which of the following contributes to SG but not to osmolality?
Urine with a SG consistently between 1.002 and 1.003 indicates
In which of the following conditions is the urine SG likely to be below 1.025?
Chronic renal failure
Which statement regarding methods for measuring SG is true?
To correct a urinometer, subtract 0.001 per each 3 degrees below 15.5 degrees celcius.
What is the principle of the colormetric reagent strip determination of SG in urine?
Ionic strength alters the pKa of a polyelectrolyte
Which statement regarding urine pH is true?
Contamination should be suspected if urine pH is less than 4.5
in renal tubular acidosis, the pH of urine is
The normal daily urine output for an adult is approx
the SG of the filtrate in bowman's space is approx
A patient with partially compensated respiratory alkalosis would have a urine pH of
Which of the following is most likely to cause a false-positive dry reagent strip test for urinary protein?
Highly buffered alkaline urine
When testing for urinary protein with SSA, which condition may produce a false-positive result?
The presence of x-ray contrast media
A discrepancy between the urine SG determined by measuring refractive index and urine osmolality would be most likely to occur
After an intravenous pyelogram
Which of the following is likely to result in a false negative dry reagent strip test for proteinuria?
Daily loss of protein in urine normally does not exceed:
Which of the following is least likely to cause a false-positive result with turbidimetric protein tests?
Which statement best describes the clinical utility of tests for microalbuminuria?
Testing may detect early renal involvement in diabetes mellitus
Dry reagent strip tests for microalbuminuria that compare albumin to creatinine determine the creatinine concentration based upon which principle?
Formaiton of a Cu2+-creatinine complex
Which of the following conditions is least likely to be detected by dry reagent strip tests for proteinurina?
Renal tubular proteinuria
The normal renal threshold for glucose is
In which of the following conditions is glycosuria most likely?
In addition to ascorbate, the glucose oxidase reaction may be inhibited by which substance?
Acetoacetic acid (AAA)
A positive glucose oxidase test and negative test for reducing sugars indicates
A negative glucose oxidase test and a positive test for reducing sugars in urine indicates:
The presence of nonglucose reducing sugar such as galactose
In what condition may urinary ketone tests underestimate ketosis
AAA is detected in urine by reaction with
Nondiabetic ketonuria can occur in all of the following except?
Which statement regarding the classical nitroprusside reaction for ketones is true?
It may be falsely positive in PKU
hemoglobin in urine can be differentiated from myoglobin using
80% ammonium sulfate to precipitate hemoglobin
Which of the conditions is associated with negative blood test and an increase in urine urobilinogen?
Extravascular hemolytic anemia
WHich statement about the dry reagent strip blood test is true?
Abnormal color may be absent from the urine when the reaction is positive
A moderate-positive blood test and trace protein test are seen on the dry reagent strip, and 11-20 red blood cells per HPF are seen in the microscopic exam. These results are most likely caused by which of the following?
Recent urinary tract catheterization
Which of the following results are discrepant?
Negative blood but 6-10 RBCS/HPF
Which of the following statements regarding the dry reagent strip test for bilirubin is true?
The test detects only conjugated bilirubin
Which of the reagents is used to detect urobilinogen in urine?
Which of the following statements regarding urinary urobilinogen is true?
Dry reagent strips do not detect decreased levels
Which of the following statements regarding the test for nitrate in urine is true?
the test is dependent upon adequate dietary nitrate content
Which statement about the dry reagent strip test for leukocytes is true?
The reaction is based upon the hydrolysis of substrate by WBC esterases
Which of the following statements about creatinine clearance is correct?
Creatinine clearance is dependent upon lean body mass
A male patient's eGFR is 75 mL/min. this indicates
Reduced glomerular filtration without uremia
Which of the following tests is a specific measure of glomerular filtration?
Which statement regarding urea is true?
Urea is 100% filtered by the glomeruli
Which of the following dyes are used int Sternheimer-Malbin stain?
Crystal violet and safranin
Which of the following statements regarding WBCs in urinary sediment is true?
WBC casts indicated that pyuria is of renal rather than lower urinary
Which description of sediment with sternheimer-malbin stain is correct?
Transitional epithelium: Cytoplasm pale blue, nucleus dark blue
Which of the following statements regarding epithelial cells in the urinary system is correct?
Transitional cells originate from the upper urethra, ureters, bladder, or renal pelvis
Which of the statements regarding examination of unstained sediment is true?
Large numbers of transitional cells are often seen after catheterization
Which of the following statements regarding cells found in urinary sediment is true?
