Urine and body fluids rot exam

Which of the following characteristics of cerebrospinal fluid is present if blood is due to subarachnoid hemorrhage (SAH)?

Blood is evenly distributed in all tubes.

Bence-Jones proteinuria is associated with all of the following conditions except: a. Macroglobulinemia b. Pernicious anemia c. Multiple myeloma d. Amyloidosis

Pernicious anemia

Which is the best method for examination of synovial crystals:

Polarized light

A daily urine output which is over 2500 mL/24 hours is referred to as:

Polyuria

Normal crystals that can be found in urine include:

Triple phosphate

Xanthochromia in a premature infant may be due to an immature blood-brain barrier.

True

The normal range for urine pH is:

4.5 to 8.0

CSF lymphocytosis is associated with all of the following except: a. Cerebral abscess b. Viral meningitis c. Chronic fungal meningitis d. Chronic tuberculous meningitis

Cerebral abscess

Which of the following macroscopic findings is MOST consistent with the microscopic finding of casts?

Positive protein

Which of the following is true about Bence-Jones protein when performing the heat precipitation test?

Precipitates between 40° and 60°C but redissolves at 100°C

The sediment from a freshly collected urine specimen is examined microscopically. In addition to bacteria, what other finding from the list below would further indicate the presence of a urinary tract infection (UTI)?

> 100 white blood cells (WBCs)/ HPF

How many white blood cells (WBCs) would be considered normal for adult cerebrospinal fluid?

0-5 WBCs/uL

Which of the following would be the most characteristic finding in synovial fluid in a case of pseudogout:

Calcium pyrophosphate crystals

The volume of urine recommended for centrifugation for a microscopic examination is:

10 - 15 mL

Oliguria is usually correlated with:

Acute glomerulonephritis

The reagent strip method for protein primarily tests for which type of protein?

Albumin

Which of the following ketones is NOT detected in the Acetest® tablet method?

Beta-hydroxybutyric acid

In a normal CSF the protein concentration as compared to that in the serum is generally:

Less than 1%

Which one of the following crystals is NOT found in normal urine? a. Triple phosphate b. Ammonium biurate c. Calcium oxalate d. Leucine

Leucine

Which of the following cells are considered abnormal and clinically significant on a CSF differential?

Myeloblast

A semen sample for semen analysis should generally be received at the testing site within what period of time?

One hour

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

How should the production of a blue or purple color on the test pad of an Ictotest® be interpreted?

Positive for bilirubin

Which of the following statements is true for the reagent strip procedure?

Prolonged immersion may wash out reagents.

Semi-automated and automated urine chemical reagent strip readers:

Remove subjectivity allowing for better reproducibility

Traumatic tap

These tubes of cerebrospinal fluid (CSF) arrive in the laboratory for evaluation. The tubes were numbered in the order in which they were obtained, with #1 being the first tube collected and #3 being the last tube collected. What may be indicated by the macroscopic appearance of CSF?

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 150 x 10=1500 1500/10 x 0.1

Ethylene glycol

A 62-year-old man drank an unknown liquid in a suicide attempt, and his urine contained crystals similar in shape to those shown in this image. This man MOST likely ingested:

What is the optimal time to begin initial microscopic examination of a semen specimen, assuming liquefaction is complete?

30 minutes

What is the lower reference limit for progressive motility of spermatozoa when performing a semen analysis?

32%

For BEST results, a semen sample should remain at which of the following temperatures following collection?

37oC

Which of the following would be considered normal for a glucose level in cerebrospinal fluid?

60 mg/dL

What is generally accepted as the lower threshold value for semen pH from fertile males?

7.2

Which of the following substances are detected with Clinitest® tablets? a. Glucose only b. Glucose and albumin c. Ketones d. All reducing substances

All reducing substances

Which of the following tests would be employed in order to detect neural tube defects:

Alpha fetoprotein

Where does most cerebrospinal fluid (CSF) originate?

Choroid plexus

The Clinitest® reaction is based on which of the following principles?

Copper reduction

Leucine crystals

Identify the urine sediment elements shown by the arrow

Leucine crystals

Identify the urine sediment elements shown by the arrow:

Starch crystals

Identity the urine sediment elements shown by the arrow:

A low CSF glucose level is associated with all the following except: a. Hyperglycemia b. Fungal meningitis c. Amebic meningitis d. Trichinosis meningitis

Hyperglycemia

Nephrotic syndrome is associated with all of the following clinical findings, except: a. Increased proteinuria b. Decreased serum albumin c. Hyperproteinemia d. Edema

Hyperproteinemia

MACROPHAGES

The image is a stained smear of cerebrospinal fluid. What type of cells are the three right cells in this field?

