BOC: Urinalysis / Body fluids / Lab management
For BEST results, if not tested immediately, a semen sample should remain at which of the following temperatures following collection?
37 ºC helps to maintain sperm integrity tested within 1 hour
According to the lower normal reference limit stated by WHO, which of the following sperm concentrations would be considered abnormally low?
5 x 106 spermatozoa/mL RR: 15 - 200 million
A technologist performed a STAT spinal fluid count by pipetting undiluted spinal fluid in a Neubauer Counting Chamber and counting both sides of the chamber (4 large WBC squares on each side). A total of 54 White Cells were counted. How many White Cells would there be per cubic millimeter?
67.5 WBC/µL= Avg # cells counted /(# squares counted x 0.1) WBC = 54 / (8 squares x 0.1) = 67.5/µL
What is generally accepted as the lower threshold value for semen pH from fertile males?
7.2 7.2-8
Lab management: Your laboratory has 17,264 hours of total paid labor time. Of this amount, 1458 hours are nonproductive. If your employees work 40-hour work weeks each year, what is the total number of FTEs (full-time equivalents) needed to run the laboratory?
8.3 FTEs Calculation = 17,264 hours paid for labor / 2080 hours per person = 8.3 FTEs
Lab management: Each day, laboratorians must evaluate the quality of samples submitted to the laboratory for analysis, specifically to help prevent pre-analytical errors
A-lipemic: serum appears milky or opaque, high concentration of lipids in the blood B-hemolyzed: appears pinkish/red in color, rupture of RBC, irregular blood drawing C-normal: straw-colored, yellow color D-icteric: dark yellow, elevated bilirubin, improper clearance of bilirubin can result in hyperbilirubinemia
Which of the following would be the most characteristic finding in synovial fluid in a case of pseudogout?
Calcium pyrophosphate crystals endocrine disorder, high levels of calcium, also degenerative arthritis producing cartilage calcification Monosodium urate crystals: gout WBC seen in viral or bacterial infections macrophages in viral infections, but usually normal
Lab management: What type of policy is required by OSHA for every laboratory that uses hazardous chemicals?
Chemical hygiene plan
Which of the following areas of the brain and spinal cord is responsible for producing CSF?
Choroid plexuses CSF flows through the subarachnoid space dura mater is part of the meninges CSF is reabsorbed back in the blood capillaries in the arachnoid granulations
Urine RR:
Color - Yellow (light/pale to dark/deep amber) Clarity/turbidity - Clear or cloudy pH - 4.5-8 Specific gravity - 1.005-1.025 Glucose - ≤130 mg/d CSF glucose - 2/3 of glucose Ketones - None Nitrites - Negative Leukocyte esterase - Negative Bilirubin - Negative Urobilirubin - Small amount (0.5-1 mg/dL) Blood - ≤3 RBCs Protein - ≤150 mg/d RBCs - ≤2 RBCs/hpf WBCs - ≤2-5 WBCs/hpf Squamous epithelial cells - ≤15-20 squamous epithelial cells/hpf Casts - 0-5 hyaline casts/lpf Crystals - Occasionally Bacteria - None Yeast - None
Lymphocyte pleocytosis refers to a(n) _____________ in a CSF when compared to a normal sample
Increased number of lymphocytes lymphocytes:monocytes 70:30 in adults 30:70 in children
What type of white blood cell is seen MOST frequently in urine sediment with infections of the urinary system?
Neutrophil urinary bacterial infections Eosinophil: drug-induced interstitial nephritis Lymphocyte and Monocyte: early stages of renal transplant rejection
To screen for urinary tract infections, leukocyte esterase results should be evaluated along with the results from which of these other reagent strip tests?
Nitrite help to detect the presence of gram-negative bacteria
All of the following are methods employed for measuring the specific gravity of urine, EXCEPT?
Osmolality dependent on the number of particles of solute in a unit of solution measured by freezing point depression Refractometry, Hydrometry, and Urine reagent strips all are
A patient with suspected intraabdominal malignancy had a paracentesis procedure performed. The fluid was then sent to the laboratory for examination and fluid differential. perinuclear hof seen
Plasma cells plasma cell malignancy in the abdominal cavity or stressful conditions
When a patient has a bile duct obstruction, the bilirubin test portion of the reagent strip is:
Positive because conjugated bilirubin is present and is excreted by the kidneys. Unconjugated bilirubin: RBC breakdown, not able to be excreted from the kidneys, not cause a positive urine bilirubin
Which of the following macroscopic findings is MOST consistent with the microscopic finding of casts?
