LAB CE - UABF

What type of white blood cell is seen MOST frequently in urine sediment with infections of the urinary system? a. Eosinophil b. Lymphocyte c. Monocyte d. Neutrophil

d. Neutrophil

Sulfosalicylic acid (SSA) can be used to confirm the result of which of the following tests included on a urine reagent strip? a.Protein b.Glucose c.Bilirubin d. Urobilinogen

a.Protein

Oliguria is usually correlated with: a. Acute glomerulonephritis b. Diabetes mellitus c. Hepatitis d. Tubular damage

a. Acute glomerulonephritis

The yellow clumped needles or granule-like crystals that are indicated by the arrows in the image are: a. Bilirubin crystals b. Leucine crystals c. Cystine crystals d. Cholesterol crystals

a. Bilirubin crystals

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? a. Hyaline casts b. White cell casts c. Granular casts d. Waxy casts

a. Hyaline casts -- The presence of 0-2 hyaline casts per low power field is considered normal, and it can be found following strenuous exercising, dehydration, heat exposure, and emotional stress. White cell casts are seen in renal infection or inflammation such as pyelonephritis. Granular casts are composed of plasma protein aggregates and cellular remnants. Waxy casts are refractile with squared-off ends and are associated with chronic renal failure.

Which of the following is characteristic of an exudate effusion? a. Leukocyte count greater than 1,000 WBC/µL b. Clear appearance c. Protein concentration less than 3.0 g/dL d. Absence of fibrinogen

a. Leukocyte count greater than 1,000 WBC/µL -- 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 and malignancies. Exudate effusion characteristics include: Leukocyte count greater than 1,000 WBC/µL Fluid : Serum Protein ratio > 0.5 Yellow or cloudy appearance Possible spontaneous clotting

A copper reduction method (e.g. Clinitest® or Benedict's) is performed on pediatric specimens in order to check for the presence of: a. Reducing substances b. Aspirin c. Protein d. Ketones

a. Reducing substances

The presence of increased protein levels 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

What effect may bacterial contamination have on urine pH? a. The bacteria may make the pH more alkaline. b. The bacteria may make the pH more acidic. c. The bacteria would not affect urine pH. d. The bacteria will keep the pH neutral.

a. The bacteria may make the pH more alkaline.

All of the following statements are true regarding the reagent strip test procedure, EXCEPT? a. Urine should be centrifuged before dipping the reagent strip. b. Urine should be well mixed before dipping the reagent strip. c. When visually reading the reagent strip, the test results should be read at the prescribed time suggested by the manufacturer after dipping the strip in the urine specimen. d. Prolonged immersion may wash out test reagents.

a. Urine should be centrifuged before dipping the reagent strip.

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? a. 0.5 mL b. 1.5 mL c. 3.5 mL d. 4.5 mL

b. 1.5 mL -- The typical ejaculate contains usually between 2-5 mL of semen. According to WHO's reference limits, the lower reference limit for semen volume is 1.5 mL. Volumes above or below the reference intervals are associated with infertility.

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 µL of sample. What volume of diluent should be used? a. 70 µL b. 270 µL c. 300 µL d. 30 µL

b. 270 µL -- A simple 1:10 dilution, as this is the case, uses the formula: sample volume/(sample volume + diluent volume) = 1/10 or sample volume x 10 = sample volume + diluent volume 30 µL x 10 = 30 µL + diluent volume diluent volume = 300 µL - 30 µL Diluent volume = 270 µL So, to make a 1:10 dilution, 270 µL of diluent should be added to 30 µL of sample,

According to the lower normal reference limit stated by WHO, which of the following sperm concentrations would be considered abnormally low? a. 25 x 106 spermatozoa/mL b. 5 x 106 spermatozoa/mL c. 15 x 106 spermatozoa/mL d. 35 x 106 spermatozoa/mL

b. 5 x 106 spermatozoa/mL

Which of the following would be considered a normal value for a glucose level in cerebrospinal fluid? a. 30 mg/dL b. 60 mg/dL c. 120mg/dL d. 150 mg/dL

b. 60 mg/dL

A CSF glucose value is 62 mg/dL. What would you estimate the serum glucose? a. 65 mg/dL b. 93 mg/dL c. 120 mg/dL d. 180 mg/dL

b. 93 mg/dL -- CSF glucose is roughly estimated to be about 2/3 of the serum glucose level in mg/dL. Therefore: 62 mg/dL = 2/3 x serum glucose serum glucose = 62 mg/dL x 3/2 serum glucose = 93 mg/dL

