Lab CE urinalysis and body fluids
Cerebrospinal fluid (CSF) specimens are usually collected by lumbar puncture and placed in numbered tubes starting with the first tube collected. If four tubes are collected, which tube would be used for a cell count and differential? Tube #1 Tube #2 Tube #3 Tube #4
Tube #3
What urine contaminant could cause a falsely elevated level of urinary albumin, thus giving the false interpretation of kidney damage? A. Blood from menstruation B. Feces from urine collections during bowel movement C. Incomplete cleaning of the genitalia with a disinfectant prep pad D. Diluting the urine sample with water
A. Blood from menstruation
A voided urine specimen is delivered from the women's clinic to the laboratory six hours after collection. The following results are reported: Color: yellow Protein: negative Bilirubin: negative Clarity: cloudy Glucose: negative Urobilinogen: 0.2 mg/dLSp. Gravity: 1.020 Ketone: negative Nitrite: positive pH: 9.0 Blood: negative Leukocyte esterase: negative What might these results indicate? A. The patient has a urinary tract infection. B. The urine may have remained too long at room temperature and bacterial contaminants have affected the nitrite and pH results. C. The specimen had a preservative added. D. The leukocyte esterase result is wrong.
B. The urine may have remained too long at room temperature and bacterial contaminants have affected the nitrite and pH results.
The image on the right is a Wright-Giemsa stained CSF smear (1000X). What structures are indicated by the arrows? Bacteria Platelets Stain precipitate Malarial parasites
Bacteria
What are the microscopic elements that are indicated by arrows in this image? Bacteria Calcium oxalate crystals Triple phosphate crystals Artifact
Bacteria
Which of the following ketones is NOT detected in the Acetest® tablet method? Acetone Beta-hydroxybutyric acid Acetoacetic acid Beta-hydroxybutyric acid and acetone
Beta-hydroxybutyric acid
Which of the following characteristics of cerebrospinal fluid is present if blood is due to subarachnoid hemorrhage (SAH)? A. Sample clots on standing. B. Blood is evenly distributed in all tubes. C. The supernatant is clear when centrifuged within one hour. D. Blood is more visible in the first tube collected and less and less visible in each subsequent tube thereafter.
B. Blood is evenly distributed in all tubes.
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 urine specimen is received in the laboratory late in the afternoon. The specimen was collected early in the morning and was accidentally left in bright sunlight and at room temperature on a counter in the outpatient clinic. The test order is for urine bilirubin screening. Which of the following could occur as a result of the storage conditions? A. False-positive test result B. False-negative test result C. No adverse effect from the storage conditions D. It can not be determined based on the information provided.
B. False-negative test result
A urine specimen produced yellow foam when shaken. What is the cause of the yellow foam? Phosphates Bilirubin Normal Red blood cells
Bilirubin
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
Bilirubin crystals
Bacterial contamination of a urine specimen from a normal healthy individual could originate from all of the following except: Contaminated urine container Vagina Bladder Vulva
Bladder
What types of cells are NOT present in this field of a cytocentrifuged CSF sample? Red cells Lymphocytes Neutrophils Blasts
Blasts
Which of the following substances can cause a false positive result for blood on the urine chemical reagent strip? Ascorbic acid Bleach in the collecting bottle High levels of nitrite High specific gravity
Bleach in the collecting bottle
A urine production of less than 400 mL/day is: A. Consistent with normal renal function and water balance B. Termed isosthenuria C. Defined as oliguria D. Associated with diabetes mellitus
C. Defined as oliguria
A patient presents to his family doctor with respiratory issues. He has a history of being a heavy smoker for more than 20 years, so the physician orders a BAL cell count with differential. Which of the following cells would most closely correlate with the patient's medical history? A. Macrophages with phagocytized red blood cells B. Macrophages with phagocytized bacteria C. Macrophages with purple/black inclusions D. Macrophages without any inclusions