Positive protein Decreased pH Decreased urinary flow rate Increased urine concentration
The primary site of reabsorption of glomerular filtrate is the:
Proximal convoluted tubule convoluted portion of the nephron reabsorption of glucose, amino acids, sodium, and chloride; active transport water and urea; passive transport Loop of Henle: u shaped, Water, sodium, and urea; passive transport and descending, chloride; active transport and ascending distal convoluted tubule: final concentration of urine begins, aldosterone controls the reabsorption of sodium, body need for sodium collecting duct: final concentration of urine, depends on the osmotic gradient, ADH
Which of the following tests require a 72-hour stool (fecal) collection?
Quantitative fecal fat refrigerated Occult blood, O & P, and stool culture testing on random
A 1:10 dilution is made on a CSF sample. Five squares on each side of the hemacytometer are counted for a total of 10 squares and a total of 150 cells are recorded. What is the count per microliter?
1500 #cells counted x dilution / #large squares x 0.1
A dilution commonly used for a routine sperm count is:
1:20
Lab management: In absorbance spectrophotometry:
Absorbance is directly proportional to the concentration measures the amount of light transmitted through a solution analyzing the pattern of wavelengths absorbed by a given sample
Lab management: Which of the following statements regarding a biomarker with high sensitivity is TRUE?
Accurately identifies the presence of disease and has few false negatives sensitivity specificity: probability or likelihood that only patients with the disease will test positive for the disease
The ketone component that is measured by the nitroprusside reaction is:
Acetoacetic acid purple to violet
A clean-catch midstream urine specimen from a 57-year-old woman was sent to the microbiology laboratory for culture. The patient had a history of fever, chills, and flank pain upon examiation. The urine grew out 10,000 cfu/mL of Escherichia coli. Which of the following categories would the patient be classified?
Acute, uncomplicated pyelonephritis <10 WBC common UTI Acute, uncomplicated UTI in women: dysuria, urgency, frequency, suprapubic pain, no urinary symptoms prior, >1,000 cfu/mL, >10 WBC
Which one of the following proteins in cerebrospinal fluid (CSF) is used to monitor the integrity of the blood-brain barrier?
Albumin ordinarily it is not found to any great extent in the central nervous system
Which protein is represented by the band labeled by the number 4 on the SPE scan? (cathode to anode; 1 to 4)
Albumin closest to the anode (+) migrates the fastest cathode to anode: slowest to fastest gamma, beta, alpha 2, alpha 1, albumin
Which of the following substances are detected with Clinitest® tablets?
All reducing substances Benedict's copper reduction reaction screening for inborn metabolic problems galactosemia
Lab management: The product produced in amplification is termed:
Amplicon Codon: three nucleotide base sequence coding for amino acid Nucleic acid: polymer made of monomers such as RNA Translation: mRNA is decoded to produce amino acid chains
Serous fluid effusions may result from all of the following EXCEPT:
Dehydration fluid build-up between the membranes where serous fluid is produced Congestive heart failure, infection, and inflammation, and malnutrition all causes
Lab management: The number of patients correctly diagnosed for the disease or not having the disease is defined as:
Efficiency used in addition to the sensitivity and specificity diagnostic value predictive values: ability of a method to correctly determine the presence of disease Sensitivity: probability only pts will test pos
The lecithin to sphingomyelin ratio (L/S) is used to assess:
Fetal lung maturity above 2:1 indicates mature lung development
Significantly increased levels of ketones are typically detected in the urine with all of the following conditions, EXCEPT?
Following a low-impact exercise routine Ketones are intermediate products of fat metabolism in: diabetic acidosis, excessive carbohydrate loss, and starvation
Which of the following conditions will cause a positive reagent strip blood result due to hematuria?
