Urinalysis and Body Fluids (BOC)

After receiving a 24-hour urine for quantitative total protein analysis, the technician must first:

a. subculture the urine for bacteria
b. add the appropriate preservative
c. screen for albumin using a dipstick
d. measure the total volume

d. measure the total volume

False results in urobilinogen testing may occur if the urine specimen is:

a. exposed to light
b. adjusted to a neutral pH
c. cooled to a room temperature
d. collected in a nonsterile container

a. exposed to light

A clean-catch urine is submitted to the laboratory for routine urinalysis and culture. The routine urinalysis is done first, and 3 hours later, the specimen is sent to the microbiology department for culture. The specimen should:

a. be centrifuged, and the supernatant cultured
b. be rejected due to the time delay
c. not be cultured if no bacteria are seen
d. be processed for culture only if the nitrate is positive

b. be rejected due to the time delay

Which of the following urine results is most apt to be changed by prolonged exposure to light?

a. pH
b. protein
c. ketones
d. bilirubin

d. bilirubin

Urine samples should be examined within 1 hour of voiding because:

a. RBCs, leukocytes and casts agglutinate on standing for several hours at room temperature
b. urobilinogen increases and bilirubin decreases after prolonged exposure to light
c. bacterial contamination will cause alkalinization of the urine
d. ketones will increase due to bacterial and cellular metabolism

c. bacterial contamination will cause alkalinization of the urine

The following results were obtained on a urine specimen at 8:00 am:

pH: 5.5
protein: 2+
glucose: 3+
ketones: 3+
blood: negative
bilirubin: positive
nitrite: positive

If this urine specimen was stored uncapped at 5C without preservation and retested at 2pm, which of the following test results would be changed due to these storage conditions?

a. glucose
b. ketones
c. protein
d. nitrite

b. ketones

A urine specimen comes to the laboratory 7 hours after it is obtained. It is acceptable for culture only if the specimen has been stored:

a. at room temperature
b. at 4-7C
c. frozen
d. with a preservative additive

b. at 4-7C

Which of the following would be affected by allowing a urine specimen to remain at room temperature for 3 hours before analysis?

a. occult blood
b. specific gravity
c. pH
d. protein

c. pH

A 24-hour urine from a man who had no evidence of kidney impairment was sent to the laboratory for hormone determination. The volume was 600 mL, but there was some question as to the completeness of the 24-hour collection. The next step would be to:

a. perform the hormone determination, since 600 mL is a normal 24-hour urine volume
b. check the creatinine level; if it is <1 g, do the procedure
c. report the hormone determination in mg/dL in case the specimen was incomplete
d. check the creatinine level; if it is >1 g, do the procedure

d. check the creatinine level; if it is >1 g, do the procedure

Failure to observe RBC casts in a urine specimen can be caused by:

a. staining the specimen
b. centrifuging an unmixed specimen
c. mixing the sediment after decantation
d. examining the sediment first under low power

b. centrifuging an unmixed specimen

eGFR calculated by the MDRD formula takes into account the age, BUN, race, albumin and what else for its calculations?

a. urea
b. ammonia
c. creatinine
d. cystatin C

c. creatinine

The creatinine clearance is reported in:

a. mg/dL
b. mg/24 hours
c. mL/min
d. mL/24 hours

c. mL/min

Microalbumin can be measure by a random urine collection. An inicreased microalbumin is predictive of:

a. diabetes mellitus
b. nephropathy
c. hypertension
d. nephrotic syndrome

b. nephropathy

A patient with uncontrolled diabetes mellitus will most likely have:

a. pale urine with a high specific gravity
b. concentrated urine with a high specific gravity
c. pale urine with a low specific gravity
d. dark urine with a high specific gravity

a. pale urine with a high specific gravity

While performing an analysis of a baby's urine, the technologist notices the specimen to have a "mousy" odor. Of the following substances that may be excreted in urine, the one that most characteristically produces this odor is:

a. phenylpyruvic acid
b. acetone
c. coliform bacilli
d. porphyrin

a. phenylpyruvic acid

An ammonia-like odor is characteristically associated with urine from patients who:

a. are diabetic
b. have hepatitis
c. have an infection with Proteus sp.
d. have a yeast infection

c. have an infection with Proteus sp.

