Urinalysis and Other Body Fluids Exam Simulator
Renal Threshold
concentration at which a substance in the blood spills into urine
A positive leukoesterase test indicated the presence of . what type of cell in the urine?
granulocytes
Viral meningitis in CSF
spectrum of lymphocytes and monocytes
What may cause a false-positive protein reading on a urinalysis dipstick?
urine specimen is highly pigmented
What test on a urine chemical reagent strip would never be reported out as negative?
urobilinogen
Bacterial meningitis in CSF
will show mainly neutrophils
Allergic reaction in CSF
will show predominantly eosinophils
What type of infection is common in diabetic patients?
yeast infections
Bilirubin Crystals
yellow, needle like that may appear in clumps found in acid urine and are associated with liver disease
In order to avoid falsely elevated spinal fluid cell counts one should: A) use an aliquot only from the first tube collected B) use only those specimens showing no turbidity C) centrifuge all specimens before counting D) select an aliquot from the last tube collected
D) select an aliquot from the last tube collected cellular elements can enter the spinal fluid collection tube when the skin is pierced or punctured in a way that causes increased bleeding, leading to falsely elevated spinal fluid counts
All of the following statements are true regarding the reagent strip test procedure EXCEPT? A) urine should not be centrifuged prior to dipping the reagent strip B) urine should be mixed well prior to dipping the reagent strip C) when visually reading the reagent strip, all result can be read immediately after dipping the strip in the urine specimen D) prolonged immersion may wash out test reagents
C) when visually reading the reagent strip, all result can be read immediately after dipping the strip in the urine specimen the results should be read at the prescribed time suggested by the manufacturer after sipping the strip in urine
Hyaline Casts
generally appear as colorless, homogenous, and transparent with rounded edges seen as a result of dehydration, after diuretic therapy, in renal disease, and transiently as a result of exercise
When would a urine reagent strip be positive for blood?
hematuria hemoglobinuria myoglobinuria
Xanthochromia in CSF is characteristic of what?
hemorrhage
What can be associated with acidic urinary pH?
high urine glucose
Trichomonas vaginalis
highly motile pear shaped 8-15 microns has multiple anterior flagella and the nucleus is often apparent
Tyrosine Cyrstals
highly refractive brown to black needles occur in acidic urine found in patients with severe liver disease
What are casts that might be found in the urine of healthy people after strenuous exercise?
hyaline casts granular casts
What cells produce a positive leukocyte esterase test?
neutrophils eosinophils basophils
What urinalysis reagent strip test would be positive in a urinary tract infection?
nitrites
Urine sediments that show a maltese cross under polarized light
oval fat bodies
Enterobius vermicularis ova
ovoid in shape with one side flattened embryo is separated from the shell by a clear space
To ensure precision and accuracy of the reagent strip tests used for chemical analysis of urine, it is necessary that:
positive and negative controls be run on a daily basis and when a new bottle of test strips is opened
What is an example of a macroscopic urinalysis abnormality?
positive proteins
Cholesterol is used by the body for what function?
precursor for hormone synthesis
Leukemia with CNS involvement
presence of blasts will show immature cells
What body parts are directly involved in the production of semen?
prostate seminal vesicles bulbourethral gland
Signs of Acute Glomerulonephritis
red blood cells white blood cells proteinuria casts
Oxidation of hemoglobin to methemoglobin in an acidic urine after several hours may cause what color to produce?
red to brown
A copper reduction method is performed on pediatric specimens in order to check for the presence of what?
reducing substances
At what temperature should the urine be prior to testing with the reagent strip method?
room temperature
How does ion concentration in the urine relate to specific gravity?
specific gravity increases as ionic concentration increases
What types of epithelial cells line the genitourinary system?
squamous cuboidal transitional
A WBC differential count on CSF should be performed using what technique?
stained smear of a cytocentrifuged specimen
What crystalline elements are found in acid urine?
tyrosine and cystine
Amorphous urate crystals
urate salts frequently appear in acid or neutral urine in a noncrystalline amorphous form yellowish-brown- granular appearance may be seen in normal urine soluble in dilute alkali, and can change to uric acid crystals in the presence of concentrated hydrochloric acid
Crystals that are exclusively found in acidic urine
uric acid calcium oxalate amphorous urates
What protein in CSF is used to monitor the integrity of the blood-brain barrier?
albumin because it is not found to any great extent in the CNS
What substances are detect with Clinitest tablets?
all reducing substances
Crystals that are exclusively found in alkaline urine
amorphous phosphate ammonium biurates triple phosphates calcium carbonates calcium phosphates
Bence-Jones proteinuria can seen in what conditions?
amyloidosis multiple myeloma macroglobulinemia
What are standard methods for measuring specific gravity?
urine reagent strips refractometry harmonic oscillation densitometry
What type of lining cells are found in BALs?
bronchial lining cells - rounded nucleus at one end of the cell with a column of cytoplasm, with possible intact cilia while others do not
Which of the following tests included on urine chemical reagent strip would never be reported out as negative? A) urobilinogen B) bilirubin C) leukocyte esterase D) blood
A) urobilinogen urobilinogen is reabsorbed from the intestines into the blood and then filtered out by the glomerulus in the kidney, this is the reason why there is a small amount of urobilinogen present in urine
What is the lower reference limit for sperm concentration?
