LabCE UA Exam
How do you distrubute 3 tubes of CSF in the lab
#1 Chemistry #2 Micro #3 Hematology
Which of the following test included on a urine reagent strip would never be reported out as negative? Urobilinogen bILIRUBIN Leukocyte esterase Nitrite
uroblininogen
Which of the following statements regarding the L/S ratio is true? A ratio of 2:1 or grater usually indicates adquate pulmonary surfactant to prevent RDS A ratio of 1:5:1 indicates fetal lung maturity in pregnancies associated w/ diabetes mellitus Spingomyelin levels increase during the 3rd trimester causing the L/S ratio to fall slightly during the last 2 weeks of gestation A PG spot indicates the presence of meconium in amniotic fliud
A ratio of 2:1 or grater usually indicates adquate pulmonary surfactant to prevent RDS
A 3 year old girl was brought to the ER with a temp of 103 d.F., lethargy, and cervical rigidity. 3 tubes of cloudy CSF were delivered to the lab. Preliminary test results showed WBC: 4500/ul Diff: 88% neutrophils 12% lymphs Glucose: 15mg/dL Protein: 140 mg/dL GS: no org detected. What prelim diagnosis should the physician consider?
Bacterial meningitis
Fecal urobilinogen level may be markedly decreased b/c of: Hemolysis Decreased intestinal reabsorption of urobilinogen Increased serum bilirubin Biliary obstruction
Biliary obstruction
The elements indicated by the arrows are more likely to be seen in patients with which condition?
Diabetes
Which of the following casts might be found in the urine of a healthy individual after strenuous exercise?
Hyaline casts and granular casts
Nephrotic syndrome is associated w/ all of the following clinical findings except: Increased proteinuria, Decreased serum albumin, Hyperproteinemia, Edema
Hyperproteinemia
Which of the following methods would be employed to collect sweat for chloride analysis
Iontophoresis
If CSF tubes numbered #1, #2, and #3 CANNOT be analyzed w/i one hour, the correct procedure for the microbiology sample tube is to
Leave it at room temp (refrigerating or freezing will destroy Nesseria meningitides)
In a normal CSF the protein concentration as compared to that in the plasma is generally
Less than 1%
All of the following crystals are found in normal urine except: triple phosphate ammonium biurate calcium oxalate leucine
Leucine
the image is a Wright-Giemsa stained smear (1000x) of CSF. The arrows point to cells that may indicate which condition? Allergic Rxn Bacterial Meningitis Leukemia w/ CNS involvement Viral meningitis
Leukemia w/ CNS involvement
Which of the following is characteristic of an exudate effusion? Leukocyte count greater than 1000 WBC/ul Clear appearance Protein concentratoin less than 3.0 g/dL Absence of fibrinogen
Leukocyte count greater than 1000 WBC/ul
All of the statements below about synovial fluid are true except: Arthrocentesis is performed as a means to evaluate arthritis and other joint disorders Synovial fluid is present only in movable joints Joint fluid resembles plasma in viscosity Joint fluid has approx. the same glucose as plasma
Joint fluid resembles plasma in viscosity
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 int he urine?
Ketones
WBC casts are most likely to indicate disease of the
Kidney
Which of the following can cause a false positive for ketones? L-Dopa metabolites Lightly pigmented urine Using a freshly collected urine specimen Presence of bacteria
L-Dopa metabolites
Which of the following conditions is most likely when an oligoclonal band is seen in CSF electrophoresis without a corresponding serum peak? Lymphoproliferative disorder Viral meningitis MS Traumatic Lumbar Puncture
MS
A tech decides to make a 1:20 dilution of 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 tech do to obtain the most accurate count?
Make a larger dilution
Myglobinuria is MOST likely to be noted in urine specimens form patients with which of the following disorders
Massive Muscle Trauma
The urine macroscopic results were completely normal and w/i range. UPon viewing the microscopic, the tech noticed these circular elements. What could be the ID of the elements?
RBC
On a patient that has a large amount of glucose in their urine, what would be the expected SG taken from a refractometer in comparison to the dipstick SG?
Refractometer SG would be higher than Dipstick SG
Semi-automated and automated urine chemical reagent strip readers:
Remove subjectivity allowing for better reproducability
Which of the following cells when found upon microscopic examination of the urine would be most indicative of kidney disease?
Renal tubular epithelial cells
A semen specimen was collected 3 hours before it was brought to the lab for exam. What course of action should be taken?
Report compromised specimen on report
When an unpreserved urine specimen cannot be cultured immediately, which storage method is most appropriate
STored in the refrigerator at 4 d.C. for up to 24 hours
What is the identity of the cells that are indicated by the arrow in this image?