Glomerulonephritis also renal calculi, and pyelonephritis
Nitrates in urine are reduced to nitrites by:
Gram-negative bacteria prolonged urinary retention in the bladder is necessary to obtain result Gram-positive bacteria, yeast, and acid fast bacteria doesnt have enzyme reductase
A spectrophotometric scan of amniotic fluid may be valuable in the determination of which of the following conditions:
HDN Amniotic fluid bilirubin is elevated 450nm
A urine sample is cloudy pink in appearance. The microscopic examination reveals the presence of intact red blood cells. The term used to describe these findings is:
Hematuria associated with bleeding in the kidneys or urinary tract Oliguria: less than 400 mL/day Myoglobinuria: myoglobin in urine, due to muscle destruction, clear red-brown urine
A reagent strip test for hemoglobin has been reported positive. Microscopic examination fails to yield red blood cells. This patient's urine condition can be called:
Hemoglobinuria red cells have lysed and released their intracellular hemoglobin no see in microscopic examination urine strip detects hemoglobin hemolytic anemia and severe burns Hemosidenuria: denatured ferritin
Lab management: The usual radiation source in atomic absorption instruments is the:
Hollow cathode lamp filled with argon or neon gas cylindrical metal cathode; containing the metal for excitation and an anode gas particles are ionized w/ high voltage Deuterium provides UV radiation
A technologist performed urine microscopic testing on a patient who submitted a urine sample following strenuous exercising. Which of the following casts is most likely to be found in this urine sample?
Hyline casts strenuous exercising, dehydration, heat exposure, and emotional stress White cell casts: renal infection or inflammation; pyelonephritis. Granular casts: plasma protein aggregates and cellular remnants. Waxy casts: chronic renal failure
Which one of the following statements concerning Tamm-Horsfall protein is FALSE?
It is the protein that is predominantly detected by a urine reagent strip test. albumin (highest conc in body) not tamm-horsfall protein in the urine (proteinuria): renal disease glomerular membrane prevents the passage of high molecular weight proteins "protein error of indicators" produced by the tubules acts as a coating and lubricant in the tubules Hyaline casts are formed by this in distal tubule
The glucose result on a urine specimen from an infant is negative on the urine chemical reagent strip, what is the next step?
It must be followed by the copper reduction test (Clinitest®) to check for other reducing substances. used to check for other reducing substances reagent tablet based on Benedict's copper reduction reaction screening for inborn metabolic problems; galactosemia Acetest®: confirmatory test for ketones
White blood cell casts are MOST likely to indicate disease of the:
Kidney pyelonephritis also could be in glomerulonephritis, interstitial nephritis, and lupus nephritis
Lab management: If CSF tubes numbered #1, #2 and #3 CANNOT be analyzed within one hour, the correct procedure for the microbiology sample tube is to:
Leave it at room temperature -refrigerating, freezing, or incubating the specimen at 56 degrees will destroy Neisseria meningitides -sample should not be thrown away -Tube #1: chemistry or serological - stored frozen. -Tube #2: microbiology testing - at room temperature. -Tube #3: cell count in hematology - stored in the refrigerator.
All of the following crystals are found in normal urine, EXCEPT?
Leucine maple syrup urine disease Calcium oxalates are normal w/ varying pH Ammonium biurate and triple phosphate in normal alkaline
The image is a stained smear of cerebrospinal fluid. (large amount of cytoplasm and the vacuoles)
Macrophages normal cells in CSF
A patient presents to his family doctor with respiratory issues. He has a history of being a heavy smoker for more than 20 years, so the physician orders a BAL cell count with differential. Which of the following cells would most closely correlate with the patient's medical history?
Macrophages with purple/black inclusions heavy smoker for more than 20 years cells contain hemosiderin aka siderophages Macrophages with phagocytized red blood cells - removal in spleen Macrophages with phagocytized bacteria - bacterial infection
A typical Bronchoalveolar lavage differential contains all the cells EXCEPT:
Mesothelial cells -lining cells for serous fluids -typical include ciliated lining cells, macrophages, and lymphocytes
Monocytes, Macrophages, Mesothelial cells, or Lymphocytes?
Monocytes: large, convoluted nuclei and large cytoplasms, not really in CSF, sometimes in meningitis Macrophages: not seen in CSF, in meningitis, large w/ abundant cytoplasm Mesothelial cells: not in CSF, sometimes hard to differentiate w/ macrophages Lymphocytes: condensed chromatin and scant blue cytoplasm, increased with viral infections or meningitis
Which of the following conditions is most likely when an oligoclonal band is seen in CSF electrophoresis without a corresponding serum peak?