Renal tubular cells are often polyhedral and have eccentric nucleus round nucleus
Which of the following statements regarding RBCs in the urinary sediment is true?
RBCs of glomerular origin often appear dysmorphic
Renal tubular epithelial cells are shed into the urine in largest numbers in which condition?
Cytomegalovirus infection of the kidney
The ova of which parasite may be found in the urinary sediment?
Oval fat bodies are often seen in
All of the following statements regarding urinary casts are true except
Casts can be seen in significant numbers even when protein tests are negative
Which condition promotes the formation of casts in urine
reduced filtrate formation
The mucoprotein that forms the matrix of a hyaline cast is called
Pseudocasts are often caused by
Which of the following statements regarding urinary casts is correct?
Broad casts are associated with severe renal tubular obstruction
A sediment with moderate hematuria and RBC casts most likely results from
Urine sediment characterized by pyuria with bacterial and WBC casts indicates
Which type of casts signals the presence of chronic renal failure
When examining urinary sediment, which of the following is considered an abnormal finding?
0-1 renal cell casts per LPF
How can hexagonal uric acid crystals be distinguished from cystine crystals?
Cystine gives a positive nitroprusside test after reduciton with sodium cyanide
The presence of tyrosine and leucine crystals together in urine sediment usually indicated
Chronic liver disease
Which of the following crystals is considered nonpathogenic?
At which pH are ammonium biurate crystals usually found in urine?
Alkaline urine only
Which of the following urine crystals is seen commonly in alkaline and neutral urine?
magnesium ammonium phosphate
Which crystal appears in urine as a long, thin hexagonal plate and is linked to ingestion of large amounts of benzoic acid?
Small yellow needles are seen in the sediment of a urine sample with a pH of 6.0. Which of the following crystals can be ruled out?
Oval fat bodies are derived from
Renal tubular epithelium
Oval fat bodies are often associated with
Urine of constant SG ranging from 1.008-1.010 most likely indicates
Renal tubular failure
Which of the following characterizes prerenal failure, and helps to differentiate it from acute renal failure caused by renal disease?
BUN:creatinine ratio of 20:1 or higher
Which of the following conditions characterizes chronic glomerulonephritis and helps to differentiate it from acute glomerulonephritis?
Which of the following conditions is seen in acute renal failure and helps to differentiate it from prerenal failure?
Abnormal urinary sediment
Which of the following conditions characterizes acute renal failure and helps to differentiate it from chronic renal failure?
the serum concentration of which analyte is likely to be decreased in untreated cases of acute renal failure?
Which of the following conditions is associated with the greatest proteinuria?
Which of the following conditions is often a cause of glomerulonephritis?
Systemic lupus erythematosus
Acute pyelonephritis is commonly caused by
Bacterial infection of medullary interstitium
All of the following are common characteristics of the nephrotic syndrome except
hematuria and pyuria
Which of the following conditions is a characteristic finding in patients with obstructive renal disease?
Whewellite and weddellite kidney stones are composed of
Which of the abnormal crystals is often associated with formation of renal calculi?
Which statement about renal calculi is true?
Calcium oxalate and calcium phosphate account for about three-fourths of all stones
CSF is formed by ultrafiltration of plasma through the
Which statement regarding CSF is true?
Normal values for mononuclear cells are higher for infants than adults
When collecting CSF, a difference between opening and closing fluid pressure greater than 100 mm H2O indicates
Low CSF volume
Which of the following findings is consistent with a sub arachnoid hemorrhage rather than traumatic tap?
The term used to denote a high WBC count in the CSF is
which of the following conditions is most often associated with normal CSF glucose and protein?
The diagnosis of multiple sclerosis is often based upon which finding
The presence of oligoclonal bands by electrophoresis
Which of the results is consistent with fungal meningitis?
Pleocytosis of mixed cellularity
In what suspected condition should a wet prep using a warm slide be examined?
Which of the following CSF test results is most commonly increased in patients with multiple sclerosis
Which of the following is an inappropriate procedure for performing routine CSF analysis?
A differential is done only if the total WBC count is greater than 10/uL
Which cell is present in the CSF in greater numbers in newborns than in older children or adults
Neutrophilic pleocytosis is usually associated with all of the following except
Which statement about CSF protein is true?
CSF IgG is increased in panencephalitis
Which of the following statements regarding routine microbiological examination of CSF is true?