Squamous epithelial Cells
Identify the urine sediment elements shown by the arrow:
Starch Crystals
What is the lower reference limit for progressive motility of spermatozoa when performing semen analysis? 12% 22% 32% 40%
32%
Urinalysis Report on 37 yr old female seen in ER w/ headache, hypertension, weight loss, mild edema: color: red Clarity: cloudy SG: 1.010 p.H. 5.0 Glucose: Neg Protein: 3+ Ketones: Neg Nitrite: Neg Blood:moderate Urobilinogen: Normal Microscopic: 25-50 RBC, 2-4 WBC, 2-5 Granular casts, 2-5 hyaline casts, 0-2 RBC casts, few epi What is the most probable diagnosis
Acute pyelonephritis (RBC, WBC, Proteinuria, casts)
Which of the following tests is the best screening test for neural tube defects? Placental lactogen Bilirubin Estriol Alpha-fetaprotein
Alpha-fetaprotein
Common crystals which can be found in acid urine include:
Amorphous urates and calcium oxalate
What are the microscopic elements indicated by the arrows in this image?
Bacteria
Slight turbidity observed in a urinalysis correlates with what results
Bacteria and WBCs
Detection of a fruity odor in fresh urine sample may be indicative of all of the following except: Starvation Malabsorption Bacterial Infection Diabetes mellitus
Bacterial Infection
A urine specimen produced yellow foam when shaken. What is the cause of the yellow foam?
Bilirubin
What is the identification of these crystals seen in a urine with an acid pH?
Calcium oxalate
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
Calcium pyrophosphate crystals
Identify the urine sediment
Cholesterol Crystals
The renal threshhold is best described as
Concentration at which kidney can no longer filter the blood
The Clinitest reaction is based on which of the following principles
Copper reduction
Which of the following tests woudl be used in the assessment of glomerular filtration? 24 hr urine protein Creatinine clearance PSP test URea
Creatinine Clearance
An India Ink preparation is used to identify:
Cryptococcus neoformans in CSF
The measurement of Na and Cl in sweat is the most useful test for the diagnosis of what condition/disease
Cystic fibrosis
Identify the urine sediment elements shown by the arrow:
Cystine Crystals
Which defines SG: Weight Density Volume Density of a soln compared to Density of water
Density of a soln compared to Density of water
What is the role of albuminuria testing
Detect small urinary concentrations of albumin before there is irreparable renal damage
Sudan III will confirm presence of:
Fat
Identify the urine sediment element.
Fatty Cast
All of the following tests are part of the routine semen analysis except: pH Motility Fructose Morphology
Fructose level
Nitrates in urine are reduced to nitrites by: GP bacteria Acid fast bacteria GN bacteria Yeasts
GN bacteria
All of the following hormones are produced primarily int he pancreating islets except: Gastrin Glucagon Insulin Pancreating polypeptide
Gastrin (produced in GI tract)
The indicator used in the pH test region of the chemical reagent strips for urine is/are:
Methyl red and Bromthymol blue
Bence-Jones proteinuria can be seen in all of the following conditions except: Amyloidosis Nephrotic syndrome Multiple Myeloma Macroglobulinemia
Nephrotic syndrome
All of the following are methods employed for measuring the specific gravity of urine, except? Refractometry Hydrometry Osmolality Urine reagent Strips
Osmolality
Parasites which can be found in urinary sediment include all of the folowing except: Enterobius vernicularis, Trichomonas vaginalis, Plasmodium malariae, Schistosoma haematobium
Plasmodium malariae
The estimation of hyaluronic acid concentration by measurement of viscosity is useful in evaluating which type of fluid Cerebrospinal Pleural Peritoneal Synovial
Synovial
A pt suspected of UTI has a negative nitrite test but bacteria is present upon microscopic exam. What may have caused this discrepant result
The bacteria present is not a nitrite reducer
All of the following statements are true regarding urinalysis reagent strips except? Prolonged immersion may wash out reagents Strips should be stored to prevent exposure to moisture Some tests require specified reading times The expiration date on the bottle does not matter, as long as the controls are acceptable
The expiration date on the bottle does not matter, as long as the controls are acceptable
Identify the urine sediment elements shown by the arrow:
Uric Acid Crystals
Which of the following methods would be used to confirm the presence of Bence-Jones protein in the urine
Urine protein electrophoresis or immunoelectrophoresis
Which of the following statements is true for SG measure by the urine chemical reagent strip method? High concentrations of protein in urine do not increase the readings when using the urine chemical reagent strip An alkaline pH would not affect the SG result using a reagent strip method The urine chemical reagent strip method is not affected by the presence of x-ray constrast media in the urine specimen 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
The urine chemical reagent strip method is not affected by the presence of x-ray constrast media in the urine specimen
All of the following are characteristics of cast, EXCEPT: They are cylindrical bodies They are formed either in the distal convuluted tubules or the collecting ducts of the kidney They contain Tamm-Horsfall mucoprotein They are formed in the urethra
They are formed in the urethra
These tubes of CSF arrives in the lab for eval. They were numbered in the order they were obtained. what may be indicated by the macroscopic appearance?
