Assessment CM

Question 1

What is the LAST STEP in the handwashing procedure?

Dry hands with a paper towel.
Turn off faucet with a clean paper towel to prevent recontamination.
Rub to form lather, create friction, and loosen debris.
Rinse hands in a downward position.

Answer 1

Turn off faucet with a clean paper towel to prevent recontamination.

CORRECT HANDWASHING TECHNIQUE
1. Wet hands with warm water.
2. Apply antimicrobial soap.
3. Rub to form lather, create friction, and loosen debris.
4. Thoroughly clean between fingers, including thumbs, under fingernails and rings, and up
to the wrist, for at least 15 SECONDS. (6th 20 seconds)
5. Rinse hands in a DOWNWARD POSITION.
6. Dry with a paper towel.
7. Turn off faucets with a clean paper towel to prevent recontamination.

Question 2

The required amount of urine for drug testing (COC):

5 to 10 mL
10 to 15 mL
20 to 30 mL
30 to 45 mL

Answer 2

30 to 45 mL

Urine specimen collections may be “witnessed” or “unwitnessed.” The decision to obtain a witnessed collection is indicated when it is suspected that the donor may alter or
substitute the specimen or it is the policy of the client ordering the test. If a witnessed specimen collection is ordered, a same-gender collector will observe the collection of 30
to 45 mL of urine. Witnessed and unwitnessed collections should be immediately handed to the collector.

Question 3

Acceptable urine temperature for drug testing (COC):

20 to 24C
30 to 35C
32.5 to 37.7C
37.7 to 42C

Answer 3

32.5 to 37.7C

The urine temperature must be taken within 4 minutes from the time of collection to confirm the specimen has not been adulterated. The temperature should read within the
range of 32.5°C to 37.7°C. If the specimen temperature is not within range, the temperature should be recorded and the supervisor or employer contacted immediately.
Urine temperatures outside of the recommended range may indicate specimen contamination. Recollection of a second specimen as soon as possible will be necessary.

Question 4

Primary inorganic component of urine:

Urea
Creatinine
Chloride
Potassium

Answer 4

Chloride

UREA: primary ORGANIC component; product of protein and amino acid
metabolism
CHLORIDE: primary INORGANIC component; found in combination with sodium (table salt)
and many other inorganic substances

Question 5

Polyuria, an increase in daily urine volume:

Greater than 400 mL/day in adults
Greater than 1200 mL/day in adults
Greater than 2L/day in adults
Greater than 2.5 L/day in adults

Answer 5

Greater than 2.5 L/day in adults

Normal daily urine output is usually 1200 to 1500 mL, a range of 600 to 2000 mL is considered normal.
Polyuria, an increase in daily urine volume (greater than 2.5 L/day in adults and 2.5 to 3 mL/kg/day in children), is often associated with diabetes mellitus and diabetes insipidus;
however, it may be artificially induced by diuretics, caffeine, or alcohol, all of which suppress the secretion of antidiuretic hormone.
Oliguria, a decrease in urine output (which is less than 1 mL/kg/hr in infants, less than 0.5 mL/kg/hr in children, and less than 400 mL/day in adults), is commonly seen when the
body enters a state of dehydration as a result of excessive water loss from vomiting, diarrhea, perspiration, or severe burns.

Question 6

The most routinely used method of urine preservation is:

Boric acid
Formalin
Refrigeration
Sodium fluoride

Answer 6

Refrigeration

The most routinely used method of preservation is refrigeration at 2°C to 8°C, which decreases bacterial growth and metabolism.
If the urine is to be cultured, it should be refrigerated during transit and kept refrigerated until cultured up to 24 hours.2 The specimen must return to room temperature before
chemical testing by reagent strips.

Question 7

A 24-hour urine for CATECHOLAMINE determination may be preserved
with:

Formalin
Boric acid
Hydrochloric acid, 6N
Sodium fluoride

Answer 7

Hydrochloric acid, 6N

FROM HENRY: 24-HOUR URINE COLLECTION PRESERVATIVES
None (refrigerate): amino acids, amylase, calcium, citrate, chloride, copper, creatinine, delta ALA, glucose, 5-HIAA, heavy metals (arsenic, lead, mercury), histamine, immunoelectrophoresis, lysozyme, magnesium, methylmalonic acid, microalbumin, mucopolysaccharides, phosphorus, porphobilinogen, porphyrins, potassium, protein,
protein electrophoresis, sodium, urea, uric acid, xylose tolerance

10 g boric acid: aldosterone, cortisol
10 mL 6N HCl: catecholamines, cystine, homovanillic acid, hydroxyproline, metanephrines, oxalate, VMA

If processing delayed longer than 24 hours: equal amounts of 50% alcohol, Saccomanno’s fixative, and SurePath or Preserve CT Cytologic examination

Question 8

In the three-glass collection technique for diagnosis of prostatic infection,
which tube is used as a control for bladder and kidney infection?

First specimen
Second specimen
Third specimen
None of these

Answer 8

Second specimen

THREE-GLASS COLLECTION
In prostatic infection, the third specimen will have a white blood cell/ high-power field count and a bacterial count 10 times that of the first specimen. Macrophages containing lipids may also be present.
The second specimen is used as a control for bladder and kidney infection. If it is positive, the results from the third specimen are invalid because infected urine has contaminated
the specimen.

Question 9

The human kidneys receive approximately ___ % of the blood pumped through the heart at all times.

Approximately 5%
Approximately 15%
Approximately 25%
Approximately 50%

Answer 9

Approximately 25%

The renal artery supplies blood to the kidney.
The human kidneys receive approximately 25% of the blood pumped through the heart at
all times.

Question 10

The part of the nephron that functions as a SIEVE:

Glomerulus
Loop of Henle
Proximal convoluted tubules
Distal convoluted tubules

Answer 10

Glomerulus

The glomerulus functions as a sieve or filter.
The glomerulus serves as a nonselective filter of plasma substances with molecular weights less than 70,000, several factors influence the actual filtration process.
These include the cellular structure of the capillary walls and Bowman’s capsule, hydrostatic pressure and oncotic pressure, and the feedback mechanisms of the reninangiotensin-aldosterone system (RAAS).

Question 11

It corrects renal blood flow in the following ways: causing VASODILATION OF THE AFFERENT ARTERIOLES and CONSTRICTION OF THE EFFERENT ARTERIOLES, stimulating reabsorption of sodium and water in the proximal convoluted tubules, and triggering the release of the sodium-retaining hormone aldosterone by the adrenal cortex and antidiuretic hormone by the hypothalamus:

Renin
Angiotensin I
Angiotensin II
Aldosterone

Answer 11

Angiotensin II

Angiotensin II corrects renal blood flow in the following ways: causing vasodilation of the afferent arterioles and constriction of the efferent arterioles, stimulating reabsorption of
sodium and water in the proximal convoluted tubules, and triggering the release of the sodium-retaining hormone aldosterone by the adrenal cortex and antidiuretic hormone by the hypothalamus.

Question 12

The original reference method for clearance tests:

Creatinine clearance
Inulin clearance
Urea clearance
Beta2- microglobulin

Answer 12

Inulin clearance

Although inulin was the original reference method for clearance tests, current methods are available that are endogenous and can provide accurate GFR results.
The earliest glomerular filtration tests measured urea because of its presence in all urine specimens and the existence of routinely used methods of chemical analysis.

Question 13

Calculate the creatinine clearance using these date obtained from a person with 1.73 m2 body surface area: serum creatinine: 1.8 mg/dL;
urine creatinine: 54 mg/dL; and urine volume 640 mL in 24 hours.

3 mL/min
13 mL/min
21 mL/min
68 mL/min

Answer 13

13 mL/min

Urine volume (mL/min)
640 mL/24 hours x 1 hour/60 minutes = 0.44 mL/min.
Creatinine clearance (mL/min)
Formula: UV/P (patient is of the average body surface area)
[(54 mg/dL) x (0.44 mL/min)]/1.8 mg/dL = 13.2 mL/min

Question 14

Calculate the creatinine clearance using these data: Serum creatinine: 1.8 mg/dL; urine volume: 640 mL in 24 hours; urine creatinine: 54 mg/dL; and body surface area: 1.25 m2.

1.1 mL/min
5 mL/min
13 mL/min
18 mL/min

Answer 14

18 mL/min

Urine volume (mL/min)
640 mL/24 hours x 1 hour/60 minutes = 0.44 mL/min

Creatinine clearance (mL/min)
Formula: (UV/P) x (1.73 m2/A)
[(54 mg/dL) (0.44 mL/min) / 1.8 mg/dL] x 1.73 m2/1.25 m2 = 18.3 mL/min

Question 15

The test most commonly associated with tubular secretion and renal blood flow

Creatinine clearance
Fishberg test
Mosenthal test
p-aminohippuric acid (PAH) test

Answer 15

p-aminohippuric acid (PAH) test

The test most commonly associated with tubular secretion
and renal blood flow is the p-aminohippuric acid (PAH) test

Question 16

Patients with DIABETES INSIPIDUS tend to produce urine in _____ volume with _____ specific gravity.

Increased; decreased
Increased; increased
Decreased; decreased
Decreased; increased

Answer 16

Increased; decreased

DIABETES INSIPIDUS: high urine volume, low specific gravity
DIABETES MELLITUS: high urine volume, high specific gravity

Question 17

A catheterized urine specimen is collected:

After stimulating urine production with intravenous histamine
By aspirating it with a sterile syringe inserted into the bladder
Following midstream, clean-catch urine collection procedures
From a sterile tube passed through the urethra into the bladder

Answer 17

From a sterile tube passed through the urethra into the bladder

Question 18

All of the following should be discarded in biohazardous waste containers EXCEPT:

Urine specimen containers, urine
Towels used for decontamination
Disposable lab coats
Blood collection tubes

Answer 18

Urine specimen containers, urine

Question 19

The correct method for labeling urine specimen containers is to:

Attach the label to the lid
Attach the label to the bottom
Attach the label to the container
Use only a wax pencil for labeling

Answer 19

Attach the label to the container

Labels must be ATTACHED TO THE CONTAINER, NOT TO THE LID, and should not become detached if the container is refrigerated or frozen.

Question 20

Storage of urine specimens for BILIRUBIN and UROBILINOGEN testing:

Clear container
Amber container
Preserved with formalin
None of these

Answer 20

Amber container

Because of the instability of bilirubin and urobilinogen in urine when exposed to room temperature and light, testing should be performed as soon as possible. Specimens should be stored in darkness or collected in amber tubes or amber 24-hour containers.

Question 21

First-morning urine, EXCEPT:

Routine screening
Pregnancy testing
Urobilinogen determination
Evaluation of orthostatic proteinuria

Answer 21

Urobilinogen determination

AFTERNOON SPECIMEN (2 PM to 4 PM)
UROBILINOGEN DETERMINATION
GREATEST UROBILINOGEN EXCRETION

Question 22

Phenol derivatives found in certain intravenous medications produce ______ urine on oxidation.

Yellow
Orange
Green
Purple

Answer 22

Green

STRASINGER PAGE 62: Green
STRASINGER PAGE 62: Brown/black

Question 23

The clarity of a urine sample should be determined:

Using glass tubes only, never plastic
Following thorough mixing of the specimen
After addition of salicylic acid
After the specimen cools to room temperature

Answer 23

Following thorough mixing of the specimen

n routine urinalysis, clarity is determined in the same manner that ancient physicians used: by visually examining the MIXED SPECIMEN while holding it IN FRONT OF A LIGHT
SOURCE. The specimen should, of course, be in a clear container.

Question 24

Many particulates, print blurred through urine:

Hazy
Cloudy
Turbid
Milky

Answer 24

Cloudy

URINE CLARITY
Clear: no visible particulates, transparent
Hazy: few particulates, print easily seen through urine
Cloudy: many particulates, print blurred through urine
Turbid: print cannot be seen through urine
Milky: may precipitate or be clotted

Question 25

Sensitivity of the urine specific gravity reagent pad: 1.010 to 1.035 1.015 to 1.035 1.000 to 1.002 1.000 to 1.030

Answer 25

1.000 to 1.030

Question 26

A routine urinalysis on a urine specimen collected from a hospitalized patient revealed a specific gravity greater than 1.050 with the use of REFRACTOMETRY. The best explanation for this specific gravity result is that the urine: Old and has deteriorated Contains radiographic contrast media Concentrated because the patient is ill and dehydrated Contains abnormally high levels of sodium and other electrolytes because the patient is taking diuretics

Answer 26

Contains radiographic contrast media ## Footnote Abnormally high results—above 1.040—are seen in patients who have recently undergone an intravenous pyelogram. This is caused by the excretion of the injected radiographic contrast media. The reagent strip specific gravity measures only ionic solutes, thereby eliminating the interference by the large organic molecules, such as urea and glucose, and by radiographic contrast media and plasma expanders that are included in physical measurements of specific gravity.

Question 27

Cabbage urine odor: Isovaleric acidemia Methionine malabsorption Phenylketonuria Urinary tract infection

Answer 27

Methionine malabsorption ## Footnote Aromatic: normal Foul, ammonia-like: bacterial decomposition, urinary tract infection Fruity, sweet: ketones (diabetes mellitus, starvation, vomiting) Maple syrup: maple syrup urine disease Mousy: phenylketonuria Rancid: tyrosinemia Sweaty feet: isovaleric acidemia Cabbage: methionine malabsorption Bleach: contamination

Question 28

A lack of any urine odor may indicate: Acute tubular necrosis Isovaleric acidemia Methionine malabsorption Phenylketonuria

Answer 28

Acute tubular necrosis ## Footnote Lack of odor in urine from patients with acute renal failure suggests acute tubular necrosis rather than prerenal failure.

Question 29

All of the following are important to protect the integrity of reagent strips EXCEPT: Removing the desiccant from the bottle Storing in an opaque bottle Storing at room temperature Resealing the bottle after removing a strip

Answer 29

Removing the desiccant from the bottle

Question 30

Which of the following tests is affected LEAST by standing or improperly stored urine? Glucose Protein pH Bilirubin

Answer 30

Protein ## Footnote CHANGES IN UNPRESERVED URINE 1. Color - modified or darkened 2. Clarity - decreased 3. Odor - increased 4. pH - increased 5. Glucose - decreased 6. Ketones - decreased 7. Bilirubin - decreased 8. Urobilinogen - decreased 9. Nitrite - increased 10. RBCs, WBCs - decreased 11. Bacteria - increased

Question 31

A sensitive, although not specific indicator of damage to the kidneys: Urea Creatinine Proteinuria Ketonuria

Answer 31

Proteinuria ## Footnote Demonstration of proteinuria in a routine analysis does not always signify renal disease; however, its presence does require additional testing to determine whether the protein represents a normal or a pathologic condition.

Question 32

An indicator of PREECLAMPSIA: Cylindruria Hematuria Ketonuria Proteinuria

Answer 32

Proteinuria ## Footnote Preeclampsia is a pregnancy condition characterized by hypertension, proteinuria, and often edema, usually occurring late in the second trimester or early in the third trimester, and affecting 5 to 10% of pregnancies. It is a major cause of maternal and perinatal mortality. If the mother develops convulsions, the condition is called eclampsia. The only cure for preeclampsia is delivery of the placenta.

Question 33

Concentration of SSA in the cold precipitation method: 1% sulfosalicylic acid 3% sulfosalicylic acid 5% sulfosalicylic acid 10% sulfosalicylic acid

Answer 33

3% sulfosalicylic acid

Question 34

REPORTING OF SSA TURBIDITY: Turbidity, granulation, no flocculation: Trace 1+ 2+ 3+ 4+

Answer 34

2+ ## Footnote SULFOSALICYLIC ACID (3% SSA) PRECIPITATION TEST Negative No increase in turbidity <6 mg/dL Trace Noticeable turbidity 6-30 mg/dL 1+ Distinct turbidity with no granulation 30-100 mg/dL 2+ Turbidity with granulation, no flocculation 100-200 mg/dL 3+ Turbidity with granulation and flocculation 200-400 mg/dL 4+ Clumps of protein >400 mg/dL

Question 35

Significant albumin excretion rate (AER): 0.02 to 1 ug/min 1 to 2 ug/min 5 to 15 ug/min 2 to 20 ug/min 20 to 200 ug/min

Answer 35

20 to 200 ug/min ## Footnote Microalbumin was considered significant when 30 to 300 mg of albumin is excreted in 24 hours or the AER is 20 to 200 μg/min.

