UA, BODY FLUIDS, IMMUNOLOGY

B Cell Maturation occurs in the 

  Thymus 

  Bone Marrow 

  Thyroid 

  Pituitary 

  Bone Marrow 

Choose all of the correct statements regarding the spleen:

It filters antigens from the blood. 

Contains primary and secondary nodules rich in neutrophiles. 

It contains megakaryocyte precursors. 

It functions to remove old and defective red blood cells from circulation.

It filters antigens from the blood. 

It functions to remove old and defective red blood cells from circulation.

GALT Lymphoid tissues are associated with: (Choose all that apply)

  IgA production 

  Brain 

  Peyer’s patches 

  Lymphoid Tissue of the intestines

  IgA production 

  Peyer’s patches 

  Lymphoid Tissue of the intestines

The role the Tissue Mast Cell plays in regulating an immune response primarily involves receptors which bind to:

  Ig M 

  Ig E 

  Ig A 

  B Lymphocytes

  Ig E 

MHC Class II antigens:

  Have beta-2 macroglobulin in them 

  are found on every nucleated cell 

  are located on monocytes, B-cells and activated T-cells 

  bind to proteins inside the cell

  are located on monocytes, B-cells and activated T-cells 

The rapid rise of antibody on the secondary immune response is primarily due to:

  Memory T cells 

  Memory B cells 

  IgA 

  NK cells

  Memory B cells 

Clonal expansion and differentiation of stimulated B cells will occur in: 

  Immunosuppression

  Adaptive Immunity 

  Delayed Hypersensitivity 

  Innate Immunity

  Adaptive Immunity 

The Immunogenicity of a foreign agent is influenced by:

  Chemical complexity  

  Molecular weight 

  Degradability

  All of the available choices

  All of the available choices

This is true when interpreting a Serum Protein Electrophoresis pattern:

a decreased or absent gamma peak is a hallmark for Waldenstrom's disease 

Increased albumin is indicative of nephrotic syndrome 

"immediate response" pattern shows a decrease in both albumin and alpha-2

an increased alpha-2 may be comprised of increased haptoglobin

an increased alpha-2 may be comprised of increased haptoglobin

The Indirect Fluorescent Antibody Anti Nuclear Antibody test (ANA) utilizes a fluorescent tagged antihuman antibody in conjunction with which of the following to demonstrate the presence of autoantibodies:

  Fluorescent tagged nucleoli from trypanosomes 

  Hep-2 cell substrate 

  MLK cell line 

  Fluorescent dye to visualize cell nucleus

  Hep-2 cell substrate 

A patient with fibrous build-up in her skin has: 

The autoantibodies are against microtubules.

The patient has rheumatoid arthritis 

She has the fibrous build up due to anti-IgG depositing in her skin 

The patient is suffering from scleroderma

The patient is suffering from scleroderma

CTL Cytoxic T Lymphocytes are recognized by which of the following cell markers?

  CD19+ 

  CD16 and CD56 

  CD4+ 

  CD8+

  CD8+

A 12 year old female presented to her physician with a sore throat, lymphadenopathy and fatigue. Her laboratory results were: 5000 lymphocytes/μL with 10% variant lymphocytes. CMV antibody screen and heterophile antibody screen were both negative. These results :

Confirm a diagnosis of infectious mononucleosis 

Suggests a diagnosis of infectious mononucleosis but should be followed by a test for IgM anti-VCA to strengthen the diagnosis 

Indicates that the diagnosis is not infectious mononucleosis because the heterophile screen is negative 

Suggest a diagnosis of infectious mononucleosis but should be followed by FTA-ABS to confirm the diagnosis

Suggests a diagnosis of infectious mononucleosis but should be followed by a test for IgM anti-VCA to strengthen the diagnosis 

