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AUBF > HARR EE2 > Flashcards

HARR EE2 Flashcards

1
Q 
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

A. Choroid plexus

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2
Q

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

A. Normal values for mononuclear cells are higher

for infants than adults

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3
Q

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

A. Low CSF volume

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4
Q

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

A

C. Xanthochromia

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5
Q 
The term used to denote a high WBC count in the
CSF is:
A. Empyema
B. Neutrophilia
C. Pleocytosis
D. Hyperglycorrhachia
A

C. Pleocytosis

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6
Q 
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
A

D. Acute bacterial meningitis

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7
Q

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

A

D. Viral meningitis

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8
Q

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

A

C. The presence of oligoclonal bands by

electrophoresis

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9
Q 
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
A

B. Pleocytosis of mixed cellularity

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10
Q 
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
A

B. Amoebic meningoencephalitis

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11
Q

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

A

C. IgG index

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12
Q

. 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. A differential is done only if the total WBC

count is greater than 10/μL

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13
Q 
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
A

C. Monocytes

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14
Q 
Neutrophilic pleocytosis is usually associated with
all of the following except:
A. Cerebral infarction
B. Malignancy
C. Myelography
D. Neurosyphilis
A

D. Neurosyphilis

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15
Q

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

A

C. CSF IgG is increased in panencephalitis,

malignancy, and neurosyphilis

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16
Q

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

A

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

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17
Q 
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
A

B. Group B Streptococcus

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18
Q

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

A

C. Tau protein

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19
Q

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

A

B. Mesothelial cells, PMNs, lymphocytes, and

macrophages may be present in normal fluids

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20
Q 
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
A

C. An increased volume of serous fluid

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21
Q

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

A

C. LD fluid/serum ratio = 0.25

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22
Q

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

A

C. The formation of a clot

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23
Q

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

A. An RBC count of 8,000/μL

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24
Q 
Which of the following conditions is commonly associated with an exudative effusion?
A. Congestive heart failure
B. Malignancy
C. Nephrotic syndrome
D. Cirrhosis
A

B. Malignancy

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25
Q

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

A

D. Lymphatic obstruction

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26
Q

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

A

C. RA

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27
Q

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

A

D. Pneumothorax

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28
Q 
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

A. 300/μL 25% 100,000/μL

29
Q

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

A

D. Viscosity

30
Q 
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

A. Septic arthritis

31
Q

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

A

B. A PMN with inclusions formed by immune

complexes

32
Q 
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

A. Uric acid or monosodium urate

33
Q 
Which crystal causes “pseudogout”?
A. Oxalic acid
B. Calcium pyrophosphate
C. Calcium oxalate
D. Cholesterol
A

B. Calcium pyrophosphate

34
Q 
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
A

C. Uric acid

35
Q 
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
A

C. Hemorrhagic arthritis

36
Q

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

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

37
Q

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

A

B. Neisseria gonorrhoeae

38
Q

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

A.200/μL 25% 2,000/μL

39
Q

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

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

450-nm peak is due to bilirubin

40
Q 
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
A

C. Amniotic fluid bilirubin

41
Q 
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
A

B. L/S ratio

42
Q

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

43
Q

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

A

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

44
Q

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

A

B. In ectopic pregnancy, serum hCG doubling time

is below expected levels

45
Q

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

A

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

heterophile antibodies

46
Q

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

A

C. Antigen excess caused a falsely low result in the

undiluted sample

47
Q

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

A

B. Nondisjunction of chromosome 21 (G trisomy)

48
Q

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

A. Serum unconjugated estriol

49
Q

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

A. Maternal serum may be used to screen for open

neural tube defects

50
Q

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

A

B. Free β hCG and pregnancy-associated plasma

protein A

51
Q

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

A

B. MoM normalizes for gestational age

52
Q

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

A

B. The test should not be performed before

week 24 or after the end of week 34

53
Q

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

A

C. Acrosomal deficiency

54
Q 
What is the most common cause of male infertility?
A. Mumps
B. Klinefelter’s syndrome
C. Varicocele
D. Malignancy
A

C. Varicocele

55
Q 
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

A. 15 million per mL

56
Q

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

A. Tapering of the head

57
Q 
Which of the following stains is used to determine
sperm viability?
A. Eosin Y
B. Hematoxylin
C. Papanicolaou
D. Methylene blue
A

A. Eosin Y

58
Q

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

A. Volume 1.0 mL

59
Q

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

A

B. Sample collected following coitus

60
Q 
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

A. 1 × 106/mL

61
Q

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

A

C. Fructose

62
Q 
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
A

B. H. pylori infection

63
Q 
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
A

C. Z–E syndrome

64
Q 
. In determining free HCl, the gastric fluid is
titrated to pH \_\_\_.
A. 6.5
B. 4.5
C. 3.5
D. 2.0
A

C. 3.5

65
Q 
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

A. Secretin stimulation

66
Q 
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
A

B. D-Xylose absorption

67
Q 
Which of the following is commonly associated
with occult blood?
A. Colon cancer
B. Atrophic gastritis
C. Pernicious anemia
D. Pancreatitis
A

A. Colon cancer

68
Q 
Which test is most sensitive in detecting persons with chronic pancreatitis?
A. Fecal trypsin
B. Fecal chymotrypsin
C. Fecal elastin-1
D. Plasma lipase
A

C. Fecal elastin-1

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