15 x 10^6 spermatozoa/ml
If a spinal fluid is slightly hazy, what is the best dilution?
1:10
What is the lower reference limit for semen volume?
2.0 ml
What is the L/S ration that indicates adequate functioning?
2:1 or greater usually indicates adequate pulmonary surfactant to prevent respiratory distress syndrome (RDS)
What is normal urine pH?
4.5-8
Which of the following characteristic of an exudate effusion? A) leukocyte count greater than 1000 WBC/uL B) clear appearance C) protein concentration less than 3.0 g/dl D) absence of fibrinogen
A) leukocyte count greater than 1000 WBC/uL Effusion is the increase of fluid between the serous membranes due to disruption of the mechanisms of formation and reabsorption of serous fluid. Exudates are caused by conditions affecting the particular cavity such as infections/malignancies. Leukocyte count greater than 1000 WBC/uL Serum protein ratio > 0.5 Yellow or cloudy appearrance possible spontaneous clotting
The presence of increased levels of protein in the urine may be an early indicator of which of the following conditions? A) renal disease B) diabetes C) hepatitis D) pharyngitis
A) renal disease normal physiologic criteria allow low molecular weight proteins, primarily albumin, to be filtered through the glomerular capillary wall...the majority of albumin content is below the threshold of detection
What is the lower reference limit for progressive motility of spermatozoa when performing a semen analysis? A) 12% B) 22% C) 32% D) 40%
C) 32%
All of the following statements are true regarding storing and handling of chemical reagents strips if you are using a manual method (visually reading the reagent strip), EXCEPT? A) compare strip color to color chart to check for correlating color B) handle strips at end away from test area C) remove cap of test strip bottle and leave it off until testing is complete D) store the test strip container at room temperature
C) remove cap and test strip bottle and leave it off until testing is complete
What types of urine sediment elements are found in acidic urine?
Cholesterol crystals - colorless notched plates Uric acid crystals - yellow-brown four-sided flat planes, rosettes, or wedges Cystine crystals = colorless, hexagonal shape
What can cause a false positive result for ketones?
L-dope metabolites
CSF pleocytosis
an increased number of lymphocytes in a CSF when compared to a normal sample
Cholesterol crystals
appear in acid urine as large, flat, transparent plates with notched corners associated with nephrotic syndrome
Waxy Casts
appear smooth and homogenous, and highly refractile seen in patients with severe renal failure and can be due to allograft rejection
India Ink preparation is used to identify what?
cryptococcus neoformans in CSF
colorless hexagonal plate crystals
cystinuria
cylindroid cast
hyaline cast tapered at one end
Immature cells in CSF
leukemia with CNS involvement
ependymal cells
line cavities of the brain and spinal cord, circulate cerebrospinal fluid
What are the MAIN functions of the distal convoluted tubules?
maintain water-electrolyte and acid-base balance
Myoglobinuria is MOST likely to be noted in urine specimens from patients with which disorder?
massive muscle trauma
Glitter Cell
neutrophil
If all four CSF tubes contain visible blood. What is the best explanation?
subarachnoid hemorrhage
Hemoglobinuria
the presence of hemoglobin in the urine, indicates the cells have lysed and released their intracellular hemoglobin red urine
What are characteristics of casts?
they are cylindrical bodies they are formed either in the distal convoluted tubules or the collecting ducts of the kidney they contain tamm-horsfall mucoproteins
Ammonium biurate crystals
thorny apple appearance occur when specimens are not stored properly
What are normal crystals that can be found in urine?
triple phosphate
What crystal would most likely be found in normal alkaline urine?
triple phosphate
According to the lower normal reference limited stated by WHO, which of the following sperm concentrations would be considered abnormally low? A) 25 x 10^6 spermatozoa/mL B) 5 x 10^6 spermatozoa/mL C) 15 x 10^6 spermatozoa/mL D) 35 x 10^6 spermatozoa/mL
B) 5 x 10^6 spermatozoa/mL
Which of the following cells would be increased if the cerebrospinal fluid (CSF) of a patient suspected of having multiple sclerosis? A) neutrophils B) lymphocytes C) macrophages D) monocytes
B) lymphocytes Increased lymphocytes are typically associated with viral infections. Noninfectious causes for increased lymphocytes such as MS. Neutrophils in the CSF are indicative of bacterial infection.