Traumatic Tap
Which of the following crystals would most likely be found in normal ALKALINE urine?
Triple Phosphate
Identify the urine sediment elements present in this acidic urine
amorphous urate crystals
identify the urine sediment element indicated by the arrow in the illustration
hyaline cast
Fatal lung maturity can be determined from amniotic fluid b/c the surfactant is primarily composed of
phosphatidylcholine and other phospholipids
Which of the following macroscopic findings is MOST consistent with the microscopic finding of casts?
positive protein
An increased number of the cells seen in the image, upon microscopic examination of the urine is termed:
Hematuria
A reagent strip test for hemoglobin has been reported positive. Microscopic examination fails to yield RBC. This pts urine condition can be called:
Hemoglobinuria
Pleural fluid was sent to the lab for a WBC count. The specimen was not diluted. WBCs in 5 large squares were counted in each side. 35 cells in top 33 cells in bottom. Calculate total WBC count.
680 cells/mm^3 total cells/uL = (68)/(10*.1)
The volume of urine recommended for centrifugation for a microscopic examination is
10-15 mL
A sample of CSF is diluted 1:100; the std 9 squares of a hemocytometer were counted on each side for a total of 18 squares. Side 1 = 186 cells Side 2 = 184 cells Total = 370 What is the cell count /uL? 1.03x10^4 2.06x10^4 4.62x10^4 9.25x10^4
2.06x10^4 Cells/uL = (370 x 100)/ (18 x 0.1) = 2.06 x 10 ^ 4
A spinal fluid that is slightly hazy is briefly examined microscopically. The tech performing the count decides to make a 1:10 dilution using 30uL of sample. What volume of diluent should be used?
270 uL
The normal range for urine pH is
4.5 - 8.0
Which of the following would be considered a normal value for a glucose level in a CSF?
60 mg/dL Normal is 90-100 mg/dL. CSF values are ~ 60-70% of serum values.
The ketone component that is measured by nitroprusside reaction is
Acetone
Oliguria is usually correlated with: Acute glomerulonephritis Diabetes mellitus Hepatitis Tubular Damage
Acute glomerulonephritis
A 62 yr old man drank an unknown liquid in a suicide attempt. 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
When an automated or semi-automated method is used to read urine reagent strips, QC testing must be performed at least:
Every day of pt testing & when a new bottle is opened
The following urine test results were obtained form a 6 mo. old African American infant who experiences vomiting and diarrhea after milk ingestion and has failed to gain weight. pH: 5.0 Protein: Neg Glucose: Neg Ketones: Neg Blood: Neg Bilirubin: Neg Nitrite: Neg Urobilinogen: 0.1 EU/dL Clinitest: 2+ These results are clinically significant in which of the following disorders?
Galactosemia
The technologists in the UA department received a sample for a microscopic exam. Which of the following conditions would most closely match this patients microscopic urinalysis morphology?
Glomerulonephritis (Presence of RBCs)
A positive leukocyte esterase test indicate the presence in a urine specimen of which of the following? Lymphocytes Granulocytes Erythrocytes Epithelial Cells
Granulocytes
Effusion fluids are classified as transudates or exudates. According to Light's Criteria all of the following is applicable to an exudate except? Pleural fluid/serum protein ratio >0.5 Pleural fluid/serum LDH ratio >0.6 Pleural fluid LDH <2/3 the normal upper limit for serum Serum-ascites albumin gradient (SAGG) <1.1g/dL
Pleural fluid LDH <2/3 the normal upper limit for serum
A daily urine output which is over 2500mL/24hrs is referred to as
Polyuria
A urine specimen which was collected in a dark container, stored in the dark, has a pH of 7.5, and whose sample aliquot is wrapped in foil, is most likely being sent for:
Porphyrins
When a pt 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
Positive because conjugated bilirubin is present and is excreted by the kidneys
How should the production of a blue or purple color on the test pad of an Ictotest be interpreted?
Positive for bilirubin
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
What is the most probable condition when a clean catch urine gave these results: Appearance = cloudy, amber pH 5.0 SG = 1.015 Protein =1+ Glucose = Neg Occult Blood = trace Nitrite = positive Microscopic = many bacteria and 30 - 40 WBC/HPF
UTI
Which of the following may cause a false-positive protein reading on a urinalysis dipstick? Urine pH is between 5.0 and 6.0 Specimen has been refrigerated Urine specimen is highly pigmented Urine specimen with a low specific gravity
Urine specimen is highly pigmented
Which of the following urine chemical reagent strip tests is based on the Ehrlich-aldehyde rxn?
Urobilinogen
Which of the following casts is characteristically associated with acute pyelonephritis: Red Cell White Cell Fatty Waxy
White Cell
What term is used to describe yellow CSF?
Xanthochromia