An India Ink preparation is used to identify:

Cryptococcus neoformans in CSF

Ammonium biurate crystal

Identify the crystal indicated by the arrow in this alkaline urine:

Lymphocyte pleocytosis refers to a decreased number of lymphocytes in a CSF when compared to a normal sample. True or False.

False

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

Which of the following casts might be found in the urine of a healthy individual after strenuous exercise?

Hyaline casts and granular casts

Which of the following can cause a false positive result for ketones? (Choose ALL correct answers)

L-Dopa metabolites

Which of the following is characteristic of an exudates effusion?

Leukocyte count greater than 1000 WBC/uL

A technologist decides to make a 1:20 dilution of cerebrospinal fluid (CSF) after briefly evaluating a portion of the sample microscopically. After making the dilution and charging the chambers, the number of cells that are observed in each of the large squares of the hemocytometer is >100. What should the technologist do to obtain the most accurate count?

Make a larger dilution

At what temperature should the urine be prior to testing with the reagent strip method?

Room temperature

Parasites which can be found in urinary sediment include all of the following EXCEPT: a. Enterobius vermicularis b. Trichomonas vaginalis c. Plasmodium malariae d. Schistosoma haematobium

Plasmodium malariae

When preparing a slide for morphologic examination, what is the reason for adding a drop of albumin to the cerebrospinal fluid (CSF) sample prior to cytocentrifugation?

Preserve the integrity of the cells

Sulfosalicylic acid (SSA) can be used to confirm the result of which of the following tests included on a urine reagent strip?

Protein

The primary site of reabsorption of glomerular filtrate is the:

Proximal convoluted tubule

A semen specimen was collected three hours before it was brought to the laboratory for examination. What course of action should be taken?

Report the specimen as compromised on the final report.

White blood cells (WBCs)

The cells that are indicated by the arrows in this urine sediment (using phase contrast microscopy) are:

Cholesterol crystals

The crystals seen in this image are ____?

Diabetes

The elements indicated by the arrows are more likely to be seen in patients with which condition?

Leukemia with CNS involvement

The image is a Wright-Giemsa stained smear (1000X) of cerebrospinal fluid (CSF). The arrows point to cells that may indicate which of the following conditions?

Presumptive malignant cells

The image is a Wright-Giemsa stained smear (1000X) of cerebrospinal fluid (CSF). What is the identification of the cells that are indicated by the arrows?

A urine specimen was collected at 6:00 a.m. and remained at room temperature until it was received in the laboratory at 3:30 p.m. How may the pH of the specimen be affected by the extended time at room temperature if bacteria are present in the specimen?

The pH may become more alkaline

Calcium oxlate

What is the identification of these crystals seen in a urine with an acid pH?

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?

With each new lot of reagent strips and every day of patient testing

Cell counts on CSF specimens should be performed within what time frame following collection of the CSF sample?

Within one hour

Fecal urobilinogen level may be markedly decreased because of:

biliary obstruction

All of the statements below about synovial fluid are true EXCEPT: a. arthrocentesis is performed as a means to evaluate arthritis and other joint disorders b. synovial fluid is present only is movable joints c. joint fluid resembles plasma in viscosity d. joint fluid has approximately the same glucose as plasma

joint fluid resembles plasma in viscosity

On a Cytospin preparation from a pleural fluid, 50% of the cells have the following characteristics:-uniform, regular arrangement-some cells resemble a "fried egg"-multiple nuclei-smooth nuclear outline and homogeneous chromatin-when present in clumps, there are clear spaces between the cells ("windows")How should these cells be classified?

mesothelial cells

3-year old girl was brought to the ER with a temperature of 103o F, lethargy, and cervical rigidity. Three tubes of cloudy CSF were delivered to the Lab, and preliminary test result showed: WBC: 4,500 / uL Differential : 88% neutrophils Glucose: 15 mg/dL 12% lymphocytes Protein: 140 mg/dL Gram stain: No organisms observed From these results, what preliminary diagnosis SHOULD the physician consider?

Bacterial meningitis

Bacterial contamination of a urine specimen from a normal healthy individual could originate from all of the following except: a. Contaminated urine container b. Vagina c. Bladder d. Vulva

Bladder

The renal threshold is best described as:

Concentration at which a substance in the blood spills into urine

A urine production of less than 400 mL/day is:

Defined as oliguria

Parasites which can be found in urinary sediment include all of the following EXCEPT: a. Enterobius vermicularis b. Trichomonas vaginalis c. Plasmodium malariae d. Schistosoma haematobium

Plasmodium malariae

sperm concentration of 25 X 10 6 spermatozoa/ mL would be considered an abnormally low concentration, according to the lower normal reference limit stated in WHO 5th edition. True or False?

