Urinalysis Study Guide, part 4

The presence of hemosiderin in macrophages in the CSF is characteristic of: a. bacterial meningitis. b. viral meningitis. c. cerebral hemorrhage. d. traumatic puncture.

cerebral hemorrhage

Collection tubes for synovial fluid include all of the following except: a. red plain. b. citrate. c. EDTA. d. SPS.

citrate

Use of direct and compensated polarizing microscopy in the identification of crystals allows for differentiation based on all of the following except: a. birefringence against a black background. b. intensity of birefringence. c. positive and negative birefringence. d. diagonal orientation of crystals to the compensator axis.

diagonal orientation of crystals to the compensator axis

Cerebrospinal fluid circulates in and/or around all of the following except: a. brainstem. b. subarachnoid space. c. dura mater. d. spinal cord.

dura mater

An excess accumulation of fluid in a body cavity that is caused by increased hydrostatic pressure, decreased plasma oncotic pressure, and increased permeability of the endothelium is a(n): a. exudate. b. effusion. c. transudate. d. edema.

effusion

The term ascites refers to: a. any effusion. b. effusion from the peritoneal cavity. c. effusion from the pleural cavity. d. effusion from the pericardial cavity.

effusion from the peritoneal cavity

A physician receives a laboratory report on a peritoneal fluid specimen from a 72-year-old male. The physician scans the report for the following results: Total protein ratio: greater than 0.5 Lactate dehydrogenase (LD) ratio: greater than 0.6 Glucose: less than 60 mg/dL Serum glucose: 115 mg/dL Based on these results, the physician determines that the effusion was most likely a(n): a. transudate. b. exudate. c. malignant transudate. d. serum-effusion mixture.

exudate

Delay in handling and processing serous fluids for microbial testing can result in: a. false-positive results. b. false-negative results. c. no impact if a plain red tube is used. d. A and C.

false-positive results

All of the following characteristics are true about the preparation of slides using centrifugation except: a. preserves cellular morphology. b. easiest to perform. c. good cellular recovery. d. least expensive to use.

good cellular recovery

The technologist receives a turbid synovial fluid specimen from the OR for microscopic examination. Based on clarity of the specimen, he decides to make a dilution prior to performing the cell count. He mixes the specimen well and dilutes it with: a. 2% acetic acid. b. hyaluronidase buffer. c. hypertonic saline (70%). d. B or C

hyaluronidase buffer

Turbidity may be present in CSF as a result of all of the following except: a. increased protein. b. WBC count greater than 200 cells/mL. c. RBC count greater than 400 cells/mL. d. increased glucose.

increased glucose

All of these statements are true with regard to uric acid except: a. the uric acid concentration in synovial fluid is equivalent to that of blood plasma. b. a diagnosis of gout can be made based on an increased plasma uric acid level and the patient's symptoms. c. the presence of MSU crystals in synovial fluid is diagnostic of gout. d. increased plasma levels of uric acid are required for the diagnosis of gout.

increased plasma levels of uric acid are required for the diagnosis of gout

The most common causes of bacterial meningitis include all of the following except: a. Neisseria meningitidis. b. Streptococcus pneumoniae. c. Haemophilus influenzae. d. influenza virus.

influenza virus

All of these statements are true with regard to synovial fluid except: a. it is the sole nutrient source for articular cartilage. b. it is formed by the ultrafiltration of plasma across the synovial membrane. c. its glucose, uric acid, and total protein concentrations are equivalent to those of blood plasma. d. it is secreted by synoviocytes.

its glucose, uric acid, and total protein concentrations are equivalent to those of blood plasma

Chylous effusions may result from which pathogenic condition? a. Myxedema b. Lymphoma c. Rheumatoid arthritis d. Tuberculosis

lymphoma

The physician removes 1 mL of CSF from a 2-year-old patient and immediately puts it into a properly labeled, single sterile tube. The technologist delivers the STAT specimen to: a. immunology. b. hematology. c. chemistry. d. microbiology.

microbiology

The predominant white cell found in the CSF of healthy neonates is the: a. neutrophil. b. lymphocyte. c. eosinophil. d. monocyte.