Immunofluorescent antibody tests are best described as:

fluorescent test looking for viral antigen directly in the patient specimen 

antibody mediated cell lysis enhanced with a fluorescent stain 

a hemagglutination inhibition reaction 

fluorescent test using serum and FITC tagged antihuman globulin 

fluorescent test using serum and FITC tagged antihuman globulin 

The acute phase reactant that responds the fastest, increases several hundred fold after injury and is the most sensitive indicator of acute inflammation is:

  C-reactive protein 

  haptoglobin 

  fibrinogen 

  complement

  C-reactive protein 

A 50 year old male Is seen by his physician because of increasing fatigue and weakness.  He also reports pain in his lower back and arms when he walks. The CBC reveals that he has anemia.  His leukocyte count and differential are normal, except for rouleux appearance of the red blood cells.  The physician orders the following tests: ESR, kidney screening profile, liver profile and radiographic skeletal survey. The tests reveal an elevated ESR, normal  kidney function profile, normal liver profile except for increased globular protein, and bone lesions in various sites from the skeletal survey.  Patients with this disease have defects in:

synthesis of normal immunoglobulins 

cellular immunity 

humoral immunity and synthesis of normal immunoglobulins 

humoral immunity

humoral immunity and synthesis of normal immunoglobulins 

The RPR test is:

can be falsely positive for patients who have SLE 

a Treponemal antibody assay 

needs to be interpreted with a microscope to see the agglutination 

the confirmatory test for syphilis

can be falsely positive for patients who have SLE 

A patient’s specimen is strongly positive in an ANA ELISA. Which of the following would not be an appropriate follow-up to this result?

  Specific ENA ELISA tests 

  IFA on human epithelial type 2 (HEp-2) cells 

  Specific anti-DNA ELISA 

  Rheumatoid factor (RF) assay

  Rheumatoid factor (RF) assay

False negatives due to the over abundance of antibody is:

  least often seen in agglutination reactions            

  prozone 

  postzone 

  polyzone

prozone 

A 50 year old female complained of increased pain and stiffness in her fingers and wrists for over a year's duration. The laboratory results were as follows: ESR elevated, increased CRP, positive rheumatoid factor, negative ANA and normal complement levels. What is the most probable diagnosis?        

  CREST syndrome 

  SLE 

  Syphilis 

  Rheumatoid arthritis

  Rheumatoid arthritis

Which disease might be indicated by antibodies to smooth muscle?

  Sjögren syndrome 

Atrophic gastritis

  Autoimmune hepatitis 

  Myasthenia gravis

  Autoimmune hepatitis 

The rapid plasma reagin (RPR) for syphilis does not need to be read microscopically because the antigen is:

cardiolipin     

  inactivated bacterial cells 

  particulate (latex bead) 

  complexed to charcoal

  complexed to charcoal

The role that the macrophage plays in regulating an immune response primarily  involves its interaction with which of the following elements of the immune system:

  Plasma cells 

  platelets

Immunoglobulin

CD4 cells

CD4 cells

Systemic lupus erythematosus and the presence of dsDNA are most likely associated with which of the following antinuclear antibody immunofluorescent patterns?

  rim 

  homogeneous

  nucleoli 

  speckled 

homogeneous

The portion of the nephron which extends below the cortex and into the medulla of the kidney is:

  Loop of Henle 

  Glomerulus 

  Afferent arteriole 

  Bowman's capsule

  Loop of Henle 

An emphysema patient is known to be in respiratory acidosis, a condition in which CO2, carbon dioxide, is retained.  In compensation, large amounts of (NH4) ammonia are released.  You would expect the urine pH to be:

acidic 

  basic 

  >9.0 

  normal

acidic 

A runner suffering from heat prostration is brought to the Emergency Room for observation.  A urine sediment revealed no bacteria, (1+) 10-15 WBC, rare RBC, and (3-4+) hyaline cast.  From this information you can assume:

  the patient is essentially normal 

  the patient has toxic nephrosis 

  the patient suffers from acute pyelonephritis 

  the patient is in an acute phase of cystitis

  the patient is essentially normal 

A 68-year-old male is admitted to the hospital with a diagnosis of Chronic End-Stage Renal disease.  You would expect his urine sediment to predominate with:

  waxy casts 

  fatty casts 

  red blood cell casts 

  d. epithelial cell casts

  waxy casts 

Which of the following will be least affected in an unpreserved specimen left at room temperature overnight?

