Urinalysis 2

A 35-year-old diabetic woman is suspected of developing renal insufficiency. Which of the following specimens should be obtained to determine the amount of creatinine being excreted in the urine? a. 12 hour timed collection b. Midstream clean catch sample c. 24 hour timed collection d. Two hour postprandial

c. 24 hour timed collection

A urine sample is primarily acidic in nature (pH 5.0-6.0), but can vary depending on the time of day and diet. What is the overall normal range for urine pH? a. 7.35-7.45 b. 4.0-6.0 c. 4.5-8.0 d. 6.0-7.0

c. 4.5-8.0

Which of the following disorders frequently occurs following a bacterial infection of the skin or throat? a. Rapidly progressive glomerulonephritis b. Chronic glomerulonephritis c. Acute glomerulonephritis d. Membranous glomerulonephritis

c. Acute glomerulonephritis

The yellowing of CSF found in xanthochromia is caused by... a. Presence of myoglobin b. Excess Protein c. Bilirubin d. Hyaluronic acid

c. Bilirubin

Which of the following physical characteristics provides the best indicator of urine concentration and body hydration? a. Odor b. Clarity c. Color d. Foam

c. Color

This urine crystal (flat hexagons) is seen as hexagonal plates in an acid pH. a. Cholesterol b. Calcium oxalate c. Cystine d. Triple Phosphate

c. Cystine

Pseudo-peroxidase activity of ________ is used to produce a color reaction to test for the analyte. a. Leukocytes b. Nitrites c. Hemoglobin d. Urobilinogen

c. Hemoglobin

The average daily urine output is approximately: a. 100 to 200 mL per day b. 1000-2000 mL per day c. 1000-2000 L per day 50-100 L per day

b. 1000-2000 mL per day

Which of the following would be considered normal if found during the physical exam of a urine sample? a. A clear yellow urine that changes color on standing b. A clear yellow urine that becomes cloudy upon refrigeration c. A freshly voided urine that is light yellow and cloudy d. A freshly voided urine that is brown and clear

b. A clear yellow urine that becomes cloudy upon refrigeration

Positive leukocyte esterase and nitrite chemical test strips are likely to be indicative of what? a. Specimen contamination with formalin b. Bacterial infection of the urinary tract c. Improperly preserved specimen d. Aseptic inflammation of joints

b. Bacterial infection of the urinary tract

This crystal (fuzzy brown/yellow needle clumps) is usually found in acidic urine, and can be seen in patients with liver disorders as bright yellow granules or clumped needles. a. Tyrosine b. Bilirubin c. Radiographic dye d. Leucine

b. Bilirubin

Which of the following crystals would you expect to find in the synovial fluid of a patient with pseudogout? a. Triple phosphate b. Calcium pyrophosphate c. Uric acid d. Calcium oxalate

b. Calcium pyrophosphate

Mass screening in adults for occult blood is performed primarily to detect what? a. Celiac disease b. Colorectal cancer c. Ulcers d. Hemorrhoids

b. Colorectal cancer

The major function of the Loop of Henle is to: a. Secrete drug metabolites b. Concentrate the urine c. Reabsorb protein d. Filter glucose

b. Concentrate the urine

What would you expect to happen to urine volume after an injection of ADH? a. Increased urine volume excreted b. Decreased urine volume excreted c. No change to urine volume

b. Decreased urine volume excreted

Which of the following is most likely to be the cause of a positive blood biochemical test on urine dip stick? a. Large amounts of ascorbic acid b. Muscle trauma c. Improperly mixed sample d. Post-hepatic jaundice

b. Muscle trauma

A urine that produces a large amount of white foam should be suspected to contain increased amounts of which substance? a. Bilirubin b. Protein c. Urobilin d. Urobilinogen

b. Protein

The bilirubin reagent strip test and tablet tests are based on which reaction? a. Ehrlich's p-dimethylaminobenzaldehyde reagent b. The coupling of bilirubin with diazonium salt c. Oxidation of bilirubin to biliverdin d. Copper reduction of bilirubin

b. The coupling of bilirubin with diazonium salt

Directly after collection, what should be done to a synovial fluid to prepare it for hematologic analysis? a. Freeze sample immediately b. Transfer a portion to an EDTA tube c. Centrifuge the sample and remove the supernatant d. Entire syringe with needle attached should be sent directly to hematology

b. Transfer a portion to an EDTA tube

Substances bound to plasma proteins in the blood can be eliminated in the urine by which mechanism? a. Glomerular filtration b. Tubular secretion c. Glomerular select secretion d. Tubular reabsorption

