ee finals cm

Which of the following dyes are used to make Sternheimer-Malbin stain?

A. Hematoxylin and eosin

B. Crystal violet and safranin

C. Methylene blue and eosin

D. Methylene blue and safranin

Body fluids/Apply principles of basic laboratory procedures/Staining/1

b

Which of the following statements regarding WBCs in urinary sediment is true?

A.“Glitter cells” seen in urinary sediment are a sign of renal disease

B. Bacteriuria in the absence of WBCs indicates lower urinary tract infection (UTI)

C. WBCs other than PMNs are not found in urinary sediment

D. WBC casts indicate that pyuria is of renal, rather than lower urinary, origin

Body fluids/Correlate clinical and laboratory data/Urinary sediment/2

d

Which description of urinary sediment with the Sternheimer-Malbin stain is correct?

A. Transitional epithelium: cytoplasm pale blue, nucleus dark blue

B. Renal epithelium: cytoplasm light blue, nucleus dark purple

C. Glitter cells: cytoplasm dark blue, nucleus dark purple

D. Squamous epithelium: cytoplasm pink, nucleus pale blue

Body fluids/Apply knowledge of fundamental biological characteristics/Staining/2

a

SITUATION: A 5-mL urine specimen is submitted for routine urinalysis and is

analyzed immediately. The SG of the sample is 1.012, and the pH is 6.5. The dry reagent

strip blood test result is a large positive (3+), and the microscopic examination shows 11

to 20 RBCs/HPF. The leukocyte esterase reaction is a small positive (1+), and the

microscopic examination shows 0 to 2 WBCs/HPF. What is the most likely cause of these

results?

A. Myoglobin is present in the sample

B. Free hemoglobin is present

C. Insufficient volume is causing microscopic results to be underestimated

D. Some WBCs have been misidentified as RBCs

Body fluids/Apply knowledge to identify sources of error/Urinalysis/3

C

5. Which of the following statements regarding epithelial cells in the urinary system is

correct?

A. Caudate epithelial cells originate from the upper urethra

B. Transitional cells originate from the upper urethra, ureters, bladder, or renal pelvis

C. Cells from the proximal renal tubule are usually round

D. Squamous epithelium line the vagina, urethra, and wall of the urinary bladder

Body fluids/Apply knowledge of fundamental biological characteristics/Urine sediment/2

B.

Which of the statements regarding examination of unstained urinary sediment is true?

A. Renal cells can be differentiated reliably from WBCs

B. Large numbers of transitional cells are often seen after catheterization

C. Neoplastic cells from the bladder are not found in urinary sediment

D. RBCs are easily differentiated from nonbudding yeast

Body fluids/Correlate clinical and laboratory data/Urine sediment/2

B

Which of the following statements regarding cells found in urinary sediment is true?

A. Transitional cells resist swelling in hypotonic urine

B. Renal tubular cells are often polyhedral and have an eccentric round nucleus

C. Trichomonads have an oval shape with a prominent nucleus and a single anterior

flagellum

D. Clumps of bacteria are frequently mistaken for blood casts

Body fluids/Apply knowledge of fundamental biological characteristics/Urine sediment/2

B

Which of the following statements regarding RBCs in the urinary sediment is true?

A. Yeast cells will lyse in dilute acetic acid but RBCs will not

B. RBCs are often swollen in hypertonic urine

C. RBCs of glomerular origin often appear dysmorphic

D. Yeast cells will tumble when the cover glass is touched, but RBCs will not

Body fluids/Apply knowledge of fundamental biological characteristics/Urine sediment/2

C

Renal tubular epithelial cells are shed into urine in largest numbers in which condition?

A. Malignant renal disease

B. Acute glomerulonephritis

C. Nephrotic syndrome

D. Cytomegalovirus (CMV) infection of the kidney

Body fluids/Evaluate laboratory data to recognize health and disease states/Urinary

sediment/2

D

The ova of which parasite is likely be found in the urinary sediment?

A. Trichomonas vaginalis

B. Entamoeba histolytica

C. Schistosoma hematobium

D. Trichuris trichiura

Body fluids/Apply knowledge of fundamental biological characteristics/Urinary sediment/1

C

Oval fat bodies are often seen in:

A. Chronic glomerulonephritis

B. Nephrotic syndrome

C. Acute tubular nephrosis

D. Renal failure of any cause

Body fluids/Correlate clinical and laboratory data/Urine sediment/2

B

12. Which statement regarding urinary casts is true?

A. Many hyaline casts may appear in urinary sediment after jogging or exercise

B. The finding of even a single cast indicates renal disease

C. Casts can be seen in significant numbers even when protein tests are negative

D. Hyaline casts will dissolve readily in acid urine

A

Which condition promotes the formation of casts in urine?