Urine that develops a port wine color after standing may contain:

a. melanin
b. porphyrins
c. bilirubin
d. urobilinogen

b. porphyrins

Acid urine that contains hemoglobin will darken on standing due to the formation of:

a. myoglobin
b. sulfhemoglobin
c. methemoglobin
d. red blood cells

c. methemoglobin

Urine from a 50-year-old man was noted to turn dark red on standing. This change is caused by:

a. glucose
b. porphyrins
c. urochrome
d. creatinine

b. porphyrins

The clarity of a urine sample should be determined:

a. using glass tubes only; never plastic
b. following thorough mixing of the specimen
c. after addition of sulfosalicylic acid
d. after the specimen cools to room temperature

b. following thorough mixing of the specimen

Milky urine form a 24-year-old woman would most likely contain:

a. spermatozoa
b. many white blood cells
c. red blood cells
d. bilirubin

b. many white blood cells

A brown-black urine would most likely contain:

a. bile pigment
b. porphyrins
c. melanin
d. blood cells

c. melanin

The yellow color of urine is primarily due to

a. urochrome pigment
b. methemoglobin
c. bilirubin
d. homogenistic acid

a. urochrome pigment

Red urine may be due to

a. bilirubin
b. excess urobilin
c. myoglobin
d. homogenistic acid

c. myoglobin

A urine specimen collected on an apparently healthy 25-year-old man shortly after he finished eating lunch was cloudy but showed normal results on a multiple reagent strip analysis. The most likely cause of the turbidity is

a. fat
b. white blood cells
c. urates
d. phosphates

d. phosphates

In which of the following metabolic diseases will urine turn dark brown to black upon standing?

a. phenylketonuria
b. alkaptonuria
c. maple syrup disese
d. aminoaciduria

b. alkaptonuria

Urine osmolality is related to:

a. pH
b. filtration
c. specific gravity
d. volume

c. specific gravity

Urine specific gravity is an index of the ability of the kidney to:

a. filter the plasma
b. concentrate the urine
c. alter the hydrogen ion concentration
d. reabsorb sodium ions

b. concentrate the urine

Osmolality is a measure of:

a. dissolved particles, including ions
b. undissociated molecules only
c. total salt concentration
d. molecule size

a. dissolved particles, including ions

A patient urine sample has an increased protein and a high specific gravity. Which of the following would be a more accurate measure of urine concentration?

a. osmolality
b. ketones
c. refractive index
d. pH

a. osmolality

To prepare a solution appropriate for quality control of the refractometer, a technician should use:

a. urea with a specific gravity of 1.040
b. water with a specific gravity of 1.005
c. sodium chloride with a specific gravity of 1.022
d. calcium chloride with an osmolarity of 460

c. sodium chloride with a specific gravity of 1.022

A urine's specific gravity is directly proportional to its:

a. turbidity
b. dissolved solids
c. salt content
d. sugar content

b. dissolved solids

Isosthenuria is associated with a specific gravity which is usually:

a. variable between 1.001 and 1.008
b. variable between 1.015 and 1.022
c. fixed around 1.010
d. fixed around 1.020

c. fixed around 1.010

The fluid leaving the glomerulus normally has a specific gravity of:

a. 1.001
b. 1.010
c. 1.020
d. 1.030

b. 1.010

An antidiuretic hormone deficiency is associated with a:

a. specific gravity around 1.031
b. low specific gravity
c. high specific gravity
d. variable specific gravity

b. low specific gravity

Use of a refractometer over a urinometer is preferred due to the fact that the refractometer uses:

a. large volume of urine and compensates for temperature
b. small volume of urine and compensates for glucose
c. small volume of urine and compensates for temperature
d. small volume of urine and compensates for protein

c. small volume of urine and compensates for temperature

Calibration of refractometers is done by measuring the specific gravity of distilled water and:

a. protein
b. glucose
c. sodium chloride
d. urea

c. sodium chloride

The method of choice for performing a specific gravity measurement of urine following administration of x-ray contrast dyes is:

a. reagent strip
b. refractometer
c. urinometer
d. densitometer

a. reagent strip

Which of the following urinary parameters are measured during the course of concentration and dilution tests to assess renal tubular function?

a. urea, nitrogen and creatinine
b. osmolality and specific gravity
c. sodium and chloride
d. sodium and osmolality

b. osmolality and specific gravity

Refractive index is a comparison of:

a. light velocity in solutions to light velocity in solids
b. light velocity in air to light velocity in solutions
c. light scattering by air to light scattering by solutions
d. light scattering by particles in solution

b. light velocity in air to light velocity in solutions

Which of the following can give a false-negative urine protein reading?