All CSF specimens should be cultured using BAP, CAP, and supplemented broth
Which organism is the most frequent cause of bacterial meningitis in neonates?
Group B streptococcus
Following a head injury, which protein will identify the presence of CSF leakage through the nose?
Which of the following statements regarding serous fluid is true?
Mesothelial cells, PMNs, lymphocytes, and macrophages may be present in normal fluids
The term effusion refers to
An increased volume of serous fluid
which of the following laboratory results is characteristic of a transudative fluid?
LD fluid/Serum ratio = 0.25
Which observation is least useful in distinguishing a hemorrhagic serous fluid from a traumatic tap?
the formation of a clot
Which of the following laboratory results on a serous fluid is most likely to be caused by a traumatic tap?
An RBC count of 8,000
Which of the following conditions is commonly associated with an exudative effusion?
Which of the following conditions is associated with a chylous effusion?
Which of the following conditions is most often associated with a pleural fluid glucose below 30 mg/dL
In which conditions is the pleural fluid pH likely to be above 7.3?
Which of the following hematology values best frames the upper reference limits for peritoneal fluid?
WBC: 300, PMNs- 25%, RBC count-100,000
Which of the following characteristics is higher for synovial fluid than for the serous fluids
In which type of arthritis is the synovial WBC count likely to be greater than 50,000?
What type of cell is a "ragocyte"
A PMN iwth inclusions formed by immune complexes
Which of the following crystals is the cause of gout
Uric acid or monosodium urate
Which of the crystal causes pseudogout
In which condition is the synovial fluid glucose most likely to be within normal limits
Which statement about synovial fluid in RA is true
Synovial/serum IgG is usually 1:2 or higher
Which of the following organisms accounts for the majority of septic arthritis cases in young and middle aged adults?
Which of the following hematology values best frames the upper reference limits for synovial fluid?
WBC 200, 25% PNMs, RBC 2,000
Which of the following statements about amniotic fluid bilirubin measured by scanning spectrophotometry is true?
The 410 nm peak is due to hemoglobin and the 450 nm peak is due to bilirubin
Which test best correlates with the severity of HDN?
Amniotic fluid bilirubin
Which is the reference method for determining fetal lung maturity?
Which of the following statements regarding the L/S ratio is true?
A ratio of 2:1 or greater usually indicates adequate pulmonary surfactant to prevent respiratory distress syndrome
Which of the following conditions is most likely the cause a falsely low L/S ratio?
Centrifugation at 1,000 for 10 minutes
Which of the following statements accurately describes hCG levels in pregnancy?
In ectopic pregnancy, serum hCG doubling time is below expected levels
Which of the following statements regarding pregnancy testing is true?
A false-positive result may occur in patients with heterophile antibodies
Most cases of Downs syndrome are the result of
Nondisjunction of Chromosome 21 (G trisomy)
Which assay result is often approximately 25% below the expected level in pregnancies associated with Down syndrome?
Serum unconjugated estriol
Which of the following statements about AFP is correct?
Maternal serum may be used to screen for open neural tube defects
First trimester screening for Downs syndrome can be performed using which markers?
Free beta hCG and pregnancy-associated plasma protein A
When performing marker screening tests for Down syndrome, why are results expressed in multiples of the median (MoM) rather than concentration?
MoM normalizes for gestational age
Which statement regarding the fetal fibronectin test is true?
The test should not be performed before week 24 or after the end of week 34
what is the term for sperm when the anterior portion of the headpiece is smaller than normal?
What is the most common cause of male infertility
Which of the following values is the lower limit of normal for sperm concentration
15 million per mL
Which morphological abnormality of sperm is most often associated with varicocele?
Tapering of the head
which of the following stains is used to determine sperm viability?
Which of the following semen analysis results is abnormal?
Volume 1.) mL
Which of the following sample collection and processing conditions will lead to inaccurate seminal fluid analysis results?
Sample collected following coitus
When performing a seminal fluid analysis, what is the upper limit of normal for WBCs?
1 x 10^6/mL
Which carbohydrate measurement is clinically useful when performing a seminal fluid analysis?
Which condition is most often associated with gastric ulcers
H. pylori infection
In which condition is the highest level of serum gastrin usually seen?
In determining free HCl, The gastric fluid is titrated to pH
Which test can identify persons with gastrin-secreting tumors who do not demonstrate a definitively increased plasma gastrin
Which of the following tests would be normal in pancreatic insufficiency?
Which of the following is commonly associated with occult blood?
Which test is most sensitive in detecting persons with chronic pancreatitis?
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