A. Chronic production of alkaline urine

B. Polyuria

C. Reduced filtrate formation

D. Low urine SG

Body fluids/Apply knowledge of fundamental characteristics/Urine casts/2

C

 The mucoprotein that forms the matrix of a hyaline cast is called:

A. Bence-Jones protein

B. β-Microglobulin

C. Tamm-Horsfall protein

D. Arginine-rich glycoprotein

C

“Pseudocasts” are often caused by:

A. A dirty cover glass or slide

B. Bacterial contamination

C. Amorphous urates

D. Mucus in urine

C

Which of the following statements regarding urinary casts is correct?

A. Fine granular casts are more significant than coarse granular casts

B. Cylindruria is always clinically significant

C. The appearance of cylindroids signals the onset of end-stage renal disease

D. Broad casts are associated with severe renal tubular obstruction

D

A sediment with moderate hematuria and RBC casts most likely results from:

A. Chronic pyelonephritis

B. Nephrotic syndrome

C. Acute glomerulonephritis

D. Lower urinary tract obstruction

C

Urine sediment characterized by pyuria with bacterial and WBC casts indicates:

A. Nephrotic syndrome

B. Pyelonephritis

C. Polycystic kidney disease

D. Cystitis

B

Which type of casts signals the presence of chronic renal failure?

A. Blood casts

B. Fine granular casts

C. Waxy casts

D. Fatty casts

C

SITUATION: Urinalysis of a sample from a patient suspected of having a transfusion

reaction reveals small, yellow-brown crystals in the microscopic examination. Dry

reagent strip tests are normal with the exception of a positive blood reaction (moderate)

and trace positive protein. The pH of urine is 6.5. What test should be performed to

positively identify the crystals?

A. Confirmatory test for bilirubin

B. Cyanide–nitroprusside test

C. Polarizing microscopy

D. Prussian blue stain

D

When examining urinary sediment, which of the following is considered an abnormal

finding?

A. 2 RBCs/HPF

B. 1 hyaline cast per low-power field (LPF)

C. 1 renal cell cast per LPF

D. 5 WBCs/HPF

C

SITUATION: A urine sample with a pH of 6.0 produces an abundance of pink sediment

after centrifugation that appears as densely packed yellow- to reddish-brown granules

under the microscope. The crystals are so dense that no other formed elements can be

evaluated. What is the best course of action?

A. Request a new urine specimen

B. Suspend the sediment in prewarmed saline, and then repeat centrifugation

C. Acidify a 12-mL aliquot with three drops of glacial acetic acid, and heat to 56°C for 5

minutes before centrifuging

D. Add five drops of 1N HCl to the sediment and examine

B

How can hexagonal uric acid crystals be distinguished from cystine crystals?

A. Cystine is insoluble in hydrochloric acid, but uric acid is soluble

B. Cystine gives a positive nitroprusside test after reduction with sodium cyanide

C. Cystine crystals are more highly pigmented

D. Cystine crystals form at neutral or alkaline pH, uric acid forms at neutral to acidic pH

B

The presence of tyrosine and leucine crystals together in urinary sediment usually

indicates:

A. Renal failure

B. Chronic liver disease

C. Hemolytic anemia

D. Hartnup disease

B

Which of the following crystals is considered nonpathological?

A. Hemosiderin

B. Bilirubin

C. Ammonium biurate

D. Cholesterol

C

At which pH are ammonium biurate crystals usually found in urine?

A. Acid urine only

B. Acid or neutral urine

C. Neutral or alkaline urine

D. Alkaline urine only

D

Which of the following crystals is seen commonly in alkaline and neutral urine?

A. Calcium oxalate

B. Uric acid

C. Magnesium ammonium phosphate

D. Cholestero

C

Which crystal appears in urine as a long, thin hexagonal plate and is linked to ingestion

of large amounts of benzoic acid?

A. Cystine

B. Hippuric acid

C. Oxalic acid

D. Uric acid

B

Small, yellow needles are seen in the sediment of a urine sample with a pH of 6.0. Which

of the following crystals can be ruled out?

A. Sulfa crystals

B. Bilirubin crystals

C. Uric acid crystals

D. Cholesterol crystals

D

Oval fat bodies are derived from:

A. Renal tubular epithelium

B. Transitional epithelium

C. Degenerated WBCs

D. Mucoprotein matrix

A

Oval fat bodies are often associated with:

A. Lipoid nephrosis

B. Acute glomerulonephritis

C. Aminoaciduria

D. Pyelonephritis

A

Urine of constant SG ranging from 1.008 to 1.010 most likely indicates:

A. Addison disease

B. Renal tubular failure

C. Prerenal failure

D. Diabetes insipidus

B

Which of the following characterizes prerenal failure, and helps to differentiate it from

acute renal failure caused by renal disease?

