"Urinalysis and Body Fluids" AAB MOCK EXAM missed questions

Neutrophils and bacteria

A physician obtains a peritoneal fluid sample by lavage on a patient who complained of fever and abdominal pain following an automobile accident. The fluid is analyzed in the laboratory. How should the sample shown in the image to the right be reported? Lymphocytes Eosinophils and parasites Mesothelial cells Neutrophils and bacteria

Lyse the red blood cells

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 yeast cells Lyse the red blood cells Dissolve the oil droplets Crenate the red blood cells

This represents normal kidney function A urine osmolality of 800 mOsm or higher is considered normal when patients were deprived of fluid for 12 hrs.

A urine concentration test was performed on a patient after a fluid intake deprivation period with the following findings: After 12 hours Urine Osmolality = 850 mOsm/KgAfter 16 hours Urine Osmolality = 850 mOsm/Kg What do these results indicate? This represents normal kidney function This represents a loss of tubular function and concentrating ability. This represents a laboratory error, as these results are not medically possible. These results represent end-stage renal disease.

Defined as oliguria

A urine production of less than 400 mL/day is: Consistent with normal renal function and water balance Termed isosthenuria Defined as oliguria Associated with diabetes mellitus

Hydrometry

All of the following are methods employed for measuring the specific gravity of urine, EXCEPT? Refractometry Hydrometry Osmolality Urine reagent strips

Flattened cells

All of the following are types of epithelial cells that line the genitourinary system EXCEPT: Squamous Cuboidal Transitional Flattened cells

Triple phosphates

All of the following crystals can be exclusively found in acidic urine EXCEPT: Calcium oxalates Acid urates Triple phosphates Amorphous urates

Calcium oxalate

All of the following normal urine crystals are most often found in a urine specimen that has a pH > 7 EXCEPT: Calcium oxalate Triple phosphate Ammonium biurate Calcium carbonate

Fructose level

All of the following tests are part of the routine semen analysis, EXCEPT: The correct answer is highlighted below pH Motility Fructose level Morphology

Lymphocytes

All of the following white blood cells would produce a positive leukocyte esterase test on the urine chemical reagent strip, EXCEPT? Neutrophils Eosinophils Basophils Lymphocytes

Blast cells

Identify the important blood cells displayed in this cerebrospinal fluid sample. Atypical lymphocytes Basophils Monocytes Blast cells

Synovial lining cells

Identify the large, foamy cells in the joint fluid image shown to the right. Macrophage Bronchial lining cells Tumor clump Synovial lining cells

Yeast

Identify the majority of cells present in this urine slide. Red blood cells White blood cells (WBCs) Yeast Squamous epithelial cells

Nucleated red blood cells (NRBCs)

Identify the predominant (in number of cells, not size) nucleated cell in this cerebrospinal fluid cytospin differential. Nucleated red blood cells (NRBCs) Neutrophils Metamyelocyte Tumor cells

Hyaline cast

Identify the urine sediment element indicated by the arrow in the illustration: Mucus thread Cylindroid Hyaline cast Waxy cast

Cylindroid type of hyaline cast with tapered end

Identify the urine sediment element shown by the arrow. Mucus thread Cylindroid Fiber Amorphous urates

Renal tubular epithelial cast

Identify the urine sediment element shown by the arrow: Waxy cast Hyaline cast Renal tubular epithelial cast Granular cast

Triple phosphate crystals

Identify the urine sediment elements indicated by the arrow in the illustration: Cholesterol crystals Triple phosphate crystals Amorphous urate crystals Ammonium biurate crystals

Uric acid crystals

Identify the urine sediment elements shown by the arrow: Cholesterol crystals Uric acid crystals Amorphous urate crystals Cystine crystals

Mucus threads

Identify the urine sediment elements shown by the arrow: Cylindroids Mucus threads Hyaline casts Budding yeast

WBC casts

Identify the urine sediment elements shown by the arrow: WBC casts RBC casts Waxy casts Granular casts

Waxy cast

Identify the urine sediment elements shown by the arrow: Waxy cast Granular cast Renal tubular epithelial cast Hyaline cast

Red blood cells

Identify the urine sediments present in this image observed using brightfield microscopy. White blood cells Red blood cells Squamous epithelial cells Yeast

Mesothelial cell

The following image is from a cytocentrifuged preparation of serous fluid. The arrow is pointing to which of the following: Neutrophil Lymphocyte Mesothelial cell Malignant cell

Presumptive malignant cells The cells that are indicated by the arrows are presumptive malignant cells. The characteristics that help to identify these, and the surrounding cells, as a malignant cells include: giant cells, cellular crowding, high nuclear to cytoplasm (N/C) ratio, non-uniform nuclei, irregular nuclear membranes, multinucleation, and vacuolation.