monocyte

All of the following are functions of CSF except: a. neural communication. b. transport of nutrients. c. removal of metabolic wastes. d. protection of the central nervous system (CNS).

neural communication

The predominant cell type in a differential cell count on a pleural fluid caused by systemic disease is the: a. neutrophil. b. lymphocyte. c. malignant cell. d. mesothelial cell.

neutrophil

All of the following cellular distortions are associated with cytocentrifugation except: a. nuclear lobes of PMNs take on a pyknotic appearance. b. cells at the center of the cell button may be small and have denser nuclear chromatin. c. cytoplasmic vacuoles and/or granules localize along the cell periphery. d. irregular cytoplasmic processes form.

nuclear lobes of PMNs take on a pyknotic appearance

An increase in the number of cells in CSF is referred to as: a. leukocytosis b. histiocytosis c. pleocytosis d. erythrocytosis

pleocytosis

All of these conditions result in an increase in CSF protein except: a. pneumoencephalography. b. cerebral infarction. c. viral meningitis. d. endocrine disorders.

pneumoencephalography

High fluid amylase levels 1.5 to 2 times higher than the serum value occur most often in all of the following pathologic conditions except: a. metastatic disease. b. esophageal rupture. c. rheumatoid arthritis. d. gastroduodenal perforation.

rheumatoid arthritis

The physician performs a spinal tap and hands you the first tube. You note that it is extremely bloody. The second and third tubes are equally bloody. The technologist surmises that the presence of blood is most likely due to: a. a subarachnoid hemorrhage. b. bacterial meningitis. c. encephalitis. d. a traumatic tap.

subarachnoid hemorrhage

All of these statements are true with regard to serous membranes except: a. they surround the heart, lungs, and abdominal organs. b. they line internal surfaces of the body cavity wall. c. they produce an ultrafiltrate of plasma. d. the composition of serous fluid is similar to that of plasma.

the composition of serous fluid is similar to that of plasma

Acceptable transport and analysis conditions of synovial fluid include: a. transport on ice; warm to room temperature for analysis. b. transport at room temperature; refrigerate until analyzed, warm to room temperature to analyze. c. transport at 37 °C and place in a 37 °C incubator until analyzed. d. transport and analyze at room temperature.

transport and analyze at room temperature

All of the following are associated with low CSF glucose values except: a. traumatic puncture. b. metastatic tumor cell infiltration. c. increased glycolysis in the CNS. d. meningitis.

traumatic puncture

All of these statements are true with regard to the presence of malignant cells in CSF except:1. The cells may be from metastatic tumors2. The cells resemble choroid plexus and ependymal cells3. The cells appear singly or in clumps4. The cells are the result of leukemic infiltration5. The result should be reported if more than 10 cells are observed a. 1, 2, and 3 b. 2, 4, and 5 c. 5 d. All of the above

5

Which serous glucose values correlate correctly with the pathologic condition? 1. Tuberculosis: greater than 60 mg/dL 2. Malignant neoplasms: greater than 60 mg/dL 3. Bacterial infection: less than 60 mg/dL 4. Rheumatoid arthritis: less than 60 mg/dL a. 1 and 2 b. 3 and 4 c. 1, 3, and 4 d. All of the above

3 and 4

All of the following diluents can be used for a WBC count on synovial fluid except: a. 3% acetic acid. b. hypotonic saline. c. hyaluronidase buffer. d. 0.85% saline.

3% acetic acid

All of these statements are true with regard to the presence of malignant cells in CSF except: 1. The cells may be from metastatic tumors 2. The cells resemble choroid plexus and ependymal cells 3. The cells appear singly or in clumps 4. The cells are the result of leukemic infiltration 5. The result should be reported if more than 10 cells are observed a. 1, 2, and 3 b. 2, 4, and 5 c. 5 d. All of the above

5

If tuberculous meningitis is suspected, which type of stain is ordered? a. Gram stain b. Acid-fast stain c. India ink d. Eosin stain

Acid-fast stain

Which statement with regard to the formation of serous fluid is not true? a. Hydrostatic pressure forces serous fluid to form in the cavity. b. The permeability of the capillaries regulates the protein composition of the ultrafiltrate. c. Plasma proteins produce oncotic pressure in the cavity. d. The lymphatic system removes fluid from a cavity by absorption.