b. Tubular secretion

Of the following, which would most likely be the cause of a cloudy urine specimen? a. urobilinogen b. leukocytes c. bilirubin d. glucose

b. leukocytes

What is the single most important piece of information used in identification of urinary crystals? a. Color b. pH c. Clarity d. Specific gravity

b. pH

Normal renal blood flow is approximately: a. 1200 mL/min b. 60 mL/min c. 600 mL/min d. 120 mL/min

a. 1200 mL/min

What would you expect to see if our patient has isosthenuric urine? a. A specific gravity identical to the plasma filtrate entering the Bowman's Capsule b. A highly concentrated urine c. A fixed specific gravity at 1.055 d. A specific gravity consistently less than 1.010

a. A specific gravity identical to the plasma filtrate entering the Bowman's Capsule

Which of the following is impermeable to water? a. Ascending Loop of Henle b. Proximal Convoluted Tubule c. Descending Loop of Henle d. Distal Convoluted Tubule

a. Ascending Loop of Henle

Water reabsorption occurs throughout the nephron, with the exception of the: a. Ascending limb of the Loop of Henle b. Cortical collecting tubules c. Descending limb of the Loop of Henle d. Proximal convoluted tubules

a. Ascending limb of the Loop of Henle

This crystal (envelope, square) is typically found in acidic or neutral urine, and is commonly described as a colorless envelope. a. Calcium oxalate b. Calcium carbonate c. Triple phosphate d. Uric acid

a. Calcium oxalate

Regarding gross appearance, normal spinal fluid is described as: a. Clear and colorless b. Clear and Pale yellow c. Red and bloody d. Xanthochromic

a. Clear and colorless

Based on the physical exam, which of the following urine samples would be least likely to contain blood and/or hemoglobin? a. Cloudy amber urine b. Clear red urine c. Cloudy pink urine d. Cloudy brown urine

a. Cloudy amber urine

Which of the following is a pre-analytical component of a quality assessment program? a. Collection instructions for a patient b. Quality control c. Delta checks d. Microscopic turnaround time

a. Collection instructions for a patient

What is the name of a shrunken red cell found in highly concentrated urine? a. Crenated cell b. Ghost cell c. Sickle cell d. Rough cell

a. Crenated cell

Which of the following would be most likely to cause a false positive nitrite dipstick test? a. Deeply colored red urine b. High concentrations of ascorbic acid c. Presence of bacteria d. Lack of urinary nitrate due to diet

a. Deeply colored red urine

Which component of the nephron is located in the renal medulla? a. Loop of Henle b. Afferent arteriole c. Ureter d. Glomerulus

a. Loop of Henle

A non-invasive method for collection of urine for routine culture is: a. Midstream clean-catch b. Cystoscopy c. Catheterization d. Suprapubic aspiration

a. Midstream clean-catch

Fat droplets will exhibit maltese cross formation with which type of microscopy? a. Polarized light b. Filtered contrast c. Phase contrast d. Refracted light

a. Polarized light

You perform a urinalysis and obtain the following results: Macroscopic Exam: Color- Yellow Clarity- Turbid Specific Gravity- 1.017 pH- 6.5 Protein- Neg Glucose- Neg Ketones- Neg Blood- 2+ Urobilinogen- Neg Nitrite- Positive Leukocyte Esterase- Positive Microscopic Exam: WBCs- 26-100/HPF RBCs- 6-10/HPF WBC Casts- 11-26/LPF Bacteria- Many What is most likely the cause of these findings? a. Pyelonephritis b. Acute glomerulonephritis c. Cystitis d. Nephrotic Syndrome

a. Pyelonephritis

In which instance would you expect to see a positive urine ketone with a negative urine glucose? a. Someone that has been stranded on a desert island for two weeks with no food b. Someone with a bile obstruction c. Someone with hepatitis d. Someone that has Diabetes Mellitus

a. Someone that has been stranded on a desert island for two weeks with no food

Xanthochromia is most often associated with which condition? a. Subarachnoid hemorrhage b. Viral meningitis c. Bacterial meningitis d. Multiple Sclerosis

a. Subarachnoid hemorrhage

From where do transitional epithelial cells originate? a. Upper urethra bladder b. Glomerulus c. Collecting ducts and renal tubules d. Lower urethra and vagina

a. Upper urethra bladder

Which of the following is the major organic substance found in urine? a. Urea b. Uric acid c. Protein d. Glucose