FALSE

A spectrophotometric scan of amniotic fluid may be valuable in the determination of which of the following conditions:

Hemolytic disease of the newborn

The primary mechanism responsible for glomerular filtration is:

Hydrostatic differential in glomerular tufts

Fatty cast

Identify the urine sediment element:

Which of the following methods may be employed to definitively identify Bence-Jones proteins?

Immunoelectrophoresis

Normal adult CSF may have 0-5 white blood cells (WBCs) / uL. Which of the following cell types account for 60-100% of these WBCs?

Lymphocytes

Which of the following white blood cells would NOT produce a positive leukocyte esterase test on the urine chemical reagent strip?

Lymphocytes

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 bloo

Myoglobinuria is MOST likely to be noted in urine specimens from patients with which of the following disorders?

Massive muscle trauma

What is the primary functional unit of the kidney?

Nephron

Which of the following are functions of CSF? Select ALL that apply one or more: a. Supply nutrients to nervous system tissue. b. Regulate body metabolism. c. Protect spinal cord from injury. d. Remove waste products from cerebral metabolism.

Protect spinal cord from injury. Remove waste products from cerebral metabolism. Supply nutrients to nervous system tissue.

Reabsorption in the kidneys primarily occurs in:

Proximal convoluted tubule

Which of the following statements is true regarding the storage and handling of urinalysis chemical reagent strips? a. Make sure all of the pads on the strip have the same color prior to using the strip. b. Touching the reagent areas of the strip will not interfere with test results. c. Remove only enough strips for immediate use. d. The bottle of reagent strips can remain uncovered once it has been opened.

Remove only enough strips for immediate use

Transitional epithelial cells

The cells shown in the image to the right are:

Yeast

The constituents that are indicated by the arrows in this image of a stained urine sediment are:

Leucine crystals

The crystals that are seen in this image are:

A negative glucose oxidase test and a positive test for reducing sugars in urine indicates:

The presence of a non-glucose reducing sugar such as galactose

A test that can be used as a confirmatory test for urobilinogen is:

Watson-Schwartz Test

Ammonium biurate

What is the identification of this crystal seen in a urine with an alkaline pH?

RBC cast

What type of cast is shown in the illustration?

Cells seen in the microscopic examination of the urine of a 30 year old female which are smaller than RBC's but much the same shape are probably:

Yeast cells

wo CSF specimens were sent to the Lab with the following results:Tube #1 = 11,200 rbc/uLTube #2 = 300 rbc/uLThe results on these CSF specimens are indicative of:

a traumatic tap

Charcot-Leyden crystals in stool may be associated with an immune response and are thought to be the breakdown products of:

eosinophils

On a Cytospin preparation from a pleural fluid, 50% of the cells have the following characteristics:-uniform, regular arrangement-some cells resemble a "fried egg"-multiple nuclei-smooth nuclear outline and homogeneous chromatin-when present in clumps, there are clear spaces between the cells ("windows")How should these cells be classified? Select one:

ependymal cells

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

What is the lower reference limit for semen volume according to the World Health Organization, WHO Laboratory Manual for the Examination and Processing of Human Semen, 5th edition?

1.5 mL

A spinal fluid that is slightly hazy is briefly examined microscopically. The technologist performing the count decides to make a 1:10 dilution using 30 uL of sample. What volume of diluent should be used?

270 uL

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

What is the approximate volume of spinal fluid in an adult?

90-150 mL

A CSF glucose value is 62 mg/gL. What would you estimate the serum glucose?

93 mg/dL

The ketone component that is measured by the nitroprusside reaction is:

Acetoacetic acid

Below is a urinalysis report on a 37-year-old woman seen in the ER with headache, hypertension, weight loss and mild edema: Color: red Clarity: cloudy Sp. Gravity 1.010 pH 5.0 Glucose: negative Protein: 3+ Ketones: negative Nitrite: negative Blood: moderate Urobilinogen: normal Microscopic:25-50 RBC2-4 WBC2-5 granular casts2-5 hyaline casts0-2 RBC castsfew epithelial cells Based on the urinalysis report above, the MOST probable diagnosis of this patient's condition is:

Acute glomerulonephritis

False-positive tests for protein on a urine reagent strip may be caused by: a. Blood presence in the specimen b. High amounts of bilirubin c. Alkaline medication d. All of the above

All of the above

Which of the following characteristics of cerebrospinal fluid are considered abnormal? a. Turbidity b. Bloody appearance c. Xanthochromia d. All of the above

All of the above

Which of the following conditions produce glycosuria? a. Diabetes mellitus b. Fanconi's syndrome c. Impaired tubular reabsorption/advanced kidney failure d. All of the above

All of the above

A patient who has a primarily vegetarian diet will most likely have:

An alkaline urine pH

Hematuria

An increased number of these cells, when found upon microscopic examination of urine is termed:

Substances found in urinary sediment that are more easily distinguished by use of polarized microscope are:

Anisotropic cholesterol droplets

Sudan III will confirm the presence of:

Fat

Which of the following artifacts may be mistaken for casts?