Identify the urine sediment element shown by the arrow. a. Mucus thread b. Cylindroid c. Fiber d. Amorphous urates

b. Cylindroid

Examples of conditions resulting in benign proteinuria include: a. Multiple myeloma and dehydration b. Dehydration and orthostatic proteinuria c. Lupus erythematosus and multiple myeloma d. Orthostatic proteinuria and lupus erythematosus

b. Dehydration and orthostatic proteinuria

A positive leukocyte esterase test indicates the presence of which of the following in a urine specimen? a. Lymphocytes b. Granulocytes c. Erythrocytes d. Epithelial cells

b. Granulocytes

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: a. Hematuria b. Hemoglobinuria c. Oliguria d. Hemosiderinuria

b. Hemoglobinuria

Normal adult CSF may have 0-5 white blood cells (WBCs)/µL. Which of the following cell types account for 60-100% of these WBCs? a, Neutrophils b. Lymphocytes c.Monocytes d. Eosinophils

b. Lymphocytes -- Typically, majority of cells seen in a normal adult CSF specimen are lymphocytes and monocytes (70:30 ratio). This ratio is reversed in children.

Which of the following cells are lining cells that could be seen in a peritoneal fluid? a. Choroidal cells b. Mesothelial cells c. Ependymal cells d. Squamous epithelial cells

b. Mesothelial cells

A WBC differential count on CSF should be performed using the following technique: a. Wet mount of sample from collection tube b. Stained smear of a cytocentrifuged specimen c. Directly from hemocytometer chamber count d. Directly from stained hemocytometer count

b. Stained smear of a cytocentrifuged specimen

Identify the urine sediment elements indicated by the arrow in the illustration: a. Cholesterol crystals b. Triple phosphate crystals c. Amorphous urate crystals d. Ammonium biurate crystals

b. Triple phosphate crystals

Which of the following cells when found upon microscopic examination of the urine would be most indicative of kidney disease: a. WBCs and bacteria b. Tubular epithelial cells c. Squamous epithelial cells d. RBCs

b. Tubular epithelial cells -- Renal tubular epithelial cells may be found rarely in healthy patients, but in increased numbers, can indicate destruction of the kidney's tubules (nephrons). These cells are small and round. Conditions associated with the presence of these cells include allograft rejection, viral infection, and other less common conditions. WBCs and bacteria may be indicative of a urinary tract infection. Squamous epithelial cells are the largest cells found in urine sediment and are normally shed from the lower linings of the urethra. They typically do not have clinical significance. RBCs are seen due to vascular injury within the GI tract or due to damage to the glomerular membrane.

Name the crystals present on this slide. a. Leucine b. Tyrosine c. Cholesterol d. Cystine

b. Tyrosine -- These are tyrosine crystals, they are usually found in acid/neutral urine and appear as fine-needle clumps or rosettes. They are indicative of liver disease. Leucine crystals are associated with liver disease. They are found in acid to neutral pH urine specimens and are yellow in color. Concentric circles and radial striations are noted microscopically. Cholesterol crystals appear in acid urine as large, flat, transparent plates with notched corners. Cystine crystals are present in acidic urine, are typically colorless, and have a characteristic of hexagonal plates. These crystals are associated with cystinuria.

Which of the following answer choices correctly state the use of urine reagent strips for chemical analysis? a. Urine chemical reagent strips readers can utilize any manufacturer's dipsticks. b. Use of a well-mixed, uncentrifuged urine sample at room temperature is the technique for urine reagent strips. c. The urine reagent test strips method is very reliable and quick as the timing for chemical reactions to take place is the same. d. The reagent strip can be left in the urine specimen for several minutes without causing any problem.

b. Use of a well-mixed, uncentrifuged urine sample at room temperature is the technique for urine reagent strips.

What is the lower reference limit for sperm concentration according to the World Health Organization, WHO Laboratory Manual for the Examination and Processing of Human Semen, WHO press, Geneva, Switzerland, 2010? a. 5 x 10^6 spermatozoa/mL b. 10 x 10^6 spermatozoa/mL c. 15 x 10^6 spermatozoa/mL d. 30 x 10^6 spermatozoa/mL

c. 15 x 10^6 spermatozoa/mL

Which of the following areas of the brain and spinal cord is responsible for producing CSF? a. Subarachnoid space b. Dura mater c. Choroid plexuses d. Arachnoid granulations

c. Choroid plexuses

Which test uses a vaginal fluid specimen to differentiate amniotic fluid from urine and other body fluids? a. Optical density (OD) of bilirubin b. Osmolality c. Fern test d. Amine (Whiff) test

c. Fern test -- The fern test is the correct answer. It is used to evaluate the presence of amniotic fluid in cases of premature membrane rupture. Vaginal fluid is observed microscopically on a slide for "fern-like" crystals, formed by protein and sodium chloride content. Spectrophotometric analysis of amniotic fluid measures the change in optical density (OD) of bilirubin. The absorbance difference at 450 nm is plotted on a Liley graph to determine the severity of fetal distress in hemolytic disease of the newborn (HDN). Osmolality measures particles in solution, such as sodium and chloride, and is used for the evaluation of renal concentrating ability. The amine (Whiff) test uses KOH and saline vaginal fluid suspension to detect the presence of a "fishy" odor due to the volatilization of amines produced by anaerobic bacteria in bacterial vaginosis (BV).