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? Ependymal cells Atypical lymphocytes Presumptive malignant cells Immature white blood cells

Leukemia with CNS involvement

The image is a stained smear of cerebrospinal fluid. The cells present in this field may indicate what condition? Allergic reaction Bacterial meningitis Leukemia with CNS involvement Viral meningitis

Lymphocytes

The image on the right is a cytospin preparation of cerebrospinal fluid viewed at 1000X magnification. What is the identity of the primary blood cell type observed in this microscopic field? Monocytes Macrophages Mesothelial cells Lymphocytes

Eosinophil

The image shown is a cytospin preparation of cerebrospinal fluid (CSF). What is the blood cell type that is indicated by the arrow? Segmented neutrophil Monocyte Eosinophil Macrophage

1.5 mL

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? 0.5 mL 1.5 mL 3.5 mL 4.5 mL

Nephron

What is the primary functional unit of the kidney? Ureter Glomerulus Nephron Distal convoluted tubule

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: Negative because unconjugated bilirubin is increased and cannot be excreted by the kidneys. Positive because unconjugated bilirubin is increased and is excreted by the kidneys. Negative because conjugated bilirubin is decreased and cannot be excreted by the kidneys. Positive because conjugated bilirubin is present and is excreted by the kidneys.

Preserve the integrity of the cells.

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? Enhance staining of the elements. Preserve the integrity of the cells. Increases the fluid volume so that cells will form a monolayer on the slide. Dilute the sample

#1 Chemistry, #2 Microbiology, #3 Hematology

When three tubes of cerebrospinal fluid are received in the laboratory they should be distributed to the various laboratory sections as follows: #1 Hematology, #2 Chemistry, #3 Microbiology #1 Chemistry, #2 Microbiology, #3 Hematology #1 Microbiology, #2 Hematology, #3 Chemistry #1 Chemistry, #2 Hematology, #3 Microbiology

Sulfosalicylic

Which acid is most frequently used to precipitate protein for confirmatory urinalysis tests? Trichloroacetic Nitric Sulfosalicylic Acetic

Albumin remember nephrotic syndrome is associated with heavy proteinuria (albuminuria)

Which analyte measurement is used to detect early nephropathy in a diabetic patient? Lactic acid Albumin Ketones HbA1C

Polarized light

Which is the best method for examination of synovial crystals? Phase contrast Darkfield microscopy Brightfield microscopy Polarized light

Mesothelial cells also for pleural and pericardial

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

Leukocyte count greater than 1,000 WBC/µL

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

Beta-hydroxybutyric acid

Which of the following ketones is NOT detected in the Acetest® tablet method? Acetone Beta-hydroxybutyric acid Acetoacetic acid Beta-hydroxybutyric acid and acetone

The urine specimen is highly pigmented.

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

Meat-filled diet

Which of the following will cause an acidic urine pH? Hyperventilation Meat-filled diet Vegetarian diet Old urine specimen

Calcium pyrophosphate crystals

Which of the following would be the most characteristic finding in synovial fluid in a case of pseudogout? Monosodium urate crystals Calcium pyrophosphate crystals Macrophage infiltration Mixed RBC/WBC infiltration

Stained smear of a cytocentrifuged specimen

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

Cryptococcus neoformans

A cerebrospinal fluid sample from a possible meningitis patient demonstrated a round, budding yeast of variable size on Gram stain. The specimen was cultured to routine fungal media without cycloheximide. The organism rapidly produced urease and demonstrated brown pigmented colonies on niger seed agar. The organism identification is: Cryptococcus neoformans Candida albicans Malassezia furfur Trichosporan species

Polyuria

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

Lymphocytes and Blasts

A patient suffering from typical leukemic symptoms presents in the emergency room. Physicians order a spinal tap after noticing possible central nervous system involvement. What are the cells seen in the spinal fluid cytospin preparation? Reactive mesothelial cells Lymphocytes and Blasts Monocytes Reactive Lymphocytes

An alkaline urine pH

A patient who has a primarily vegetarian diet will most likely have: An acid urine pH An alkaline urine pH A neutral pH pH is not affected by the patient's diet

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.

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? Monocytes Atypical lymphocytes Blasts Plasma cells

Mesothelial cells, neutrophils, and red blood cells The major cells present are mesothelial cells in a clump, which is consistent with a patient with pneumonia. There are also segmented neutrophils and red blood cells present as well in the background.

After reviewing this cytospin from a pleural fluid, identify the cells that would be the appropriate to report? Macrophages, neutrophils, and red blood cells Mesothelial cells, neutrophils, and red blood cells Tumor cells, neutrophils, and red blood cells Plasma cells, neutrophils, and red blood cells.

Acute glomerulonephritis

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 Acute pyelonephritis Acute cystitis Nephrotic syndrome

Acute Leukemia

Blast cells found in a spinal fluid differential are most likely associated with which of the following? Bacterial meningitis Acute Leukemia Viral meningitis Metastatic carcinomas

An increased number of lymphocytes in a CSF when compared to a normal sample.

CSF pleocytosis can refer to: A decreased number of lymphocytes in a CSF when compared to a normal sample. An increased number of lymphocytes in a CSF when compared to a normal sample. An increased number of myeloblasts in a CSF when compared to a normal sample. A decreased number of monocytes in a CSF when compared to a normal sample.

