HARR EE2 Flashcards by GERVELYN O. GABON

Cerebrospinal fluid (CSF) is formed by ultrafiltration of plasma through the:
A. Choroid plexus
B. Sagittal sinus
C. Anterior cerebral lymphatics
D. Arachnoid membrane

A. Choroid plexus

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Which statement regarding CSF is true?
A. Normal values for mononuclear cells are higher
for infants than adults
B. Absolute neutrophilia is not significant if the
total WBC count is less than 25/μL
C. The first aliquot of CSF should be sent to the
microbiology laboratory
D. Neutrophils compose the majority of WBCs in
normal CSF

A. Normal values for mononuclear cells are higher

for infants than adults

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When collecting CSF, a difference between
opening and closing fluid pressure greater than
100 mm H2O indicates:
A. Low CSF volume
B. Subarachnoid hemorrhage
C. Meningitis
D. Hydrocephalus

A. Low CSF volume

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Which of the following findings is consistent
with a subarachnoid hemorrhage rather than a
traumatic tap?
A. Clearing of the fluid as it is aspirated
B. A clear supernatant after centrifugation
C. Xanthochromia
D. Presence of a clot in the sample

C. Xanthochromia

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The term used to denote a high WBC count in the
CSF is:
A. Empyema
B. Neutrophilia
C. Pleocytosis
D. Hyperglycorrhachia

C. Pleocytosis

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SITUATION: What is the most likely cause of the following CSF results
CSF glucose 20 mg/dL; 
CSF protein 200 mg/dL; 
CSF lactate 50 mg/dL (reference range 5–25 mg/dL)
A. Viral meningitis
B. Viral encephalitis
C. Cryptococcal meningitis
D. Acute bacterial meningitis

D. Acute bacterial meningitis

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Which of the following conditions is most often
associated with normal CSF glucose and protein?
A. Multiple sclerosis
B. Malignancy
C. Subarachnoid hemorrhage
D. Viral meningitis

D. Viral meningitis

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The diagnosis of multiple sclerosis is often based
upon which finding?
A. The presence of elevated protein and low glucose
B. A decreased IgG index
C. The presence of oligoclonal bands by
electrophoresis
D. An increased level of CSF β microglobulin

C. The presence of oligoclonal bands by

electrophoresis

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Which of the following results is consistent with
fungal meningitis?
A. Normal CSF glucose
B. Pleocytosis of mixed cellularity
C. Normal CSF protein
D. High CSF lactate

B. Pleocytosis of mixed cellularity

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In what suspected condition should a wet prep
using a warm slide be examined?
A. Cryptococcal meningitis
B. Amoebic meningoencephalitis
C. Mycobacterium tuberculosis infection
D. Neurosyphilis

B. Amoebic meningoencephalitis

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Which of the following CSF test results is most
commonly increased in patients with multiple
sclerosis?
A. Glutamine
B. Lactate
C. IgG index
D. Ammonia

C. IgG index

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. Which of the following is an inappropriate
procedure for performing routine CSF analysis?
A. A differential is done only if the total WBC
count is greater than 10/μL
B. A differential should be done on a stained CSF
concentrate
C. A minimum of 30 WBCs should be differentiated
D. A Wright’s-stained slide should be examined
rather than a chamber differential

A. A differential is done only if the total WBC

count is greater than 10/μL

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Which cell is present in the CSF in greater numbers in newborns than in older children  or adults?
A. Eosinophils
B. Lymphocytes
C. Monocytes
D. Neutrophils

C. Monocytes

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Neutrophilic pleocytosis is usually associated with
all of the following except:
A. Cerebral infarction
B. Malignancy
C. Myelography
D. Neurosyphilis

D. Neurosyphilis

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Which statement about CSF protein is true?
A. An abnormal serum protein electrophoretic
pattern does not affect the CSF pattern
B. The upper reference limit for CSF total protein
in newborns is one-half adult levels
C. CSF IgG is increased in panencephalitis,
malignancy, and neurosyphilis
D. Antibodies to Treponema pallidum disappear
after successful antibiotic therapy

C. CSF IgG is increased in panencephalitis,

malignancy, and neurosyphilis

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Which of the following statements regarding
routine microbiological examination of CSF
is true?
A. A Gram stain is performed on the CSF prior to
concentration
B. The Gram stain is positive in fewer than 40% of
cases of acute bacterial meningitis
C. India ink and acid fast stains are indicated if
neutrophilic pleocytosis is present
D. All CSF specimens should be cultured using
sheep blood agar, chocolate agar, and
supplemented broth