Question 36

Sensitivity of the Multistix protein pad: 1 to 5 mg/dL albumin 5 to 10 mg/dL albumin 10 to 15 mg/dL albumin 15 to 30 mg/dL albumin

Answer 36

15 to 30 mg/dL albumin ## Footnote PROTEIN REAGENT PAD Multistix: 15 to 30 mg/dL albumin Chemstrip: 6 mg/dL albumin

Question 37

Bence Jones protein precipitates at temperatures between ___, and redissolves at near ___C. Precipitates at 100-120C, and redissolves at 60C Precipitates at 10 to 20C, and redissolves at 100C Precipitates at 80-100C, and redissolves at 60C Precipitates at 40 to 60C, and redissolves at 100C

Answer 37

Precipitates at 40 to 60C, and redissolves at 100C

Question 38

The principle of “protein error of indicators” is based on: Protein changing the pH of the specimen Protein changing the pKa of the specimen Protein accepting hydrogen from the indicator Protein giving up hydrogen to the indicator

Answer 38

Protein accepting hydrogen from the indicator ## Footnote Protein (primarily albumin) accepts hydrogen ions from the indicator.

Question 39

A patient’s random urine consistently contains a trace of protein but no casts, cells, or other biochemical abnormality. The first voided morning sample is consistently negative for protein. These findings can be explained by: Normal diurnal variation in protein loss Early glomerulonephritis Orthostatic or postural albuminuria Microalbuminuria

Answer 39

Orthostatic or postural albuminuria ## Footnote ORTHOSTATIC (POSTURAL) PROTEINURIA Patients suspected of orthostatic proteinuria are requested to empty the bladder before going to bed, collect a specimen immediately upon arising in the morning, and collect a second specimen after remaining in a vertical position for several hours. Both specimens are tested for protein, and if orthostatic proteinuria is present, a negative reading will be seen on the first morning specimen, and a positive result will be found on the second specimen.

Question 40

A urine specimen is tested by a reagent strip test and the sulfosalicylic acid test to determine whether protein is present. The former yields a negative protein, whereas the latter results in a reading of 2+ protein. Which of the following statements best explains this difference? -Urine contained excessive amount of amorphous urates or phosphates that caused the turbidity seen with SSA -Urine pH was greater than 8, exceeding the buffering capacity of the strip, thus causing false-negative reaction -Protein other than albumin must be present in the urine -Reading time of the reagent strip test was exceeded, causing a false negative reaction to be detected

Answer 40

Protein other than albumin must be present in the urine

Question 41

Most frequently performed chemical analysis on urine: Bilirubin Glucose Ketone Protein

Answer 41

Glucose ## Footnote Because of its value in the detection and monitoring of diabetes mellitus, the glucose test is the most frequently performed chemical analysis on urine.

Question 42

A patient sends the following question to an online consumer health Web site: "I am a 22-year-old female who experienced increasing headaches, thirst, and decreasing energy. I was studying in the library when I felt lightheaded and passed out. I was taken to a hospital emergency department and they told me that my serum Acetest® was 40 mg/dL and urine glucose was 500 mg/dL. What does this mean?" How would you reply? Your lab results pattern suggests diabetes mellitus. You probably have been crash dieting recently. The two results do not fit any disease pattern. The tests need to be repeated because they could not possibly occur together.

Answer 42

Your lab results pattern suggests diabetes mellitus. ## Footnote A positive urine glucose plus a positive serum ketone strongly suggest uncontrolled diabetes mellitus. There is an increased rate of fatty acid oxidation occurring in light of the inaccessibility of the glucose, especially to skeletal muscle. If the patient had only been dieting, the glucose would be negative.

Question 43

Glucosuria not accompanied by hyperglycemia can be seen in which of the following? Hormonal disorders Gestational diabetes Diabetes mellitus Renal disease

Answer 43

Renal disease ## Footnote RENAL GLYCOSURIA Glycosuria occurs in the absence of hyperglycemia when the reabsorption of glucose by the renal tubules is compromised. This is frequently referred to as “renal glycosuria” and is seen in end-stage renal disease, cystinosis, and Fanconi syndrome.

Question 44

The primary reason for performing a Clinitest is to: Check for high ascorbic acid levels Confirm a positive reagent strip glucose Check for newborn galactosuria Confirm a negative glucose reading

Answer 44

Check for newborn galactosuria ## Footnote Depending on the laboratory population Clinitest is often performed on pediatric specimens from patients up to at least the age of 2 years. Galactose in the urine of a newborn represents an “inborn error of metabolism” in which lack of the enzyme galactose-1-phosphate uridyl transferase prevents breakdown of ingested galactose and results in failure to thrive and other complications, including death. All states have incorporated screening for galactosemia into their required newborn screening programs because early detection followed by dietary restriction can control the condition.

Question 45

Negative Clinitest: Glucose Galactose Lactose Sucrose

Answer 45

Sucrose ## Footnote Keep in mind that table sugar is sucrose, a nonreducing sugar, and does not react with Clinitest or glucose oxidase strips.

Question 46

A urine sample that tests positive for ketones but negative for glucose is most likely from a patient suffering from: Diabetes mellitus Diabetes insipidus Polydipsia Starvation

Answer 46

Starvation

Question 47

Ketonuria may be caused by all of the following except: Bacterial infections Diabetic acidosis Starvation Vomiting

Answer 47

Bacterial infections ## Footnote CLINICAL SIGNIFICANCE OF KETONES Clinical reasons for increased fat metabolism include the inability to metabolize carbohydrate, as occurs in diabetes mellitus; increased loss of carbohydrate from vomiting; and inadequate intake of carbohydrate associated with starvation and malabsorption.

Question 48

The primary reagent in the reagent strip test for ketones is: Glycine Lactose Sodium hydroxide Sodium nitroprusside

Answer 48

Sodium nitroprusside ## Footnote Reagent strip tests use the sodium nitroprusside (nitroferricyanide) reaction to measure ketones. In this reaction, acetoacetic acid in an alkaline medium reacts with sodium nitroprusside to produce a purple color. The test does not measure B-hydroxybutyrate and is only slightly sensitive to acetone when glycine is also present.

Question 49

Positive result in the ketone reagent pad: Brown Blue Pink Purple

Answer 49

Purple ## Footnote Acetoacetate (and acetone) + sodium nitroprusside + (glycine) = PURPLE COLOR

Question 50

Reagent pad positive result in the presence of hemoglobin or myoglobin: Brown Red Pink-purple Green-blue

Answer 50

Green-blue ## Footnote In the presence of free hemoglobin/myoglobin, uniform color ranging from a negative yellow through green to a strongly positive green-blue appears on the pad.

Question 51

A speckled pattern on the blood pad of the reagent strip indicates: Hematuria Hemoglobinuria Myoglobinuria All of the above

Answer 51

Hematuria ## Footnote Intact red blood cells are lysed when they come in contact with the pad, and the liberated hemoglobin produces an isolated reaction that results in a speckled pattern on the pad.

Question 52

Significant albumin excretion rate (AER): 0.02 to 1 ug/min 1 to 5 ug/min 5 to 15 ug/min 2 to 20 ug/min 20 to 200 ug/min

Answer 52

20 to 200 ug/min ## Footnote Microalbumin was considered significant when 30 to 300 mg of albumin is excreted in 24 hours or the AER is 20 to 200 μg/min.

Question 53

Bilirubin combines with 2,6-dichlorobenzene-diazonium-tetrafluoroborate in an acid medium to produce an azodye, with colors ranging from: Green to blue Green to brown Pink to purple Yellow to orange

Answer 53

Pink to purple ## Footnote BILIRUBIN REAGENT PAD 2, 4-dichloroaniline diazonium salt: TAN 2,6-dichlorobenzene-diazonium-tetrafluoroborate: PINK TO VIOLET

Question 54

Which of the following are characteristic urine findings from a patient with hemolytic jaundice? A positive test for bilirubin and an increased amount of urobilinogen A positive test for bilirubin and a decreased amount of urobilinogen A negative test for bilirubin and an increased amount of urobilinogen A negative test for bilirubin and a decreased amount of urobilinogen

Answer 54

A negative test for bilirubin and an increased amount of urobilinogen

Question 55

Which of the following results show characteristic urine findings from a patient with an obstruction of the bile duct? A positive test for bilirubin and an increased amount of urobilinogen A positive test for bilirubin and a decreased amount of urobilinogen A negative test for bilirubin and an increased amount of urobilinogen A negative test for bilirubin and a decreased amount of urobilinogen

Answer 55

A positive test for bilirubin and a decreased amount of urobilinogen

Question 56

False positive Ehrlich’s reaction for urobilinogen, EXCEPT: Porphobilinogen Formalin Indican Sulfonamides

Answer 56

Formalin ## Footnote UROBILINOGEN REAGENT PAD (MULTISTIX) False-positive: Porphobilinogen Indican p-aminosalicylic acid Sulfonamides Methyldopa Procaine Chlorpromazine Highly pigmented urine False-negative: Old specimens Preservation in formalin

Question 57

The positive reagent strip test for nitrite in this patient is probably caused by which of the following? An infection from gram-negative bacteria An infection from gram-positive bacteria A yeast infection An old urine specimen, unsuitable for examination

Answer 57

An infection from gram-negative bacteria

Question 58

A positive nitrite test and a negative leukocyte esterase test is an indication of a: Dilute random specimen Specimen with lysed leukocytes Vaginal yeast infection Specimen older than 2 hours

Answer 58

Specimen older than 2 hours ## Footnote False-positive results are obtained if nitrite testing is not performed on fresh samples, because multiplication of contaminant bacteria soon produces measurable amounts of nitrite. A true positive nitrite test should be accompanied by a positive leukocyte esterase test.

Question 59

Reagent pad contains para-arsanilic acid or sulfanilamide: pH Protein Leukocyte Nitrite

Answer 59

Nitrite ## Footnote Nitrite is detected by the Greiss reaction, in which nitrite at an acidic pH reacts with an aromatic amine (para-arsanilic acid or sulfanilamide) to form a diazonium compound that then reacts with tetrahydrobenzoquinolin compounds to produce a pink-colored azodye.

Question 60

Positive reagent pad for nitrite: Blue Brown Pink Purple

Answer 60

Pink ## Footnote Nitrite is detected by the Greiss reaction, in which nitrite at an acidic pH reacts with an aromatic amine (para-arsanilic acid or sulfanilamide) to form a diazonium compound that then reacts with tetrahydrobenzoquinolin compounds to produce a pink-colored azodye.

Question 61

Nitrite tests should be performed on first morning specimens or specimens collected after urine has remained in the bladder for at least ___ hours. At least 1 hour At least 2 hours At least 3 hours At least 4 hours

Answer 61

At least 4 hours ## Footnote Nitrite tests should be performed on first morning specimens or specimens collected after urine has remained in the bladder for at least 4 hours.

Question 62

Chemical testing in urine that requires patients to include diet that contains green vegetables: Bilirubin Glucose Ketone Nitrite

Answer 62

Nitrite ## Footnote The reliability of the test depends on the presence of adequate amounts of nitrate in the urine. This is seldom a problem in patients on a normal diet that contains green vegetables; however, because diet usually is not controlled prior to testing, the possibility of a falsenegative result owing to lack of dietary nitrate does exist.

Question 63

High urine specific gravity: False positive nitrite False negative nitrite False positive blood False positive glucose

Answer 63

False negative nitrite ## Footnote HIGH URINE SPECIFIC GRAVITY FALSE POSITIVE: Protein FALSE NEGATIVE: Glucose, blood, nitrite

Question 64

The reagent strip reaction that requires the longest reaction time is the: Bilirubin pH Leukocyte esterase Glucose

Answer 64

Leukocyte esterase ## Footnote READING TIMES 30 seconds: glucose, bilirubin 40 seconds: ketone 45 seconds: specific gravity 60 seconds (1 minute): pH, protein, blood, urobilinogen and nitrite 120 seconds (2 minutes): leukocyte esterase

Question 65

All of the following can be detected by the leukocyte esterase reaction except: Neutrophils Eosinophils Lymphocytes Basophils

Answer 65

Lymphocytes ## Footnote The LE test detects the presence of esterase in the granulocytic white blood cells (neutrophils, eosinophils, and basophils) and monocytes, but not lymphocytes

Question 66

Urine volume frequently used because multiparameter reagent strips are easily immersed in this volume: 5 mL volume 12 mL volume 30 mL volume 45 mL volume

Answer 66

12 mL volume ## Footnote A standard amount of urine, usually between 10 and 15 mL, is centrifuged in a conical tube. This provides an adequate volume from which to obtain a representative sample of the elements present in the specimen. A 12-mL volume is frequently used because multiparameter reagent strips are easily immersed in this volume, and capped centrifuge tubes are often calibrated to this volume.

Question 67

Centrifugation speed that produces an optimum amount of urine sediment with the least chance of damaging the elements: 5 minutes at a relative centrifugal force (RCF) of 400 5 minutes at a relative centrifugal force (RCF) of 500 5 minutes at a relative centrifugal force (RCF) of 600 5 minutes at a relative centrifugal force (RCF) of 1,000

Answer 67

5 minutes at a relative centrifugal force (RCF) of 400 ## Footnote The speed of the centrifuge and the length of time the specimen is centrifuged should be consistent. Centrifugation for 5 minutes at a relative centrifugal force (RCF) of 400 produces an optimum amount of sediment with the least chance of damaging the elements.

Question 68

Initial magnification: Objective Ocular

Answer 68

Objective ## Footnote SLIDE > OBJECTIVE > OCULAR Objective: FIRST LENS SYSTEM, INITIAL MAGNIFICATION Ocular: SECOND LENS SYSTEM, FURTHER MAGNIFICATION

Question 69

Further magnification: Objective Ocular

Answer 69

Ocular ## Footnote SLIDE > OBJECTIVE > OCULAR Objective: FIRST LENS SYSTEM, INITIAL MAGNIFICATION Ocular: SECOND LENS SYSTEM, FURTHER MAGNIFICATION

Question 70

Microscope component that GATHERS AND FOCUSES THE ILLUMINATION LIGHT onto the specimen for viewing. Aperture diaphragm Rheostat Condenser Ocular

Answer 70

Condenser ## Footnote CONDENSER Focuses the light on the specimen and controls the light for uniform illumination

Question 71

Which of the following should be used to REDUCE LIGHT INTENSITY in bright-field microscopy? Aperture diaphragm Rheostat Condenser Objective

Answer 71

Rheostat

Question 72

Type of microscope that ENHANCES VISUALIZATION OF ELEMENTS WITH LOW REFRACTIVE INDICES, such as hyaline casts, mixed cellular casts, mucous threads, and Trichomonas. Fluorescence microscope Interference-contrast microscope Phase-contrast microscope Polarizing microscope

Answer 72

Phase-contrast microscope ## Footnote Bright-field microscopy: used for routine urinalysis Phase-contrast microscopy: enhances visualization of elements with low refractive indices, such as hyaline casts, mixed cellular casts, mucous threads and Trichomonas Polarizing microscopy: aids in identification of cholesterol in oval fat bodies, fatty casts, and crystals Dark-field microscopy: aids in identification of Treponema pallidum Fluorescence microscopy: allows visualization of naturally fluorescent microorganisms or those stained by a fluorescent dye Interference-contrast: produces a three-dimensional microscopy-image and layer-by-layer imaging of a specimen

Question 73

A type of microscope that produces a three-dimensional microscopy image and layer-by-layer imaging of a specimen Fluorescence microscope Interference-contrast microscope Phase-contrast microscope Polarizing microscope

Answer 73

Interference-contrast microscope ## Footnote Two types of interference-contrast microscope 1. Hoffman - modulation contrast 2. Nomarski - differential interference contrast Bright-field microscopes can be adapted for both methods

Question 74

Of all the urine sediment elements, _____ are the most difficult to recognize. RBCs WBCs RTE cells Sperms

Answer 74

RBCs ## Footnote The reasons for this include RBCs’ lack of characteristic structures, variations in size, and close resemblance to other urine sediment constituents. RBCs are frequently confused with yeast cells, oil droplets, and air bubbles.

Question 75

Significant number of eosinophils in urine: More than 1% eosinophils More than 5% eosinophils More than 10% eosinophils More than 15% eosinophils

Answer 75

More than 1% eosinophils ## Footnote The percentage of eosinophils in 100 to 500 cells is determined. Eosinophils are not normally seen in the urine; therefore, the finding of more than 1% eosinophils is considered significant.

