Chemical Examinations

*Question: What is the 11th parameter added to the chemical examination of urine?
A) Bilirubin
B) Leukocyte Esterase
C) Ascorbic Acid
D) Urobilinogen

*Answer: C) Ascorbic Acid

*Question: Which mnemonic represents the parameters affected by ascorbic acid interference?
A) GLASS
B) BBLNG
C) PRIDE
D) URINE

*Answer: B) BBLNG

*Question: What is added to reagent strips to eliminate ascorbic acid interference?
A) Sulfosalicylic acid
B) Sodium nitroprusside
C) Iodate
D) Diazonium salt

*Answer: C) Iodate

*Question: What happens if the reagent strip is soaked too long in urine?
A) The color intensifies
B) Reagents leach from the pads causing erroneous results
C) Specific gravity increases
D) pH becomes alkaline

*Answer: B) Reagents leach from the pads causing erroneous results

*Question: What is the main source of error for reagent strip testing?
A) Use of first morning specimen
B) Masking of color due to highly pigmented specimens
C) Excess ascorbic acid in pads
D) Cold temperature of specimen

*Answer: B) Masking of color due to highly pigmented specimens

*Question: Which reagent strip parameter has the longest reading time?
A) pH
B) Glucose
C) Specific Gravity
D) Leukocyte Esterase

*Answer: D) Leukocyte Esterase

*Question: What is the reading time for glucose on a Multistix reagent strip?
A) 60 seconds
B) 30 seconds
C) 45 seconds
D) 120 seconds

*Answer: B) 30 seconds

*Question: Which parameters share a reading time of 60 seconds on the reagent strip?
A) Glucose and Bilirubin
B) Ketone and Specific Gravity
C) pH, Protein, Blood, Urobilinogen, and Nitrite
D) Leukocyte Esterase and Nitrite

*Answer: C) pH, Protein, Blood, Urobilinogen, and Nitrite

*Question: What is the reading time for Specific Gravity on a reagent strip?
A) 30 seconds
B) 40 seconds
C) 45 seconds
D) 60 seconds

*Answer: C) 45 seconds

*Question: What is the reading time for Ketone on the reagent strip?
A) 30 seconds
B) 40 seconds
C) 45 seconds
D) 60 seconds

*Answer: B) 40 seconds

*Question: Which reagent strip parameter has the shortest reading time on Multistix?
A) Bilirubin
B) Glucose
C) Nitrite
D) pH

*Answer: B) Glucose

*Question: What is the principle of the pH reagent strip reaction?
A) Greiss Reaction
B) Diazo Reaction
C) Double Indicator System
D) Protein Error of Indicators

*Answer: C) Double Indicator System

*Question: Which indicators are used in the pH reagent pad?
A) Tetrabromophenol blue and sodium nitroprusside
B) Methyl Red and Bromthymol blue
C) Potassium iodide and peroxidase
D) Diazonium salt and SSA

*Answer: B) Methyl Red and Bromthymol blue

*Question: What pH increments does Multistix use for pH measurement?
A) 0.25 increments (4.5–8.5)
B) 0.5 increments (5.0–8.5)
C) 1.0 increments (5.0–9.0)
D) 1.0 increments (4.5–9.0)

*Answer: B) 0.5 increments (5.0–8.5)

*Question: A urine pH greater than 8.5 most likely indicates:
A) Diabetes mellitus
B) High-meat diet
C) Unpreserved specimen or contamination with alkaline detergents
D) Renal tubular acidosis

*Answer: C) Unpreserved specimen or contamination with alkaline detergents

*Question: What is the expected urinary pH range for a first morning specimen?
A) 4.5–8.0
B) 6.0–8.0
C) 5.0–6.0
D) 7.0–8.5

*Answer: C) 5.0–6.0

*Question: Why is urine alkaline after a meal?
A) Increased ammonia production
B) Alkaline tide — body conserves hydrogen for HCl production
C) Increased bicarbonate excretion from kidney disease
D) Post-prandial glucose surge