D. All CSF specimens should be cultured using
sheep blood agar, chocolate agar, and
supplemented broth

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Which organism is the most frequent cause of bacterial meningitis in neonates?
A. Neisseria meningitidis
B. Group B Streptococcus
C. Streptococcus pneumoniae
D. Klebsiella pneumoniae

B. Group B Streptococcus

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Following a head injury, which protein will
identify the presence of CSF leakage through
the nose?
A. Transthyretin
B. Myelin basic protein
C. Tau protein
D. C-reactive protein

C. Tau protein

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Which of the following statements regarding
serous fluids is true?
A. The normal volume of pleural fluid is 30–50 mL
B. Mesothelial cells, PMNs, lymphocytes, and
macrophages may be present in normal fluids
C. X-ray can detect a 10% increase in the volume
of a serous fluid
D. Normal serous fluids are colorless

B. Mesothelial cells, PMNs, lymphocytes, and

macrophages may be present in normal fluids

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The term effusion refers to:
A. A chest fluid that is purulent
B. A serous fluid that is chylous
C. An increased volume of serous fluid
D. An inflammatory process affecting the
appearance of a serous fluid

C. An increased volume of serous fluid

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Which of the following laboratory results is
characteristic of a transudative fluid?
A. SG = 1.018
B. Total protein = 3.2 g/dL
C. LD fluid/serum ratio = 0.25
D. Total protein fluid/serum ratio = 0.65

C. LD fluid/serum ratio = 0.25

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Which observation is least useful in distinguishing
a hemorrhagic serous fluid from a traumatic tap?
A. Clearing of fluid as it is aspirated
B. Presence of xanthochromia
C. The formation of a clot
D. Diminished RBC count in successive aliquots

C. The formation of a clot

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Which of the following laboratory results on a
serous fluid is most likely to be caused by a
traumatic tap?
A. An RBC count of 8,000/μL
B. A WBC count of 6,000/μL
C. A hematocrit of 35%
D. A neutrophil count of 55%

A. An RBC count of 8,000/μL

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Which of the following conditions is commonly associated with an exudative effusion?
A. Congestive heart failure
B. Malignancy
C. Nephrotic syndrome
D. Cirrhosis

B. Malignancy

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Which of the following conditions is associated with a chylous effusion? A. Necrosis B. Pulmonary infarction or infection C. Systemic lupus erythematosus or rheumatoid arthritis D. Lymphatic obstruction

D. Lymphatic obstruction

Which of the following conditions is most often associated with a pleural fluid glucose below 30 mg/dL? A. Diabetes mellitus B. Pancreatitis C. RA D. Bacterial pneumonia

C. RA

In which condition is the pleural fluid pH likely to be above 7.3? A. Bacterial pneumonia with parapneumonic exudate B. Rheumatoid pleuritis C. Esophageal rupture D. Pneumothorax

D. Pneumothorax

``` Which of the following hematology values best frames the upper reference limits for peritoneal fluid? WBC Count of PMNs RBC Count A. 300/μL 25% 100,000/μL B. 10,000/μL 50% 500,000/μL C. 50,000/μL 50% 500,000/μL D. 100,000/μL 75% 1,000,000/μL ```

A. 300/μL 25% 100,000/μL

Which of the following characteristics is higher for synovial fluid than for the serous fluids? A. SG B. Glucose C. Total protein D. Viscosity

D. Viscosity

``` In which type of arthritis is the synovial WBC count likely to be greater than 50,000/μL? A. Septic arthritis B. Osteoarthritis C. RA D. Hemorrhagic arthritis ```

A. Septic arthritis

What type of cell is a “ragocyte”? A. Cartilage cell seen in inflammatory arthritis B. A PMN with inclusions formed by immune complexes C. A plasma cell seen in RA D. A macrophage containing large inclusions

B. A PMN with inclusions formed by immune | complexes

``` Which of the following crystals is the cause of gout? A. Uric acid or monosodium urate B. Calcium pyrophosphate or apatite C. Calcium oxalate D. Cholesterol ```

A. Uric acid or monosodium urate

``` Which crystal causes “pseudogout”? A. Oxalic acid B. Calcium pyrophosphate C. Calcium oxalate D. Cholesterol ```

B. Calcium pyrophosphate

``` A synovial fluid sample is examined using a polarizing microscope with a red compensating filter. Crystals are seen that are yellow when the long axis of the crystal is parallel to the slow vibrating light. When the long axis of the crystal is perpendicular to the slow vibrating light, the crystals appear blue. What type of crystal is present? A. Calcium oxalate B. Calcium pyrophosphate C. Uric acid D. Cholesterol ```

C. Uric acid

``` In which condition is the synovial fluid glucose most likely to be within normal limits? A. Septic arthritis B. Inflammatory arthritis C. Hemorrhagic arthritis D. Gout ```