Amorphous urates and calcium oxalate

Common crystals which can be found in ACID urine include: Amorphous phosphates and amorphous urates Amorphous urates and calcium oxalate Calcium carbonate and calcium oxalate Calcium oxalate and amorphous phosphates

Pleural fluid lactate dehydrogenase (LDH) <2/3 the normal upper limit for serum

Effusion fluids are classified as transudates or exudates. According to Light's criteria, all of the following applies to an exudate EXCEPT? Pleural fluid/serum protein ratio >0.5 Pleural fluid/serum lactate dehydrogenase (LDH) ratio >0.6 Pleural fluid lactate dehydrogenase (LDH) <2/3 the normal upper limit for serum Serum-ascites albumin gradient (SAGG) <1.1 g/dL

Neutrophil

Glitter cell is a term used to describe a specific type of: Ketone body Oval fat body Bacteria Neutrophil

Brown/black

Homogentisic acid in urine will cause urine to be which of the following colors? Green Pink Port-wine Brown/black

0-5 WBCs/µL

How many white blood cells (WBCs) would be considered normal for adult cerebrospinal fluid? Any number of WBCs is considered abnormal 0-5 WBCs/µL 6-10 WBCs/µL Up to 30 WBCs/µL

White blood cells (WBCs)

In reference to semen analysis microscopic examination, differentiation, and enumeration of "round cells" which are often present in semen count are referred as: Sperm vitality Seminal fluid fructose White blood cells (WBCs) Bacteria

Hyperproteinemia

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

Refractometer SG would be higher than Dipstick SG.

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 lower than dipstick SG. Refractometer SG would be higher than Dipstick SG. Dipstick SG would be the same as refractometer SG. Unable to determine.

Fat

Sudan III will confirm the presence of: Parasites Sperm Mucus Fat

Squamous epithelial cell

The cell indicated by the arrow is a: Transitional epithelial cell Renal tubular epithelial cell Squamous epithelial cell Macrophage

Yeast

The constituents that are indicated by the arrows in this image of stained urine sediment are: Red blood cells Yeast Renal epithelial cells Leukocytes

Cystine crystals

The crystals seen in these images are: Leucine crystals Bilirubin crystals Cystine crystals Cholesterol crystals

Leucine crystals

The crystals seen in this image are: Bilirubin crystals Leucine crystals Cystine crystals Cholesterol crystals

Diabetes

The elements indicated by the arrows are more likely to be seen in patients with which condition? Bacterial infection Nephrotic syndrome Diabetes Renal failure

4.5 to 8.0

The normal range for urine pH is: 4.5 to 8.0 5.0 to 6.0 5.5 to 6.6 7.35 to 7.45

Hydrostatic differential in glomerular tufts

The primary mechanism responsible for glomerular filtration is: Osmotic gradient Concentration of blood components Rate of blood flow through the kidneys Hydrostatic differential in glomerular tufts

Proximal convoluted tubule

The primary site of reabsorption of glomerular filtrate is the: Loop of Henle Proximal convoluted tubule Distal convoluted tubule Collecting duct

Glomerulonephritis

The technologist in the urinalysis department received a sample for a microscopic examination. The image to the right shows the microscopic urinalysis. Which of the following conditions below would most closely match this patient's microscopic urinalysis morphology? Diabetes mellitus Glomerulonephritis Yeast infection Pyuria

Bilirubin crystals

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

Chronic inflammation

This serum protein electrophoresis scan most likely represents which condition? Chronic inflammation Myocardial infarction Liver disease Monoclonal gammopathy

One hour

To determine if xanthochromia is present in a cerebrospinal fluid sample, the sample must be centrifuged within: One hour Two hours Three hours Four hours

Bacteria

What are the microscopic elements that are indicated by arrows in this image? Bacteria Calcium oxalate crystals Triple phosphate crystals Artifact

Waxy cast

What element is indicated by the arrow on this slide? Finely granular cast Waxy cast Cylindroid White blood cells (WBCs)

Ependymal clump

What is the identification of this cellular clump found in CSF? Note the presence of many similar-appearing nuclei without distinct lines of demarcation between cells. Cartilage cell Tumor cell clump Ependymal clump Lymphoblast clump

Squamous epithelial cells (SECs)

What is the identity of the cells that are indicated by the arrow in this image? White blood cells (WBCs) Red blood cells (RBCs) Yeast Squamous epithelial cells (SECs)

32% WTO grades sperm motility as progressive motility (PM), nonprogressive motility (NP), and immotility (IM). PM is defined as sperm moving linearly or in a large circle, NP is sperm moving without progression, and IM represents sperm with no movement. The lower reference limit for progressive motility is 32%. The lower reference limit for total motility (progressive + non-progressive) is 40 %.

What is the lower reference limit for progressive motility of spermatozoa when performing a semen analysis? 12% 22% 32% 40%