*Answer: B) Alkaline tide — body conserves hydrogen for HCl production

*Question: Calcium oxalate crystals only precipitate in what environment?
A) Alkaline urine
B) Neutral urine
C) Acidic urine
D) Hypotonic urine

*Answer: C) Acidic urine

*Question: Which diet leads to acidic urine?
A) Vegetarian diet
B) High-fruit diet
C) High-meat diet
D) Low-protein diet

*Answer: C) High-meat diet

*Question: What is the principle of the protein reagent strip reaction?
A) Diazo Reaction
B) Protein Error of Indicators
C) Greiss Reaction
D) Double Sequential Enzymatic Reaction

*Answer: B) Protein Error of Indicators

*Question: Which protein does the reagent strip pad detect exclusively?
A) Globulin
B) Bence Jones Protein
C) Albumin
D) Myoglobin

*Answer: C) Albumin

*Question: What is the acid buffer pH maintained in the protein reagent pad?
A) 5.0
B) 3.0
C) 7.0
D) 4.5

*Answer: B) 3.0

*Question: What is the minimum clinically significant proteinuria detected by the reagent strip?
A) 10 mg/dL
B) 20 mg/dL
C) 30 mg/dL
D) 50 mg/dL

*Answer: C) 30 mg/dL

*Question: Which of the following is a cause of false-positive protein on the reagent strip?
A) Microalbuminuria
B) Proteins other than albumin
C) Highly alkaline urine
D) Low specific gravity

*Answer: C) Highly alkaline urine

*Question: Which of the following causes a false-negative protein result on the reagent strip?
A) Detergents
B) Highly alkaline urine
C) Proteins other than albumin
D) High specific gravity

*Answer: C) Proteins other than albumin

*Question: What is the indicator used by Multistix for protein detection?
A) Tetrachlorophenol-tetrabromosulfonphthalein
B) Bromothymol blue
C) Tetrabromophenol blue
D) Potassium iodide

*Answer: C) Tetrabromophenol blue

*Question: Bence Jones Protein is associated with which disease?
A) Diabetes mellitus
B) Multiple myeloma
C) Lupus erythematosus
D) Streptococcal glomerulonephritis

*Answer: B) Multiple myeloma

*Question: At what temperature does Bence Jones Protein coagulate?
A) 20–30°C
B) 40–60°C
C) 70–80°C
D) 100°C

*Answer: B) 40–60°C

*Question: What happens to Bence Jones Protein when heated to 100°C?
A) It remains coagulated
B) It dissolves again (becomes soluble)
C) It precipitates further
D) It changes color

*Answer: B) It dissolves again (becomes soluble)

*Question: What is the confirmatory test for Bence Jones Protein?
A) Sulfosalicylic acid precipitation
B) Heat precipitation test
C) Serum electrophoresis and immunoelectrophoresis
D) Ictotest

*Answer: C) Serum electrophoresis and immunoelectrophoresis

*Question: Which type of proteinuria is diagnosed when a random specimen is positive for protein but the first morning specimen is negative?
A) Glomerular proteinuria
B) Tubular proteinuria
C) Orthostatic proteinuria
D) Microalbuminuria

*Answer: C) Orthostatic proteinuria

*Question: Microalbuminuria is defined as albumin levels of:
A) >30 mg/dL
B)

*Answer: B) <30 mg/dL

*Question: Microalbuminuria is a predictor for early onset of which disease?
A) Hepatitis
B) Diabetic nephropathy
C) Multiple myeloma
D) Orthostatic hypotension

*Answer: B) Diabetic nephropathy

*Question: Which condition causes tubular proteinuria?
A) Increased blood pressure
B) Glomerular membrane damage
C) Fanconi syndrome
D) Intravascular hemolysis

*Answer: C) Fanconi syndrome

*Question: What is the principle of the Sulfosalicylic Acid (SSA) test?
A) Hot precipitation test
B) Cold precipitation test
C) Enzymatic reaction
D) Diazo reaction