A. BUN:creatinine ratio of 20:1 or higher

B. Urine:plasma osmolal ratio less than 2:1

C. Excess loss of sodium in urine

D. Dehydration

A

Which of the following conditions characterizes chronic glomerulonephritis and helps

differentiate it from acute glomerulonephritis?

A. Hematuria

B. Polyuria

C. Hypertension

D. Azotemia

B

Which of the following conditions is seen in acute renal failure and helps differentiate it

from prerenal failure?

A. Hyperkalemia and uremia

B. Oliguria and edema

C. Low creatinine clearance

D. Abnormal urinary sediment

D

Which of the following conditions characterizes acute renal failure and helps

differentiate it from chronic renal failure?

A. Hyperkalemia

B. Hematuria

C. Cylindruria

D. Proteinuria

A

The serum concentration of which analyte is likely to be decreased in untreated cases of

acute renal failure?

A. Hydrogen ions

B. Inorganic phosphorus

C. Calcium

D. Uric acid

C

Which of the following conditions is associated with the greatest proteinuria?

A. Acute glomerulonephritis

B. Chronic glomerulonephritis

C. Nephrotic syndrome

D. Acute pyelonephritis

C

Which of the following conditions is often a cause of glomerulonephritis?

A. Hypertension

B. CMV infection

C. Systemic lupus erythematosus (SLE)

D. Heavy metal poisoning

C

Acute pyelonephritis is commonly caused by:

A. Bacterial infection of medullary interstitium

B. Circulatory failure

C. Renal calculi

D. Antigen–antibody reactions within the glomeruli

A

Which of the following is associated with nephrotic syndrome?

A. Hyperlipidemia

B. Uremia

C. Hematuria and pyuria

D. Dehydration

A

Which of the following conditions is a characteristic finding in patients with obstructive

renal disease?

A. Polyuria

B. Azotemia

C. Dehydration

D. Alkalosis

B

Whewellite and weddellite kidney stones are composed of:

A. Magnesium ammonium phosphate

B. Calcium oxalate

C. Calcium phosphate

D. Calcium carbonate

B

Which of the following abnormal crystals is often associated with formation of renal

calculi?

A. Cystine

B. Ampicillin

C. Tyrosine

D. Leucine

A

Which statement about renal calculi is true?

A. Calcium oxalate and calcium phosphate account for about three-fourths of all stones

B. Uric acid stones can be seen on radiography

C. Triple phosphate stones are found principally in the ureters

D. Stones are usually composed of single salts

A

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

Which statement regarding CSF is true?

A. Normal values for mononuclear cells are higher for infants than for 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

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

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 protein in the sample

C

The term used to denote a high WBC count in the CSF is:

A. Empyema

B. Neutrophilia

C. Pleocytosis

D. Hyperglycorrhachia

C

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

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

The diagnosis of MS is suggested by 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

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

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

Which of the following CSF test results is most commonly increased in patients with

MS?

A. Glutamine

B. Lactate

C. IgG index

D. Ammonia

C

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-stained slide should be examined, rather than a chamber differential

A

Which cell is present in CSF in greater numbers in newborns than in older children or

adults?

A. Eosinophils

B. Lymphocytes

C. Monocytes

D. Neutrophils

C

Neutrophilic pleocytosis is usually associated with all of the following except:

A. Cerebral infarction

B. Malignancy

C. Myelography

D. Neurosyphilis

D

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 (URL) for CSF total protein in newborns is one half the adult

level

C. CSF IgG is increased in panencephalitis, malignancy, and neurosyphilis

D. Antibodies to Treponema pallidum disappear after successful antibiotic therapy

C

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

19. Which organism is the most frequent cause of bacterial meningitis in neonates?

A. Neisseria meningitidis

B. Group B Streptococcus

C. Haemophilus influenzae

D. Klebsiella pneumoniae

B

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

Which of the following statements regarding serous fluids is true?

A. The normal volume of pleural fluid is 30 to 50 mL

B. Mesothelial cells, PMNs, lymphocytes, and macrophages may be present in normal fluids

C. Radiography can detect a 10% increase in the volume of a serous fluid

D. Normal serous fluids are colorless

B

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

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

24. 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

25. Which of the following laboratory results on a serous fluid is most likely to be caused bya 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

Which of the following conditions is commonly associated with an exudative effusion?