Question 76

FECAL CONTAMINATION of a urine specimen can also result in the presence of ova from intestinal parasites in the urine sediment. The most common contaminant is: Enterobius vermicularis Schistosoma haematobium Trichomonas vaginalis Entamoeba histolytica

Answer 76

Enterobius vermicularis ## Footnote Fecal contamination of a urine specimen can also result in the presence of ova from intestinal parasites in the urine sediment. The most common contaminant is ova from the pinworm Enterobius vermicularis.

Question 77

MOST FREQUENT PARASITE ENCOUNTERED IN THE URINE: Enterobius vermicularis Schistosoma haematobium Trichomonas vaginalis Entamoeba histolytica

Answer 77

Trichomonas vaginalis ## Footnote The most frequent parasite encountered in the urine is Trichomonas vaginalis. The Trichomonas trophozoite is a pear-shaped flagellate with an undulating membrane. It is easily identified in wet preparations of the urine sediment by its rapid darting movement in the microscopic field. Trichomonas is usually reported as rare, few, moderate, or many per hpf.

Question 78

Reporting of Trichomonas vaginalis: With WBCs With motility

Answer 78

With motility ## Footnote Because their characteristic motility provides the best means of positively identifying them, a fresh urine specimen is needed.

Question 79

When not moving, Trichomonas is more difficult to identify and may resemble a: WBC Transitional epithelial cell Renal tubular epithelial cell All of these

Answer 79

All of these ## Footnote When not moving, Trichomonas is more difficult to identify and may resemble a WBC, transitional, or RTE cell. Use of phase microscopy may enhance visualization of the flagella or undulating membrane.

Question 79

Reporting of spermatozoa: Do not report Rare, few, moderate or many per LPF Rare, few, moderate or many per HPF Present, based on laboratory protocol

Answer 79

Present, based on laboratory protocol ## Footnote STRASINGER: Reporting of spermatozoa: Present, based on laboratory protocol

Question 80

Only elements found in the urinary sediment that are unique to the kidney: Red blood cells Epithelial cells Casts Crystals

Answer 80

Casts ## Footnote Casts are the only elements found in the urinary sediment that are unique to the kidney. They are formed within the lumens of the distal convoluted tubules and collecting ducts, providing a microscopic view of conditions within the nephron.

Question 81

During microscopy casts are usually seen: Center of coverslip Near the edge of coverslip Outside the coverslip All of these

Answer 81

Near the edge of coverslip ## Footnote Examination of the sediment for the detection of casts is performed using lower power magnification. When the glass cover-slip method is used, low-power scanning should be performed along the edges of the cover slip.

Question 82

Casts increased in CONGESTIVE HEART FAILURE: Granular casts Hyaline casts WBC casts Epithelial casts

Answer 82

Hyaline casts ## Footnote The most frequently seen cast is the hyaline type, which consists almost entirely of uromodulin. The presence of zero to two hyaline casts per lpf is considered normal, as is the finding of increased numbers following strenuous exercise, dehydration, heat exposure, and emotional stress. Pathologically, hyaline casts are increased in acute glomerulonephritis, pyelonephritis, chronic renal disease, and congestive heart failure.

Question 83

Pyelonephritis can be differentiated from cystitis by the presence of ________. Eosinophils Hyaline casts WBC casts Bacteriuria

Answer 83

WBC casts ## Footnote The appearance of WBC casts in the urine signifies infection or inflammation within the nephron. They are most frequently associated with pyelonephritis and are a primary marker for distinguishing pyelonephritis (upper UTI) from cystitis (lower UTI).

Question 84

Which of the following could be a broad cast? Hyaline cast Granular cast Waxy cast All of these

Answer 84

All of these ## Footnote All types of casts may occur in the broad form. However, considering the accompanying urinary stasis, the most commonly seen broad casts are granular and waxy casts.

Question 85

Most commonly seen broad casts: RBC and WBC casts WBC and epithelial casts Hyaline and granular casts Granular and waxy casts

Answer 85

Granular and waxy casts ## Footnote All types of casts may occur in the broad form. However, considering the accompanying urinary stasis, the most commonly seen broad casts are granular and waxy casts.

Question 86

A 62-year-old patient with hyperlipoproteinemia has a large amount of protein in his urine. Microscopic analysis yields moderate to many fatty, waxy, granular and cellular casts. Many oval fat bodies are also noted.This is most consistent with: Nephrotic syndrome Acute pyelonephritis Viral infection Acute glomerulonephritis

Answer 86

Nephrotic syndrome

Question 87

Reporting of normal crystals: Averaged and reported per LPF Averaged and reported per HPF Rare, few, moderate or many per LPF Rare, few, moderate or many per HPF

Answer 87

Rare, few, moderate or many per HPF ## Footnote Crystals are usually reported as rare, few, moderate, or many per hpf. Abnormal crystals may be averaged and reported per lpf.

Question 88

Lemon-shaped crystals: Ammonium biurate Calcium phosphate Uric acid Triple phosphate

Answer 88

Uric acid ## Footnote HENRY Uric acid crystals occur at low pH (5–5.5) and are seen in a variety of shapes, including rhombic or four-sided flat plates, prisms, oval forms with pointed ends (lemon-shaped), wedges, rosettes, and irregular plates.

Question 89

Increased amounts of these crystals in fresh urine is seen in patients with leukemia who are receiving chemotherapy: Calcium phosphate Calcium oxalate Triple phosphate Uric acid

Answer 89

Uric acid ## Footnote Increased amounts of uric acid crystals, particularly in fresh urine, are associated with: 1. Increased levels of purines and nucleic acids and are seen in patients with leukemia who are receiving chemotherapy 2. Patients with Lesch-Nyhan syndrome 3. Patients with gout

Question 90

MT notices calcium oxalate crystals in urine, but the atypical form. To confirm identity of these crystals: Soluble with acetic acid Soluble with dilute HCl Soluble with acetic acid and dilute HCl None of these

Answer 90

Soluble with dilute HCl ## Footnote Weddelite (dihydrate CaOx, most common): envelope, pyramidal Whewellite (monohydrate CaOx, less frequent): dumbbell, oval Calcium oxalate crystals: Soluble in dilute HCl Insoluble in acetic acid

Question 91

Crystals associated with ethylene glycol poisoning: Envelope or pyramidal crystals Oval or dumbbell crystals

Answer 91

Oval or dumbbell crystals ## Footnote Ethylene glycol (antifreeze) poisoning (monohydrate forms) - dumbbell, oval The MONOHYDRATE FORM is most frequently seen in children and pets because antifreeze tastes sweet and uncovered containers left in the garage can be very tempting.

Question 92

Apatite crystals: Calcium phosphate Monohydrate calcium oxalate Dihydrate calcium oxalate Triple phosphate

Answer 92

Calcium phosphate ## Footnote Calcium phosphate: APATITE Monohydrate calcium oxalate: WHEWELLITE Dihydrate calcium oxalate: WEDDELITE Triple phosphate: STRUVITE

Question 93

Calculi formation at pH > 7: Uric acid, cystine, xanthine Triple phosphate, calcium phosphate Calcium oxalate, apatite All of these

Answer 93

Triple phosphate, calcium phosphate ## Footnote pH < 5.5: Uric acid, cystine, or xanthine calculi pH 5 to 6: Calcium oxalate and apatite calculi pH >7: Magnesium ammonium phosphate or calcium phosphate

Question 94

Calculi associated with RAPID PROTEIN CATABOLISM: Calcium oxalate Cystine Uric acid None of these

Answer 94

Uric acid ## Footnote URIC ACID AND URATE CALCULI 1. Gout 2. Polycythemia 3. Leukemia 4. Lymphoma 5. Liver disease 6. Acid isohydria 7. Theophylline and thiazide therapy 8. Conditions associated with rapid protein catabolism

Question 95

Calculi associated with EXCESSIVE GLYCOGEN BREAKDOWN: Calcium oxalate Cystine Uric acid None of these

Answer 95

Calcium oxalate ## Footnote CALCIUM OXALATE CALCULI 1. Oxaluria 2. Incomplete catabolism of carbohydrates 3. Isohydria at pH 5.5 to 6.0 4. Excessive glycogen breakdown

Question 96

The most common composition of renal calculi is: Calcium oxalate Magnesium ammonium phosphate Cystine Uric acid

Answer 96

Calcium oxalate ## Footnote Approximately 75% of the renal calculi are composed of calcium oxalate or calcium phosphate. Magnesium ammonium phosphate (struvite), uric acid, and cystine are the other primary calculi constituents.

Question 97

Urinalysis on a patient with severe back pain being evaluated for renal calculi would be most beneficial if it showed: Heavy proteinuria Low specific gravity Uric acid crystals Microscopic hematuria

Answer 97

Microscopic hematuria ## Footnote Urine specimens from patients suspected of passing or being in the process of passing renal calculi are frequently received in the laboratory. The presence of microscopic hematuria resulting from irritation to the tissues by the moving calculus is the primary urinalysis finding.

Question 98

Positive result for the acid-albumin and CTAB test for mucopolysaccharides: White turbidity Yellow turbidity Yellow spot Blue spot

Answer 98

White turbidity

Question 99

Positive result for the METACHROMATIC STAINING SPOT TEST for mucopolysaccahrides: White turbidity Yellow turbidity Yellow spot Blue spot

Answer 99

Blue spot

Question 100

Key to the diagnosis is the demonstration of antineutrophilic cytoplasmic antibody (ANCA) in the patient’s serum: Berger disease Goodpasture's syndrome Henoch-Schonlein purpura Wegener granulomatosis

Answer 100

Wegener granulomatosis ## Footnote Wegener granulomatosis causes a granuloma-producing inflammation of the small blood vessels primarily of the kidney and respiratory system. Key to the diagnosis of Wegener granulomatosis is the demonstration of antineutrophilic cytoplasmic antibody (ANCA) in the patient’s serum.

Question 101

The presence of renal tubular epithelial cells and casts is an indication of: Acute interstitial nephritis Chronic glomerulopnephritis Minimal change disease Acute tubular necrosis

Answer 101

Acute tubular necrosis ## Footnote Urinalysis findings include mild proteinuria, microscopic hematuria, and, most noticeably, the presence of RTE cells and RTE cell casts containing tubular fragments consisting of three or more cells.

Question 102

Increased eosinophils, WBC casts without bacteria: Acute glomerulophritis Acute interstitial nephritis Acute pyelonephritis Acute tubular necrosis

Answer 102

Acute interstitial nephritis ## Footnote ACUTE INTERSTITIAL NEPHRITIS AIN is primarily associated with an allergic reaction to medications that occurs within the renal interstitium, possibly caused by the medication binding to the interstitial protein. Urinalysis results include hematuria, possibly macroscopic, mild to moderate proteinuria, numerous WBCs, and WBC casts without bacteria. Differential leukocyte staining for the presence of increased eosinophils may be useful to confirm the diagnosis.

Question 103

The only protein produced by the kidney is: Albumin Uromodulin Uroprotein Globulin

Answer 103

Uromodulin ## Footnote Uromodulin is a more recent name for Tamm-Horsfall protein Uromodulin is a glycoprotein and is the only protein produced by the kidney. It is produced by the proximal and distal convoluted tubules.

Question 104

In automated microscopy, the DNA within the cells is stained by an orange dye: Phenathridine Carbocyanine

Answer 104

Phenathridine ## Footnote PHENATHRIDINE: ORANGE, DNA CARBOCYANINE: GREEN Nuclear membranes, mitochondria, and negatively charged cell membranes

Question 105

In automated microscopy, the nuclear membranes, mitochondria and negatively charged cell membranes are stained by the green dye: Phenathridine Carbocyanine

Answer 105

Carbocyanine ## Footnote PHENATHRIDINE: ORANGE, DNA CARBOCYANINE: GREEN Nuclear membranes, mitochondria, and negatively charged cell membranes

Question 106

The concentration of hCG is generally at a particular level in serum about 2 to 3days after implantation. This is the concentration at which most sensitive laboratory assays can give a positive serum hCG result. What is the lowest level of hormone for which most current serum hCG tests can give a positive result? 25 mIU/mL 50 mIU/mL 100 mIU/mL 100, 000 mIU/mL

Answer 106

25 mIU/mL ## Footnote In a normal pregnancy, detectable amounts of about 25 mIU/mL β- hCG are secreted 2 to 3 days (48 to 72 hours) after implantation, or approximately 8 to 10 days after conception or fertilization.

Question 107

The most specific assays for human chorionic gonadotropin (hCG) use antibody reagents against which subunit of hCG? Alpha Beta Gamma Chorionic

Answer 107

Beta ## Footnote Alpha subunit of HCG - similar to LH, FSH and TSH Beta subunit is unique for HCG

Question 108

In the card pregnancy test: no band appears at T and a black or gray band is visible at the C position Positive Negative Invalid

Answer 108

Negative ## Footnote CARD PREGNANCY TEST 1. POSITIVE: Two separate black or gray bands, one at T and the other at C, are visible in the results window, indicating that the specimen contains detectable levels of hCG. Although the intensity of the test band may vary with different specimens, the appearance of two distinct bands should be interpreted as a positive result. 2. NEGATIVE: If no band appears at T and a black or gray band is visible at the C position, the test can be considered negative, indicating that a detectable level of hCG is not present. 3. INVALID: If no band appears at C or incomplete or beaded bands appear at the T or C position, the test is invalid. The test should be repeated using another Card Pregnancy Test device. If the test band appears very faint, it is recommended that a new sample be collected 48 hours later and tested again using another Card Pregnancy Test device

Question 109

What department is the CSF tube labeled 3 routinely sent to? Hematology Chemistry Microbiology Serology

Answer 109

Hematology

Question 110

Fourth CSF tube may be drawn for: Cell counts Chemical tests Chemistry and cell counts Microbiology or additional serologic tests

Answer 110

Microbiology or additional serologic tests

Question 111

If only a small amount of CSF is obtained, which is the most important procedure to perform first? Cell count Chemistry Immunology Microbiology

Answer 111

Microbiology

Question 112

A web-like pellicle in a refrigerated CSF specimen indicates: Tubercular meningitis Multiple sclerosis Primary CNS malignancy Viral meningitis

Answer 112

Tubercular meningitis

Question 113

A CSF total cell count is diluted with: Distilled water Normal saline Acetic acid Hypotonic saline

Answer 113

Normal saline ## Footnote Dilutions for total cell counts are made with normal saline, mixed by inversion, and loaded into the hemocytometer with a Pasteur pipette.

Question 114

A CSF WBC count is diluted with: Distilled water Normal saline Acetic acid Hypotonic saline

Answer 114

Acetic acid ## Footnote Lysis of RBCs must be obtained before performing the WBC count on either diluted or undiluted specimens. Specimens requiring dilution can be diluted in the manner described previously, substituting 3% glacial acetic acid to lyse the RBCs. Adding methylene blue to the diluting fluid stains the WBCs, providing better differentiation between neutrophils and mononuclear cells.

Question 115

As little as 0.1 mL of CSF combined with one drop of ________ produces an adequate CELL YIELD when processed with the cytocentrifuge. 10% albumin 30% albumin 1% HCl 3% acetic acid

Answer 115

30% albumin ## Footnote Adding albumin increases the cell yield and decreases the cellular distortion frequently seen on cytocentrifuged specimens.

Question 116

The purpose of adding albumin to CSF before cytocentrifugation is to: Increase the cell yield Decrease the cellular distortion Improve the cellular staining Increase cell yield and decrease cellular distortion

Answer 116

Increase cell yield and decrease cellular distortion ## Footnote Adding albumin increases the cell yield and decreases the cellular distortion frequently seen on cytocentrifuged specimens.

Question 117

The presence of which of the following cells is increased in a parasitic infection? Neutrophils Macrophages Eosinophils Lymphocytes

Answer 117

Eosinophils ## Footnote Increased eosinophils are seen in the CSF in association with parasitic infections, fungal infections (primarily Coccidioides immitis), and introduction of foreign material, including medications and shunts, into the CNS.

Question 118

Fungal infection associated with increased eosinophils in CSF: Blastomyces dermatitidis Coccidioides immitis Cryptococcus neoformans Histoplasma capsulatum

Answer 118

Coccidioides immitis ## Footnote Increased eosinophils are seen in the CSF in association with parasitic infections, fungal infections (primarily Coccidioides immitis), and introduction of foreign material, including medications and shunts, into the CNS.