*Answer: B) Cold precipitation test

*Question: In the SSA test, what protein level corresponds to a 2+ result?
A) 30–100 mg/dL
B) 6–30 mg/dL
C) 100–200 mg/dL
D) 200–400 mg/dL

*Answer: C) 100–200 mg/dL

*Question: What turbidity and protein range corresponds to a 4+ SSA result?
A) Turbidity with granulation; 200–400 mg/dL
B) Clumps of protein; >400 mg/dL
C) Noticeable turbidity; 6–30 mg/dL
D) Distinct turbidity, no granulation; 30–100 mg/dL

*Answer: B) Clumps of protein; >400 mg/dL

*Question: Why is the Clinitest NOT considered a confirmatory test for glucose?
A) It is less sensitive than the reagent strip
B) It detects reducing sugars like galactose, not specifically glucose
C) It uses an enzymatic reaction instead of copper reduction
D) It cannot detect glucose at all

*Answer: B) It detects reducing sugars like galactose, not specifically glucose

*Question: Which sugar is detected by Clinitest but NOT by the glucose reagent strip?
A) Fructose
B) Sucrose
C) Galactose
D) Lactose

*Answer: C) Galactose

*Question: What is the principle of the Clinitest tablet?
A) Greiss Reaction
B) Benedict's principle (copper reduction)
C) Double sequential enzymatic reaction
D) Diazo reaction

*Answer: B) Benedict's principle (copper reduction)

*Question: What is the pass-through phenomenon in the Clinitest?
A) The strip leaches reagent into the urine
B) When sugar >200 mg/dL, the color reverts back to its original color
C) The tablet dissolves before the reaction is complete
D) Glucose is converted to galactose

*Answer: B) When sugar >200 mg/dL, the color reverts back to its original color

*Question: What should be done when a pass-through phenomenon is observed in Clinitest?
A) Use 10 drops of urine
B) Re-test using 2 drops of urine instead of 5
C) Dilute the urine with distilled water
D) Add more reagent tablets

*Answer: B) Re-test using 2 drops of urine instead of 5

*Question: What is the principle of the glucose reagent strip reaction?
A) Protein Error of Indicators
B) Copper reduction
C) Double Sequential Enzymatic Reaction
D) Diazo Reaction

*Answer: C) Double Sequential Enzymatic Reaction

*Question: Which two enzymes are required for the glucose reagent strip reaction?
A) Peroxidase and lipase
B) Glucose oxidase and peroxidase
C) Glucokinase and hexokinase
D) Amylase and glucose oxidase

*Answer: B) Glucose oxidase and peroxidase

*Question: What indicator does Multistix use for glucose detection?
A) Tetramethylbenzidine
B) Bromothymol blue
C) Potassium iodide (green to brown)
D) Sodium nitroprusside

*Answer: C) Potassium iodide (green to brown)

*Question: What is the ideal specimen for glucose testing?
A) Random specimen
B) 2-hour post-prandial specimen
C) Fasting specimen
D) First morning specimen

*Answer: C) Fasting specimen

*Question: Which of the following causes a false-negative glucose result on the reagent strip?
A) Oxidizing agents
B) Detergents
C) Ascorbic acid
D) High urine pH

*Answer: C) Ascorbic acid

*Question: Which of the following causes a false-positive glucose result on the reagent strip?
A) Ascorbic acid
B) High specific gravity
C) Low temperature
D) Oxidizing agents such as detergents

*Answer: D) Oxidizing agents such as detergents

*Question: Renal glycosuria is characterized by:
A) High blood glucose with normal urine glucose
B) Normal blood glucose with glucose in urine
C) High blood glucose with high urine glucose
D) Low blood glucose with high urine glucose

*Answer: B) Normal blood glucose with glucose in urine

*Question: Which of the following conditions can cause hyperglycemia of nondiabetic origin?
A) Fanconi syndrome
B) End-stage renal disease
C) Cushing syndrome
D) Tubular proteinuria