Plasma proteins produce oncotic pressure in the cavity

Which of the following terms and descriptions is incorrectly matched? a. Pleural cavity—surrounds the abdominal organs b. Pericardial cavity—surrounds the heart c. Parietal membrane—lines the body wall d. Visceral membrane—covers organs

Pleural cavity—surrounds the abdominal organs

Which of the following is an incorrect match? a. Lung cancer—exudate b. Hypoproteinemia—transudate c. Pneumonia—transudate d. Inflammatory condition—exudate

Pneumonia—transudate

Viscous body fluids require the use of which type of pipette? a. Sterile transfer pipette b. Positive displacement pipette c. Air displacement pipette d. Serologic pipette

Positive displacement pipette

A chylous effusion can be differentiated from a pseudochylous effusion by which of the following results? a. Triglycerides 30 mg/dL; chylomicrons present b. Triglycerides 60 mg/dL; chylomicrons absent c. Triglycerides 120 mg/dL; chylomicrons present d. Triglycerides 150 mg/dL; chylomicrons absent

Triglycerides 120 mg/dL; chylomicrons present

Which of the three collection tubes for synovial fluid is/are examined for color, clarity, and viscosity and reported out by the technologist? a. Tube #1 b. Tube #2 c. Tube #3 d. A and B

Tube #2

WBC counts of less than 200 WBCs/µL indicate: a. aseptic inflammation. b. gouty arthritis. c. bacterial arthritis. d. a normal count.

a normal count

The total protein fluid to serum ratio and fluid to serum lactate dehydrogenase ratio in serous fluid is a reliable means to differentiate: a. pericardial fluid from peritoneal and pleural fluid. b. serous fluid from plasma. c. a transudate from an exudate. d. peritoneal fluid from pleural fluid.

a transudate from an exudate

The blood-brain barrier modulates the interface of the blood and CSF via tight junctures between: a. dura mater and arachnoid. b. adjacent endothelial cells. c. single-layer epithelial cells. d. arachnoid granulations.

adjacent endothelial cells

During a paracentesis, a cloudy, yellow effusion shows clotting as it is withdrawn; this is most likely: a. a transudate. b. an exudate. c. plasma. d. edematous fluid.

an exudate

Hydrocephalus is a condition that results in the excess accumulation of CSF as a result of: a. overproduction of CSF. b. mental retardation. c. an obstruction that blocks reabsorption. d. increased flow between the ventricles.

an obstruction that blocks reabsorption

The differential count on a synovial fluid specimen shows 6% monocytes, 85% neutrophils, and 9% lymphocytes. This count indicates which joint condition? a. Parasitic infection b. Bacterial arthritis c. Traumatic arthritis d. Metastatic carcinoma

bacterial arthritis

A 5-year-old female presents to the ED with a fever of 102.8 °F, confusion, and sleepiness. The mother reports that the child had been feeling nauseous and had vomited yesterday but not today. The examination further reveals that the child has photosensitivity. A lumbar puncture is performed, and the test results are as follows: Color: Colorless Clarity: Cloudy (2+) Gram stain: Negative Culture: Pending Leukocyte count: 5500 cells/mL Differential count: Monocytes: 5% Lymphocytes: 5% Neutrophils: 90% Total protein: 100 mg/dL Glucose: 35 mg/dL Lactate: 50 mg/dL Based on the CSF report and the clinical symptoms, the physician suspects the child has: a. bacterial meningitis. b. viral stomach flu. c. Reye's syndrome. d. viral meningitis.

bacterial meningitis

All of the following can cause xanthochromic CSF except: a. normal neonate. b. intracerebral hemorrhage. c. protein concentration exceeding 150 mg/dL. d. bacterial meningitis.

bacterial meningitis

Upon performing a spinal tap on a 32-year-old male patient, the physician notes an "opening" CSF pressure of 200 mm Hg. The physician proceeds to remove what amount of CSF? a. 2 mL b. 10 mL c. 15 mL d. 20 mL

2 mL

Which of the following solutions cannot be used to dilute synovial fluid when it is significantly turbid? a. 2% acetic acid b. Hyaluronidase buffer c. 0.85% saline d. B and C

2% acetic acid

CSF cell counts are usually performed on tube #: a. 1. b. 2. c. 3. d. 4.