a. contamination with vaginal discharge
b. heavy mucus
c. presence of blood
d. very dilute urine

d. very dilute urine

The pH of a urine specimen measures the:

a. free sodium ions
b. free hydrogen ions
c. total acid excretion
d. volatile acids

b. free hydrogen ions

Upon standing at room temperature, a urine pH typically:

a. decreases
b. increases
c. remains the same
d. changes depending on bacterial concentration

b. increases

Urine reagent strips should be stored in a(n):

a. refrigerator (4-7C)
b. incubator (37C)
c. cool dry area
d. open jar exposed to air

c. cool dry area

The principle of the reagent strip test for urine protein depends on:

a. an enzyme reaction
b. protein error of indicators
c. copper reduction
d. the toluidine reaction

b. protein error of indicators

The protein section of the urine reagent strip is most sensitive to:

a. albumin
b. mucoprotein
c. Bence Jones protein
d. globulin

a. albumin

Routine screening of urine samples for glycosuria is performed primarily to detect:

a. glucose
b. galactose
c. bilirubin
d. ketones

a. glucose

Which of the following reagents is used to react with ketones in the urine?

a. sodium nitroprusside
b. acetoacetic acid
c. acetone
d. beta-hydroxybutyric acid

a. sodium nitroprusside

A test area of a urine reagent strip is impregnated with only sodium nitroprusside. This section will react with:

a. acetoacetic (diacetic) acid
b. leukocyte esterase
c. beta-hydroxybutyric acid
d. ferric chloride

a. acetoacetic (diacetic) acid

A reagent strip area impregnated with stabilized, diazotized 2,4 - dichloroaniline will yield a positive reaction with:

a. bilirubin
b. hemoglobin
c. ketones
d. urobilinogen

a. bilirubin

Which of the following factors will not interfere with the reagent strip test for leukocytes?

a. ascorbic acid
b. formaldehyde
c. nitrite
d. urinary protein level of 500 mg/dL

c. nitrite

Excess urine on the reagent strip can turn a normal pH result into a falsely acidic pH when which of the following reagents runs into the pH pad?

a. tetrabromphenol blue
b. citrate buffer
c. glucose oxidase
d. alkaline copper sulfate

b. citrate buffer

When employing the urine reagent strip method, a false-positive protein result may occur in the presence of:

a. large amounts of glucose
b. x-ray contrast media
c. Bence Jones protein
d. highly alkaline urine

d. highly alkaline urine

A 17-year-old girl decided to go on a starvation diet. After 1 week of starving herself, what substance would most likely be found in her urine?

a. protein
b. ketones
c. glucose
d. blood

b. ketones

A 2-year-old child had a positive urine ketone. This would most likely be caused by:

a. vomiting
b. anemia
c. hypoglycemia
d. biliary tract obstruction

a. vomiting

A patient's urinalysis revealed a positive bilirubin and a decreased urobilinogen level. These results are associated with:

a. hemolytic disease
b. biliary obstruction
c. hepatic disease
d. urinary tract infection

b. biliary obstruction

A urine specimen with an elevated urobilinogen and a negative bilirubin may indicate:

a. obstruction of the biliary tract
b. viral hepatitis
c. hemolytic jaundice
d. cirrhosis

c. hemolytic jaundice

Microscopic analysis of a urine specimen yields a moderate amount of red blood cells in spite of a negative result for occult blood using a reagent strip. The technologist should determine if this patient has taken:

a. vitamin C
b. a diuretic
c. high blood pressure medicine
d. antibiotics

a. vitamin C

The purpose for routinely screening diabetes mellitus patients for microalbuminuria is to monitor the development of:

a. urinary tract infection
b. renal disease
c. yeast infections
d. diabetes insipidus

b. renal disease

The principle of the reagent strip test for microalbuminuria is:

a. a diazo reaction
b. the protein error of indicators
c. a dye-binding reaction
d. the release of hydrogen ions to an indicator

c. a dye-binding reaction

The reason that an albumin:creatinine ratio can be run on a random specimen is:

a. creatinine corrects for over or under body hydration
b. a first morning specimen may be too concentrated
c. albumin corrects for over or under body hydration
d. the reaction is sensitive to any level of albumin

a. creatinine corrects for over or under body hydration

To prepare the reagent used in confirmatory protein testing, a technician would:

a. dissolve 3 g sulfosalicylic acid in 100 mL of water
b. dissolve 5 g trichloroacetic acid in 100 mL of water
c. combine 3 mL of hydrochloric acid and 97 mL of water
d. combine 5 mL of glacial acetic acid and 95 mL of water

a. dissolve 3 g sulfosalicylic acid in 100 mL of water

A positive result for bilirubin on a reagent strip should be followed up by:

a. notifying the physician
b. requesting a new specimen
c. performing an Ictotest
d. performing a urobilinogen

c. performing an Ictotest

Ammonium sulfate was added to red urine. The urine had a positive reaction for blood, but no RBCs were seen on microscopic examination. After centrifugation the supernatant fluid is red. The abnormal color is caused by:

a. pyridium
b. hemoglobin
c. porphyrins
d. myoglobin

d. myoglobin

A urine tested with Clinitest exhibits a passthrough reaction and is diluted by adding 2 drops of urine to 10 drops water. This is a dilution of:

a. 1:4
b. 1:5
c. 1:6
d. 1:8

c. 1:6

When performing a routine urinalysis, the technologist notes a 2+ protein result. He should:

a. request another specimen
b. confirm with the acid precipitation test
c. test for Bence Jones protein
d. report the result obtained without further testing

b. confirm with the acid precipitation test

The confirmatory test for a positive protein result by the reagent strip method uses:

a. Ehrlich reagent
b. a diazo reaction
c. sulfosalicylic acid
d. a copper reduction tablet

c. sulfosalicylic acid

A urine specimen is analyzed for glucose by a glucose oxidase reagent strip and a copper reduction test. If both results are positive, which of the following interpretations is correct?

a. galactose is present
b. glucose is present
c. lactose is not present
d. sucrose is not present

b. glucose is present

A woman in her ninth month of pregnancy has a urine sugar which is negative with the urine reagent strip, but gives a positive reaction with the copper reduction method. The sugar most likely responsible for these results is:

a. maltose
b. galactose
c. glucose
d. lactose

d. lactose

A urinalysis performed on a 2-week-old infant with diarrhea shows a negative reaction with the glucose oxidase reagent strip. A copper reduction tablet test should be performed to check the urine sample for the presence of:

a. glucose
b. galactose
c. bilirubin
d. ketones

b. galactose

When using the sulfosalicylic acid test, false-positive protein results may occur in the presence of:

a. ketones
b. alkali
c. glucose
d. radiographic contrast media

d. radiographic contrast media

Which of the following is the primary reagent in the copper reduction tablet?

a. sodium carbonate
b. copper sulfate
c. glucose oxidase
d. polymerized diazonium salt

b. copper sulfate

In most compound light microscopes, the ocular lens has a magnification of:

a. 10x
b. 40x
c. 50x
d. 100x

a. 10x

The best way to lower the light intensity of the microscope is to:

a. lower the condenser
b. adjust the aperture diaphragm
c. lower the rheostat
d. raise the condenser

c. lower the rheostat

The advantage to using phase microscopy in urinalysis is to:

a. provide higher magnification
b. enhance constituents with a low refractive index
c. allow constituents to stain more clearly
d. provide a larger field of view

b. enhance constituents with a low refractive index

The presence of leukocytes in urine is known as:

a. chyluria
b. hematuria
c. leukocytosis
d. pyuria

d. pyuria

Oval fat bodies are:

a. squamous epithelial cells that contain lipids
b. renal tubular epithelial cells that contain lipids
c. free-floating fat droplets
d. white blood cells with phagocytized lipids

b. renal tubular epithelial cells that contain lipids

A microscopic examination of urine sediment reveals ghost cells. These red blood cells seen in urine with a:

a. >2% glucose concentrations
b. specific gravity <1.007
c. large amounts of ketone bodies
d. neutral pH

b. specific gravity <1.007

Glitter cells are a microscopic finding of:

a. red blood cells in hypertonic urine
b. red blood cells in hypotonic urine
c. white blood cells in hypertonic urine
d. white blood cells in hypotonic urine

d. white blood cells in hypotonic urine

What cell is most commonly associated with vaginal contamination?