Question 119

Which of the following may resemble a LYMPHOCYTE in CSF? Blastoyces Coccidioides Cryptococcus Histoplasma

Answer 119

Cryptococcus

Question 120

Nonpathologically significant cells are most frequently seen after DIAGNOSTIC PROCEDURES such as PNEUMOENCEPHALOGRAPHY and in fluid obtained from VENTRICULAR TAPS or during NEUROSURGERY: Choroidal cells Ependymal cells Spindle-shaped cells All of these

Answer 120

All of these

Question 121

Myeloblasts are seen in the CSF: In bacterial infections In conjunction with CNS malignancy After cerebral hemorrhage As a complication of acute leukemia

Answer 121

As a complication of acute leukemia ## Footnote Lymphoblasts, myeloblasts, and monoblasts in the CSF are frequently seen as a serious complication of acute leukemias. Nucleoli are often more prominent than in blood smears.

Question 122

The most frequently performed chemical test on CSF: Glucose determination Lactate determination Protein determination India ink staining

Answer 122

Protein determination ## Footnote The most frequently performed chemical test on CSF is the protein determination.

Question 123

The reference range for CSF protein is: 6 to 8 g/dL 15 to 45 g/dL 6 to 8 mg/dL 15 to 45 mg/dL

Answer 123

15 to 45 mg/dL ## Footnote Reference values for total CSF protein are usually listed as 15 to 45 mg/dL, but are somewhat method dependent, and higher values are found in infants and people over age 40. This value is reported in milligrams per deciliter and not grams per deciliter, as are plasma protein concentrations.

Question 124

CSF can be differentiated from serum by the presence of: Albumin Globulin Prealbumin Tau transferrin

Answer 124

Tau transferrin ## Footnote Transferrin is the major beta globulin present; also, a separate carbohydrate-deficient transferrin fraction, referred to as “tau,” is seen in CSF and not in serum.

Question 125

In serum, the second most prevalent protein is IgG; in CSF, the second most prevalent protein is: Transferrin Prealbumin IgA Ceruloplasmin

Answer 125

Prealbumin

Question 126

Elevated CSF protein values can be caused by all of the following except: Meningitis Multiple sclerosis Fluid leakage CNS malignancy

Answer 126

Fluid leakage ## Footnote Abnormally low values are present when fluid is leaking from the CNS. The causes of elevated CSF protein include damage to the blood–brain barrier, immunoglobulin production within the CNS, decreased normal protein clearance from the fluid, and neural tissue degeneration. Meningitis and hemorrhage conditions that damage the blood–brain barrier are the most common causes of elevated CSF protein.

Question 127

The integrity of the blood–brain barrier is measured using the: CSF/serum albumin index CSF/serum globulin ratio CSF albumin index CSF IgG index

Answer 127

CSF/serum albumin index ## Footnote CSF/SERUM ALBUMIN INDEX An index value less than 9 represents an intact blood– brain barrier. The index increases relative to the amount of damage to the barrier.

Question 128

The finding of oligoclonal bands in the CSF and not in the serum is seen with: Multiple myeloma CNS malignancy Multiple sclerosis Viral infections

Answer 128

Multiple sclerosis

Question 129

Oligoclonal banding in cerebrospinal fluid but not in serum, EXCEPT: Encephalitis Multiple myeloma Neurosyphilis Guillain-Barre disease

Answer 129

Multiple myeloma ## Footnote The presence of two or more oligoclonal bands in the CSF that are not present in the serum can be a valuable tool in diagnosing multiple sclerosis, particularly when accompanied by an increased IgG index. Other neurologic disorders including encephalitis, neurosyphilis, Guillain-Barré syndrome, and neoplastic disorders also produce oligoclonal banding that may not be present in the serum.

Question 130

Measurement of which of the following can be replaced by CSF GLUTAMINE analysis in children with Reye syndrome? Ammonia Lactate Glucose Alpha-ketoglutarate

Answer 130

Ammonia ## Footnote Glutamine is produced from ammonia and alpha ketoglutarate by the brain cells. This process serves to remove the toxic metabolic waste product ammonia from the CNS. The normal concentration of glutamine in the CSF is 8 to 18 mg/dL. Elevated levels are associated with liver disorders that result in increased blood and CSF ammonia.

Question 131

Before performing a Gram stain on CSF, the specimen must be: Filtered Warmed to 37C Centrifuged Mixed

Answer 131

Centrifuged ## Footnote All smears and cultures should be performed on concentrated specimens because often only a few organisms are present at the onset of the disease. The CSF should be centrifuged at 1500 g for 15 minutes, and slides and cultures should be prepared from the sediment.

Question 132

The procedure recommended by the CDC to diagnose neurosyphilis: RPR VDRL MHA-TP FTA-ABS

Answer 132

VDRL ## Footnote Although many different serologic tests for syphilis are available when testing blood, the procedure recommended by the CDC to diagnose neurosyphilis is the Venereal Disease Research Laboratories (VDRL), even though it is not as sensitive as the fluorescent treponemal antibody-absorption (FTA-ABS) test for syphilis. The rapid plasma regain (RPR) test is not recommended because it is less sensitive than the VDRL.

Question 133

An elevated maternal serum AFP, may indicate an amniocentesis at: 15 to 18 weeks 20 to 42 weeks

Answer 133

15 to 18 weeks ## Footnote INDICATIONS FOR PERFORMING AMNIOCENTESIS INDICATED AT 15 TO 18 WEEKS’ GESTATION  Mother’s age of 35 or older at delivery  Family history of chromosome abnormalities, such as trisomy 21 (Down syndrome)  Parents carry an abnormal chromosome rearrangement  Earlier pregnancy or child with birth defect  Parent is a carrier of a metabolic disorder  Family history of genetic diseases such a sickle cell disease, Tay-Sachs disease, hemophilia, muscular dystrophy, sickle cell anemia, Huntington chorea, and cystic fibrosis  Elevated maternal serum alpha-fetoprotein  Abnormal triple marker screening test  Previous child with a neural tube disorder such as spina bifida, or ventral wall defects (gastroschisis)  Three or more miscarriages INDICATED LATER IN THE PREGNANCY (20 TO 42 WEEKS)  Fetal lung maturity  Fetal distress  HDN caused by Rh blood type incompatibility  Infection

Question 134

The amount of amniotic fluid increases in quantity throughout pregnancy, reaching a peak of approximately ____ mL during the third trimester, and then gradually decreases prior to delivery. 100 to 200 mL 200 to 400 mL 400 to 800 mL 800 to 1, 200 mL

Answer 134

800 to 1, 200 mL

Question 135

A maximum of ___ mL of amniotic fluid is collected in sterile syringes. 5 mL 10 mL 20 mL 30 mL

Answer 135

30 mL

Question 136

Presence of meconium in amniotic fluid: Colorless Blood-streaked Yellow Dark green Dark red-brown

Answer 136

Dark green ## Footnote Meconium, which is usually defined as a newborn’s first bowel movement, is formed in the intestine from fetal intestinal secretions and swallowed amniotic fluid. It is a dark green, mucus-like material. It may be present in the amniotic fluid as a result of fetal distress.

Question 137

Dark red-brown amniotic fluid: Traumatic tap, abdominal trauma, intra-amniotic hemorrhage Hemolytic disease of the newborn Meconium Fetal death

Answer 137

Fetal death ## Footnote A very dark red-brown fluid is associated with fetal death

Question 138

Amniotic fluid specimens are placed in amber-colored tubes prior to sending them to the laboratory to prevent the destruction of: Alpha-fetoprotein Bilirubin Cytogenetics Lecithin

Answer 138

Bilirubin

Question 139

Why are amniotic specimens for cytogenetic analysis incubated at 37°C prior to analysis? To detect the presence of meconium To differentiate amniotic fluid from urine To prevent photo-oxidation of bilirubin to biliverdin To prolong fetal cell viability and integrity

Answer 139

To prolong fetal cell viability and integrity

Question 140

How are specimens for FLM testing delivered to and stored in the laboratory? Delivered on ice and refrigerated Immediately centrifuged Kept at room temperature Delivered in a vacuum tube

Answer 140

Delivered on ice and refrigerated

Question 141

Amniotic fluid bilirubin is measured by: Turbidimetric method Dye-binding method Spectrophotometric analysis Fluorometric analysis

Answer 141

Spectrophotometric analysis ## Footnote Amniotic fluid bilirubin is measured by spectrophotometric analysis using serial dilutions. When bilirubin is present, a rise in OD is seen at 450 nm because this is the wavelength of maximum bilirubin absorption.

Question 142

A significant rise in the OD of amniotic fluid at 450 nm indicates the presence of which analyte? Bilirubin Lecithin Oxyhemoglobin Sphingomyelin

Answer 142

Bilirubin

Question 143

For OD 450, specimens that are contaminated with blood are generally unacceptable because maximum absorbance of oxyhemoglobin occurs at ___ nm and can interfere with the bilirubin absorption peak Oxyhemoglobin and bilirubin 410 nm Oxyhemoglobin and bilirubin 450 nm Oxyhemoglobin 410 nm, bilirubin 450 nm Oxyhemoglobin 450 nm, bilirubin 410 nm

Answer 143

Oxyhemoglobin 410 nm, bilirubin 450 nm ## Footnote Specimens that are contaminated with blood are generally unacceptable because maximum absorbance of oxyhemoglobin occurs at 410 nm and can interfere with the bilirubin absorption peak. This interference can be removed by extraction with chloroform if necessary

Question 144

A ΔA450 value that falls into Zone I indicates: Normal finding without significant hemolysis Moderate hemolysis Severe hemolysis High fetal risk

Answer 144

Normal finding without significant hemolysis ## Footnote Zone I: no more than a mildly affected fetus Zone II: moderate hemolysis and require careful monitoring anticipating an early delivery or exchange transfusion upon delivery Zone III: severe hemolysis and suggests a severely affected fetus; intervention through induction of labor or intrauterine exchange transfusion must be considered

Question 145

Plotting the amniotic fluid OD on a Liley graph represents the severity of hemolytic disease of the newborn. A value that is plotted in ZONE II indicates what condition of the fetus? No hemolysis Mildly affected fetus Moderately affected fetus requiring close monitoring Severely affected fetus that requires intervention

Answer 145

Moderately affected fetus requiring close monitoring ## Footnote Zone I: no more than a mildly affected fetus Zone II: moderate hemolysis and require careful monitoring anticipating an early delivery or exchange transfusion upon delivery Zone III: severe hemolysis and suggests a severely affected fetus; intervention through induction of labor or intrauterine exchange transfusion must be considered

Question 146

In the FOAM OR SHAKE TEST, amniotic fluid is mixed with: 1% NaOH 10% NaOH 70% ethanol 95% ethanol

Answer 146

95% ethanol ## Footnote Amniotic fluid is mixed with 95% ethanol, shaken for 15 seconds, and allowed to sit undisturbed for 15 minutes. At the end of this time, the surface of the fluid is observed for the presence of a continuous line of bubbles around the outside edge. The presence of bubbles indicates that a sufficient amount of phospholipid is available to reduce the surface tension of the fluid even in the presence of alcohol, an antifoaming agent.

Question 147

Increases the OD of the amniotic fluid at 650 nm: AFP Bilirubin Lamellar bodies Oxyhemoglobin

Answer 147

Lamellar bodies ## Footnote OD 650 nm: LAMELLAR BODIES (FETAL LUNG MATURITY) An OD of 0.150 has been shown to correlate well with an L/S ratio of greater than or equal to 2.0 and the presence of phosphatidyl glycerol.

Question 148

When severe HDN is present, which of the following tests on the amniotic fluid would the physician NOT ORDER to determine whether the fetal lungs are mature enough to withstand a premature delivery? AFP levels Foam stability index Lecithin/sphingomyelin ratio Phosphatidylglycerol detection

Answer 148

AFP levels ## Footnote Neural tube defects (NTD) are one of the most common birth defects. It can be detected by maternal serum alpha-fetoprotein (MSAFP) blood test, high-resolution ultrasound, and amniocentesis. Increased levels of alpha-fetoprotein (AFP) in both the maternal circulation and the amniotic fluid can be indicative of fetal neural tube defects, such as anencephaly and spina bifida.

Question 149

True for SPUTUM: Green in color Secreted by the tracheobronchial tree Healthy individual normally produce sputum All of these

Answer 149

Secreted by the tracheobronchial tree ## Footnote SPUTUM is the material secreted by the tracheobronchial tree and brought up by coughing. The healthy individual does not normally produce sputum.

Question 150

Formed elements in sputum are best studied by which CYTOLOGICAL techniques? AFB stain Gram's stain Pap's stain Wright's stain

Answer 150

Pap's stain ## Footnote Pap’s stain: SPUTUM CYTOLOGY Wright’s stain: DIFFERENTIATES NEUTROPHILS FROM EOSINOPHILS

Question 151

Which of the following may resemble MYELIN GLOBULE in sputum? Blastomyces Coccidioides Cryptococcus Histoplasma

Answer 151

Blastomyces ## Footnote Myelin globules: little or no significance but may be mistaken for Blastomyces (yeastlike fungi). They are colorless, round, oval or pea-shaped of various sizes.

Question 152

Dense, crystalline concretions (may be large enough to be grossly visible) may be seen in sputum in: Bronchial asthma Broncholithiasis Pneumonia Tuberculosis

Answer 152

Broncholithiasis

Question 153

Which of the following stimulate the parietal cells to produce hydrochloric acid? Gastrin Intrinsic factor Pepsin Trypsin

Answer 153

Gastrin

Question 154

Gastric tube inserted through the mouth: Levin tube Rehfuss tube

Answer 154

Rehfuss tube ## Footnote The gastric juice is obtained by insertion of a gastric tube into the stomach 1. REHFUSS tube (introduced through the mouth) 2. LEVIN tube (inserted through the nose) 3. Disposable plastic tubes are usually employed

Question 155

Gastric tube inserted through the nose: Levin tube Rehfuss tube

Answer 155

Levin tube ## Footnote The gastric juice is obtained by insertion of a gastric tube into the stomach 1. REHFUSS tube (introduced through the mouth) 2. LEVIN tube (inserted through the nose) 3. Disposable plastic tubes are usually employed

Question 156

Normal fasting gastric fluid appears: Dark red-brown Clear and pale yellow Pale yellow with food particles Pale gray and slightly mucoid

Answer 156

Pale gray and slightly mucoid

Question 157

What is the preferred gastric stimulant? Histamine Histalog Insulin Pentagastrin

Answer 157

Pentagastrin ## Footnote Pentagastrin is the preferred stimulant because it resembles true gastrin

Question 158

Hypoglycemia is induced with which of the following to test for the completeness of VAGOTOMY? Histamine Histalog Insulin Pentagastrin

Answer 158

Insulin

Question 159

The cell most frequently seen in bronchoalveolar lavage (BAL): Macrophages Lymphocytes Neutrophils Eosinophils

Answer 159

Macrophages

Question 160

In bronchoalveolar lavage (BAL), which cell type is elevated in CIGARETTE SMOKERS, and in cases of bronchopneumonia, toxin exposure, and diffuse alveolar damage: Macrophages Lymphocytes Neutrophils Eosinophils

Answer 160

Neutrophils

Question 161

Normal lymphocyte count in bronchoalveolar lavage (BAL): Less than 1% Less than 3% 1 to 15% 56 to 80%

Answer 161

1 to 15%

Question 162

The entire process of spermatogenesis takes approximately ___ days 50 days 70 days 90 days 120 days

Answer 162

90 days ## Footnote When spermatogenesis is complete, the immature sperm (nonmotile) enter the epididymis. In the epididymis, the sperm mature and develop flagella. The entire process takes approximately 90 days. The sperm remain stored in the epididymis until ejaculation, at which time they are propelled through the ductus deferens (vas deferens) to the ejaculatory ducts

Question 163

Produce most of the fluid present in semen (60%to 70%): Testes and epididymis Seminal vesicles Prostate gland Bulbourethral gland

Answer 163

Seminal vesicles ## Footnote Semen is composed of four fractions that are contributed by the testes, epididymis, seminal vesicles, prostate gland, and bulbourethral glands. The seminal vesicles produce most of the fluid present in semen (60% to 70%), and this fluid is the transport medium for the sperm.

Question 164

Produces milky acidic fluid containing high concentrations of acid phosphatase, citric acid, zinc, and proteolytic enzymes responsible for both the coagulation and liquefaction of the semen following ejaculation: Testes and epididymis Seminal vesciles Prostate gland Bulbourethral gland

Answer 164

Prostate gland ## Footnote Approximately 20% to 30% of the semen volume is acidic fluid produced by the prostate gland. The milky acidic fluid contains high concentrations of acid phosphatase, citric acid, zinc, and proteolytic enzymes responsible for both the coagulation and liquefaction of the semen following ejaculation.