3

Cerebrospinal fluid formation, circulation, and reabsorption into the blood is a dynamic process in which how many milliliters of CSF are turned over per hour? a. 10 b. 20 c. 85 d. 150

20

How many leukocytes are normally present in the CSF of a child? a. 0 to 5 cells/mL b. 0 to 10 cells/mL c. 0 to 20 cells/mL d. 0 to 30 cells/mL

0 to 10 cells/mL

Total protein testing on a patient who underwent a peritoneocentesis reports a serum plasma total protein of 6.8 g/dL and pleural fluid total protein of 4.5 g/dL. What is the fluid to serum total protein ratio? a. 6.8 to 4.5 b. 0.7 to 11.3 c. 1.5 d. 0.7

0.7

Specific diagnoses of serous fluid analyses are supported by which of the following?1. Differential count2. Gram stain and culture3. Chemical analyses4. Color and clarity a. 1 and 2 b. 2, 3, and 4 c. 4 d. All of the above

1 and 2

Which statements about monosodium urate (MSU) crystals and calcium pyrophosphate dehydrate (CPPD) crystals are true? 1. MSU crystals are needlelike and have pointed ends; CPPD crystals are smaller and blunter. 2. MSU crystals appear bright against a black background; CPPD crystals appear weak. 3. MSU crystals are negative birefringent and appear blue when their longitudinal axes are parallel to the axis of the red compensator plate; CPPD crystals are yellow when their longitudinal axes are parallel to the axis of the red compensator plate. 4. MSU crystals and CPPD crystals are present in chronic inflammatory disease. a. 1 and 2 b. 1, 2, and 3 c. 1 and 4 d. All of the above

1 and 2

The use of liquid EDTA in synovial fluid specimens prevents: 1. formation of crystalline structures. 2. bacterial growth. 3. clotting of fibrinogen. 4. enzymatic action of hyaluronidase. a. 1 and 3 b. 1, 2, and 3 c. 3 and 4 d. All of the above

1 and 3

Which synovial fluid test result(s) allow definitive diagnosis of joint diseases? 1. Bacteria 2. Color 3. Crystals a. 1 and 2 b. 1 and 3 c. 2 and 3 d. 1, 2, and 3

1 and 3

A differential count on paracentesis fluid includes which of the following? 1. WBCs 2. Mesothelial cells 3. Malignant cells 4. RBCs a. 1 and 3 b. 2 and 4 c. 1, 2, and 3 d. 2, 3, and 4

1, 2, and 3

It is 2100 hours, and a thoracentesis specimen from a 65-year-old male is delivered by the ED nurse to the laboratory immediately after collection. The nurse hands the technologist a heparinized syringe, an EDTA tube, a plain tube, an SPS tube, and a plastic container for cytology containing 100 mL of pleural fluid. The technologist should: 1. immediately run the pH on the syringe sample. 2. store the sample for PAP staining at room temperature. 3. complete the cell count and chemical analyses within 1 hour. 4. perform a STAT Gram stain and do the culture setup ASAP. a. 1 and 2 b. 2, 3, and 4 c. 1, 3, and 4 d. All of the above

1, 3, and 4

A nucleated cell count of 0 to 100 cells/µL requires how many drops of body fluid when preparing a slide by cytocentrifugation? a. 2 b. 3 or 4 c. 5 or 6 d. 10

10

What is the cell count on a slightly cloudy CSF that was performed using a 1:2 dilution, counting the five large squares and giving duplicate counts of 45 cells for each count? a. 22.5 × 10^6 WBCs/L b. 45 × 10^6 WBCs/L c. 90 × 10^6 WBCs/L d. 180 × 10^6 WBCs/L