a. Urea

This crystal (diamonds), found in acidic urine, may be seen as four-sided flat plates, wedges, or rosettes. a. Uric acid b. Ammonium biurate c. Calcium oxalate d. Triple phosphate

a. Uric acid

This cast (smooth, opaque, wide, sections) most frequently appears to have a brittle consistency. a. Waxy b. Hyaline c. Granular d. Fatty

a. Waxy

You receive a sample for urinalysis and obtain the following results: Color- yellow Clarity- Clear Specific Gravity (Dipstick)- 1.005 Specific Gravity (Refractometer)- 1.030 pH- 6.5 Protein- Neg Glucose- 500 mg/dL Ketones- Neg Blood- Neg Bilirubin- Neg Urobilinogen- 0.2 mg/dL Nitrite- Neg Leukocyte esterase- Neg What is most likely the cause of the discrepant specific gravity results? Which reading should be reported because it most accurately represents the concentrating ability of this patient's kidneys? a. High glucose is causing the high refractometer reading, and measurement by refractometer should be reported b. High glucose is causing the low dipstick reading, and measurement by refractometer should be reported c. High glucose is causing the high refractometer reading, and measurement by dipstick should be reported d. High glucose is causing the low dipstick reading, and measurement by dipstick should be reported

c. High glucose is causing the high refractometer reading, and measurement by dipstick should be reported

The presence of which of the following distinguishes synovial fluid from other extravascular fluids? a. Protein b. Lactate dehydrogenase c. Hyaluronic acid d. Glucose

c. Hyaluronic acid

This crystal, typically found in acid or neutral urine, is described as yellow-brown spheres that demonstrate concentric circles and radial striations. a. Bilirubin b. Cholesterol c. Leucine d. Cystine

c. Leucine

Differentiation of red blood cells, yeast, and oil droplets may be accomplished by all of the following except: a. Observation of budding yeast b. Lysis of red blood cells by acetic acid c. Lysis of yeast cells by dilute HCL d. Increased refractility of oil droplets

c. Lysis of yeast cells by dilute HCL

More than 66% of the filtered water, sodium, and chloride, and 100% of filtered glucose, amino acids, and proteins are reabsorbed in which part of the nephron? a. Distal Convoluted Tubule b. Collecting Tubules c. Proximal Convoluted Tubule d. Loop of Henle

c. Proximal Convoluted Tubule

Which of the following is not a function of the kidney? a. Regulation of body's fluid levels b. Removal of metabolic waste c. Removal of excess protein from the blood d. Regulation of acid/base balance

c. Removal of excess protein from the blood

You receive an outpatient sample for urinalysis and obtain the following results: Color- Yellow Clarity- Hazy Specific Gravity- 1.024 pH- 9.0 Protein- Neg Glucose- Neg Ketones- Neg Blood- Neg Bilirubin- Neg Urobilinogen- 0.2 mg/dL Nitrite- Positive Leukocyte esterase- Neg What would be the most appropriate course of action to follow next? a. Protein result is likely discrepant due to high pH and should be repeated b. Results should be reported, and the sample should be sent for culture c. Results should be rejected, and a new sample should be collected d. Positive urobilinogen with a negative bilirubin indicate a possible hemolytic anemia- results should be reported after confirmatory test for bilirubin

c. Results should be rejected, and a new sample should be collected

You receive a sample for a Urinalysis and obtain the following results: Macroscopic Exam: Color- Yellow Clarity- Hazy Specific Gravity- 1.020 pH- 7.5 Protein- Neg Blood- Neg Glucose- Neg Ketones- Neg Bilirubin- Neg Urobilinogen- Neg Nitrite- Neg Leukocyte Esterase- Moderate Microscopic Exam: WBC- 11-25/HPF Bacteria- Many Which statement best explains the discrepancy between the chemical and microscopic exam? a. The bacteria present are most likely E. coli b. The sample is most likely contaminated c. The bacteria present are most likely gram positive d. This is a first morning specimen

c. The bacteria present are most likely gram positive

You have a physician on the phone questioning a negative urine bilirubin result that was reported on a patient in the ER. Her patient is jaundiced, so she believes the result is incorrect. Which of the following is NOT a possible explanation of the negative test result. a. The nurse forgot to send the sample to the lab right away and let it sit near a window in the patients room for three hours b. The sample was labeled with the incorrect patient ID c. The patient has a bile duct obstruction d. The patient is having a hemolytic transfusion reaction