C. Hemorrhagic arthritis

Which statement about synovial fluid in RA is true? A. Synovial/serum IgG is usually 1:2 or higher B. Total hemolytic complement is elevated C. Ninety percent of RA cases test positive for rheumatoid factor in synovial fluid D. Demonstration of rheumatoid factor in joint fluid is diagnostic for RA

A. Synovial/serum IgG is usually 1:2 or higher

Which of the following organisms accounts for the majority of septic arthritis cases in young and middle-age adults? A. H. influenzae B. Neisseria gonorrhoeae C. Staphylococcus aureus D. Borrelia burgdorferi

B. Neisseria gonorrhoeae

Which of the following hematology values best frames the upper reference limits for synovial fluid? ``` WBC Count of PMNs RBC Count A.200/μL 25% 2,000/μL B. 5,000/μL 50% 10,000/μL C. 10,000/μL 50% 50,000/μL D. 20,000/μL 5% 500,000/μL ```

A.200/μL 25% 2,000/μL

Which of the following statements about amniotic fluid bilirubin measured by scanning spectrophotometry is true? A. The 410-nm peak is due to hemoglobin and the 450-nm peak is due to bilirubin B. Baseline correction is not required if a scanning spectrophotometer is used C. Chloroform extraction is necessary only when meconium is present D. In normal amniotic fluid, bilirubin increases with gestational age

A. The 410-nm peak is due to hemoglobin and the | 450-nm peak is due to bilirubin

``` Which test best correlates with the severity of HDN? A. Rh antibody titer of the mother B. Lecithin/sphingomyelin (L/S) ratio C. Amniotic fluid bilirubin D. Urinary estradiol ```

C. Amniotic fluid bilirubin

``` Which is the reference method for determining fetal lung maturity? A. Human placental lactogen B. L/S ratio C. Amniotic fluid bilirubin D. Urinary estriol ```

B. L/S ratio

Which of the following statements regarding the L/S ratio is true? A. A ratio of 2:1 or greater usually indicates adequate pulmonary surfactant to prevent respiratory distress syndrome (RDS) B. A ratio of 1.5:1 indicates fetal lung maturity in pregnancies associated with diabetes mellitus C. Sphingomyelin levels increase during the third trimester, causing the L/S ratio to fall slightly during the last 2 weeks of gestation D. A phosphatidylglycerol (PG) spot indicates the presence of meconium in the amniotic fluid

A. A ratio of 2:1 or greater usually indicates adequate pulmonary surfactant to prevent respiratory distress syndrome (RDS)

Which of the following conditions is most likely to cause a falsely low L/S ratio? A. The presence of PG in amniotic fluid B. Freezing the specimen for one month at –20°C C. Centrifugation at 1,000 × g for 10 minutes D. Maternal diabetes mellitus

C. Centrifugation at 1,000 × g for 10 minutes

Which of the following statements accurately describes hCG levels in pregnancy? A. Levels of hCG rise throughout pregnancy B. In ectopic pregnancy, serum hCG doubling time is below expected levels C. Molar pregnancies are associated with lower levels than expected for the time of gestation D. hCG returns to nonpregnant levels within 2 days following delivery, stillbirth, or abortion

B. In ectopic pregnancy, serum hCG doubling time | is below expected levels

Which of the following statements regarding pregnancy testing is true? A. β Subunits of human chorionic gonadotropin (hCG), thyroid-stimulating hormone (TSH), and follicle-stimulating hormone (FSH) are very similar B. Antibodies against the β subunit of hCG cross-react with luteinizing hormone (LH) C. A false-positive result may occur in patients with heterophile antibodies D. Serum should not be used for pregnancy tests because proteins interfere

C. A false-positive result may occur in patients with | heterophile antibodies

SITUATION: A pregnant female was seen by her physician who suspected a molar pregnancy. An hCG test was ordered and found to be low. The sample was diluted 10-fold and the assay was repeated. The result was found to be grossly elevated. What best explains this situation? A. The wrong specimen was diluted B. A pipeting error was made in the first analysis C. Antigen excess caused a falsely low result in the undiluted sample D. An inhibitor of the antigen–antibody reaction was present in the sample

C. Antigen excess caused a falsely low result in the | undiluted sample

Most cases of Down syndrome are the result of: A. Nondisjunction of an E chromosome (E trisomy) B. Nondisjunction of chromosome 21 (G trisomy) C. A 14–21 chromosome translocation D. Deletion of the long arm of chromosome 21

B. Nondisjunction of chromosome 21 (G trisomy)

Which assay result is often approximately 25% below the expected level in pregnancies associated with Down syndrome? A. Serum unconjugated estriol B. L/S ratio C. Amniotic fluid bilirubin D. Urinary chorionic gonadotropin