180 × 10^6 WBCs/L

A slightly cloudy body fluid is submitted for a cell count. The technologist will make which of the following recommended WBC dilutions for slightly cloudy specimens before performing the cell count? a. Undiluted b. 1:2 c. 1:10 d. 1:20

1:2

Which of the following statements regarding CSF microscopic examinations is false?1. At room temperature 40% of WBCs in CSF will lyse in 2 hours.2. RBCs are typically present in CSF due to recent cerebral hemorrhage.3. Keeping specimen at body temperature can significantly reduce WBC lysis to about 15%.4. Cell counts should be refrigerated if there is a delay in counting. a. 1, 2, and 3 b. 1, 2, and 4 c. 2 and 3 d. 2 and 4

2 and 4

Which of the following statements is false regarding the use of albumin as a reference protein to monitor permeability of the blood-brain barrier? a. Albumin is not synthesized in the CNS. b. Presence of albumin in CSF indicates passage across the blood-brain barrier. c. Albumin presence in CSF is not affected by the puncture procedure. d. All of the above are true.

Albumin presence in CSF is not affected by the puncture procedure

A 38-year-old woman sees her orthopedic physician about fluid buildup on her knee. The physician aspirates the fluid and puts it into labeled tubes for pickup by the courier in about 1 hour for delivery to the laboratory. The physician has put equal amounts of fluid into which tubes? 1. Red plain 2. EDTA 3. SPS 4. Sodium fluoride a. 1 and 2 b. 1, 3, and 4 c. 2, 3, and 4 d. All of the above

All of the above

What color does xanthochromia appear as in the supernatant of CFS? a. Yellow b. Orange c. Pink d. All of the above

All of the above

Which of the following ensures an accurate cell count when using a hemacytometer?1. Avoiding high dilutions on body fluids2. Counting additional squares if the count is low3. Adjusting calculations based on the volume of body fluid counted4. Performing and analyzing dilutions in duplicate a. 1 and 2 b. 1, 2, and 4 c. 3 and 4 d. All of the above

All of the above

Which pathologic condition(s) demonstrate(s) oligoclonal bands in the CSF?1. Panencephalitis2. Multiple sclerosis3. Neurosyphilis4. Bacterial meningitis5. Viral meningitis a. 1 and 4 b. 2 c. 4 and 5 d. All of the above

All of the above

Which statement is not true with regard to the total protein in synovial fluid? a. The concentration is approximately one-third that of the total protein of blood plasma. b. The total protein level of the synovial fluid is elevated in conditions of increased permeability of the synovial membrane. c. An increase in the total protein level of the synovial fluid is useful for differentiating between rheumatoid arthritis and septic arthritis. d. Increased synthesis within the joint results in an increased total protein concentration.

An increase in the total protein level of the synovial fluid is useful for differentiating between rheumatoid arthritis and septic arthritis

The CSF/serum albumin index is useful in determining which of the following? a. Albumin gradient between blood plasma and CSF b. Breach in the blood-brain barrier c. Presence of bacteria in the meninges d. Normal production of CSF

Breach in the blood-brain barrier

Semen that fails to liquefy after 60 minutes must be pretreated using which of the following before performing sperm counts, motility assessment, and chemical tests? a. Sodium bicarbonate/formalin mixture b. Bromelain c. Turk's solution d. Warming in a 37°C water bath for 30 minutes

Bromelain

Which of the following appear as flat, rectangular plates with notched corners and variable birefringence based on the thickness of the crystal? a. Corticosteroid crystals b. Hydroxyapatite crystals c. Cholesterol crystals d. Starch granules

Cholesterol crystals

Which of the following can result in depolymerization of hyaluronic acid in synovial fluid? a. 2% acetic acid b. Clostridium perfringens c. EDTA d. Rice bodies

Clostridium perfringens

The following results are obtained from analysis of a synovial fluid specimen: Red-brown fluid of decreased viscosity Total leukocyte count of 7000 cells/µL Plasma-synovial fluid glucose difference of 10 mg/dL Based on this information, the specimen most likely reflects which type of condition? a. Noninflammatory b. Inflammatory c. Septic d. Hemorrhagic