*Answer: C) Cushing syndrome

*Question: Which ketone body is the "parent" ketone and precursor to the other two?
A) Acetone
B) Beta-hydroxybutyrate
C) Acetoacetic acid
D) Ketoacetic acid

*Answer: C) Acetoacetic acid

*Question: What percentage of total ketones does beta-hydroxybutyrate comprise?
A) 2%
B) 20%
C) 50%
D) 78%

*Answer: D) 78%

*Question: What is the principle of the ketone reagent strip reaction?
A) Diazo Reaction
B) Sodium Nitroprusside Reaction
C) Greiss Reaction
D) Pseudoperoxidase activity

*Answer: B) Sodium Nitroprusside Reaction

*Question: Which ketone does the reagent strip primarily detect?
A) Acetone
B) Beta-hydroxybutyrate
C) Acetoacetic acid
D) All three equally

*Answer: C) Acetoacetic acid

*Question: What additional reagent does Chemstrip include to detect acetone in ketone testing?
A) Lactose
B) Glycine
C) Sodium nitroprusside
D) Disodium phosphate

*Answer: B) Glycine

*Question: What does the presence of urinary ketones indicate in a patient on insulin therapy?
A) Adequate insulin dosage
B) Hypoglycemia
C) Insufficient insulin dosage
D) Renal glycosuria

*Answer: C) Insufficient insulin dosage

*Question: Which of the following causes a false-positive ketone result?
A) Unpreserved specimen
B) Formalin
C) Large amounts of levodopa and medications with sulfhydryl groups
D) Ascorbic acid

*Answer: C) Large amounts of levodopa and medications with sulfhydryl groups

*Question: Why can a false-negative ketone result occur with an unpreserved specimen?
A) Ketones are oxidized by bacterial enzymes
B) Ketones are volatile and evaporate
C) Bacteria convert ketones to glucose
D) Reagent pads dissolve in unpreserved urine

*Answer: B) Ketones are volatile and evaporate

*Question: Which tablet contains lactose as an ingredient for better color differentiation?
A) Clinitest
B) Ictotest
C) Acetest
D) SSA

*Answer: C) Acetest

*Question: What is the clinically significant threshold for red blood cells in urine?
A) >1 RBC/mL
B) >3 RBCs/mL
C) >5 RBCs/mL
D) >10 RBCs/mL

*Answer: C) >5 RBCs/mL

*Question: Which type of urine appearance is associated with hematuria?
A) Red and clear
B) Red and cloudy
C) Brown and clear
D) Amber and hazy

*Answer: B) Red and cloudy

*Question: What is the most common non-pathologic cause of hematuria?
A) Renal calculi
B) Anticoagulant therapy
C) Strenuous exercise
D) Glomerular disease

*Answer: C) Strenuous exercise

*Question: What is the appearance of urine in hemoglobinuria?
A) Red and cloudy
B) Red and clear
C) Brown and cloudy
D) Yellow and clear

*Answer: B) Red and clear

*Question: What causes hemosiderin granules in renal tubular epithelial cells?
A) Denatured ferritin retained in RTE cytoplasm after hemoglobin reabsorption
B) Bilirubin deposits in tubules
C) Excess glucose in tubules
D) Myoglobin precipitation in nephron

*Answer: A) Denatured ferritin retained in RTE cytoplasm after hemoglobin reabsorption

*Question: What is the heme-containing protein in muscles associated with rhabdomyolysis?
A) Hemoglobin
B) Myoglobin
C) Haptoglobin
D) Ferritin

*Answer: B) Myoglobin

*Question: High concentrations of myoglobin in urine can lead to:
A) Diabetic coma
B) Acute renal failure
C) Liver cirrhosis
D) Hemolytic anemia

*Answer: B) Acute renal failure

*Question: What is the principle of the blood reagent strip reaction?
A) Diazo Reaction
B) Protein Error of Indicators
C) Pseudoperoxidase activity of hemoglobin
D) Double Sequential Enzymatic Reaction