A. Serum unconjugated estriol

Which of the following statements about AFP is correct? A. Maternal serum may be used to screen for open neural tube defects B. Levels above 4 ng/mL are considered positive C. Elevated levels in amniotic fluid are specific for spina bifida D. AFP levels increase in pregnancies associated with Down syndrome

A. Maternal serum may be used to screen for open | neural tube defects

First-trimester screening for Down syndrome can be performed using which markers? A. Alpha fetoprotein and unconjugated estriol B. Free β hCG and pregnancy-associated plasma protein A C. Intact hCG and dimeric inhibin A D. Dimeric inhibin B and α fetoprotein

B. Free β hCG and pregnancy-associated plasma | protein A

When performing marker screening tests for Down syndrome, why are results expressed in multiples of the median (MoM) rather than concentration? A. Concentration is not normally distributed B. MoM normalizes for gestational age C. Some tests cannot be reported in mass units D. Mean cannot be determined accurately for these analytes

B. MoM normalizes for gestational age

Which statement regarding the fetal fibronectin test is true? A. A positive test is correlated with a low probability of delivery within 14 days B. The test should not be performed before week 24 or after the end of week 34 C. The test is performed on amniotic fluid D. The test is used to identify amniotic fluid after rupture of the fetal membranes

B. The test should not be performed before | week 24 or after the end of week 34

What is the term for sperm when the anterior portion of the headpiece is smaller than normal? A. Azoospermia B. Microcephaly C. Acrosomal deficiency D. Necrozoospermia

C. Acrosomal deficiency

``` What is the most common cause of male infertility? A. Mumps B. Klinefelter’s syndrome C. Varicocele D. Malignancy ```

C. Varicocele

``` Which of the following values is the lower limit of normal for sperm concentration? A. 15 million per mL B. 40 million per mL C. 60 million per mL D. 100 million per mL ```

A. 15 million per mL

Which morphological abnormality of sperm is most often associated with varicocele? A. Tapering of the head B. Cytoplasmic droplet below the neckpiece C. Lengthened neckpiece D. Acrosomal deficiency

A. Tapering of the head

``` Which of the following stains is used to determine sperm viability? A. Eosin Y B. Hematoxylin C. Papanicolaou D. Methylene blue ```

A. Eosin Y

Which of the following semen analysis results is abnormal? A. Volume 1.0 mL B. Liquefaction 40 minutes at room temperature C. pH 7.6 D. Motility 50% progressive movement

A. Volume 1.0 mL

Which of the following sample collection and processing conditions will lead to inaccurate seminal fluid analysis results? A. Sample stored at room temperature for 1 hour before testing B. Sample collected following coitus C. Sample collected without an anticoagulant D. Sample collected without use of a condom

B. Sample collected following coitus

``` When performing a seminal fluid analysis, what is the upper limit of normal for WBCs? A. 1 × 106/mL B. 5 × 106/mL C. 10 × 106/mL D. 20 × 106/mL ```

A. 1 × 106/mL

Which carbohydrate measurement is clinically useful when performing a seminal fluid analysis? A. Glucose B. Galactose C. Fructose D. Maltose

C. Fructose

``` Which condition is most often associated with gastric ulcers? A. Cancer of the stomach B. H. pylori infection C. Zollinger–Ellison (Z–E) syndrome D. Pernicious anemia ```

B. H. pylori infection

``` In which condition is the highest level of serum gastrin usually seen? A. Atrophic gastritis B. Pernicious anemia C. Z–E syndrome D. Cancer of the stomach ```

C. Z–E syndrome

``` . In determining free HCl, the gastric fluid is titrated to pH ___. A. 6.5 B. 4.5 C. 3.5 D. 2.0 ```

C. 3.5

``` Which test can identify persons with gastrin-secreting tumors who do not demonstrate a definitively increased plasma gastrin concentration? A. Secretin stimulation B. Pentagastrin C. Cholecystokinin–pancreozymin D. Trypsinogen ```

A. Secretin stimulation

``` Which of the following tests would be normal in pancreatic insufficiency? A. Secretin stimulation B. D-Xylose absorption C. Twenty-four-hour fecal fat D. β Carotene absorption ```

B. D-Xylose absorption

``` Which of the following is commonly associated with occult blood? A. Colon cancer B. Atrophic gastritis C. Pernicious anemia D. Pancreatitis ```

A. Colon cancer

``` Which test is most sensitive in detecting persons with chronic pancreatitis? A. Fecal trypsin B. Fecal chymotrypsin C. Fecal elastin-1 D. Plasma lipase ```

C. Fecal elastin-1