Question 165

Semen is collected following a period of sexual abstinence of at least___ days to not more than ___ days. At least 1 day to not more than 3 days At least 2 days to not more than 7 days At least 5 days to not more than 7 days At least 7 days to not more than 10 days

Answer 165

At least 2 days to not more than 7 days ## Footnote Specimens are collected following a period of sexual abstinence of at least 2 days to not more than 7 days. Specimens collected following prolonged abstinence tend to have higher volumes and decreased motility.

Question 166

Liquefaction of a semen specimen should take place within: 1 hour 2 hours 3 hours 4 hours

Answer 166

1 hour ## Footnote A fresh semen specimen is clotted and should liquefy within 30 to 60 minutes after collection; therefore, recording the time of collection is essential for evaluating semen liquefaction. Failure of liquefaction to occur within 60 minutes may be caused by a deficiency in prostatic enzymes and should be reported

Question 167

If after 2 hours, the seminal fluid has not liquefied, which of the following may be added to induce liquefaction? Dulbecco's phosphate-buffered saline Dulbecco's phosphate-buffered saline and hyaluronidase Dulbecco's phosphate-buffered saline, alpha-chymotrypsin and bromelain Alpha-chymotrypsin and bromelain

Answer 167

Dulbecco's phosphate-buffered saline, alpha-chymotrypsin and bromelain ## Footnote If after 2 hours the specimen has not liquified, an equal volume of physiologic Dulbecco’s phosphate-buffered saline or proteolytic enzymes such as alpha-chymotrypsin or bromelain may be added to induce liquefaction and allow the rest of the analysis to be performed.

Question 168

Normal seminal fluid volume 2 to 5 mL 3 to 10 mL 10 to 15 mL 15 mL to 20 mL

Answer 168

2 to 5 mL ## Footnote Normal semen volume ranges between 2 and 5 mL. It can be measured by pouring the specimen into a clean graduated cylinder calibrated in 0.1-mL increments.

Question 169

Watery seminal fluid: Viscosity grade of 0 Viscosity grade of 4

Answer 169

Viscosity grade of 0 ## Footnote Ratings of 0 (watery) to 4 (gel-like) can be assigned to the viscosity report.

Question 170

Gel-like seminal fluid: Viscosity grade of 0 Viscosity grade of 4

Answer 170

Viscosity grade of 4 ## Footnote Ratings of 0 (watery) to 4 (gel-like) can be assigned to the viscosity report.

Question 171

Normal pH of semen: pH of 2.0 to 4.0 pH of 4.5 to 8.0 pH of 7.4 to 7.5 pH of 7.2 to 8.0

Answer 171

pH of 7.2 to 8.0 ## Footnote The normal pH of semen is alkaline with a range of 7.2 to 8.0. Increased pH indicates infection within the reproductive tract. A decreased pH may be associated with increased prostatic fluid, ejaculatory duct obstruction, or poorly developed seminal vesicles.

Question 172

Increased pH of semen: Increased prostatic fluid Ejaculatory duct obstruction Poorly developed seminal vesicles Infection within the reproductive tract

Answer 172

Infection within the reproductive tract ## Footnote The normal pH of semen is alkaline with a range of 7.2 to 8.0. Increased pH indicates infection within the reproductive tract. A decreased pH may be associated with increased prostatic fluid, ejaculatory duct obstruction, or poorly developed seminal vesicles.

Question 173

SPERM MOTILITY: slower speed, some lateral movement. 0 1.0 2.0 3.0 4.0

Answer 173

3.0 ## Footnote 4.0 (a) Rapid, straight-line motility 3.0 (b) Slower speed, some lateral movement 2.0 (b) Slow forward progression, noticeable lateral movement 1.0 (c) No forward progression 0 (d) No movement

Question 174

SPERM MOTILITY: no forward progression. 0 1.0 2.0 3.0 4.0

Answer 174

1.0 ## Footnote 4.0 (a) Rapid, straight-line motility 3.0 (b) Slower speed, some lateral movement 2.0 (b) Slow forward progression, noticeable lateral movement 1.0 (c) No forward progression 0 (d) No movement

Question 175

SPERM MOTILITY: slow forward progression, noticeable lateral movement a b c d

Answer 175

b ## Footnote 4.0 (a) Rapid, straight-line motility 3.0 (b) Slower speed, some lateral movement 2.0 (b) Slow forward progression, noticeable lateral movement 1.0 (c) No forward progression 0 (d) No movement

Question 176

Included in computer-assisted semen analysis (CASA): Sperm velocity Sperm velocity and trajectory Sperm velocity, trajectory and morphology Sperm velocity, trajectory, sperm concentration and morphology

Answer 176

Sperm velocity, trajectory, sperm concentration and morphology ## Footnote CASA provides objective determination of both sperm velocity and trajectory (direction of motion). Sperm concentration and morphology are also included in the analysis. Currently, CASA instrumentation is found primarily in laboratories that specialize in andrology and perform a high volume of semen analysis.

Question 177

Location of the nucleus of sperm: No nucleus Head Neckpiece Midpiece Tail

Answer 177

Head

Question 178

Critical to ovum penetration: Acrosomal cap Cell membrane Mitochondria Tail

Answer 178

Acrosomal cap

Question 179

The acrosomal cap should encompass approximately ___ of the head and cover approximately___ of the sperm nucleus. Half of the head and covers half of the sperm nucleus Half of the head and covers 2/3 of the sperm nucleus Two-thirds of the head and covers half of the sperm nucleus Two-thirds of the head and covers 2/3 of the sperm nucleus

Answer 179

Half of the head and covers 2/3 of the sperm nucleus ## Footnote The acrosomal cap should encompass approximately half of the head and cover approximately two thirds of the sperm nucleus.

Question 180

It is surrounded by a mitochondrial sheath that produces the energy required by the tail for motility: Head Neckpiece Midpiece Flagellum

Answer 180

Midpiece ## Footnote The midpiece is approximately 7.0 μm long and is the thickest part of the tail because it is surrounded by a mitochondrial sheath that produces the energy required by the tail for motility.

Question 181

Round cells that are of concern and may be included in sperm counts and morphology analysis are: Leukocytes Spermatids RBCs Leukocytes and spermatids

Answer 181

Leukocytes and spermatids ## Footnote Immature sperm and WBCs, often referred to as “round” cells. Only fully developed sperm should be counted. Immature sperm and WBCs, often referred to as “round” cells, must not be included. However, their presence can be significant, and they may need to be identified and counted separately. Stain included in the diluting fluid aids in differentiating between immature sperm cells (spermatids) and leukocytes, and they can be counted in the same manner as mature sperm. A count greater than 1 million leukocytes per milliliter is associated with inflammation or infection of the reproductive organs that can lead to infertility. The presence of more than 1 million spermatids per milliliter indicates disruption of spermatogenesis. This may be caused by viral infections, exposure to toxic chemicals, and genetic disorders.

Question 182

Living sperm cells in the eosin-nigrosin stain: Green against a yellow background Purple against a red background Red against a purple background Not infiltrated by the dye and remain bluish white

Answer 182

Not infiltrated by the dye and remain bluish white ## Footnote Living cells are not infiltrated by the dye and remain bluish white, whereas dead cells stain red against the purple background. Normal vitality requires 50% or more living cells and should correspond to the previously evaluated motility.

Question 183

Dead sperm cells in the eosin-nigrosin stain: Green against a yellow background Purple against a red background Red against a purple background Not infiltrated by the dye and remain bluish white

Answer 183

Red against a purple background ## Footnote Living cells are not infiltrated by the dye and remain bluish white, whereas dead cells stain red against the purple background. Normal vitality requires 50% or more living cells and should correspond to the previously evaluated motility.

Question 184

Seminal fluid specimens can be screened for the presence of fructose using the resorcinol test that produces an _____ color when fructose is present. Black Blue Green Orange

Answer 184

Orange ## Footnote Specimens can be screened for the presence of fructose using the resorcinol test that produces an orange color when fructose is present.

Question 185

Specimens for fructose levels should be tested within 2 hours of collection or _____ to prevent fructolysis. Frozen Incubated at 37C Preserved with formalin Refrigerated

Answer 185

Frozen ## Footnote Specimens for fructose levels should be tested within 2 hours of collection or frozen to prevent fructolysis.

Question 186

Decreased sperm motility with clumping: Decreased sperm vitality Lack of seminal vesicle support medium Female anti-sperm antibodies Male anti-sperm antibodies

Answer 186

Male anti-sperm antibodies ## Footnote The presence of antibodies in a male subject can be suspected when clumps of sperm are observed during a routine semen analysis. Sperm-agglutinating antibodies cause sperm to stick to each other in a head-to-head, head-to-tail, or tail to- tail pattern.1 The agglutination is graded as “few,” “moderate,” or “many” on microscopic examination. Two frequently used tests to detect the presence of antibody-coated sperm are the mixed agglutination reaction (MAR) test and the immunobead test.

Question 187

A decreased neutral alpha-glucosidase suggests a disorder of the: Epididymis Seminal vesicles Prostate gland Bulbourethral gland

Answer 187

Epididymis ## Footnote Just as decreased fructose levels are associated with a lack of seminal fluid, decreased neutral alpha-glucosidase, glycerophosphocholine, and L-carnitine suggest a disorder of the epididymis. Decreased zinc, citric acid, glutamyl transpeptidase, and acid phosphatase indicate a lack of prostatic fluid. Spectrophotometric methods are used to quantitate citric acid and zinc.

Question 188

For post-vasectomy semen analysis, specimens are tested: -Beginning 1 month post-vasectomy and continuing until two consecutive monthly specimens show no sperm -Beginning 2 months post-vasectomy and continuing until two consecutive monthly specimens show no sperm -Beginning 3 months post-vasectomy and continuing until two consecutive monthly specimens show no sperm -Beginning 3 months post-vasectomy and continuing until three consecutive monthly specimens show no sperm

Answer 188

Beginning 2 months post-vasectomy and continuing until two consecutive monthly specimens show no sperm ## Footnote FOR POSTVASECTOMY SEMEN ANALYSIS: Specimens are routinely tested at monthly intervals, beginning at 2 months postvasectomy and continuing until two consecutive monthly specimens show no spermatozoa. A negative wet preparation is followed by specimen centrifugation for 10 minutes and examination of the sediment

Question 189

Before testing, very viscous synovial fluid should be treated with: Normal saline Hyaluronidase Distilled water Hypotonic saline

Answer 189

Hyaluronidase ## Footnote Very viscous fluid may need to be pretreated by adding one drop of 0.05% hyaluronidase in phosphate buffer per milliliter of fluid and incubating at 37°C for 5 minutes.

Question 190

Normal volume of synovial fluid: Less than 1.5 mL Less than 3.5 mL Less than 7.5 mL Less than 10.5 mL

Answer 190

Less than 3.5 mL ## Footnote The normal amount of fluid in the adult knee cavity is less than 3.5 mL, but can increase to greater than 25 mL with inflammation.

Question 191

A synovial fluid string measuring _____ is considered normal. 0.5 to 1 cm string 1 to 2 cm string 2 to 4 cm string 4 to 6 cm string

Answer 191

4 to 6 cm string ## Footnote A string measuring 4 to 6 cm is considered normal.

Question 192

ROPE'S (MUCIN CLOT) TEST: when added to a solution of 2% to5% acetic acid, normal synovial fluid forms: No clot Friable clot Soft clot Solid clot

Answer 192

Solid clot ## Footnote When added to a solution of 2% to 5% acetic acid, normal synovial fluid forms a solid clot surrounded by clear fluid. Good (solid clot) Fair (soft clot) Low (friable clot) Poor (no clot)

Question 193

Normal synovial fluid WBC count: Less than 200 cells/uL Less than 400 cells/uL Less than 1,000 cells/uL Less than 2,000 cells/uL

Answer 193

Less than 200 cells/uL ## Footnote RBC COUNT: LESS THAN 2,000 cells/uL WBC COUNT: LESS THAN 200 cells/uL SYNOVIAL FLUID WBC COUNT: WBC counts less than 200 cells/uL are considered normal and may reach 100,000 cells/uL or higher in severe infections

Question 194

Joint disorder with WBC count of 800/uL: Group I, non-inflammatory Group II, inflammatory Group III, septic Group IV, hemorrhagic Normal synovial fluid WBC count

Answer 194

Group I, non-inflammatory ## Footnote SYNOVIAL FLUID WBC COUNT Normal: less than 200 cells/uL Noninflammatory: less than 1, 000 cells/uL Immunologic: 2,000 to 75,000 cells/uL Crystal-induced: up to 100,000 cells/uL Septic: 50,000 to 100,000 cells/uL Hemorrhagic: WBCs equal to blood

Question 195

When diluting a synovial fluid WBC count, all of the following are acceptable except: Acetic acid Isotonic saline Hypotonic saline Saline with saponin

Answer 195

Acetic acid ## Footnote SYNOVIAL FLUID + ACETIC ACID = CLOT FORMATION Traditional WBC diluting fluid cannot be used because it contains acetic acid that causes the formation of mucin clots. If it is necessary to lyse the RBCs, hypotonic saline (0.3%) or saline that contains saponin is a suitable diluent. Methylene blue added to the normal saline stains the WBC nuclei, permitting separation of the RBCs and WBCs during counts performed on mixed specimens.

Question 196

Vacuolated macrophage with ingested neutrophils: LE cell Ragocyte Reiter cell Rice bodies

Answer 196

Reiter cell

Question 197

Neutrophil with dark cytoplasmic granules containing immune complexes: LE cell Ragocyte Reiter cell Rice bodies

Answer 197

Ragocyte

Question 198

Synovial fluid crystals found in cases of gout: Calcium phosphate (apatite) Calcium pyrophosphate Calcium oxalate Monosodium urate

Answer 198

Monosodium urate ## Footnote Increased serum uric acid resulting from impaired metabolism of purines; increased consumption of high-purine-content foods, alcohol, and fructose; chemotherapy treatment of leukemias; and decreased renal excretion of uric acid are the most frequent causes of gout.

Question 199

Synovial fluid crystals found in cases of pseudogout: Calcium phosphate (apatite) Calcium pyrophosphate Calcium oxalate Monosodium urate

Answer 199

Calcium pyrophosphate ## Footnote Pseudogout is most often associated with degenerative arthritis, producing cartilage calcification and endocrine disorders that produce elevated serum calcium levels.

Question 200

Synovial fluid crystals found in cases of osteoarthritis: Calcium phosphate (apatite) Calcium pyrophosphate Calcium oxalate Monosodium urate

Answer 200

Calcium phosphate (apatite)

Question 201

Shape of calcium pyrophosphate crystals in synovial fluid: Envelopes Flat, variable-shaped plates Needles Rhomboid square, rods

Answer 201

Rhomboid square, rods

Question 202

Most frequently requested test in synovial fluid: Gram stain and culture Glucose Protein Uric acid

Answer 202

Glucose ## Footnote The most frequently requested test is the glucose determination, because markedly decreased glucose values indicate inflammatory (group II) or septic (group III) disorders.

Question 203

Required tube for synovial fluid glucose analysis: Sterile heparinized Nonanticoagulated Tube with liquid EDTA Tube with sodium fluoride

Answer 203

Tube with sodium fluoride ## Footnote To prevent falsely decreased values caused by glycolysis, specimens should be analyzed within 1 hour or preserved with sodium fluoride. Sterile heparinized or SPS: Gram stain and culture Liquid EDTA or heparin: cell counts Sodium fluoride: glucose analysis Non-anticoagulated: all other tests

Question 204

Serous fluid for pH determination must be: Maintained aerobically and incubated at 37C Maintained anaerobically and incubated at 37C Maintained aerobically in ice Maintained anaerobically in ice

Answer 204

Maintained anaerobically in ice ## Footnote Specimens for pH must be maintained anaerobically in ice.

Question 205

Fluid: serum protein and lactic dehydrogenase ratios are performed on serous fluids: When malignancy is suspected To classify transudates and exudates To determine the type of serous fluid When a traumatic tap has occurred

Answer 205

To classify transudates and exudates ## Footnote Traditionally, a variety of laboratory tests have been used to differentiate between transudates and exudates, including appearance, total protein, lactic dehydrogenase, cell counts, and spontaneous clotting. However, the most reliable differentiation is usually obtained by determining the fluid: blood ratios for protein and lactic dehydrogenase.