*Answer: C) Pseudoperoxidase activity of hemoglobin

*Question: What reaction pattern on the blood reagent strip pad indicates hematuria?
A) Homogenous reaction
B) Uniform color change
C) Speckled pattern
D) No color change

*Answer: C) Speckled pattern

*Question: What reaction pattern indicates hemoglobinuria or myoglobinuria on the blood pad?
A) Speckled pattern
B) Homogenous reaction
C) Granular pattern
D) No reaction

*Answer: B) Homogenous reaction

*Question: What is the sensitivity of the blood reagent strip?
A) 1 RBC/mL
B) 3 RBCs/mL
C) 5 RBCs/mL
D) 10 RBCs/mL

*Answer: C) 5 RBCs/mL

*Question: Which of the following causes a false-positive blood result on the reagent strip?
A) Ascorbic acid
B) High specific gravity
C) Menstrual contamination
D) Formalin

*Answer: C) Menstrual contamination

*Question: High specific gravity causes false-negative blood results because:
A) RBCs lyse and release hemoglobin too quickly
B) RBCs crenate due to hypertonicity, making hemoglobin harder to release
C) Peroxidase activity increases
D) Ascorbic acid concentration increases

*Answer: B) RBCs crenate due to hypertonicity, making hemoglobin harder to release

*Question: In the ammonium sulfate test, myoglobinuria is identified by:
A) Red supernatant with no precipitate
B) Clear supernatant with red precipitate
C) Homogenous red solution
D) Yellow precipitate

*Answer: B) Clear supernatant with red precipitate

*Question: In the ammonium sulfate test, hemoglobinuria produces:
A) Clear supernatant with red precipitate
B) Red supernatant with no precipitate
C) Pale yellow supernatant
D) Turbid red solution

*Answer: B) Red supernatant with no precipitate

*Question: Which bilirubin fraction is water-soluble and can appear in urine?
A) B1 (unconjugated bilirubin)
B) B2 (conjugated bilirubin)
C) Indirect bilirubin
D) Bilirubin monoglucuronide

*Answer: B) B2 (conjugated bilirubin)

*Question: Which enzyme converts B1 to B2 bilirubin?
A) Peroxidase
B) Glucose oxidase
C) Glucuronyl transferase
D) Leukocyte esterase

*Answer: C) Glucuronyl transferase

*Question: What gives stool its brown color?
A) Urobilinogen
B) Urobilin
C) Stercobilin
D) Biliverdin

*Answer: C) Stercobilin

*Question: In pre-hepatic jaundice, what is the expected urine bilirubin result?
A) Strongly positive
B) Moderately positive
C) Negative (already converted)
D) Trace positive

*Answer: C) Negative (already converted)

*Question: In post-hepatic jaundice, what is the expected urobilinogen result on the reagent strip?
A) Markedly increased
B) Decreased or absent
C) Normal (reagent strip assumes presence)
D) Doubled

*Answer: C) Normal (reagent strip assumes presence)

*Question: What causes post-hepatic jaundice?
A) Intravascular hemolysis
B) Hepatitis
C) Bile duct obstruction
D) Liver cirrhosis

*Answer: C) Bile duct obstruction

*Question: Post-hepatic jaundice is associated with what stool appearance?
A) Dark brown stool
B) Bloody stool
C) Pale/white stool
D) Black tarry stool

*Answer: C) Pale/white stool

*Question: What is the principle of the bilirubin reagent strip reaction?
A) Greiss Reaction
B) Diazo Reaction
C) Pseudoperoxidase activity
D) Protein Error of Indicators

*Answer: B) Diazo Reaction

*Question: What is the positive color reaction of the Ictotest for bilirubin?
A) Pink to red
B) Yellow to green
C) Blue to purple
D) Orange to brown

*Answer: C) Blue to purple

*Question: How much more sensitive is the Ictotest compared to the reagent strip for bilirubin?
A) 2x
B) 4x
C) 6x
D) 10x