  Urobilinogen 

  Bilirubin 

  Red blood cells 

  Protein

Protein

Which statement regarding normal salt and H2O handling by the nephron is correct?

The descending limb of the tubule is impermeable to urea but highly permeable to salt 

The stimulus for ADH release is low arterial pressure in the afferent arteriole 

Renin is released in response to high plasma osmolality 

The thick ascending limb of the tubule is highly permeable to salt but not H2O

The thick ascending limb of the tubule is highly permeable to salt but not H2O

Concentration of the tubular filtrate by the countercurrent mechanism is dependent on all of the following except:

  Collecting duct 

  Proximal convoluted tubule 

  Descending loop of Henle

  Ascending loop of Henle

Ascending loop of Henle

Calculate the creatinine clearance for a patient of average size from the following data:

Urine volume: 720 mL for 12 hours

Urine creatinine: 120 mg/dL

Serum creatinine: 1.5 mg/dL

  80 mL/min 

  60 mL/min 

  100 mL/min 

  120 mL/min

80 mL/min 

For accurate evaluation of renal tubular concentrating ability, patient preparation should include:

  Increased hydration 

  Fasting 

  Fluid deprivation 

  Abstaining from all medications

  Fluid deprivation 

Following injection of ADH, a patient has a serum osmolality of 290 mOsm and a urine osmolality of 450 mOsm. The patient:

  Continued to observe water deprivation 

  May have ingested excess alcohol 

  Should be evaluated with a creatinine clearance 

  Lacks tubular response to ADH

  Lacks tubular response to ADH

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.

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

Recentrifuge the supernatant and repeat the microscopic examination 

Report these results; blood and protein correlate with microscopic results 

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

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

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?

  Ketone 

  Leukocyte esterase 

  Nitrate 

  Urobilinogen

Urobilinogen

The pigment responsible for a pink precipitate in refrigerated urine is:

  Urochrome 

  Biliverdin 

  Bilirubin 

  Uroerythrin

  Uroerythrin

Which of the following conditions is associated with a negative blood test result and an increase in urine urobilinogen?

  Extravascular hemolytic anemia 

  Calculi of the kidney or bladder 

  Crush injury 

  Malignancy of the kidney or urinary system

  Extravascular hemolytic anemia 

Failure to blot the edge of the reagent strip may result in errors in color interpretation caused by:

  Reagent leaching 

  Runover 

  Chemical concentration 

  Excess dilution

Runover 

A moderately positive result on the blood test and trace protein test are seen on the dry reagent strip, and 11 to 20 RBCs/HPF are seen in the microscopic examination. These results are most likely caused by which of the following?

  Transfusion reaction 

  Intravascular hemolytic anemia 

  Myoglobinuria 

  Recent urinary tract catheterization

  Recent urinary tract catheterization

The ketones that are produced in normal adult metabolism include all of the following except:

  Beta-hydroxybutyric acid 

  Acetoacetic acid 

  Acetone 

  Phenylketones

  Phenylketones

Detection of hemosiderin in the urine can be associated with:

  Hematuria 

  Myoglobinuria 

  Hemoglobinuria 

  Albuminuria

  Hemoglobinuria 

When bilirubin is detected in the urine, it can be assumed that:

  It has passed through the small intestine 

  The patient is diabetic 

  It is attached to protein 

  It has been conjugated in the liver

  It has been conjugated in the liver

Which of the following tests is affected least by standing or improperly stored urine?