c. The patient has a bile duct obstruction

This crystal (coffins) is found in alkaline urine, and is typically described as a colorless coffin lid. a. Uric acid b. Ammonium biurate c. Triple phosphate d. Calcium oxalate

c. Triple phosphate

This crystal (sea urchin) is described as fine needles, and is typically seen in acidic or neutral pH urine of patients with severe liver disorders. a. Bilirubin b. Cholesterol c. Tyrosine d. Cystine

c. Tyrosine

Vasopressin (ADH) is a hormone that regulates reabsorption of: a. Sodium b. Glucose c. Water d. Potassium

c. Water

Which of the following substances is the indicator of choice in fecal occult blood slide tests? a. orthotolidine b. tetramethylbenzidine c. guaiac d. benzidine

c. guaiac

The approximate renal threshold for glucose is: a. 250-270 mg/dL b. 100-110 mg/dL c. 70-100 mg/dL d. 160-180 mg/dL

d. 160-180 mg/dL

An unpreserved urine specimen collected at midnight is kept at room temperature until the next morning. Which of the following changes most likely will occur? a. Decrease in urine color and clarity b. Decrease in bacteria and nitrites c. Decrease in pH and specific gravity d. Decrease in glucose and ketones

d. Decrease in glucose and ketones

Which of the following statements regarding the microscopic examination of urine sediment is false? a. If large numbers of red blood cells are present, the chemical test for blood should be positive b. If large numbers of casts are present, the chemical test for protein should be positive c. If large numbers of white blood cells are present, the chemical test for leukocyte esterase should be positive d. If mucus is present, the chemical test for protein should be positive

d. If mucus is present, the chemical test for protein should be positive

A patient with pale yellow urine, increased glucose and increased ketones in urine is likely to have: a. Decreased specific gravity by refractometry with increased dipstick specific gravity b. Decreased specific gravity both by refractometry and dipstick methods c. Decreased specific gravity by refractometry as compared to dipstick d. Increased specific gravity by refractometry as compared to dipstick

d. Increased specific gravity by refractometry as compared to dipstick

A urine sample with 26-100 wbc/HPF and many bacteria most likely comes from a patient suffering from which of the following? a. Diabetes b. Glomerulonephritis c. Renal calculi d. Lower urinary tract infection

d. Lower urinary tract infection

A urine sample that turns dark brown or black upon standing may likely contain what substance? a. Protoporphyrin b. Urobilinogen c. Myoglobin d. Melanin

d. Melanin

The findings of increased hyaline and granular casts in the urine of an otherwise healthy individual is most often seen in which of the following? a. Early urinary tract infection b. Fecal contamination c. An improperly preserved specimen d. Recent strenuous exercise

d. Recent strenuous exercise

Which of the following can NOT be found incorporated into a cast matrix? a. Renal tubular epithelial cells b. White Blood Cells c. Red blood cells d. Squamous epithelial cells

d. Squamous epithelial cells

A urine specimen is tested for glucose by reagent strip and Clinitest. The reagent strip method is negative, but the Clinitest result is 500 mg/dL. What is most likely the cause of this result? a. The patient has glucosuria b. Pass through phenomenon c. Contamination with strong oxidizing cleaning agents caused a false negative dipstick result d. The presence of non-glucose reducing sugars in the urine

d. The presence of non-glucose reducing sugars in the urine

Which of the following statements best describes the protein reagent test strip? a. The protein reacts with sodium nitroprusside, which results in a color change b. The protein reacts with immune complexes on the pad, which results in a color change c. The protein causes a release of protons from a polyelectrolyte, altering the pH and causing a color change d. The protein accepts hydrogen ions from an indicator dye without a change in pH, which results in a color change

d. The protein accepts hydrogen ions from an indicator dye without a change in pH, which results in a color change

This cell type (round epis with tails) may be seen as spherical, polyhedral, or caudate forms. a. Reticuloendothelial cells b. Renal tubular epithelial cells c. Squamous epithelial cells d. Transitional epithelial cells

d. Transitional epithelial cells

The yellow color of normal urine is due to which pigment? a. Bilirubin b. Urobilin c. Uroerythrin d. Urochrome

d. Urochrome

The leukocyte esterase test is negative, but leukocytes are present in the urine. What is the most likely cause of this discrepancy? a. Leukocytes have not been present in urine for an adequate amount of time b. Inadequate bacteria are present in sample c. There has been contamination with strong oxidizing agents d. White blood cells present are lymphocytes

d. White blood cells present are lymphocytes