Question 206

If the blood is from a HEMOTHORAX, the fluid hematocrit is ______ of the whole blood hematocrit. Less than 20% of the whole blood hematocrit More than 20% of the whole blood hematocrit Less than 50% of the whole blood hematcrit More than 50% of the whole blood hematocrit

Answer 206

More than 50% of the whole blood hematocrit ## Footnote To differentiate between a hemothorax and hemorrhagic exudate, a hematocrit can be run on the fluid. If the blood is from a hemothorax, the fluid hematocrit is more than 50% of the whole blood hematocrit, because the effusion comes from the inpouring of blood from the injury.

Question 207

These cells are increased in pleural effusions resulting from pancreatitis and pulmonary infarction: Mesothelial cells Neutrophils Lymphocytes Plasma cells

Answer 207

Neutrophils ## Footnote Similar to other body fluids, an increase in pleural fluid neutrophils indicates a bacterial infection, such as pneumonia. Neutrophils are also increased in effusions resulting from pancreatitis and pulmonary infarction.

Question 208

Adenosine deaminase (ADA) levels higher than 40 U/L are highly indicative of: Chylous effusion Pancreatitis Tuberculosis Rheumatoid inflammation

Answer 208

Tuberculosis ## Footnote ADENOSINE DEAMINASE (ADA) ADA levels higher than 40 U/L are highly indicative of tuberculosis. They are also frequently elevated with malignancy.

Question 209

The recommended test for determining whether peritoneal fluid is a transudate or an exudate is the: Fluid:serum albumin ratio Serum ascites albumin gradient Fluid:serum lactic dehydrogenase ratio Absolute neutrophil count

Answer 209

Serum ascites albumin gradient ## Footnote Differentiation between ascitic fluid transudates and exudates is more difficult than for pleural and pericardial effusions. The serum-ascites albumin gradient (SAAG) is recommended over the fluid:serum total protein and LD ratios to detect transudates of hepatic origin. Fluid and serum albumin levels are measured concurrently, and the fluid albumin level is then subtracted from the serum albumin level. A difference (gradient) of 1.1 or greater suggests a transudate effusion of hepatic origin, and lower gradients are associated with exudative effusions.

Question 210

Elements containing concentric striations of collagen-like material and can be seen in benign conditions and are also associated with ovarian and thyroid malignancies: Lipophages Macrophages Mesothelial cells Psammoma bodies

Answer 210

Psammoma bodies

Question 211

Detection of the CA 125 tumor marker in peritoneal fluid indicates: Colon cancer Ovarian cancer Gastric malignancy Prostate cancer

Answer 211

Ovarian cancer ## Footnote The presence of CA 125 antigen with a negative CEA suggests the source is from the ovaries, fallopian tubes, or endometrium.

Question 212

The brown color of feces is due to: Urochrome Uroeythrin Urobilinogen Urobilin

Answer 212

Urobilin ## Footnote The brown color of the feces results from intestinal oxidation of stercobilinogen to urobilin.

Question 213

Blood that originates from the esophagus, stomach, or duodenum takes approximately ___ day(s) to appear in the stool. Approximately 1 day to appear in stool Approximately 3 days to appear in stool Approximately 7 days to appear in stool Approximately 10 days to appear in stool

Answer 213

Approximately 3 days to appear in stool ## Footnote Blood that originates from the esophagus, stomach, or duodenum takes approximately 3 days to appear in the stool; during this time, degradation of hemoglobin produces the characteristic black, tarry stool

Question 214

Bulky and frothy stool: Upper GI bleeding Lower GI bleeding Barium sulfate Pancreatic disorders

Answer 214

Pancreatic disorders

Question 215

Black stool: Barium sulfate Bile duct obstruction Beets and food coloring Bismuth (antacid), iron therapy

Answer 215

Bismuth (antacid), iron therapy

Question 216

Microscopic examination reveals presence of fecal WBCs EXCEPT in diarrhea caused by: Enteroinvasive E. coli (EIEC) Salmonella, Shigella Staphylococcos aureus, Vibrio spp. Yersinia, Campylobacter

Answer 216

Staphylococcos aureus, Vibrio spp. ## Footnote Microscopic screening is performed as a preliminary test to determine whether diarrhea is being caused by invasive bacterial pathogens including Salmonella, Shigella, Campylobacter, Yersinia, and enteroinvasive E. coli. Bacteria that cause diarrhea by toxin production, such as Staphylococcus aureus and Vibrio spp., viruses, and parasites usually do not cause the appearance of fecal leukocytes.

Question 217

By far the most frequently performed fecal analysis is the detection of: Carbohydrates Fats Occult blood pH

Answer 217

Occult blood ## Footnote By far the most frequently performed fecal analysis is the detection of occult blood (hidden blood).

Question 218

Reagent for the APT test: 1% NaOH 10% NaOH 70% ethanol 95% ethanol

Answer 218

1% NaOH ## Footnote APT Test (Fetal Hemoglobin) The material to be tested is emulsified in water to release hemoglobin (Hb) and, after centrifugation, 1% sodium hydroxide is added to the pink hemoglobin-containing supernatant. In the presence of alkali-resistant fetal hemoglobin, the solution remains pink (HbF), whereas denaturation of the maternal hemoglobin (HbA) produces a yellow-brown supernatant after standing for 2 minutes.

Question 219

Normal stool pH: Between pH 4 and 5 Between pH 5 and 6 Between pH 7 and 8 Between pH 8 and 9

Answer 219

Between pH 7 and 8 ## Footnote Normal stool pH is between 7 and 8; however, increased use of carbohydrates by intestinal bacterial fermentation increases the lactic acid level and lowers the pH to below 5.5 in cases of carbohydrate disorders.

Question 220

CHECK 4 BOXES: Variables in the Cockroft and Gault formula. Urine ceatinine Serum creatinine Age Race Gender Body weight in kilograms BUN Albumin

Answer 220

Serum creatinine Age Gender Body weight in kilograms

Question 221

CHECK 6 BOXES: Variables in the MODIFICATION OF DIET IN RENAL DISEASE (MDRD) formula. Urine ceatinine Serum creatinine Age Race Gender Body weight in kilograms BUN Albumin

Answer 221

Serum creatinine Age Race Gender BUN Albumin

Question 222

In the urinalysis laboratory the primary source in the chain of infection would be: Patients Needlesticks Specimens Biohardous wastes

Answer 222

Specimens ## Footnote In the clinical laboratory, the most direct contact with a source of infection is through contact with patient specimens, although contact with patients and infected objects also occurs.

Question 223

All of the following should be discarded in biohazardous waste containers except: Urine specimen containers Towels used for decontamination Disposable lab coats Blood collection tubes

Answer 223

Urine specimen containers

Question 224

An acceptable disinfectant for blood and body fluid decontamination is: Sodium hydroxide Antimicrobial soap Hydrogen peroxide Sodium hypochlorite

Answer 224

Sodium hypochlorite

Question 225

Centrifuging an uncapped specimen may produce a biologic hazard in the form of: Vectors Sharps contamination Aerosols Specimen contamination

Answer 225

Aerosols

Question 226

The first thing to do when a fire is discovered is to: Rescue person in danger Activate the alarm system Close doors to other areas Extinguish the fire if possible

Answer 226

Rescue person in danger

Question 227

If a red rash is observed after removing gloves, the employee: May be washing her hands too often May have developed a latex allergy Should apply cortisone cream Should not rub the hands so vigorously

Answer 227

May have developed a latex allergy

Question 228

The classification of a fire that can be extinguished with water is: Class A Class B Class C Class D

Answer 228

Class A

Question 229

Employers are required to provide free immunization for: HIV HTLV-1 HBV HCV

Answer 229

HBV

Question 230

The current routine infection control policy developed by CDC and followed in all health-care settings is: Universal precautions Isolation precautions Blood and body fluid precautions Standard precations

Answer 230

Standard precations ## Footnote In 1987 the CDC instituted Universal Precautions (UP). Under UP all patients are considered to be possible carriers of bloodborne pathogens. In 1996 the CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC) combined the major features of UP and blood safety isolation (BSI) guidelines and called the new guidelines Standard Precautions.

Question 231

Which of the following would be least affected in a specimen that has remained unpreserved at room temperature for more than 2 hours? Urobilinogen Ketones Protein Nitrite

Answer 231

Protein

Question 232

Which of the tubules is impermeable to water? Proximal convoluted tubule Descending loop of Henle Ascending loop of Henle Distal convoluted tubule

Answer 232

Ascending loop of Henle

Question 233

Decreased production of ADH: (two possible answers) Produces a large volume of urine Produces high urine volume Increases ammonia excretion Affects active transport of sodium

Answer 233

Produces high urine volume ## Footnote Two possible answers: In diabetes insipidus: deficiency of ADH High or large urine volume Decreased urine specific gravity

Question 234

The largest source of error in creatinine clearance tests is: Secretion of creatinine Improperly timed urine specimens Refrigeration of the urine Time of collecting blood sample

Answer 234

Improperly timed urine specimens

Question 235

Variables that are included in the MDRD-IDSM estimated creatinine clearance calculations include all of the following except: Serum creatinine Weight Age Gender

Answer 235

Weight

Question 236

A patient with a viscous orange specimen may have been: Treated for urinary tract infection Taking vitamin B Eating fresh carrots Taking antidepressants

Answer 236

Treated for urinary tract infection ## Footnote Phenazopyridine (Pyridium) Drug commonly administered for urinary tract infections

Question 237

Orange in alkaline urine, colorless in acid urine. Phenazopyridine (Pyridium) Phenindione Methyldopa Metronidazole (Flagyl)

Answer 237

Phenindione ## Footnote PHENINDIONE Anticoagulant, orange in alkaline urine, colorless in acid urine

Question 238

The principle of refractive index is to compare: Light velocity in solutions with light velocity in solids Light velocity in air with light velocity in solutions Light scattering by air with light scattering by solutions Light scattering by particles in solution

Answer 238

Light velocity in air with light velocity in solutions

Question 239

A specimen with a specific gravity of 1.001 would be considered: Hyposthenuric Not urine Hypersthenuric Isosthenuric

Answer 239

Not urine ## Footnote Specimens measuring lower than 1.002 probably are not urine. Most random specimens fall between 1.015 and 1.030.

Question 240

Leaving excess urine on the reagent strip after removing it from the specimen will: Cause run-over between reagent pads Alter the color of the specimen Cause reagents to leach from the pads Not affect the chemical reactions

Answer 240

Cause run-over between reagent pads

Question 241

Testing a refrigerated specimen that has not warmed to room temperature will adversely affect: Enzymatic reactions Dye-binding reactions Sodium nitroprusside reaction Diazo reactions

Answer 241

Enzymatic reactions

Question 242

Quality control of reagent strips is performed: Using positive and negative controls When results are questionable At least once every 24 hours All of the above

Answer 242

All of the above ## Footnote Quality Control: REAGENT STRIP TESTING 1. Test open bottles of reagent strips with known positive and negative controls every 24 hours. 2. Resolve control results that are out of range by further testing. 3. Test reagents used in backup tests with positive and negative controls. 4. Perform positive and negative controls on new reagents and newly opened bottles of reagent strips. 5. Record all control results and reagent lot numbers.

Question 243

All of the following are important to protect the integrity of reagent strips except: Removing the desiccant from the bottle Storing in an opaque bottle Storing at room temperature Resealing the bottle after removing a strip

Answer 243

Removing the desiccant from the bottle

Question 244

A urine specimen with a pH of 9.0: Indicates metabolic acidosis Should be recollected May contain calcium oxalate crystals Is seen after drinking cranberry juice

Answer 244

Should be recollected ## Footnote A pH above 8.5 is associated with an improperly preserved specimen and indicates that a fresh specimen should be obtained to ensure the validity of the analysis.

Question 245

The principle of the protein error of indicators reaction is that: Protein keeps the pH of the urine constant Albumin accepts hydrogen ions from the indicator Indicator accepts hydrogen ions from albumin Albumin changes the pH of the urine

Answer 245

Albumin accepts hydrogen ions from the indicator

Question 246

Testing for microalbuminuria is valuable for early detection of kidney disease and monitoring patients with: Hypertension Diabetes mellitus Cardiovascular disease risk All of the above

Answer 246

All of the above ## Footnote Microalbuminuria The development of diabetic nephropathy leading to reduced glomerular filtration and eventual renal failure is a common occurrence in persons with both type 1 and type 2 diabetes mellitus. Onset of renal complications can first be predicted by detection of microalbuminuria, and the progression of renal disease can be prevented through better stabilization of blood glucose levels and control of hypertension. The presence of microalbuminuria is also associated with an increased risk of cardiovascular disease.

Question 247

The primary reason for performing a Clinitest is to: Check for high ascorbic acid levels Confirm a positive reagent strip glucose Check for newborn galactosuria Confirm a negative glucose reading

Answer 247

Check for newborn galactosuria

Question 248

A speckled pattern on the blood pad of the reagent strip indicates: Hematuria Hemoglobinuria Myoglobinuria All of the above

Answer 248

Hematuria

Question 249

An elevated urine bilirubin with a normal urobilinogen is indicative of: Cirrhosis Hemolytic disease Hepatitis Biliary obstruction

Answer 249

Biliary obstruction

Question 250

A positive nitrite test and a negative leukocyte esterase test is an indication of a: Dilute random specimen Specimen with lysed leukocytes Vaginal yeast infection Specimen older than 2 hours

Answer 250

Specimen older than 2 hours ## Footnote Possible bacterial contamination

Question 251

Initial screening of the urine sediment is performed using an objective power of: 4x 10x 40x 100x

Answer 251

10x

Question 252

Crenated RBCs are seen in urine that is: Hyposthenuric Hypersthenuric Highly acidic Highly alkaline

Answer 252

Hypersthenuric

Question 253

Differentiation among RBCs, yeast, and oil droplets maybe accomplished by all of the following except: Observation of budding in yeast cells Increased refractility of oil droplets Lysis of yeast cells by acetic acid Lysis of RBCs by acetic acid

Answer 253

Lysis of yeast cells by acetic acid

Question 254

When pyuria is detected in a urine sediment, the slide should be carefully checked for the presence of: RBCs Bacteria Hyaline casts Mucus

Answer 254

Bacteria ## Footnote An increase in urinary WBCs is called pyuria and indicates the presence of an infection or inflammation in the genitourinary system.

Question 255

The largest cells in the urine sediment are: Squamous epithelial cells Urothelial epithelial cells Cuboidal epithelial cells Columnar epithelial cells

Answer 255

Squamous epithelial cells

Question 256

Following an episode of hemoglobinuria, RTE cells may contain: Bilirubin Hemosiderin granules Porphobilinogen Myoglobin

Answer 256

Hemosiderin granules ## Footnote Following episodes of hemoglobinuria (transfusion reactions, paroxysmal nocturnal hemoglobinuria, etc.), the RTE cells may contain the characteristic yellow-brown hemosiderin granules. The granules may also be seen free-floating in the urine sediment. Confirmation of the presence of hemosiderin is performed by staining the urine sediment with Prussian blue.

Question 257

A structure believed to be an oval fat body produced a Maltese cross formation under polarized light but does not stain with Sudan III. The structure: Contains cholesterol Is not an oval fat body Contains neutral fats Is contaminated with immersion oil

Answer 257

Contains cholesterol

Question 258

The finding of yeast cells in the urine is commonly associated with: Cystitis Diabetes mellitus Pyelonephritis Liver disorders

Answer 258

Diabetes mellitus ## Footnote Yeast cells, primarily Candida albicans, are seen in the urine of diabetic patients, immunocompromised patients, and women with vaginal moniliasis. The acidic, glucosecontaining urine of patients with diabetes provides an ideal medium for the growth of yeast.

Question 259

All of the following contribute to urinary crystals formation except: Protein concentration pH Solute concentration Temperature

Answer 259

Protein concentration ## Footnote Crystals are formed by the precipitation of urine solutes, including inorganic salts, organic compounds, and medications (iatrogenic compounds). Precipitation is subject to changes in temperature, solute concentration, and pH, which affect solubility.

Question 260

Casts and fibers can usually be differentiated using: Solubility characteristics Patient history Polarized light Fluorescent light

Answer 260

Polarized light ## Footnote Examination under polarized light can frequently differentiate between fibers and casts. Fibers often polarize, whereas casts, other than fatty casts, do not polarize.

Question 261

Three-dimensional images: Bright-field microscope Phase contrast microcope Interference contrast microscope Fluorescent microscope

Answer 261

Interference contrast microscope ## Footnote Interference-contrast microscopy provides a three-dimensional image showing very fine structural detail by splitting the light ray so that the beams pass through different areas of the specimen.