A. Congestive heart failure

B. Malignancy

C. Nephrotic syndrome

D. Cirrhosis

B

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 (RA)

D. Lymphatic obstruction

D

Which of the following conditions is most often associated with a pleural fluid glucose

below 30 mg/dL?

A. Diabetes mellitus

B. Pancreatitis

C. Rheumatoid arthritis

D. Bacterial pneumonia

C

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

Which of the following characteristics is higher for synovial fluid than for the serous

fluids?

A. Specific gravity

B. Glucose

C. Total protein

D. Viscosity

D

In which type of arthritis is the synovial WBC count likely to be greater than 50,000/

µL?

A. Septic arthritis

B. Osteoarthritis

C. Rheumatoid arthritis

D. Hemorrhagic arthritis

A

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

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

Which crystal causes “pseudogout”?

A. Oxalic acid

B. Calcium pyrophosphate

C. Calcium oxalate

D. Cholesterol

B

A synovial fluid sample is examined by 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

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

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

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

Given the following dry reagent strip urinalysis results, select the most appropriate

course of action:

pH = 8.0 Protein = 1+ Glucose = Neg Blood = Neg

Ketone = Neg Nitrite = Neg Bilirubin = Neg

A. Report the results, assuming acceptable quality control

B. Check pH with a pH meter before reporting

C. Perform a turbidimetric protein test, instead of the dipstick protein test, and report

D. Request a new specimen

C

Given the following urinalysis results, select the most appropriate course of action:

pH = 8.0 Protein = Trace Glucose = Neg

Ketone = Small Blood = Neg Nitrite = Neg

Microscopic findings:

RBCs = 0–2/HPF WBCs = 20–50/HPF

Bacteria = Large Crystals = Small, CaCO3

A. Call for a new specimen because urine was contaminated in vitro

B. Recheck pH because CaCO3 does not occur at alkaline pH

C. No indication of error is present; results indicate a UTI

D. Report all results except bacteria because the nitrite test was negative

C

SITUATION: A 6-mL pediatric urine sample is processed for routine urinalysis in the

usual manner. The sediment is prepared by centrifuging all of the urine remaining after

performing the biochemical tests. The following results are obtained:

SG = 1.015 Blood = Large Leukocytes = Moderate

Protein = 2+ RBCs: 5–10/HPF WBCs: 5–10/HPF

Select the most appropriate course of action.

A. Report these results; blood and protein correlate with microscopic results

B. Report biochemical results only; request a new sample for the microscopic examination

C. Request a new sample and report as quantity not sufficient (QNS)

D. Recentrifuge the supernatant and repeat the microscopic examination

B

Given the following urinalysis results, select the most appropriate course of action:

pH = 6.5 Protein = Neg Glucose = Neg

Ketone = Trace Blood = Neg Bilirubin = Neg

Microscopic findings:

Mucus = Small Ammonium urate = Large

A. Recheck urine pH

B. Report these results, assuming acceptable quality control

C. Repeat the dry reagent strip tests to confirm the ketone result

D. Request a new sample and repeat the urinalysis

A

Given the following urinalysis results, select the most appropriate first course of action:

pH = 6.0 Protein = Neg Glucose = Neg

Ketone = Neg Blood = Neg Bilirubin = Neg

Other findings:

Color: Intense Transparency: Microscopic:

yellow Clear Crystals, Bilirubin

granules = Small

A. Repeat the dry reagent strip test for bilirubin

B. Request a new sample

C. Recheck the pH

D. Perform a test for urinary urobilinogen

A

A biochemical profile gives the following results:

Creatinine = 1.4 mg/dL

BUN = 35 mg/dL

K = 5.5 mmol/L

All other results are normal, and all tests are in control. Urine from the patient has an

osmolality of 975 mOsm/kg. Select the most appropriate course of action.

A. Check for hemolysis

B. Repeat the BUN, and report only if normal

C. Repeat the serum creatinine, and report only if elevated

D. Report these results

D

A 2 p.m. urinalysis shows trace glucose on the dry reagent strip test. Fasting blood

glucose drawn 8 hours earlier is 100 mg/dL. No other results are abnormal. Select the

most appropriate course of action.