C. Macrophages with purple/black inclusions
Urine crystals of radiographic contrast media will appear similar to which of the following? Cholesterol crystals Amorphous crystals Calcium Oxalate crystals Triple Phosphate crystals
Cholesterol crystals
Where does most cerebrospinal fluid originate? Cerebral arachnoid space Choroid plexus Ventricles Lumbar region
Choroid plexus
The nitrite portion of the test strip can be used to do all of the following EXCEPT: A. Monitor antibiotic therapy B. Detect a bladder infection in an early stage in pregnant women C. Screen individuals with recurrent infections D. Detect metabolic by-products often seen in diabetic patients
D. Detect metabolic by-products often seen in diabetic patients
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
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 an unpreserved urine specimen cannot be cultured immediately, which storage method is most appropriate? A. Stored at room temperature for up to 8 hours B. Stored in the freezer for up to 24 hours C. Stored in the incubator for up to 8 hours D. Stored in the refrigerator at 4° C for up to 24 hours
D. Stored in the refrigerator at 4° C for up to 24 hours
Serous fluid effusions may result from all of the following EXCEPT: Congestive heart failure Infection and inflammation Malnutrition Dehydration
Dehydration
The exocrine functions of the kidneys include which of the following? Regulation of hormone production Elimination of metabolic waste products Maintenance of blood pressure Production of red blood cells
Elimination of metabolic waste products
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: Methanol Isopropanol Ethylene glycol Ethanol
Ethylene glycol
A typical Bronchoalveolar lavage differential contains all the cells EXCEPT: Ciliated lining cells Mesothelial cells Macrophages Lymphocytes
Mesothelial cells A typical BAL would NOT include mesothelial cells as they are lining cells for serous fluids.
The image is a stained smear of cerebrospinal fluid. The cell in this slide could be caused by what condition? Viral meningitis Allergic reaction Cerebral hemorrhage Metastasis
Metastasis
A patient has been diagnosed with an upper gastrointestinal bleed. Which of the following would be characteristic of this condition? Red stool Pale yellow, white, or gray stool Stool much darker brown or black color Mucous or blood-streaked mucus stool
Stool much darker brown or black color
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
1.5 mL ejaculate contains usually between 2-5 mL of semen. 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.
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? 5 x 106 spermatozoa/mL 10 x 106 spermatozoa/mL 15 x 106 spermatozoa/mL 30 x 106 spermatozoa/mL
15 x 106 spermatozoa/mL
The element that is indicated by the arrow is a: Red blood cell cast Granular cast Hyaline cast Renal tubular epithelial cast
Red blood cell cast
Which of the following may be associated with acidic urinary pH? Metabolic alkalosis Renal tubular acidosis Vegetarian diet High urine glucose
High urine glucose
Identify the urine sediments present in this image observed using brightfield microscopy. White blood cells Red blood cells Squamous epithelial cells Yeast
Red blood cells
The oxidation of hemoglobin to methemoglobin in acidic urine after several hours may cause which of the following color to produce? White Yellow Blue to green Red to brown
Red to brown
Urine pH values can normally vary between: 4.5 to 8.0 5.0 to 6.0 7.0 to 8.0 3.0 to 7.0
4.5 to 8.0
Pleural fluid was sent to the laboratory for a WBC count. The specimen was NOT diluted. WBCs in 5 large squares were counted in each side of the hemacytometer. The number of WBCs counted were as follows: Top counting chamber: 35 cells total (in 5 large squares) Bottom counting chamber: 33 cells total (in 5 large squares). Based on the information provided above, calculate the total WBC count. 34 cells/mm3 3.4 cells/mm3 680 cells/mm3 68 cells/mm3
68 cells/mm3 total cells/µL = (68 cells) / (10 x 0.1mm3)
Two CSF specimens were sent to the Lab with the following results:Tube #1 = 11,200 rbc/µLTube #2 = 300 rbc/µLThe results on these CSF specimens are indicative of: An infection A recent subarachnoid hemorrhage A traumatic tap An old intracranial bleeding episode
A traumatic tap
Identify the crystal indicated by the arrow in this alkaline urine: Cholesterol crystal Triple phosphate crystal Amorphous urate crystal Ammonium biurate crystal