Fibers

Which of the following parameters is generally NOT considered to be a part of a seminal fluid analysis?

Glucose concentration

Unconjugated bilirubin is conjugated in the liver with which of the following substances to become water soluble?

Glucuronic acid

Nitrates in urine are reduced to nitrites by:

Gram-negative bacteria

Which one of the following statements about urea is false?

It is decreased in dehydration

Which one of the following statements concerning Tamm-Horsfall protein is FALSE? a. It is the protein that is predominantely detected by a urine reagent strip test b. Hyaline casts are formed by this protein in the distal tubule c. It acts as a coating and lubricant in the tubules d. It is produced by the tubules

It is the protein that is predominantely detected by a urine reagent strip test

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.

White blood cell casts are MOST likely to indicate disease of the:

Kidney

Which of the following may cause a false positive bilirubin result on a urine chemical reagent strip?

Large doses of chloropromazine

Match the following terms with the statement that best describes each: Meninges Transudate Pleurisy Effusion

Meninges- MEMBRANE COVERING THE BRAIN UNDER THE SKULL Transudate- FLUID ACCUMULATION DUE TO MALFUNCTION OF ABILITY TO FORM AND REABSORB FLUID Pleurisy- INFLAMMATION OF THE PLEURAL MEMBRANE Effusion- EXCESS ACCUMULATION OF FLUID WITHIN IN ANY OF THE BODIES SEROUS CAVITY'S

Which of the following situations suggest a traumatic tap occurred? Select all that apply. a. More blood is in tube 1 than tubes 2,3, or 4. b. Immediate centrifugation reveals pink supernatant. c. Blood clots are present. d. 3+ turbidity is present.

More blood is in tube 1 than tubes 2,3, or 4. Blood clots are present

Bence-Jones proteinuria can be seen in all of the following conditions except: a. Amyloidosis b. Nephrotic syndrome c. Multiple myeloma d. Macroglobulinemia

Nephrotic syndrome

Which of the following is NOT a standard method for measuring the specific gravity of urine? a. Refractometry b. Hydrometry c. Osmolality d. Urine reagent strips

Osmolality

Match urine color with substance that might have been responsible: PHOSPHATES BILIRUBIN Pseudomonas Porphoilinogen

PHOSPHATES- White BILIRUBIN - Yellow Pseudomonas - Blue to Green Porphoilinogen-Red to Brown

A WBC differential count on CSF should be performed using the following technique:

Stained smear of a cytocentrifuged specimen

When a urine specimen cannot be cultured immediately, which storage method is most appropriate?

Stored in the refrigerator at 4° C for up to 24 hours

Which of the following would be the most appropriate method to confirm a positive protein from a urine dipstick:

Sulfosalicylic acid precipitation

The estimation of hyaluronic acid concentration by measurement of viscosity is useful in evaluating which type of fluid?

Synovial

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

Cytocentrifugation is the recommended method for preparing a cerebrospinal fluid (CSF) sample for examination of cellular morphology.

True

Which of the following cells when found upon microscopic examination of the urine would be most indicative of kidney disease:

Tubular epithelial cells

Previous subarachnoid hemorrhage

Upon centrifugation, a cerebrospinal fluid (CSF) sample supernatant exhibited xanthochromia. The image is a Wright-Giemsa stained smear that was made from that CSF sample. What condition is probably related to these macroscopic and microscopic findings?

The nephron includes all of the following except: a. Urethra b. Glomerulus c. Loop of Henle d. Proximal convoluted tubule

Urethra

Which of the following crystals will NOT normally be found in a urine specimen with a pH of 8.0?

Uric acid

What is the MOST probable condition when a clean catch urine gave these results: Appearance = cloudy, amber pH 5.0Specific Gravity = 1.015, Protein = 1+ Glucose = negative Occult Blood = trace Nitrite = positive Microscopic = many bacteria and 30 - 40 WBC/HPF.

Urinary tract infection