Hemorrhagic

Which of the following classifications of disease processes is paired incorrectly? a. Septic—fungal infection b. Hemorrhagic—traumatic arthritis c. Inflammatory—systemic lupus erythematosus d. Noninflammatory—osteoarthritis

Hemorrhagic—traumatic arthritis

Which of the following serves as evidence that CSF is produced by selective secretion from plasma and not an ultrafiltrate? a. Higher CSF concentrations of Na+, Cl-, and Mg++ and lower concentrations of K+ and Ca++ b. Lower CSF concentrations of Na+, K+, and Mg++ and lower concentrations of Ca++ and Cl- c. Higher CSF concentrations of K+ and Ca++ and lower concentrations of Na+, Cl-, and Mg++ d. Higher CSF concentrations of Na+, K+, and Cl- and lower concentrations of Mg++ and Ca++

Higher CSF concentrations of Na+, Cl-, and Mg++ and lower concentrations of K+ and Ca++

The following results are obtained from a synovial fluid specimen: Yellow-white fluid of low viscosity Total leukocyte count of 15,000 cells/µL Plasma-synovial fluid glucose difference of 35 mg/dL Based on this information, the specimen would most likely indicate what type of condition? a. Noninflammatory b. Inflammatory c. Septic d. Hemorrhagic

Inflammatory

Which pairing of condition with synovial fluid color is incorrect? a. Pale yellow—noninflammatory b. Colorless—normal c. Yellow-white—inflammatory d. Red-brown—hemorrhagic

Pale yellow—noninflammatory

Which of the following contribute to turbidity of synovial fluid and can be seen upon gross visual examination? a. Hyaluronic acid b. Rice bodies c. Crystals d. WBCs

Rice bodies

The most frequent causative organism of septic arthritis is: a. S. pyogenes. b. S. aureus. c. Haemophilus influenzae. d. Escherichia coli.

S. aureus

All of the following are true with regard to pleural fluid pH values except: a. pH value greater than 7.30 does not require drainage tubes for resolution. b. requires anaerobic sampling technique using heparinized syringe. c. useful for identifying patients with lung abscesses. d. clinically useful in pericardial, peritoneal, and pleural effusions.

clinically useful in pericardial, peritoneal, and pleural effusions

An IgG index less than 0.30 is indicative of: a. multiple sclerosis. b. inflammatory disorder. c. compromised blood-brain barrier. d. autoimmune disease.

compromised blood-brain barrier

Upon aspiration of synovial fluid and transfer to the collection tube, small drops of liquid drip slowly from the tip of the syringe, indicating that the viscosity is: a. normal. b. decreased. c. increased. d. equivalent.

decreased

All CSF specimens are processed STAT because a delay in testing may result in: a. decreased cell counts. b. decreased lactate levels. c. increased glucose levels. d. increased microbial growth.

decreased cell counts

A 30-year-old female who complains of weakness, tingling, and numbness of her legs and arms, along with an inability to move around normally at times over the past month, is being evaluated for multiple sclerosis. Test results reveal an IgG index greater than 0.70, but her CSF electrophoresis results are negative for oligoclonal bands and positive for myelin basic protein. Based on these results and the patient's clinical signs and symptoms, the physician: a. diagnoses multiple sclerosis. b. determines that the patient has a pinched nerve. c. indicates that the patient is in the convalescent phase of viral meningitis. d. suspects encephalitis.

diagnoses multiple sclerosis

The technologist is diligently performing culture identifications in microbiology when he has a horrific sneeze. From that point on, he is bothered by a clear liquid that continues to drip from his nose. This continues for several days, without any other nasal symptoms. He sees his physician and reports having a slight headache that improves when he lies down but worsens when he sits up. He has some slight photosensitivity. Based on the physical examination and patient self-reporting, the physician collects a sample of the drainage and sends it to the laboratory, along with a blood sample for electrophoretic testing. The test identifies the fluid as CSF based on the presence of which of the following? a. Transthyretin b. Albumin c. ô-Transferrin d. Myelin

ô-Transferrin