Question 262

Anti-neutrophilic cytoplasmic antibody is diagnostic for: IgA nephropathy Wegener granulomatosis Henoch-Schönlein purpura Goodpasture syndrome

Answer 262

Wegener granulomatosis

Question 263

The only protein produced by the kidney is: Albumin Uromodulin Uroprotein Globulin

Answer 263

Uromodulin

Question 264

The presence of renal tubular epithelial cells and casts is an indication of: Acute interstitial nephritis Chronic glomerulonephritis Minimal change disease Acute tubular necrosis

Answer 264

Acute tubular necrosis

Question 265

Urinalysis on a patient with severe back pain being evaluated for renal calculi would be most beneficial if it showed: Heavy proteinuria Low specific gravity Uric acid crystals Microscopic hematuria

Answer 265

Microscopic hematuria ## Footnote Urine specimens from patients suspected of passing or being in the process of passing renal calculi are frequently received in the laboratory. The presence of microscopic hematuria resulting from irritation to the tissues by the moving calculus is the primary urinalysis finding.

Question 266

False-positive levels of 5-HIAA can be caused by a diet high in: Meat Carbohydrates Starch Bananas

Answer 266

Bananas ## Footnote Patients must be given explicit dietary instructions before collecting any sample to be tested for 5-HIAA, because serotonin is a major constituent of foods such as bananas, pineapples, and tomatoes. Medications, including phenothiazines and acetanilids, also interfere with results. Patients should be directed to withhold medications for 72 hours before specimen collection.

Question 267

Which type of urine sample is needed for a D-xylose absorption test on an adult patient? 24-hour urine sample collected with 20 mL of 6N HCl 2-hour timed postprandial urine preserved with boric acid 5-hour timed urine kept under refrigeration Random urine preserved with formalin

Answer 267

5-hour timed urine kept under refrigeration ## Footnote The D-xylose absorption test is used to distinguish pancreatic insufficiency from intestinal malabsorption. The test requires a blood sample taken 2 hours after oral administration of 25 g of Dxylose, and a 5-hour timed urine sample. D-xylose is absorbed without the aid of pancreatic enzymes, and is not metabolized by the liver. Therefore, deficient absorption (denoted by a plasma level < 25 mg/dL and urine excretion of < 4g/5hours) points to malabsorption syndrome.

Question 268

In automated microscopy, Sysmex UF series, the DNA within the cells is stained by the orange dye: Carbocyanine Phenathridine Eosin Bromcresol green

Answer 268

Phenathridine ## Footnote The DNA within the cells is stained by the orange dye, phenathridine; the nuclear membranes, mitochondria, and negatively charged cell membranes are stained with a green dye, carbocyanine.

Question 269

In automated microscopy, Sysmex UF series, the nuclear membranes, mitochondria, and negatively charged cell membranes are stained with a green dye: Carbocyanine Phenathridine Eosin Bromcresol green

Answer 269

Carbocyanine ## Footnote The DNA within the cells is stained by the orange dye, phenathridine; the nuclear membranes, mitochondria, and negatively charged cell membranes are stained with a green dye, carbocyanine.

Question 270

The UF-100 and UF-50 use laser-based flow cytometry along with: Impedance detection Imedance detection and forward light scatter Impedance detection and fluorescence Impedance detection and forward light scatter Impedance detection, forward light scatter and fluorescence

Answer 270

Impedance detection, forward light scatter and fluorescence ## Footnote The UF-100 and UF-50 use laser-based flow cytometry along with impedance detection, forward light scatter, and fluorescence to identify the individual characteristics and stained urine sediment particles in a flowing stream.

Question 271

Graphic display of size distribution of any small sediment particles (ranging from 1 to 6 um2) found during the microscopic examination; helps to decide whether bacteria are present in these small ranges or if the detected particles are small crystals or amorphous. Near-infrared reflectance spectroscopy Reflectance photomtery Small-particle histogram Mass gravity meter

Answer 271

Small-particle histogram ## Footnote IRIS SLIDELESS MICROSCOPE Small particle histograms are graphic display of size distribution of f any small sediment particles (ranging from 1 to 6 um2) found during the microscopic examination. The histograms help to decide whether bacteria are present in these small ranges or if the detected particles are small crystals or amorphous.

Question 272

The functions of the CSF include all of the following except: Removing metabolic wastes Producing an ultrafiltrate of plasma Supplying nutrients to the CNS Protecting the brain and spinal cord

Answer 272

Producing an ultrafiltrate of plasma

Question 273

What department is the CSF tube labeled 3 routinely sent to? Hematology Chemistry Microbiology Serology

Answer 273

Hematology

Question 274

The presence of xanthochromia can be caused by all of the following except: Immature liver function RBC degradation A recent hemorrhage Elevated CSF protein

Answer 274

A recent hemorrhage

Question 275

A web-like pellicle in a refrigerated CSF specimen indicates: Tubercular meningitis Multiple sclerosis Primary CNS malignancy Viral meningitis

Answer 275

Tubercular meningitis

Question 276

CSF total cell count is diluted with: Distilled water Normal saline Acetic acid Hypotonic saline

Answer 276

Normal saline ## Footnote Dilutions for total cell counts are made with normal saline, mixed by inversion, and loaded into the hemocytometer with a Pasteur pipette.

Question 277

A CSF WBC count is diluted with: Distilled water Normal saline Acetic acid Hypotonic saline

Answer 277

Acetic acid ## Footnote Lysis of RBCs must be obtained before performing the WBC count on either diluted or undiluted specimens. Specimens requiring dilution can be diluted in the manner described previously, substituting 3% glacial acetic acid to lyse the RBCs. Adding methylene blue to the diluting fluid stains the WBCs, providing better differentiation between neutrophils and mononuclear cells.

Question 278

A total CSF cell count on a clear fluid should be: Reported as normal Not reported Diluted with normal saline Counted undiluted

Answer 278

Counted undiluted ## Footnote Clear specimens may be counted undiluted, provided no overlapping of cells is seen during the microscopic examination. When dilutions are required, calibrated automatic pipettes, not mouth pipetting, are used.

Question 279

The purpose of adding 30% albumin to CSF before cytocentrifugation is to: Increase the cell yield Decrease the cellular distortion Improve cellular staining Increase cell yield and decrease cellular distortion

Answer 279

Decrease the cellular distortion Increase cell yield and decrease cellular distortion ## Footnote As little as 0.1 mL of CSF combined with one drop of 30% albumin produces an adequate cell yield when processed with the cytocentrifuge. Adding albumin increases the cell yield and decreases the cellular distortion frequently seen on cytocentrifuged specimens.

Question 280

Neutrophils with pyknotic nuclei may be mistaken for: Lymphocytes Nucleated RBCs Malignant cells Spindle-shaped cells

Answer 280

Nucleated RBCs ## Footnote Neutrophils with pyknotic nuclei indicate degenerating cells. They may resemble nucleated red blood cells (NRBCs) but usually have multiple nuclei.

Question 281

Macrophages appear in the CSF after: Hemorrhage Repeated spinal taps Diagnostic procedures All of the above

Answer 281

All of the above ## Footnote The purpose of macrophages in the CSF is to remove cellular debris and foreign objects such as RBCs. Macrophages appear within 2 to 4 hours after RBCs enter the CSF and are frequently seen following repeated taps. They tend to have more cytoplasm than monocytes in the peripheral blood (PB). The finding of increased macrophages indicates a previous hemorrhage.

Question 282

Nucleated RBCs are seen in the CSF as a result of: Elevated blood RBCs Treatment of anemia Severe hemorrhage Bone marrow contamination

Answer 282

Bone marrow contamination ## Footnote NRBCs are seen as a result of bone marrow contamination during the spinal tap. This is found in approximately 1% of specimens. Capillary structures and endothelial cells may be seen following a traumatic tap.

Question 283

Myeloblasts are seen in the CSF: In bacterial infections In conjunction with CNS malignancy After cerebral hemorrhage As a complication of acute leukemia

Answer 283

As a complication of acute leukemia

Question 284

The reference range for CSF protein is: 6 to 8 g/dL 15 to 45 g/dL 6 to 8 mg/dL 15 to 45 mg/dL

Answer 284

15 to 45 mg/dL ## Footnote Reference values for total CSF protein are usually listed as 15 to 45 mg/dL, but are somewhat method dependent, and higher values are found in infants and people over age 40. This value is reported in milligrams per deciliter and not grams per deciliter, as are plasma protein concentrations.

Question 285

Elevated CSF protein values can be caused by all of the following except: Meningitis Multiple sclerosis Fluid leakage CNS malignancy

Answer 285

Fluid leakage

Question 286

The integrity of the blood–brain barrier is measured using the: CSF/serum albumin index CSF/serum globulin ratio CSF albumin index CSF IgG index

Answer 286

CSF/serum albumin index ## Footnote ALBUMIN INDEX An index value less than 9 represents an intact blood– brain barrier. The index increases relative to the amount of damage to the barrier.

Question 287

Measurement of which of the following can be replaced by CSF glutamine analysis in children with Reye syndrome? Ammonia Lactate Glucose Alpha-ketoglutarate

Answer 287

Ammonia ## Footnote Reye syndrome Acute encephalopathy and liver infiltration seen in children following viral infections

Question 288

Determining CSF ________ provides an indirect test for the presence of excess ammonia in the CSF. Alpha-ketoglutarate Glucose Glutamine Lactate

Answer 288

Glutamine ## Footnote Determining CSF glutamine provides an indirect test for the presence of excess ammonia in the CSF. The normal concentration of glutamine in the CSF is 8 to 18 mg/dL

Question 289

Before performing a Gram stain on CSF, the specimen must be: Filtered Warmed to 37C Centrifuged Mixed

Answer 289

Centrifuged ## Footnote The Gram stain is routinely performed on CSF from all suspected cases of meningitis, although its value lies in detecting bacterial and fungal organisms. All smears and cultures should be performed on concentrated specimens because often only a few organisms are present at the onset of the disease. The CSF should be centrifuged at 1500 g for 15 minutes, and slides and cultures should be prepared from the sediment. Use of the cytocentrifuge provides a highly concentrated specimen for Gram stains.

Question 290

Particular attention should be paid to the Gram stain for the CLASSIC STARBURST PATTERN produced by: Hemophilus influenzae Neisseria meninigitidis Cryptococcus neoformans Coccidioides immitis

Answer 290

Cryptococcus neoformans

Question 291

Maturation of spermatozoa takes place in the: Sertoli cells Seminiferous tubules Epidiymis Seminal vesicles

Answer 291

Epidiymis

Question 292

Enzymes for the coagulation and liquefaction of semen are produced by the: Seminal vesicles Bulbourethral glands Ductus deferens Prostate gland

Answer 292

Prostate gland

Question 293

If the first portion of a semen specimen is not collected, the semen analysis will have which of the following? Decreased pH Increased viscosity Decreased sperm count Decreased sperm motility

Answer 293

Decreased sperm count ## Footnote When a part of the first portion of the ejaculate is missing, the sperm count will be decreased, the pH falsely increased, and the specimen will not liquefy. When part of the last portion of ejaculate is missing, the semen volume is decreased, the sperm count is falsely increased, the pH is falsely decreased, and the specimen will not clot.

Question 294

A semen specimen delivered to the laboratory in a condom has a normal sperm count and markedly decreased sperm motility. This indicates: Decreased fructose Antispermicide in the condom Increased semen viscosity Increased semen alkalinity

Answer 294

Antispermicide in the condom ## Footnote Specimens should be collected by masturbation. If this is not possible, only nonlubricantcontaining rubber or polyurethane condoms should be used. Ordinary condoms are not acceptable because they contain spermicides.

Question 295

Liquefaction of a semen specimen should take place within: 1 hour 2 hours 3 hours 4 hours

Answer 295

1 hour ## Footnote A fresh semen specimen is clotted and should liquefy within 30 to 60 minutes after collection; therefore, recording the time of collection is essential for evaluating semen liquefaction. Failure of liquefaction to occur within 60 minutes may be caused by a deficiency in prostatic enzymes and should be reported.

Question 296

Proteolytic enzymes may be added to semen specimens to: Increase the viscosity Dilute the specimen Decrease the viscosity Neutralize the specimen

Answer 296

Decrease the viscosity ## Footnote Analysis of the specimen cannot begin until liquefaction (normal is within 30 to 60 minutes) has occurred. If after 2 hours the specimen has not liquified, an equal volume of physiologic Dulbecco’s phosphate-buffered saline or proteolytic enzymes such as alpha-chymotrypsin or bromelain may be added to induce liquefaction and allow the rest of the analysis to be performed.

Question 297

The primary reason to dilute a semen specimen before performing a sperm concentration is to: Immobilize the sperm Facilitate chamber count Decrease the viscosity Stain the sperm

Answer 297

Immobilize the sperm ## Footnote The most commonly used dilution is 1:20 prepared using a mechanical (positivedisplacement) pipette. Dilution of the semen is essential because it immobilizes the sperm before counting. The traditional diluting fluid contains sodium bicarbonate and formalin, which immobilize and preserve the cells; however, good results can also be achieved using saline and distilled water.

Question 298

For determination of sperm concentration, both sides of the Neubauer hemocytometer are loaded and allowed to settle for 3 to 5 minutes; then they are counted, and the counts should agree within ___%. Agree within 5% Agree within 10% Agree within 20% Agree within 30%

Answer 298

Agree within 10% ## Footnote Using the Neubauer hemocytometer, sperm are usually counted in the four corner and center squares of the large center square, similar to a manual RBC count. Both sides of the hemocytometer are loaded and allowed to settle for 3 to 5 minutes; then they are counted, and the counts should agree within 10%. An average of the two counts is used in the calculation. If the counts do not agree, both the dilution and the counts are repeated.

Question 299

The purpose of the acrosomal cap is to: Penetrate the ovum Protect the the nucleus Create energy for tail movement Protect the neckpiece

Answer 299

Penetrate the ovum

Question 300

The sperm part containing a mitochondrial sheath is the: Head Neckpiece Midpiece Tail

Answer 300

Head ## Footnote The midpiece is the thickest part of the tail because it is surrounded by a mitochondrial sheath that produces the energy required by the tail for motility.

Question 301

All of the following are associated with sperm motility except the: Head Neckpiece Midpiece Tail

Answer 301

Head ## Footnote Abnormalities in head morphology are associated with poor ovum penetration, whereas neckpiece, midpiece, and tail abnormalities affect motility.

Question 302

Additional parameters measured by Kruger’s strict morphology include all of the following except: Vitality Presence of vacuoles Acrosome size Tail length

Answer 302

Vitality ## Footnote Additional parameters in evaluating sperm morphology include measuring head, neck, and tail size; measuring acrosome size; and evaluating for the presence of vacuoles. Inclusion of these parameters is referred to as Kruger’s strict criteria. Strict criteria evaluation requires the use of a stage micrometer or morphometry. At present, evaluation of sperm morphology using strict criteria is not routinely performed in the clinical laboratory but is recommended by the WHO. Strict criteria evaluation is an integral part of assisted reproduction evaluations.

Question 303

Round cells that are of concern and may be included in sperm counts and morphology analysis are: Leukocytes Spermatids RBCs Leukocytes and spermatids

Answer 303

Leukocytes and spermatids ## Footnote Differentiation and enumeration of round cells (immature sperm and leukocytes) can also be made during the morphology examination. Peroxidase-positive granulocytes are the predominant form of leukocyte in semen and can be further differentiated from spermatogenic cells and lymphocytes using a peroxidase stain.

Question 304

Following an abnormal sperm motility test with a normal sperm count, what additional test might be ordered? Fructose level Zinc level Mixed agglutination reaction Eosin-nigrosin stain

Answer 304

Eosin-nigrosin stain ## Footnote Decreased sperm vitality may be suspected when a specimen has a normal sperm concentration with markedly decreased motility. Sperm vitality should be assessed within 1 hour of ejaculation. Vitality is evaluated by mixing the specimen with an eosin-nigrosin stain, preparing a smear, and counting the number of dead cells in 100 sperm using a brightfield or phase-contrast microscope. Living cells are not infiltrated by the dye and remain bluish white, whereas dead cells stain red against the purple background. Normal vitality requires 50% or more living cells and should correspond to the previously evaluated motility.

Question 305

Follow-up testing for a low sperm concentration would include testing for: Antisperm antibodies Seminal fluid fructose Sperm vitality Prostatic acid phosphatase

Answer 305

Seminal fluid fructose ## Footnote Low sperm concentration may be caused by lack of the support medium produced in the seminal vesicles, which can be indicated by a low to absent fructose level in the semen.