Multiple sclerosis gamma region of CSF electrophoresis (+) IgG also: inflammatory conditions, Guillain-Barre syndrome, bacterial meningitis, viral encephalitis, neurosyphilis, and subacute sclerosing panencephalitis
A 41-year-old man is admitted to the hospital complaining of a decreased frequency of urination, a constant bloated feeling, weight gain, and mild edema of the ankles and eyes. Urinalysis results are as follows: Color: pale yellow Clarity: clear pH: 5.0 SG 1.010 Glucose: 2+ Ketones: negative Protein- 3+ Blood: moderate Bilirubin: negative Bacteria: negative Urobilinogen: normal Nitrate: negative **A large amount of white foam was noted. Microscopic Results: RBCs 0-2 WBCs 0-2 Casts: 2-5 hyaline, 0 - 3 fatty casts, 0 - 2 waxy casts Few transitional epithelial cells Few oval fat bodies
Nephrotic syndrome damage to the kidneys; basement membrane of the glomerulus abnormal excretion of protein and red blood cells fats present foamy appearance of urine Oval fat bodies Fatty and waxy casts Renal tubular epithelial cells heavy protein Swelling Weight gain from fluid retention Poor appetite High blood pressure
Glitter cell is a term used to describe a specific type of:
Neutrophil exposed to hypotonic urine absorb water and swell Brownian motion ketones: cells don't get enough carbohydrates, use fats and proteins Oval fat bodies: lipid, RTE bacteria: UTI
Red blood cells (RBCs), White blood cells (WBCs), Yeast cells, or Squamous epithelial cells in urine sediment (using phase-contrast microscopy)?
Red blood cells (RBCs): slightly smaller than WBCs, smooth White blood cells (WBCs): rough appearance, contain granules, multilobed nuclei Yeast cells: oval, budding yeast, severe infections Squamous epithelial cells: large, sometimes clumps, irregular-shaped cytoplasm, prominent centrally located nucleus
The oxidation of hemoglobin to methemoglobin in acidic urine after several hours may cause which of the following color to produce?
Red to brown porphobilinogen, hematuria, myoglobinuria, etc. White: phosphates, other crystals Yellow: bilirubin, bile pigments Blue-green: Bacterial infections including urinary tract infection (UTI) by Pseudomonas
On a patient that has a large amount of glucose in their urine, what would be the expected specific gravity (SG) taken from a refractometer in comparison to the dipstick SG?
Refractometer SG would be higher than Dipstick SG. dipstick SG only measures ionic solutes; doesnt detect glucose and urea
Lab management: You are processing specimens for your laboratory when you receive a potassium test specimen in a tube that looks like the one in the image. What should you do?
Reject the specimen, the potassium test results will be increased. image is grossly hemolyzed red blood cells break down, releasing their contents into the plasma Potassium is located mostly inside the red blood cells
Which of the following descriptions best describes the term absolute value as it would relate to leukocyte differential counts.
Relative % of each cell type multiplied by total white count
Lab management: All of the following are considered repetitive strain disorders, EXCEPT?
Rheumatoid arthritis Tenosynovitis Bursitis Ganglion cysts
Lab management: Which of the following barriers are recommended in microbiology laboratories where manipulation of biosafety level 3 agents (e.g., Mycobacterium tuberculosis) is performed?
Self-closing double-door access -Class I or Class ll BSC -NEGATIVE airflow -Exhausted air must not be recirculated
Lab management: A blue-top tube containing 3.2% sodium citrate needs to be collected for coagulation studies. The physician also ordered other tests to be collected in a green-top containing lithium heparin, a serum separator tube containing a clot activator, and a lavender-top containing EDTA are collected at the same time. At what point should the blue-top tube be collected?
Should be the first tube collected -other tubes' additives could interfere with the coagulation tests
Lab management: All of the following should be done when centrifuging specimens, EXCEPT?
Specimens with anticoagulant should sit for 20 minutes before centrifugation Specimens without anticoagulants should sit at least 30 minutes Cap all tubes for centrifugation Allow the centrifuge to come to a complete stop by itself before opening it
Lab management: Which of the following instruments measures absorbance of light at a specific wavelength?
Spectrophotometer -Measures the light transmitted by a solution at a specific wavelength -concentration of the light absorbing substance in the solution Nephelometer -Measures light scattered at an angle by particles to be measured in a solution Osmometer -Measures change in vapor pressure Coulometry -Measures amount of electricity passing between two electrodes
Lab management: Give the objective, "The student will perform the biuret assay for total protein with control values within +2SD of stated values," +2SD of stated values is an example of a:
Standard terminal behavior: learner must be able to do after instructions condition: what boundaries will be placed on the learner Learning outcome: identify what the learner will be able to do or will know by the end
Which acid is most frequently used to precipitate protein for confirmatory urinalysis tests?