Bence-Jones proteinuria can be seen in all of the following conditions EXCEPT: A) amyloidosis B) nephrotic syndrome C) multiple myeloma D) macroglobulinemia
B) nephrotic syndrome Bence-Jones protiens are monoclonal light chains excreted in the urine, seen in multiple myelma, and other neoplasms of lymphoid cells. Can be detected by urine electrophoresis. Large amounts cause renal tubular damage, resulting in myeloma kidney.
What is the glucose level in CSF of a healthy person?
CSF glucose should be about 60-70% of the plasma glucose
What species of Candida accounts for around 20% of urinary yeast isolates?
Candida glabrata
Standard manual WBC count equation
Cells/ul = # cell count x dilution/ # large squares counted x 0.1ul
White blood cell casts are MOST likely to indicate disease of the: A) bladder B) ureter C) urethra D) kidney
D) Kidneys White blood cell casts are found most often in pyelonephritis cases involving the kidney.
Which of the following tests confirms the presence of Bence-Jones proteinuria: A) protein electrophoresis B) sulfosalialicyclic acid precipitiation C) cryoprecipitiation D) Immunoelectrophoresis
D) immunoelectrophoresis Immunoelectrophoresis is used to detect the presence of Bence-Jones proteins, used to help detect, diagnose, and monitor the course and treatment of conditions associated with abnormal proteins
Fatty Cast
Nephrotic syndrome
RBC Cast
This formed element consists of many red cells packed into a protein matrix.
What are characteristics of exudate effusion?
WBC > 1000/ul protein ratio > 0.5 lactate dehydrogenase (LD) ratio > 0.6
Leucine Crystals
associated with liver disease and are found in acid to neutral pH urine specimens yellow color, concentric circles, and the radial striations as characteristics of leucine crystals
A urine specimen produced yellow foam when shaken. What is the cause of the yellow foam?
bilirubin
Yellow clumped needles or granule-like crystals are what type of crystals
bilirubin crystals found in liver disease acidic urine
Granular Casts
composed of plasma protein aggregates and cellular remnants indicate renal parenchymal disease, or allograft rejection appear as cylinders of coarse or fine granules
Schistosoma haematobium
etiology of carcinoma of the bladder ova are elongated yellow color, slightly transparent, and possess a delicate terminal spine
When an automated or semi-automated method is used to read urine reagent strips, quality control testing must be performed at least?
every day of patient testing and when a new bottle is opened
Starch crystals
from body powder or gloves contamination irregular with an indentation in the center
When performing chemical examination of urine, a routine reagent strip test for protein is based on the principle of?
protein-error-of-indicators
WBC Cast
acute pyelonephritis, acute tubulointerstitial nephritis
When an automated or semi-automated method is used to read urine chemical reagent strips, quality control testing must be performed at least how often? A) once a week and with each new lot reagent strip B) with each new lot of reagent strips and every day of patient testing C) with each new instrument operator D) every day of patient testing
B) with each new lot of reagent strips and every day of patient testing
What causes a urine sample to be cloudy pink with intact RBCs?
hematuria
What type of white blood cell is seen most frequently in urine sediment with infections of the urinary system?
neutrophil
What methods are employed for measuring the specific gravity of urine?
refractometry hydrometry urine reagent strips
Plasma Cell
secrete antibodies dark blue, halo
All of the following statements are true regarding the reagent strip test procedure, EXCEPT? A) urine should not be centrifuged prior to dipping the reagent strip B) urine should be mixed well prior to dipping the reagent strip C) when visually reading the reagent strip, all results can be read immediately after dipping the strip in the urine specimen D) prolonged immersion may wash out test reagents
C) when visually reading the reagent strip, all results can be read immediately after dipping the strip in the urine specimen
Bacterial contamination of a urine specimen from a normal healthy person would originate from where?
contaminated urine container vagina vulva
Clinitest reaction is based on what principle?
copper reduction
Cystine Crystals
cystine crystals are present in acidic urine, are typically colorless, and have a characteristic hexagonal shape
The ketone component that is measured by the nitroprusside reaction is:
acetoacetic acid
Renal Tubular Epithelial Casts
caused by the sloughing of necrotic renal tubular cells due to advanced tubular destruction can be due to allograft rejection, acute tubular necrosis, and certain drugs