Question 306

Measurement of alpha-glucosidase is performed to detect a disorder of the: Seminiferous tubules Epididymis Prostate gland Bulbourethral glands

Answer 306

Epididymis ## Footnote decreased neutral alpha-glucosidase, glycerophosphocholine, and L-carnitine suggest a disorder of the epididymis.

Question 307

A specimen delivered to the laboratory with a request for prostatic acid phosphatase and glycoprotein p30 was collected to determine: Prostatic infection Presence of antisperm antibodies A possible rape Successful vasectomy

Answer 307

A possible rape ## Footnote On certain occasions, the laboratory may be called on to determine whether semen is actually present in a specimen. A primary example is in cases of alleged rape. Microscopically examining the specimen for the presence of sperm may be possible, with the best results being obtained by enhancing the specimen with xylene and examining under phase microscopy. Seminal fluid contains a high concentration of prostatic acid phosphatase, so detecting this enzyme can aid in determining the presence of semen in a specimen. A more specific method is the detection of seminal glycoprotein p30 (prostatic specific antigen [PSA]), which is present even in the absence of sperm. Further information can often be obtained by performing ABO blood grouping and DNA analysis on the specimen.

Question 308

Following a negative postvasectomy wet preparation, the specimen should be: Centrifuged and reexamined Stained and reexamined Reported as no sperm seen Detect presence of male antibodies

Answer 308

Centrifuged and reexamined ## Footnote A negative wet preparation is followed by specimen centrifugation for 10 minutes and examination of the sediment.

Question 309

Normal synovial fluid resembles: Egg white Normal serum Dilute urine Lipemic serum

Answer 309

Egg white ## Footnote The word “synovial” comes from the Latin word for egg, ovum. Normal viscous synovial fluid resembles egg white.

Question 310

When diluting a synovial fluid WBC count, all of the following are acceptable except: Acetic acid Isotonic saline Hypotonic saline Saline with saponin

Answer 310

Acetic acid ## Footnote Traditional WBC diluting fluid cannot be used because it contains acetic acid that causes the formation of mucin clots. Normal saline can be used as a diluent. If it is necessary to lyse the RBCs, hypotonic saline (0.3%) or saline that contains saponin is a suitable diluent. Methylene blue added to the normal saline stains the WBC nuclei, permitting separation of the RBCs and WBCs during counts performed on mixed specimens.

Question 311

Synovial fluid crystals associated with inflammation in dialysis patients are: Calcium pyrophosphate dihydrate Calcium oxalate Corticosteroid Monosodium urate

Answer 311

Calcium oxalate ## Footnote Calcium oxalate crystals in renal dialysis patients.

Question 312

Synovial fluid for crystal examination should be examined as a/an: Wet preparation Wright's stain Gram stain Acid-fast stain

Answer 312

Wet preparation ## Footnote Fluid is examined as an unstained wet preparation. One drop of fluid is placed on a precleaned glass slide and cover slipped. The slide can be initially examined under low and high power using a regular light microscope. Crystals may be observed in Wright’s-stained smears; however, this should not replace the wet prep examination and the use of polarized and red-compensated polarized light for identification.

Question 313

The most frequently performed chemical test on synovial fluid is: Total protein Uric acid Calcium Glucose

Answer 313

Glucose ## Footnote The most frequently requested test is the glucose determination, because markedly decreased glucose values indicate inflammatory (group II) or septic (group III) disorders.

Question 314

An increase in the amount of serous fluid is called a/an: Exudate Transudate Effusion Malignancy

Answer 314

Effusion

Question 315

Fluid:serum protein and lactic dehydrogenase ratios are performed on serous fluids: When malignancy is suspected To classify transudates and exudates To determine the type of serous fluid When a traumatic tap has occurred

Answer 315

To classify transudates and exudates ## Footnote Traditionally, a variety of laboratory tests have been used to differentiate between transudates and exudates, including appearance, total protein, lactic dehydrogenase, cell counts, and spontaneous clotting. However, the most reliable differentiation is usually obtained by determining the fluid: blood ratios for protein and lactic dehydrogenase

Question 316

A differential observation of pleural fluid associated with tuberculosis is: Increased neutrophils Decreased lymphocytes Decreased mesothelial cells Increased mesothelial cells

Answer 316

Decreased mesothelial cells

Question 317

A pleural fluid pH of 6.0 indicates: Esophageal rupture Mesothelioma Malignancy Rheumatoid effusion

Answer 317

Esophageal rupture ## Footnote A pH value as low as 6.0 indicates an esophageal rupture that is allowing the influx of gastric fluid. Pleural fluid pH lower than 7.2 may indicate the need for chest-tube drainage, in addition to administration of antibiotics in cases of pneumonia. In cases of acidosis, the pleural fluid pH should be compared with the blood pH. Pleural fluid pH at least 0.30 degrees lower than the blood pH is considered significant.

Question 318

Plasma cells seen in pleural fluid indicate: Bacterial endocarditis Primary malignancy Metastatic lung malignancy Tuberculosis infection

Answer 318

Tuberculosis infection

Question 319

The recommended test for determining whether peritoneal fluid is a transudate or an exudate is the: Fluid:serum albumin ratio Serum ascites albumin gradient Fluid:serum lactic dehydrogenase ratio Absolute neutrophil count

Answer 319

Serum ascites albumin gradient ## Footnote Differentiation between ascitic fluid transudates and exudates is more difficult than for pleural and pericardial effusions. The serum-ascites albumin gradient (SAAG) is recommended over the fluid:serum total protein and LD ratios to detect transudates of hepatic origin.

Question 320

Differentiation between bacterial peritonitis and cirrhosis is done by performing a/an: WBC count Differential Absolute neutrophil count Absolute lymphocyte count

Answer 320

Absolute neutrophil count ## Footnote Normal PERITONEAL FLUID WBC counts are less than 350 cells/μL, and the count increases with bacterial peritonitis and cirrhosis. To distinguish between those two conditions, an absolute neutrophil count should be performed. An absolute neutrophil count >250 cells/μL or >50% of the total WBC count indicates infection.

Question 321

Ascitic fluid TRANSUDATE: Bacterial peritonitis Cirrhosis Intestinal perforation, ruptured appendix Malignancy

Answer 321

Cirrhosis

Question 322

Detection of the CA 125 tumor marker in peritoneal fluid indicates: Colon cancer Ovarian cancer Gastric malignancy Prostate cancer

Answer 322

Ovarian cancer

Question 323

What is the primary cause of the normal increase in amniotic fluid as a pregnancy progresses? Fetal cell metabolism Fetal swallowing Fetal urine Transfer of water across the placenta

Answer 323

Fetal urine

Question 324

How are specimens for FLM testing delivered to and stored in the laboratory? Delivered on ice and refrigerated Immediately centrifuged Kept at room temperature Delivered in a vacuum tube

Answer 324

Delivered on ice and refrigerated ## Footnote Fluid for fetal lung maturity (FLM) tests should be placed in ice for delivery o the laboratory and kept refrigerated. Specimens for bilirubin testing must be immediately protected from light. This can be accomplished by placing the specimens in amber-colored tubes, wrapping the collection tube in foil, or by use of a black plastic cover for the specimen container. Specimens for cytogenetic studies or microbial studies must be processed aseptically and maintained at room temperature or body temperature (37°C incubation) prior to analysis to prolong the life of the cells needed for analysis.

Question 325

Why are amniotic specimens for cytogenetic analysis incubated at 37°C prior to analysis? To detect the presence of meconium To differentiate amniotic fluid from urine To prevent photo-oxidation of bilirubin to biliverdin To prolong fetal cell viability and integrity

Answer 325

To prolong fetal cell viability and integrity ## Footnote Specimens for cytogenetic studies or microbial studies must be processed aseptically and maintained at room temperature or body temperature (37°C incubation) prior to analysis to prolong the life of the cells needed for analysis.

Question 326

Plotting the amniotic fluid OD on a Liley graph represents the severity of hemolytic disease of the newborn. A value that is plotted in zone II indicates what condition of the fetus? No hemolysis Mildly affected fetus Moderately affected fetus that requires close monitoring Severely affected fetus that requires intervention

Answer 326

Moderately affected fetus that requires close monitoring ## Footnote Notice that the Liley graph plots the A450 against gestational age and is divided into three zones that represent the extent of hemolytic severity. Values falling in zone I indicate no more than a mildly affected fetus; those in zone II indicate moderate hemolysis and require careful monitoring anticipating an early delivery or exchange transfusion upon delivery, whereas a value in zone III indicates severe hemolysis and suggests a severely affected fetus. Intervention through induction of labor or intrauterine exchange transfusion must be considered when a D A450 is plotted in zone III.

Question 327

When severe HDN is present, which of the following tests on the amniotic fluid would the physician NOT ORDER to determine whether the fetal lungs are mature enough to withstand a premature delivery? AFP levels Foam stability index Lecithin/sphingomyelin ratio Phosphatidyl glycerol detection

Answer 327

AFP levels ## Footnote Increased levels of alpha-fetoprotein (AFP) in both the maternal circulation and the amniotic fluid can be indicative of fetal neural tube defects, such as anencephaly and spina bifida.

Question 328

Amniocentesis may be indicated at 15 to 18 weeks’ gestation for the following conditions to determine early treatment or intervention: CHECK FOUR (4) BOXES -Family history of chromosome abnormalities, such as trisomy 21 (Down syndrome) -Earlier pregnancy or child with birth defect -Fetal lung maturity -HDN caused by Rh blood type incompatibility -Elevated maternal serum alpha-fetoprotein -Abnormal triple marker screening test

Answer 328

-Family history of chromosome abnormalities, such as trisomy 21 (Down syndrome) -Earlier pregnancy or child with birth defect -Elevated maternal serum alpha-fetoprotein -Abnormal triple marker screening test

Question 329

Amniocentesis is indicated later in the pregnancy (20 to 42 weeks) to evaluate: CHECK TWO (2) BOXES -Family history of chromosome abnormalities, such as trisomy 21 (Down syndrome) -Earlier pregnancy or child with birth defect -Fetal lung maturity -HDN caused by Rh blood type incompatibility -Elevated maternal serum alpha-fetoprotein -Abnormal triple marker screening test

Answer 329

-Fetal lung maturity -HDN caused by Rh blood type incompatibility

Question 330

When performing an L/S ratio by thin-layer chromatography, a mature fetal lung will show: Sphingomyelin twice as concentrated as lecithin No sphingomyelin Lecithin twice as concentrated as sphingomyelin Equal concentrations of lecithin and sphingomyelin

Answer 330

Lecithin twice as concentrated as sphingomyelin ## Footnote The L/S ratio will rise to 2.0 or higher as the lecithin production increases to prevent alveolar collapse.

Question 331

A rapid immunologic test for FLM that does not require performance of thin-layer chromatography is: AFP levels Amniotic acetylcholinesterase Aminostat-FLM Bilirubin scan

Answer 331

Aminostat-FLM ## Footnote AMNIOSTAT FLM: IMMUNOLOGIC AGGLUTINATION TEST FOR PHOSPHATIDYLGLYCEROL

Question 332

The presence of phosphatidyl glycerol in amniotic fluid fetal lung maturity tests must be confirmed when: Hemolytic disease of the newborn is present The mother has maternal diabetes Amniotic fluid is contaminated by hemoglobin Neural tube disorder is suspected

Answer 332

The mother has maternal diabetes ## Footnote The presence of another lung surface lipid, phosphatidyl glycerol (PG), is also essential for adequate lung maturity and can be detected after 35 weeks’ gestation. The production of PG normally parallels that of lecithin, but its production is delayed in cases of maternal diabetes. In this circumstance, respiratory distress occurs in the presence of an L/S ratio of 2.0. Therefore, a thin-layer chromatography lung profile must include lecithin, sphingomyelin, and PG to provide an accurate measurement of FLM.

Question 333

OD 650 nm: Bilirubin Lamellar bodies Lecithin Oxyhemoglobin

Answer 333

Lamellar bodies ## Footnote The presence of lamellar bodies increases the OD of the amniotic fluid. Specimens are centrifuged at 2000 g for 10 minutes and examined using a wavelength of 650 nm.

Question 334

A lamellar body count of 50,000 correlates with: Absent phosphatidyl glycerol and L/S ratio of 1.0 L/S ratio of 1.5 and absent phosphatidyl glycerol OD at 650 nm of 1.010 and an L/S ratio of 1.1 OD at 650 nm of 0.150 and an L/S ratio of 2.0

Answer 334

OD at 650 nm of 0.150 and an L/S ratio of 2.0 ## Footnote The number of lamellar bodies present in the amniotic fluid correlates with the amount of phospholipid present in the fetal lungs. The presence of lamellar bodies increases the OD of the amniotic fluid. Specimens are centrifuged at 2000 g for 10 minutes and examined using a wavelength of 650 nm, which rules out interference from hemoglobin but not other contaminants, such as meconium. An OD of 0.150 has been shown to correlate well with an L/S ratio of greater than or equal to 2.0 and the presence of phosphatidyl glycerol. A consensus protocol for noncentrifuged samples considers LBCs greater than 50,000/uL an indication of FLM and values below 15,000/uL as immature.

Question 335

The normal composition of feces includes all of the following except: Bacteria Blood Electrolytes Water

Answer 335

Blood ## Footnote The normal fecal specimen contains bacteria, cellulose, undigested foodstuffs, GI secretions, bile pigments, cells from the intestinal walls, electrolytes, and water.

Question 336

The normal brown color of the feces is produced by: Cellulose Pancreatic enzymes Undigested foodstuffs Urobilin

Answer 336

Urobilin

Question 337

Stool specimens that appear ribbon-like are indicative of which condition? Bile duct obstruction Colitis Intestinal constriction Malignancy

Answer 337

Intestinal constriction

Question 338

What is the fecal test that requires a 3-day specimen? Fecal occult blood APT test Elastase 1 Quantitative fecal fat testing

Answer 338

Quantitative fecal fat testing ## Footnote Quantitative fecal analysis requires the collection of at least a 3-day specimen. The patient must maintain a regulated intake of fat (100 g/d) before and during the collection period.

Question 339

What is the significance of an APT test that remains pink after addition of sodium hydroxide? Fecal fat is present Fetal hemoglobin is present Fecal trypsin is present Vitamin C is present

Answer 339

Fetal hemoglobin is present ## Footnote In the presence of alkali-resistant fetal hemoglobin, the solution remains pink (HbF), whereas denaturation of the maternal hemoglobin (HbA) produces a yellow-brown supernatant after standing for 2 minutes.

Question 340

A patient whose stool exhibits increased fats, undigested muscle fibers, and the inability to digest gelatin may have: Bacterial dysentery A duodenal ulcer Cystic fibrosis Lactose intolerance

Answer 340

Cystic fibrosis

Question 341

A stool specimen collected from an infant with diarrhea has a pH of 5.0. This result correlates with a: Positive APT test Negative trypsin test Positive Clinitest Negative occult blood test

Answer 341

Positive Clinitest ## Footnote Normal stool pH is between 7 and 8; however, increased use of carbohydrates by intestinal bacterial fermentation increases the lactic acid level and lowers the pH to below 5.5 in cases of carbohydrate disorders.

Question 342

What is the recommended number of samples that should be tested to confirm a negative occult blood result? One random specimen Two samples taken from different parts of three stools Three samples taken from the outermost portion of the stool Three samples taken from different parts of two stools

Answer 342

Two samples taken from different parts of three stools ## Footnote Two samples from three different stools should be tested before a negative result is confirmed.

Question 343

A positive amine (Whiff) test is observed in which of the following syndromes? Bacterial vaginosis Vulvovaginal candidiasis Atrophic vaginitis Desquamative inflammatory vaginitis

Answer 343

Bacterial vaginosis ## Footnote Amine (Whiff) Test 1. Apply one drop of the saline vaginal fluid suspension to the surface of a clean glass slide. 2. Add one drop of 10% KOH directly to the vaginal sample. 3. Holding the slide in one hand, gently fan above the surface of the slide with the other hand and assess for the presence of a fishy amine odor. 4. Report as positive or negative. Positive: The presence of a fishy odor after adding KOH. Negative: The absence of a fishy odor after adding KOH.

Question 344

The presence of fetal fibronectin in vaginal secretions between 24 and 34 weeks’ gestation is associated with: Bacterial vaginosis Candidiasis Desquamative inflmmatory vaginitis Preterm delivery

Answer 344

Preterm delivery ## Footnote The presence of fetal fibronectin in vaginal secretions between 24 and 34 weeks’ gestation is associated with preterm delivery.