Which of the following methods would be employed to collect sweat for chloride analysis: a. Electrophoresis b. Counter electrophoresis c. Iontophoresis d. Isoelectric focusing

c. Iontophoresis -- Iontophoresis is the gold standard for the collection of sweat for sweat chloride analysis. Pilocarpine iontophoresis actually stimulates the production of sweat, which is absorbed within a gauze pad which was previously weighed dry. The sweat sample is weighed to determine how much sweat was collected. Finally, the sweat sample is analyzed for its concentration of chloride. This particular test is utilized very commonly for the screening of cystic fibrosis since these patients typically exhibit higher levels of sweat chloride. In children over the age of 6 months to adults, the reference ranges are: - Equal to or less than 39 mmol/L = Cystic Fibrosis is not likely to be present (rules-out CF) - 40 - 59 mmol/L = Intermediate Level (Cystic Fibrosis may be present, further testing required) - Greater than or equal to 60 mmol/L = Cystic Fibrosis is most likely present

Which of the following may cause a false positive bilirubin result on a urine chemical reagent strip? a. Urobilinogen b. Presence of nitrites c. Large doses of chlorpromazine d. Urobilin

c. Large doses of chlorpromazine -- A large dose of chlorpromazine, also known as Thorazine, may cause a false positive bilirubin result on a urine chemical reagent strip. This may be caused by a lowered urine pH in the presence of this compound. The other listed compounds do not cause false-positive bilirubin results.

Which of the following conditions is most likely when an oligoclonal band is seen in CSF electrophoresis without a corresponding serum peak? a. Lymphoproliferative disorder b. Viral meningitis c. Multiple sclerosis d. Traumatic lumbar puncture

c. Multiple sclerosis

A negative glucose oxidase test and a positive test for reducing sugars in urine indicate: a. True glycosuria b. A false-negative glucose oxidation reaction c. The presence of a non-glucose reducing sugar such as galactose d. These results are normal

c. The presence of a non-glucose reducing sugar such as galactose ----- A negative glucose oxidase test and a positive test for reducing sugars in urine indicate the presence of a non-glucose reducing sugar such as galactose, fructose, glyceraldehyde, etc. This is the reason that certain patient populations such as infants require additional confirmatory sugar testing on their urine samples.

Which of the following may cause a false-positive protein reading on a urinalysis dipstick? a. Urine pH is between 5.0 and 6.0. b. The specimen has been refrigerated. c. The urine specimen is highly pigmented. d. A urine specimen with low specific gravity.

c. The urine specimen is highly pigmented. -- Urine specimens that are highly pigmented may result in a false-positive protein result. Freshly voided urine should be slightly acidic (pH between 5.0 and 6.0). Acidic urine will not interfere with the protein test. However, a highly buffered alkaline urine may cause a false-positive protein reading by overriding the acid buffer that is part of the protein reagent pad. A refrigerated specimen will not cause a false-positive protein result. It is, however, best practice to allow the urine to warm up to room temperature before testing. A false-positive protein result may occur in samples with high specific gravity, not a low specific gravity.

Acetest® can be used to test for ketones in: a. Urine b. Urine and serum c. Urine, serum, and whole blood d. Urine, serum, whole blood, and CSF

c. Urine, serum, and whole blood

Identify the urine sediment elements present in this illustration: a. WBC casts b. Hyaline casts c. Waxy casts d. Fine granular casts

d. Fine granular casts -- Fine granular cases may represent degenerated cellular casts. They usually indicate renal parenchymal disease or allograft rejection. WBC casts (leukocyte casts) are seen in renal infection or inflammation such as pyelonephritis. The identification of the cast as a WBC cast is supported by the appearance of WBCs outside of the cast. Hyaline casts, the type most commonly seen in urine sediment, have a refractive index similar to the urine in which they are suspended. For this reason, hyaline casts will appear almost invisible under brightfield microscopy, but are easily off seen by phase-contrast microscopy. Waxy casts are yellow, gray, or colorless and very refractive. They resemble short broad casts with broken ends and cracked edges. They are present in patients with severe renal failure and can be due to allograft rejection.