  Bilirubin 

  Protein 

  pH 

  Glucose

Protein 

Urine production of less than 400 mL/day is:

  Consistent with normal renal function and H2O balance 

  Termed isosthenuria 

  Defined as oliguria 

  Associated with diabetes mellitus

  Defined as oliguria 

What do the following results suggest?

Color:  Yellow	Protein:  Trace	Blood:  Negative
Clarity:  Cloudy	Glucose:  Negative	Urobilinogen:  0.1EU
Specific Gravity:  1.019	Ketones:  Negative	Nitrite:  Positive
pH:  8.0	Bilirubin:  Negative	Leukocyte esterase:  Positive

  Unsatisfactory specimen 

  Normal female specimen 

  Urinary tract infection 

  Diabetes mellitus 

  Urinary tract infection 

In ascending order, the location of epithelial cells in the urinary tract is:

  Squamous, renal tubular, urothelial 

  Renal tubular, transitional, squamous 

  Transitional, renal tubular, squamous 

  Squamous, transitional, renal tubular

  Squamous, transitional, renal tubular

Urinary casts are formed in the:

  Proximal and distal tubules 

  Distal and collecting tubules 

  Distal tubules and loops of Henle 

  Proximal tubules and loops of Henle 

  Distal and collecting tubules 

To differentiate a bacterial cast from a granular cast, a clinical laboratory scientist could:

  use polarizing microscopy 

  perform a Hansel stain 

  perform a gram stain 

  add acetic acid to the sediment

  perform a gram stain 

Abnormal crystals are most frequently seen in a urine that is:

  acid 

  neutral 

  alkaline 

  collected for 24 hours

acid 

The following results are obtained on a urinalysis from a student athlete.  Based on the information provided, why is only a trace of blood detected by reagent strip?

Color:  Dark Yellow	Protein: 2+	Blood:  Trace
Clarity:  Cloudy	Glucose:  Negative	Urobilinogen:  1 EU
Specific gravity:  1.032	Ketones:  Negative	Nitrite:  Negative
pH:  6.0	Bilirubin:  Negative	Leukocyte esterase:  Negative

Microscopic:

15-20 crenated RBC's hpf     2-3 hyaline casts/lpf

Rare squamous epithelial cell 1-2 granular casts/lpf

  Protein inhibition 

  Acid pH 

  Dilute specimen 

  Crenated RBCs 

  Crenated RBCs 

Urinalysis results are being monitored on a patient following an adverse reaction occurring during surgery.  Based on the information provided, what is the significance of the elevated urobilinogen reading?

Color:  Red Brown	Protein:  1+	Blood:  Large
Clarity:  Cloudy	Glucose:  Negative	Urobilinogen:  8.0 EU
Specific gravity:  1.012	Ketones:  Negative	Nitrite:  Negative
pH:  7.0	Bilirubin:  Negative	Leukocyte esterase:  Negative

Microscopic:

6-10 RTE cells/hpf (intracellular yellow/brown granules)

3-4 homogenous RBC casts/lpf

1-2 dirty, brown casts/lpf

1-2 RTE cell casts/lpf

Many yellow-brown granules

  Urine Color 

  Liver damage 

  Intravascular hemolysis 

  Constipation

  Intravascular hemolysis 

Which of the following contributes to SG, but not to osmolality?

  Salt 

  Urea 

  Protein 

  Glucose

Protein 

In which part of the kidney is uromodulin produced?

  Nephrons and collecting ducts 

  Proximal and distal tubules 

  Bowlman's capsule and nephrons 

  Descending and ascending loop of Henle

  Proximal and distal tubules 

In which of the following disorders would waxy and broad casts be most likely to be seen?

  chronic renal failure 

  acute inerstitial nephritis 

  acute renal failure 

  chronic pyelonephritis

  chronic renal failure 

Identify the following cell:

  Clue Cell 

  Glitter Cell 

  Oval Fat Body 

  Ghost Cell

  Glitter Cell 

Identify the following:

  Ammonium biurate 

  Cholesterol 

  Triple phosphate 

  Cystine 

  Calcium carbonate

Cholesterol

Identify the following cell:

  Oval Fat Body 

  Spherical cell 

  No answer text provided. 