Ammonium biurate crystal
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
Amorphous urates and calcium oxalate
Substances found in urinary sediment that are more easily distinguished by the use of a polarized microscope are: WBC RBC Waxy casts Anisotropic cholesterol droplets
Anisotropic cholesterol droplets
Conditions that produce elevated CSF protein levels include all of the following EXCEPT: Meningitis Multiple sclerosis Hemorrhage Fluid leak
Fluid leak
All of the following tests are part of the routine semen analysis, EXCEPT: pH Motility Fructose level Morphology
Fructose level
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
Glomerulonephritis
Which of the following conditions will cause a positive reagent strip blood result due to hematuria? Hemolytic anemia Severe burns Glomerulonephritis Dehydration
Glomerulonephritis
Lymphocyte pleocytosis refers to a(n) _____________ in a CSF when compared to a normal sample. Increased number of lymphocytes Decreased number of lymphocytes Normal number of lymphocytes Absence of lymphocytes
Increased number of lymphocytes
Excessive carbohydrate loss that may occur due to vomiting, or rapid weight loss may result in the presence of which of the following substances not normally contained in the urine? Glucose Bilirubin Ketones Urobilinogen
Ketones
White blood cell casts are MOST likely to indicate disease of the: Bladder Ureter Urethra Kidney
Kidney White blood cell casts are found most often in pyelonephritis cases involving the kidney
Which of the following sites is used most often for CSF collection? Ventricles L1-L2 Suboccipital L3-L4
L3-L4
Which of the following may cause a false positive bilirubin result on a urine chemical reagent strip? Urobilinogen Presence of nitrites Large doses of chlorpromazine Urobilin
Large doses of chlorpromazine
Synovial lining cells
Large, foamy cells in the joint
All of the following crystals are found in normal urine, EXCEPT? Triple phosphate Ammonium biurate Calcium oxalate Leucine
Leucine
Identify the urine sediment elements shown by the arrow: Cholesterol crystals Uric acid crystals Leucine crystals Cystine crystals
Leucine crystals
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
Lyse the red blood cells
A 21-year-old visited her doctor. She mentioned dysuria, frequency and urgency of urination to her doctor. Which of the following urinalysis reagent strips tests would you expect to be positive for this patient based on her symptoms? Ketones Blood Bilirubin Nitrites
Nitrites
All of the following are methods employed for measuring the specific gravity of urine, EXCEPT? Refractometry Hydrometry Osmolality Urine reagent strips
Osmolality
What is the fluid created in the abdominal cavity named? Peritoneal fluid Amniotic fluid Cerebrospinal fluid Pleural fluid
Peritoneal fluid
Which is the best method for examination of synovial crystals? Phase contrast Darkfield microscopy Brightfield microscopy Polarized light
Polarized light
How should the production of a blue or purple color on the test pad of an Ictotest® be interpreted? Positive for bilirubin Positive for ketones Negative for bilirubin Negative for ketones
Positive for bilirubin
Which of the following would be the most appropriate method to confirm a positive protein from a urine dipstick: Immunoelectrophoresis Heat precipitation Sulfosalicylic acid precipitation Protein electrophoresis
Sulfosalicylic acid precipitation
What is the identification of these crystals seen in urine with an alkaline pH? Uric acid Calcium oxalate Triple phosphate Calcium carbonate
Triple phosphate
The cells that are indicated by the arrows in this urine sediment (using phase-contrast microscopy) are: Red blood cells (RBCs) White blood cells (WBCs) Yeast cells Squamous epithelial cells
White blood cells (WBCs)
When analyzing urine sediment, which of the following cells are about the same size as red blood cells? Epithelial cells White blood cells Yeast Bacteria
Yeast
A cell count is ordered on a CSF sample that is bloody. Which of the following procedures would improve the non-nucleated cell count accuracy? A. Dilute the sample to minimize the number of red blood cells in the squares being counted. B. Use Spinal Diluting Fluid, a mixture of acetic acid and crystal violet. C. Use an automated hematology cell counter. D. Use of electronic cell counter.