Sulfosalicylic (SSA) -measure protein concentration with turbidity -detect albumin and globulins and Bence-Jones proteins -acidification of proteins which causes turbidity
A urine specimen, from a premature infant, was sent for culture to the microbiology laboratory and it grew out 30,000 cfu/mL of a coagulase negative staphylococcus. The physician felt that the growth was skin contamination as the urine was collected in a U-Bag that was attached around the infant's genitalia area. The physician sent a second specimen for culture and it was reported as no growth after 48 hours. Which of the following specimens is the most probable specimen type for the second specimen that was sent to the microbiology laboratory for culture?
Suprapubic Bladder Aspiration Urine pediatric pts contamination free Straight Catheterized: more invasive, uncontaminated, physiologic conditions Clean-Catch Midstream: least invasive, clean area Indwelling Catheter: long term, hospitalized, oncology, catheter port, bacteriuria
What effect may bacterial contamination have on urine pH?
The bacteria may make the pH more alkaline. -pH >8: held non-preserved too long -allows the multiplication of urea-splitting bacteria
Lab management: Which is the main limitation of standard PCR that is not a limitation of real-time PCR?
The procedure requires endpoint measurement that may not be in direct proportion to the initial sample -inability to accurately quantitate the DNA product due to reliance on endpoint analysis -quantitation is not possible with endpoint analysis -none detect during plateau stage -Use small samples
Lab management: A prothrombin time (PT) specimen was collected at an outpatient clinic and will not be picked up by the testing laboratory's courier until several hours later. How should the specimen be stored until it is picked up by the courier?
The tube should remain unopened and be kept at room temperature (20°-25° C). 2° - 4° C may result in cold activation of factor VII plasma removed and frozen (-20C) if after 24hrs
Which of the following statements is TRUE for specific gravity measured by the urine chemical reagent strip method?
The urine chemical reagent strip method is not affected by the presence of x-ray contrast media in the urine specimen. based on the relationship between ionic concentration and specific gravity specific gravity increases as ionic concentration increases if no solutes SG would be 1.000 (1.000-1.035) high concentration of protein increases the specific gravity readings on the reagent strip alkaline pH (6.5 or higher) would affect the specific gravity result by decreasing the reading refractometer method: light is refracted in proportion to the amount of total solids dissolved in the urine
decreasing amount of blood in the sequentially collected tubes; tube #1 contains visible red blood cells, but the amount of blood decreases in the other tubes
Traumatic tap Normal CSF is clear and colorless subarachnoid hemorrhage, all three tubes would contain blood and consistent Bacterial meningitis would not show decreasing amounts of red blood cells
Which of the following crystals would most likely be found in normal ALKALINE urine?
Triple phosphate Amorphous urates and uric acid crystals: normal acidic calcium oxalate: acidic
Lab management: The process of pipetting 1.0 mL of plasma or serum into a tube containing 1.0 mL of saline, mixing the contents, and then repeating the same procedure into several additional tubes also containing 1.0 mL of saline is referred to as:
Two-fold serial dilution result in "halving" the amount of serum
All of the following crystals will normally be found in a urine specimen with a pH of 8.0, EXCEPT?
Uric acid acidic urine Ammonium biurates, Triple phosphates, and Calcium carbonates found in alkaline
Which of the following answer choices correctly state the use of urine reagent strips for chemical analysis?
Use of a well-mixed, uncentrifuged urine sample at room temperature is the technique for urine reagent strips. cells settle to bottom if not mixed well read 60-120 sec reagents leached from pad when sat for long time
Lab management: When is a CLIA certificate of compliance issued for a laboratory?
When an inspection finds the laboratory to be in compliance with all applicable CLIA requirements. A CLIA certificate for PPMPs: physician, midlevel practitioner, or dentist performs no testing other than microscopy procedures, limits the microscopy to bright-field or phase-contrast CLIA certificate of waiver: laboratory to perform only waived tests, cleared for home use CLIA certificate of accreditation: to a laboratory-based on the laboratory's accreditation by an accreditation organization approved by the Health Care Finance Administration
In a patient with acute glomerulonephritis, you would expect to find all of the following in the urine EXCEPT:
Yeast red blood cells, red blood cell casts, and protein: glomerular injury or hemorrhage within the kidney