  Glitter Cell 

  Oval Fat Body 

Identify the following:

  Ammonium biurate 

  Calcium carbonate 

  Triple phosphate 

  Cholesterol 

  Cystine 

  Ammonium biurate 

Where does most cerebrospinal fluid (CSF) originate?

  Ventricles 

  Cerebral arachnoid space 

  Choroid plexus 

  Lumbar region

  Choroid plexus 

How many white blood cells should be considered normal for adult cerebrospinal fluid?

  0-5 WBCs/uL 

  6-10 WBCs/uL 

  Any number of WBC's is considered abnormal 

  up to 30 WBCs/uL

  0-5 WBCs/uL 

Which of the following would be considered normal for a glucose level in cerebrospinal fluid?

  120 mg/dL 

  30 mg/dL 

  150 mg/dL 

  60 mg/dL

  60 mg/dL

A sperm concentration of 25 x 106 spermatozoa/mL would be considered an abnormally low concentration, according to the lower normal reference limit stated in WHO 5th edition.

  True 

  False

  False

A semen specimen was collected three hours before it was brought to the laboratory for examination.  What course of action should be taken?

Perform the wet mount only 

Report the specimen as compromised on the final report 

Complete macroscopic and microscopic examination as quickly as possible 

Perform the macroscopic and morphology procedures only

Report the specimen as compromised on the final report 

On a cytospin preparation from a pleural fluid, 50% of the cells have the following characteristics:

• uniform, regular arrangement

• some cells resemble a "fried egg"

• multiple nuclei

• smooth nuclear outline and homogeneous chromatin

• when present in clumps, there are clear spaces between the cells ("windows")

How should these cells be classified?

  atypical cancer cells 

  ependymal cells 

  tumor cells 

  mesothelial cells

  mesothelial cells

Which is the best method for examination of synovial crystals:

  Phase contrast 

  Polarized light 

  Darkfield microscopy 

  Brightfield microscopy

  Polarized light 

Which of the following parameters is generally NOT considered to be a part of a seminal fluid analysis?

  Motility 

  Glucose concentration 

  Viscosity assessment 

  Sperm count 

  Morphology examination

  Glucose concentration 

The image is a Wright-Giemsa stained smear (1000x) of a cerebrospinal fluid (CSF).  What is the identification of the cells in the smear?

  Presumptive malignant cells 

  Immature white blood cells 

  Atypical lymphocytes 

  Ependymal cells

  Presumptive malignant cells 

A 3 year old girl was brought to the ER with a temperature of 103F, lethargy, and cervical rigidity.  Three tubes of cloudy CSF were delivered to the Lab, and preliminary test results showed:

WBC: 4,500/uL Differential: 88% neutrophils

Glucose: 15 mg/dL  12% lymphocytes

Protein:  140 mg/dL

Gram stain: No organisms observed

  Brain tumor 

  subdural hematoma 

  viral meningitis 

  Bacterial meningitis

  Bacterial meningitis

Which of the following is characteristic of an exudates effusion?

  Protein concentration less than 3.0g/dL 

  Clear appearance 

  Absence of fibrinogen 

  Leukocyte count greater than 1000 WBC/uL

  Leukocyte count greater than 1000 WBC/uL

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

  Total protein 

  Viscosity 

  Glucose 

  Specific gravity

  Viscosity 

A 1:10 dilution is made on a CSF sample. Five squares on each side of the hemacytometer are counted for a total of 10 squares and a total of 150 cells are recorded. What is the count per microliter?