A. Dilute the sample to minimize the number of red blood cells in the squares being counted.
Which of the following descriptions is matched correctly to its corresponding organism? A. Enterobius vermicularis ova - ovoid in shape with one side flattened. The embryo is separated from the shell by a clear space. B. Trichomonas vaginalis - is considered an important factor in the etiology of carcinoma of the bladder. The ova are elongated and are 60 X 160 microns. They are a yellowish color, slightly transparent, and possess a delicate terminal spine. C. Schistosoma haematobium ova - have a characteristic oval body with a long thin tail and are 50 microns in length. D. Sperm - are highly motile, measuring 8 - 15 microns with a characteristic pear shape. They possess multiple anterior flagella and the nucleus is often apparent.
A. Enterobius vermicularis ova - ovoid in shape with one side flattened. The embryo is separated from the shell by a clear space.
Which of the following situations suggest a traumatic tap occurred? A. More blood is in tube 1 than tubes 2, 3, or 4. B. Immediate centrifugation reveals pink supernatant. C. All collected specimens have an oily appearance. D. 3+ turbidity is present.
A. More blood is in tube 1 than tubes 2, 3, or 4.
The ketone component that is measured by the nitroprusside reaction is: Acetoacetic acid Beta-hydroxybutyric acid Acetone C-Reactive Protein
Acetoacetic acid
Oliguria is usually correlated with: Acute glomerulonephritis Diabetes mellitus Hepatitis Tubular damage
Acute glomerulonephritis
A patient reported to her doctor that her stools have been ribbon-like over the last few weeks. What is most likely the cause of the patient's stool appearance? Diarrhea ConstipationIn flammation of the intestinal wall Bowel obstruction
Bowel obstruction
After suspecting that his patient may have lung disease, the physician sends a bronchoalveolar lavage (BAL) to the laboratory for examination. What is the cell type noted by the arrows in this cytospin sample? Lymphocytes Mesothelial cells Macrophages Bronchial lining cells
Bronchial lining cells
Which of the following statements are true regarding the storage and handling of urinalysis chemical reagent strips? A. Variations in temperature during storage will not affect the effectiveness of the chemicals on the reagent pads. 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.
C. Remove only enough strips for immediate use.
What is the urinary system composed of? A. Kidney, ureter, urinary bladder, and urethra. B. Two kidneys, two urethras, one urinary bladder, and one ureter. C. Two kidneys, two ureters, one urinary bladder, and one urethra. D. Two kidneys, one ureter, one bladder, and one urethra.
C. Two kidneys, two ureters, one urinary bladder, and one urethra
This species of Candida accounts for around 20 percent of urinary yeast isolates. Candida albicans Candida glabrata Candida krusei Candida tropicalis
Candida glabrata
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
Cryptococcus neoformans
Identify the urine sediment elements shown by the arrow: Cholesterol crystals Uric acid crystals Amorphous urate crystals Cystine crystals
Cystine crystals
What is the primary functional unit of the kidney? Ureter Glomerulus Nephron Distal convoluted tubule
Nephron
Bence-Jones proteinuria can be seen in all of the following conditions EXCEPT: Amyloidosis Nephrotic syndrome Multiple myeloma Macroglobulinemia
Nephrotic syndrome
Which of the following macroscopic findings is MOST consistent with the microscopic finding of casts? Specific gravity of 1.005 Positive protein Alkaline pH Clear urine
Positive protein
When performing a chemical examination of urine, a routine reagent strip test for protein is based on the principle of: Precipitation by acid Protein-error-of-indicators Copper reduction Ictotest tablets
Protein-error-of-indicators
The primary site of reabsorption of glomerular filtrate is the: Loop of Henle Proximal convoluted tubule Distal convoluted tubule Collecting duct
Proximal convoluted tubule
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 the CSF? Normal spinal fluid Subarachnoid hemorrhage Traumatic tap Bacterial meningitis
Traumatic tap
Which of the following crystals would most likely be found in normal ALKALINE urine? Amorphous urates Triple phosphate Uric acid Calcium oxalate
Triple phosphate Amorphous urates and uric acid crystals are found in normal acid urine. So can calcium oxalate
Which of the following cells when found upon microscopic examination of the urine would be most indicative of kidney disease: WBCs and bacteria Tubular epithelial cells Squamous epithelial cells RBCs
Tubular epithelial cells
Which of the following urine chemical reagent strip tests is based on the Ehrlich-aldehyde reaction? pH Protein Glucose Urobilinogen
Urobilinogen
Which of the following tests included on a urine reagent strip would never be reported out as negative? Urobilinogen Bilirubin Leukocyte esterase Nitrite
Urobilinogen A normal urobilinogen result is approximately: 0.2-1.0 Ehr U/dL.