A. Repeat the urine glucose, and report if positive

B. Perform a test for reducing sugars, and report the result

C. Perform a quantitative urine glucose; report as trace if greater than 100 mg/dL

D. Request a new urine specimen

A

Following a transfusion reaction, urine from a patient gives positive test results for

blood and protein. The SG is 1.015. No RBCs or WBCs are seen in the microscopic

examination. These results:

A. Indicate renal injury induced by transfusion reaction

B. Support the finding of an extravascular transfusion reaction

C. Support the finding of an intravascular transfusion reaction

D. Rule out a transfusion reaction caused by RBC incompatibility

C

A urine sample taken after a suspected transfusion reaction has a positive test result for

blood, but intact RBCs are not seen on microscopic examination. Which test result

would rule out an intravascular hemolytic transfusion reaction?

A. Negative urine urobilinogen

B. Serum unconjugated bilirubin below 1.0 mg/dL

C. Serum potassium below 6.0 mmol/L

D. Normal plasma haptoglobin

D

Given the following urinalysis results, select the most appropriate course of action:

pH = 5.0 Protein = Neg Glucose = 1,000 mg/dL

Blood = Neg Bilirubin = Neg

Ketone = Moderate SSA protein = 1+

A. Report the SSA protein test result instead of the dry reagent strip test result

B. Call for a list of medications administered to the patient

C. Perform a quantitative urinary albumin

D. Perform a test for microalbuminuria

B

Urinalysis results from a 35-year-old woman are as follows:

SG = 1.015 pH = 7.5 Protein = Trace

Glucose = Small Ketone = Neg Blood = Neg

Leukocytes = Moderate

Microscopic findings:

RBCs: 5–10/HPF WBCs: 25–50/HPF

Select the most appropriate course of action.

A. Recheck the blood reaction; if negative, look for budding yeast

B. Repeat the WBC count

C. Report all results except that for blood

D. Request the list of medications used

A

SITUATION: When examining a urinary sediment under 400× magnification, the

medical laboratory scientist (MLS) noted many RBCs to have cytoplasmic blebs and an

irregular distribution of the hemoglobin. This phenomenon is most often caused by:

A. Intravascular hemolytic anemia

B. Glomerular disease

C. Hypotonic or alkaline urine

D. Severe dehydration

B

SITUATION: A urine specimen is dark orange and turns brown after storage in the

refrigerator overnight. The MLS requests a new specimen. The second specimen is

bright orange and is tested immediately. Which test result would differ between the two

specimens?

A. Ketone

B. Leukocyte esterase

C. Urobilinogen

D. Nitrite

C

A patient’s random urine sample 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:

A. Normal diurnal variation in protein loss

B. Early glomerulonephritis

C. Orthostatic or postural albuminuria

D. Microalbuminuria

C

A urine sample with a pH of 8.0 and a specific gravity of 1.005 had a small positive

blood reaction but is negative for protein, and no RBCs are present in the microscopic

examination of urinary sediment. What best explains these findings?

A. High pH and low SG caused a false-positive blood reaction

B. The blood reaction and protein reaction are discrepant

C. Hemoglobin is present without intact RBCs because of hemolysis

D. An error was made in the microscopic examination

A urine sample has a negative blood reaction and 5 to 10 cells per high-power field that

resemble RBCs. What is the best course of action?

A. Mix a drop of sediment with 1 drop of WBC counting fluid and re-examine

B. Report the results without further testing

C. Repeat the blood test, and if negative, report the results

D. If the leukocyte esterase test is positive, report the cells as WBCs

C

A pleural fluid submitted to the laboratory is milky in appearance. Which test would be

most useful in differentiating between a chylous and pseudochylous effusion?

A. Fluid to serum triglyceride ratio

B. Fluid WBC count

C. Fluid total protein

D. Fluid:serum LD ratio

A

A CSF sample from an 8-year-old child with a fever of unknown origin was tested for

glucose, total protein, lactate, and IgG index. Glucose was 180 mg/dL, but all other

results were within the reference range. The CSF WBC count was 9 × 106/L, and the

RBC count was 10 × 106/L. The differential showed 50% lymphocytes, 35% monocytes,

10% macrophages, 3% neutrophils, and 2% neuroectodermal cells. What is the most

likely cause of these results?

A. Aseptic meningitis

B. Traumatic tap

C. Subarachnoid hemorrhage

D. Hyperglycemia

D

A WBC count and differential performed on ascites fluid gave a WBC count of 20,000/

µL with 90% macrophages. The gross appearance of the fluid was described by the

MLS as “thick and bloody.

” It was noted on the report that several clusters of these

cells were observed and that the majority of the cells contained many vacuoles

resembling paper-punch holes. What do the observations above suggest?

A. Malignant mesothelial cells were counted as macrophages

B. Adenocarcinoma from a metastatic site

C. Lymphoma infiltrating the peritoneal cavity

D. Nodular sclerosing type Hodgkin disease

A