a. white
b. transitional
c. squamous
d. glitter

c. squamous

A reagent strip test for blood has been reported positive. Microscopic examination fails to yield red blood cells. This patient's condition can be called:

a. hematuria
b. hemoglobinuria
c. oliguria
d. hemosiderinuria

b. hemoglobinuria

Ghost red blood cells are seen in urine that is:

a. acidic and dilute
b. alkaline and dilute
c. acidic and concentrated
d. alkaline and concentrated

b. alkaline and dilute

The possibility of detecting glitter cells is associated with urine that is:

a. acidic
b. dilute
c. alkaline
d. concentrated

b. dilute

An eosinophil count may be requested on urine from a patient with suspected:

a. acute glomerulonephritis
b. cystitis
c. renal lithiasis
d. acute interstitial nephritis

d. acute interstitial nephritis

Clue cells are a form of:

a. squamous epithelial cell
b. urothelial cell
c. white blood cell
d. renal tubular epithelial cell

a. squamous epithelial cell

Which of the following cells is most likely to be seen in the urine sediment following a catheterization procedure?

a. squamous epithelial cell
b. urothelial cell
c. white blood cell
d. renal tubular epithelial cell

b. urothelial cell

A patient admitted following an accident involving massive crush injuries has the following urinalysis results:

color: red brown
clarity: clear
specific gravity: 1.011
pH: 6.0
protein: 1+
blood: large
glucose, ketones, nitrite, leukocytes, bilirubin, urobilinogen: all negative

Microscopic findings: renal tubular epithelial: 5-10
renal tubular cell casts: 1-2

The discrepancy between the large amount of blood and the absence of RBCs on microscopy is caused by:
a. failure to mix the specimen before centrifuging
b. mistaking RBCs for RTE cells
c. contaminating oxidizing detergents in the container
d. the presence of myoglobin in the urine specimen

d. the presence of myoglobin in the urine specimen

(PICTURE)

What is the most likely diagnosis given this microscopic finding?

a. glomerulonephritis
b. pyelonephritis
c. nephrotic syndrome
d. cystitis

d. cystitis

(PICTURE)

Identify the formed element in this photomicrograph:

a. RBC
b. WBC
c. epithelial cell
d. yeast

a. RBC

All casts typically contain:

a. albumin
b. globulin
c. immunoglobulins G and M
d. Tamm-Horsfall glycoprotein

d. Tamm-Horsfall glycoprotein

Hyaline casts are usually found:

a. in the center of the coverslip
b. under subdued light
c. under very bright light
d. in the supernatant

b. under subdued light

Which of the following casts is most likely to be found in healthy people?

a. hyaline
b. red blood cell
c. waxy
d. white blood cell

a. hyaline

Which of the following casts is most indicative of end stage renal disease?

a. hemoglobin
b. granular
c. cellular
d. waxy

d. waxy

A technologist performed a STAT microscopic urinalysis and reported the following:

WBC: 10-13
RBC: 2-6
hyaline casts: 5-7
bacteria: 1+

The centrifuge tube was not discarded and the urine sediment was reevaluated microscopically 5 hours after the above results were reported. A second technologist reported the same results, except 2+ bacteria and no hyaline casts were found. The most probable explanation for the second technologist's findings is:

a. sediment was not agitated before preparing the microscope slide
b. casts dissolved due to decrease in urine pH
c. casts dissolved due to increase in urine pH
d. casts were never present in this specimen

c. casts dissolved due to increase in urine pH

Which of the following aids in differentiating a spherical transitional cell from a round renal tubular cell?

a. spherical transitional cell is larger
b. eccentrically-placed nucleus in the renal tubular cell
c. eccentrically-placed nucleus in the spherical transitional cell
d. round renal tubular cell is larger

b. eccentrically-placed nucleus in the renal tubular cell

The urine microscopic constituents that best differentiate between cystitis and pyelonephritis are:

a. WBCs
b. bacteria
c. RBCs
d. WBC casts

d. WBC casts

Epithelial cell casts are most indicative of:

a. glomerulonephritis
b. nephrotic syndrome
c. tubular necrosis
d. pyelonephritis

c. tubular necrosis

Granular casts found in the urine of a football player admitted to the hospital with a broken leg occurring during the game can be the result of:

a. excessive bruising
b. strenuous exercise
c. excess power drink ingestion
d. bone fracture

b. strenuous exercise

Which of the following casts most frequently appears to have a brittle consistency?

a. hyaline
b. granular
c. waxy
d. fatty

c. waxy

To distinguish between a clump of WBCs and a WBC cast, it is important to observe:

a. the presence of free-floating WBCs
b. a positive leukocyte reaction
c. a positive nitrite reaction
d. the presence of a cast matrix

d. the presence of a cast matrix