  758 

  833 

  527 

  1500

  1500

Two CSF specimens were sent to the Lab with the following results:

Tube #1 = 11,200 rbc/µL

Tube #2 = 300 rbc/µL

The results on these CSF specimens are indicative of:

  an old intracranial bleeding episode 

  faulty lab equipment 

  an infection 

  a recent subarachnoid hemorrhage 

  a traumatic tap

  a traumatic tap

What is generally accepted as the lower threshold value for semen pH from fertile males?

  7.2 

  6.5 

  8.0 

  5.5 

  7.2 

Normal adult CSF may have 0-5 white blood cells (WBCs)/µL. Which of the following cell types account for 60-100% of these WBCs?

  Neutrophils 

  Monocytes 

  Eosinophils 

  Lymphocytes

  Lymphocytes

The image is a stained smear of cerebrospinal fluid (CSF).  The cells indicate which of the following conditions?

  Leukemia with CNS involvement 

  Bacterial meningitis 

  Viral meningitis 

  Allergic reactions

  Leukemia with CNS involvement 

A semen sample for semen analysis should generally be received at the testing site within what period of time?

  One hour 

  Two hours 

  Four hours 

  Three hours

  One hour 

For BEST results, a semen sample should remain at which of the following temperatures following collection?

  37C 

  56C 

  -40C 

  Room temperature 

  4C

  37C 

Which of the following would be the most characteristic finding in synovial fluid in a case of pseudogout:

  Monosodium urate crystals 

  Macrophage infilitration 

  Calcium pyrophosphate crystals 

  Mixed RBC/WBC infiltration

  Calcium pyrophosphate crystals 

The lining covering the abdominal organs is called the

  Arachnoid membrane 

  Pseudo-membrane 

  Parietal membrane 

  Visceral membrane

  Visceral membrane

The layer of superficial squamous cells which covers the serous cavities are

  impervious to sodium 

  made up of columnar cells 

  impervious to water 

  made up of mesothelial cells

  made up of mesothelial cells

Serous fluid is formed when there is: (Choose all that apply)

  a decrease of plasma colloid osmotic pressure 

  an increase of hydrostatic pressure 

  a decrease in blood pressure 

  an increase of plasma colloid osmotic pressure

  a decrease of plasma colloid osmotic pressure 

  an increase of hydrostatic pressure 

Which statement about CSF protein is true?

Antibodies to Treponema pallidum disappear after successful antibiotic therapy 

An abnormal serum protein electrophoretic pattern does not affect the CSF pattern 

CSF IgG is increased in panencephalitis, malignancy, and neurosyphilis 

The upper reference limit (URL) for CSF total protein in newborns is one half the adult level

CSF IgG is increased in panencephalitis, malignancy, and neurosyphilis 

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?

  Serum unconjugated bilirubin below 1.0 mg/dL 

  Negative urine urobilinogen 

  Serum potassium below 6.0 mmol/L 

  Normal plasma haptoglobin

  Normal plasma haptoglobin

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?

Lymphoma infiltrating the peritoneal cavity 

Malignant mesothelial cells were counted as macrophages 

Adenocarcinoma from a metastatic site 

Nodular sclerosing type Hodgkin disease

Malignant mesothelial cells were counted as macrophages 

The Serum-Ascites Albumin Gradient is a reflection of

  Excessive IV Therapy (Hyper hydration) 

  Inadequate Reticuloendothelial System (RES) function 

  Hydrostatic pressure of the portal system 

  none of the above is correct

  Hydrostatic pressure of the portal system 

Most transudates have a leukocyte count of

  >10,000 uL 

  <5 uL 

  >1000 uL 

  <1000 uL

  <1000 uL

Synovial Fluid is composed of

  all of the above are correct 

  plasma dialysate 

  hyaluronidate 

  protein

  all of the above are correct 

A 12 year old boy sustained an injury to his knee while skating.  The knee appeared slightly swollen, red, and warm to the touch.  The synovial fluid revealed the following:

Joint Fluid	Blood
Color:  Dark pink	WBC  5.1 x 103/mm3
Viscosity:  Decreased	RBC 3.96 x 103/mm3
RBC count:  5,800 cells/ uL	ESR  22 mm/hr
WBC count:  160 cells/uL	Uric Acid:  4.5 mg/dL
% Neutrophils  20%
Glucose  90 mg/dL	Glucose:  110 mg/dL

They synovial fluid would be categorized as:

  Type II - Inflammatory 

  Type I - Non Inflammatory 

  Type V - Hemorrhagic 

  Type III - Septic

  Type V - Hemorrhagic 

Neoplastic cells found in a pleural fluid may exhibit which of the following morphologic characteristics:

  cohesive three-dimensional clusters 

  decreased nuclear cytoplasmic ratio 

  none of the available choices are correct 

  evenly distributed chromatin pattern

  cohesive three-dimensional clusters 

Complement levels in synovial fluid may be decreased in which of the following diseases?

  Multiple Myeloma 

  Gout 

  Rheumatoid arthritis 

  none of the available choices

  Rheumatoid arthritis 

Xanthochromia would most likely be associated with:

  Fungal infections 

  Auto-immune disease 

  Subarachnoid hemorrhage 

  Cerebral tumor

  Subarachnoid hemorrhage 

A 35 year old male developed sudden onset of severe headache.  Three hours later he fell to the floor, striking his head.  At the hospital he was in coma with bruises over his right eye.  Spinal fluid examination showed the following:

CSF Tube #1
Pressure:	420 mm (Normal 70-200 mm)
Color:	Reddish, cloudy
Supernatant:	Yellow (after centrifugation)
Glucose:	75 mg/dL
RBC Count:	39,000 cells/uL
WBC Count:	28 cells /uL (96% lymphocytes)
Other:	Few erythrophages present

The most likely diagnosis is:

  Multiple sclerosis 

  Traumatic lumbar puncture 

  Tuberculosis 

  Ruptured cerebral aneurysm

  Ruptured cerebral aneurysm

The concentration of Lamellar bodies in amniotic fluid is used to determine:

  Alpha-fetoprotein 

  Trisomy 21 

  Fetal lung maturity 

  Hemolytic disease of the newborn

  Fetal lung maturity 

The absence of fructose in semen is indicative of

  nercozoospermia 

  aspermia 

  azoospermia 

  all of the available choices

  azoospermia 

Which of the following serial dilutions contains an incorrect factor?

  1:5, 1:15, 1:45 

  1:4, 1:8, 1:16 

  1:2, 1:6, 1:12 

  1:1, 1:2, 1:4 

  1:2, 1:6, 1:12 

SITUATION: A 54-year-old man was admitted to the hospital after having a seizure. Many laboratory tests were performed, including an RPR, but none of the results was positive. The physician suspects a case of late (tertiary) syphilis. Which test should be performed next?

  Treponemal test, such as TP-PA on serum 

  VDRL on CSF 

  Repeat RPR, followed by VDRL 

  No laboratory test is positive for late (tertiary) syphilis 

  Treponemal test, such as TP-PA on serum 

A specimen appears to have a perinuclear staining pattern in an antineutrophil cytoplasmic antibody (ANCA) immunofluorescent assay using ethanol-fixed neutrophils, suggesting the possibility of a perinuclear ANCA (pANCA). On which of the following substrates would this specimen display cytoplasmic speckling?

  HEp-2 cells 

  Unfixed neutrophils 

  Formalin-fixed neutrophils 

  Rabbit kidney tissue

  Formalin-fixed neutrophils 

Which statement about synovial fluid in RA is true?

Total hemolytic complement is elevated 

Ninety percent of RA cases test positive for rheumatoid factor in synovial fluid 

Synovial:serum IgG is usually 1:2 or higher 

Demonstration of rheumatoid factor in joint fluid is diagnostic for RA

Synovial:serum IgG is usually 1:2 or higher