Conditions that produce elevated CSF protein levels include all of the following EXCEPT: a. Meningitis b. Multiple sclerosis c. Hemorrhage d. Fluid leak

d. Fluid leak -- Fluid leak would result in a decreased protein level. Any condition that causes damage to the blood-brain barrier mostly likely will cause elevated protein levels in the CSF. Meningitis, multiple sclerosis, and hemorrhage would all result in elevated protein levels in the CSF.

Xanthochromia in CSF is characteristic of: a. Encephalitis b. Meningitis c. Septicemia d. Hemorrhage

d. Hemorrhage -- Xanthochromia is the pink, yellowish, or orange discoloration of the CSF mostly due to the presence of RBC degradation. The yellowish discoloration can occur within 2 to 4 hours after the onset of subarachnoid hemorrhage. Spinal fluid can also appear xanthochromic due to jaundice, markedly elevated CSF protein, melanoma pigment, and carotenemia.

What are the MAIN functions of the distal convoluted tubules? a. Balance hydrogen ions and keep the body pH at 6.8 b. Control aldosterone production and ammonia reabsorption c. Excrete various antibiotics and uric acid d. Maintain water-electrolyte and acid-base balances

d. Maintain water-electrolyte and acid-base balances -- The main functions of the distal convoluted tubules are to maintain water-electrolyte and acid-base balances. These functions are controlled by antidiuretic hormone (ADH) and aldosterone.

A patient with suspected intraabdominal malignancy had a paracentesis procedure performed. The fluid was then sent to the laboratory for examination and fluid differential. Which cells predominate in this cytospin field from the patient's sample? a. Monocytes b. Atypical lymphocytes c. Blasts d. Plasma cells

d. Plasma cells -- The predominant cells in this image are plasma cells. This patient may have been suffering from a plasma cell malignancy in the abdominal cavity or been under stress conditions, hence the presence of numerous plasma cells in the peritoneal fluid. All of the cells have a characteristic perinuclear hof seen in plasma cells, but not seen in monocytes, atypical lymphocytes, or blasts.

When a patient has a bile duct obstruction, the bilirubin test portion of the reagent strip is: a. Negative because unconjugated bilirubin is increased and cannot be excreted by the kidneys. b. Positive because unconjugated bilirubin is increased and is excreted by the kidneys. c. Negative because conjugated bilirubin is decreased and cannot be excreted by the kidneys. d. Positive because conjugated bilirubin is present and is excreted by the kidneys.

d. Positive because conjugated bilirubin is present and is excreted by the kidneys. -- 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, usually caused by red blood cell breakdown, is not able to be excreted from the kidneys, and will not cause a positive urine bilirubin result.

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

The estimation of hyaluronic acid concentration by measurement of viscosity is useful in evaluating which type of fluid? a. Cerebrospinal b. Peritoneal c. Pleural d. Synovial

d. Synovial ----- Hyaluronic acid is a substance found in the synovial (joint) fluid. This allows for the thicker consistency of the fluid for cushioning and protection from friction during movement.

Which two of the following crystalline elements are found in acid urine: a. Cystine and calcium carbonate b. Triple phosphate and calcium carbonate c. Calcium phosphate and uric acid d. Tyrosine and cystine

d. Tyrosine and cystine

All of the following crystals will normally be found in a urine specimen with a pH of 8.0, EXCEPT? a. Ammonium biurates b. Triple phosphates c. Calcium carbonates d. Uric acid

d. Uric acid

A patient presents to the emergency room with severe headaches, nausea, and vomiting. CSF chemistry results are as follows: Protein - 74 mg/dL (15-45 mg/dL) Glucose - 53 mg/dL (40-85 mg/dL) Based on the patient's complaints and the above laboratory results what is the most probable condition? a. Fungal Meningitis b. Bacterial Meningitis c. Traumatic Tap d. Viral Meningitis

d. Viral Meningitis -- The correct answer here is viral meningitis with an increased protein and normal glucose levels. Further testing with serology, polymerase chain reaction, and viral culture could be used to determine the cause of the patient's problems. Fungal meningitis laboratory results will show a normal protein level and a normal to decreased glucose level. Further testing to determine a fungal meningitis infection includes latex agglutination and positive fungal growth on cultures. Bacterial meningitis will present with markedly decreased glucose and increased protein results. Bacterial organisms would most likely be seen upon Gram stain of the CSF fluid. A traumatic tap would be visible from the specimens received in the laboratory and if possible should not be used to diagnose a patient.