*Answer: B) 4x

*Question: What causes a false-negative bilirubin result on the reagent strip?
A) Indican
B) Highly pigmented urine
C) Photooxidation of bilirubin
D) Metabolites of Lodine

*Answer: C) Photooxidation of bilirubin

*Question: What is the normal urinary urobilinogen level?
A) <5 mg/dL
B) <1 mg/dL or <1 Ehrlich Unit
C) <30 mg/dL
D) <10 Ehrlich Units

*Answer: B) <1 mg/dL or <1 Ehrlich Unit

*Question: What is urobilinogen converted to in an old specimen?
A) Bilirubin
B) Stercobilin
C) Urobilin
D) Biliverdin

*Answer: C) Urobilin

*Question: What is the principle of urobilinogen detection using Multistix?
A) Diazo Reaction
B) Greiss Reaction
C) Ehrlich Reaction
D) Pseudoperoxidase activity

*Answer: C) Ehrlich Reaction

*Question: Which reagent does Multistix use for urobilinogen detection?
A) Diazonium salt
B) p-dimethylaminobenzaldehyde (Ehrlich's Reagent)
C) Sodium nitroprusside
D) Tetramethylbenzidine

*Answer: B) p-dimethylaminobenzaldehyde (Ehrlich's Reagent)

*Question: Which substance is an Ehrlich reactive substance that causes false-positive urobilinogen on Multistix?
A) Ascorbic acid
B) Porphobilinogen
C) Formalin
D) Nitrite

*Answer: B) Porphobilinogen

*Question: Why does old specimen cause false-negative urobilinogen?
A) Bacteria consume urobilinogen
B) Urobilinogen converts to urobilin
C) Urobilinogen oxidizes to bilirubin
D) Formalin interferes with the reaction

*Answer: B) Urobilinogen converts to urobilin

*Question: In which conditions is urobilinogen increased?
A) Post-hepatic jaundice and bile duct obstruction
B) Pre-hepatic and hepatic jaundice
C) Renal glycosuria and tubular proteinuria
D) Fanconi syndrome and cystinosis

*Answer: B) Pre-hepatic and hepatic jaundice

*Question: What is the principle of the nitrite reagent strip reaction?
A) Diazo Reaction
B) Ehrlich Reaction
C) Greiss Reaction
D) Pseudoperoxidase activity

*Answer: C) Greiss Reaction

*Question: Which bacteria produce a false-negative nitrite result because they lack reductase?
A) Gram-negative bacteria
B) E. coli
C) Gram-positive bacteria
D) Pseudomonas

*Answer: C) Gram-positive bacteria

*Question: What is the minimum contact time needed for a valid nitrite test?
A) 1 hour
B) 2 hours
C) 4 hours
D) 8 hours

*Answer: C) 4 hours

*Question: Which is the best specimen for nitrite testing?
A) Random urine
B) 2-hour post-prandial specimen
C) First morning urine
D) Midstream clean-catch specimen

*Answer: C) First morning urine

*Question: Heavy bacterial infection can cause a false-negative nitrite result because:
A) Bacteria inhibit the Greiss reaction
B) Bacteria further reduce nitrite to nitrogen
C) Bacteria produce ascorbic acid
D) pH becomes too alkaline for the reaction

*Answer: B) Bacteria further reduce nitrite to nitrogen

*Question: Nitrite results are read as:
A) Quantitative (mg/dL)
B) Graded 1+ to 4+
C) Positive or negative (dichotomous)
D) Reported in Ehrlich units

*Answer: C) Positive or negative (dichotomous)

*Question: What is the aromatic amine used in Multistix for nitrite detection?
A) Sulfonilamide
B) p-arsinilic acid
C) Tetrahydrobenzoquinolin
D) Tetramethylbenzidine

*Answer: B) p-arsinilic acid

*Question: Leukocyte esterase is present in which type of white blood cells?
A) Monocytes and lymphocytes
B) Granulocytes
C) Basophils and eosinophils only
D) Lymphocytes

*Answer: B) Granulocytes