What element is indicated by the arrow on this slide? Finely granular cast Waxy cast Cylindroid White blood cells (WBCs)
Waxy cast Waxy casts are a bit more refractile than other casts and they commonly have squared-off ends. They are present in patients with severe renal failure and can be due to allograft rejection.
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
White blood cells (WBCs) Round cells refer to WBCs or immature sperm cells in a semen sample.
All of the following statements are TRUE regarding storing and handling of urine reagent strips if you are using a manual method (visually read reagent strip), EXCEPT: A. Compare strip to the color chart to check for correlating color. B. Handle strips at the end away from the test area. C. Remove the cap of the test strip bottle and leave it off until testing is completed. D. Store reagent test strips at room temperature below 30° C, but not refrigerated.
C. Remove the cap of the test strip bottle and leave it off until testing is completed.
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
Calcium oxalate
Which of the following statements is TRUE for specific gravity measured by the urine chemical reagent strip method? A. High concentrations of protein in urine do not increase the readings when using the urine chemical reagent strip. B. An alkaline pH would not affect the specific gravity result using a reagent strip method. C. The urine chemical reagent strip method is not affected by the presence of x-ray contrast media in the urine specimen. D. The urine chemical reagent strip method is based on the fact that light is refracted in proportion to the amount of total solids dissolved in the urine.
C. The urine chemical reagent strip method is not affected by the presence of x-ray contrast media in the urine specimen.
What is the identification of these crystals seen in a urine with an acid pH? Uric acid Calcium oxalate Triple phosphate Calcium carbonate
Calcium oxalate
The elements indicated by the arrows are more likely to be seen in patients with which condition? Bacterial infection Nephrotic syndrome Diabetes Renal failure
Diabetes Yeast cells as a cause of infection are more commonly found in diabetes mellitus patients but can also represent contaminants with no clinical significance.
All of the following statements are true regarding urinalysis reagent strips EXCEPT? A. Prolonged immersion may wash out reagents. B. Strips should be stored to prevent exposure to moisture. C. Some tests require specified reading times. D. The expiration date on the bottle does not matter, as long as the controls are acceptable.
D. The expiration date on the bottle does not matter, as long as the controls are acceptable.
What is the element indicated by the arrow in this image? Hyaline cast Waxy cast Granular cast Red blood cell cast
Granular cast
A patient suspected of a urinary tract infection has a negative nitrite test, but bacteria is present upon microscopic examination. What may have caused this discrepant result? A. The bacteria present is not a nitrate-reducer. B. The urine specimen may have been tested too soon after collection. C. There was a tech error when the test was performed. D. The urine was in the bladder for more than 4 hours.
A. The bacteria present is not a nitrate-reducer.
Which of the following statements is TRUE for specific gravity measured by the reagent strip method? A. The reagent strip method is based on the relationship between ionic concentration and specific gravity. B. The reagent strip method is based on the fact that light is refracted in proportion to the amount of total solids dissolved in the urine. C. The reagent strip method is affected by the presence of x-ray contrast media in the urine specimen. D. An alkaline pH would not affect the specific gravity result using a reagent strip method.
A. The reagent strip method is based on the relationship between ionic concentration and specific gravity.
Effusion fluids are classified as transudates or exudates. According to Light's criteria, all of the following applies to an exudate EXCEPT? A. Pleural fluid/serum protein ratio >0.5 B. Pleural fluid/serum lactate dehydrogenase (LDH) ratio >0.6 C. Pleural fluid lactate dehydrogenase (LDH) <2/3 the normal upper limit for serum D. Serum-ascites albumin gradient (SAGG) <1.1 g/dL
C. Pleural fluid lactate dehydrogenase (LDH) <2/3 the normal upper limit for serum
