AUBF - MIDTERMS

1. Macroscopic screening of urine specimens is used to:

A. Provide results as soon as possible

B. Predict the type of urinary casts present

C. Increase cost-effectiveness of urinalysis

D. Decrease the need for polarized microscopy

A

2. Variations in the microscopic analysis of urine include all of the following except:

A. Preparation of the urine sediment

B. Amount of sediment analyzed

C. Method of reporting

D. Identification of formed elements

D

3. All of the following can cause false-negative microscopic results except:

A. Braking the centrifuge

B. Failing to mix the specimen

C. Dilute alkaline urine

D. Using midstream clean-catch specimens

C

4. The two factors that determine relative centrifugal force are:

A. Radius of rotor head and rpm

B. Radius of rotor head and time of centrifugation

C. Diameter of rotor head and rpm

D. RPM and time of centrifugation

C

5. When using the glass slide and cover-slip method, which of the following might be missed if the cover slip is overflowed?

A. Casts

B. RBCs

C. WBCs

D. Bacteria

A

6. Initial screening of the urine sediment is performed using an objective power of:

A. 4×

B. 10×

C. 40×

D. 100×

B

7. Which of the following should be used to reduce light intensity in bright-field microscopy?

A. Centering screws

B. Aperture diaphragm

C. Rheostat

D. Condenser aperture diaphragm

C

8. Which of the following are reported as number per lpf?

A. RBCs

B. WBCs

C. Crystals

D. Casts

D

9. The Sternheimer-Malbin stain is added to urine sediments to do all of the following except:

A. Increase visibility of sediment constituents

B. Change the constituents' refractive index

C. Decrease precipitation of crystals

D. Delineate constituent structures

C

10. Nuclear detail can be enhanced by:

A. Prussian blue

B. Toluidine blue

C. Acetic acid

D. Both B and C

D

11. Which of the following lipids is/are stained by Sudan III?

A. Cholesterol

B. Neutral fats

C. Triglycerides

D. Both B and C

D

12. Which of the following lipids is/are capable of polarizing light?

A. Cholesterol

B. Neutral fats

C. Triglycerides

D. Both A and B

A

13. The purpose of the Hansel stain is to identify:

A. Neutrophils

B. Renal tubular cells

C. Eosinophils

D. Monocytes

C

14. Crenated RBCs are seen in urine that is:

A. Hyposthenuric

B. Hypersthenuric

C. Highly acidic

D. Highly alkaline

B

15. Differentiation among RBCs, yeast, and oil droplets may be accomplished by all of the following except:

A. Observation of budding in yeast cells

B. Increased refractility of oil droplets

C. Lysis of yeast cells by acetic acid

D. Lysis of RBCs by acetic acid

C

16. A finding of dysmorphic RBCs is indicative of:

A. Glomerular bleeding

B. Renal calculi

C. Traumatic injury

D. Coagulation disorders

A

17. Leukocytes that stain pale blue with Sternheimer-Malbin stain and exhibit brownian movement are:

A. Indicative of pyelonephritis

B. Basophils

C. Mononuclear leukocytes

D. Glitter cells

D

18. Mononuclear leukocytes are sometimes mistaken for:

A. Yeast cells

B. Squamous epithelial cells

C. Pollen grains

D. Renal tubular cells

D

19. When pyuria is detected in a urine sediment, the slide should be carefully checked for the presence of:

A. RBCs

B. Bacteria

C. Hyaline casts

D. Mucus

B

20. Transitional epithelial cells are sloughed from the:

A. Collecting duct

B. Vagina

C. Bladder

D. Proximal convoluted tubule

C

21. The largest cells in the urine sediment are:

A. Squamous epithelial cells

B. Urothelial epithelial cells

C. Cuboidal epithelial cells

D. Columnar epithelial cells

A

22. A clinically significant squamous epithelial cell is the:

A. Cuboidal cell

B. Clue cell

C. Caudate cell

D. Columnar cell

B

23. Forms of transitional epithelial cells include all of the following except:

A. Spherical

B. Caudate

C. Convoluted

D. Polyhedral

C

24. Increased transitional cells are indicative of:

A. Catheterization

B. Malignancy

C. Pyelonephritis

D. Both A and B

D

25. A primary characteristic used to identify renal tubular epithelial cells is:

A. Elongated structure

B. Centrally located nucleus

C. Spherical appearance

D. Eccentrically located nucleus

D

26. Following an episode of hemoglobinuria, RTE cells may contain:

A. Bilirubin

B. Hemosiderin granules

C. Porphobilinogen

D. Myoglobin

B

27. The predecessor of the oval fat body is the:

A. Histiocyte

B. Urothelial cell

C. Monocyte

D. Renal tubular cell

D

28. A structure believed to be an oval fat body produced a Maltese cross formation under polarized light but does not stain with Sudan III. The structure:

A. Contains cholesterol

B. Is not an oval fat body

C. Contains neutral fats

D. Is contaminated with immersion oil

A

29. The finding of yeast cells in the urine is commonly associated with:

A. Cystitis

B. Diabetes mellitus

C. Pyelonephritis

D. Liver disorders

B

30. The primary component of urinary mucus is:

A. Bence Jones protein

B. Microalbumin

C. Uromodulin

D. Orthostatic protein

C

31. The majority of casts are formed in the:

A. Proximal convoluted tubules

B. Ascending loop of Henle

C. Distal convoluted tubules

D. Collecting ducts

C

32. Cylindruria refers to the presence of:

A. Cylindrical renal tubular cells

B. Mucus-resembling casts

C. Hyaline and waxy casts

D. All types of casts

D

33. A person submitting a urine specimen following a strenuous exercise routine can normally have all of the following in the sediment except:

A. Hyaline casts

B. Granular casts

C. RBC casts

D. WBC casts

D

34. Prior to identifying an RBC cast, all of the following should be observed except:

A. Free-floating RBCs

B. Intact RBCs in the cast

C. Presence of a cast matrix

D. A positive reagent strip blood reaction

B

35. WBC casts are primarily associated with:

A. Pyelonephritis

B. Cystitis

C. Glomerulonephritis

D. Viral infections

A

36. The shape of the RTE cell associated with renal tubular epithelial casts is primarily:

A. Elongated

B. Cuboidal

C. Round

D. Columnar

C

37. When observing RTE casts, the cells are primarily:

A. Embedded in a clear matrix

B. Embedded in a granular matrix

C. Attached to the surface of a matrix

D. Stained by components of the urine filtrate

A

38. The presence of fatty casts is associated with:

A. Nephrotic syndrome

B. Crush injuries

C. Diabetes mellitus

D. All of the above

D

39. Nonpathogenic granular casts contain:

A. Cellular lysosomes

B. Degenerated cells

C. Protein aggregates

D. Gram-positive cocci

A

40. All of the following are true about waxy casts except they:

A. Represent extreme urine stasis

B. May have a brittle consistency

C. Require staining to be visualized

D. Contain degenerated granules

C

41. Observation of broad casts represents:

A. Destruction of tubular walls

B. Dehydration and high fever

C. Formation in the collecting ducts

D. Both A and C

D

42. All of the following contribute to urinary crystals formation except:

A. Protein concentration

B. pH

C. Solute concentration

D. Temperature

A

43. The most valuable initial aid for identifying crystals in a urine specimen is:

A. pH

B. Solubility

C. Staining

D. Polarized microscopy

A

44. Crystals associated with severe liver disease include all of the following except:

A. Bilirubin

B. Leucine

C. Cystine

D. Tyrosine

C

45. All of the following crystals routinely polarize except:

A. Uric acid

B. Cholesterol

C. Radiographic dye

D. Cystine

D

46. Casts and fibers can usually be differentiated using:

A. Solubility characteristics

B. Patient history

C. Polarized light

D. Fluorescent light

C

Match the following crystals seen in acidic urine with their description/identifying characteristics:

____ Amorphous urates 1. Envelopes

____ Uric acid 2. Thin needles

____ Calcium oxalate 3. Yellow-brown, monohydrate whetstone

____ Calcium oxalate 4. Pink sediment dihydrate

5. Ovoid

4, 3, 5, 1

Match the following crystals seen in alkaline urine with their description/identifying characteristics:

____ Triple phosphate 1. Yellow granules

____ Amorphous phosphate 2. Thin prisms

____ Calcium phosphate 3. "Coffin lids"

____ Ammonium biurate 4. Dumbbell shape

____ Calcium carbonate 5. White precipitate

6. Thorny apple

3, 5, 2, 6, 4

Match the following abnormal crystals with their description/identifying characteristics:

____ Cystine 1. Bundles following refrigeration

____ Tyrosine 2. Highly alkaline pH

____ Cholesterol 3. Bright yellow clumps

____ Leucine 4. Hexagonal plates

____ Ampicillin 5. Flat plates, high specific gravity

____ Radiographic dye 6. Concentric circles, radial striations

____ Bilirubin 7. Notched corners

8. Fine needles seen in liver disease

4, 8, 7, 6, 1, 5, 3

Match the following types of microscopy with their descriptions:

____ Bright-field 1. Indirect light is reflected off the object

____ Phase 2. Objects split light into two beams

____ Polarized 3. Low refractive index objects may be overlooked

____ Dark-field 4. Three-dimensional images

____Fluorescent 5. Forms halo of light around object

____Interference 6. Detects electrons contrast emitted from objects

7. Detects specific wavelengths of light emitted from objects

3, 5, 2, 1, 7, 4

1. Most glomerular disorders are caused by:

A. Sudden drops in blood pressure

B. Immunologic disorders

C. Exposure to toxic substances

D. Bacterial infections

B

2. Dysmorphic RBC casts would be a significant finding with all of the following except:

A. Goodpasture syndrome

B. Acute glomerulonephritis

C. Chronic pyelonephritis

D. Henoch-Schönlein purpura

C

3. Occasional episodes of macroscopic hematuria over periods of 20 or more years are seen with:

A. Crescentic glomerulonephritis

B. IgA nephropathy

C. Nephrotic syndrome

D. Wegener granulomatosis

B

4. Antiglomerular basement membrane antibody is seen with:

A. Wegener granulomatosis

B. IgA nephropathy

C. Goodpasture syndrome

D. Diabetic nephropathy

C

5. Antineutrophilic cytoplasmic antibody is diagnostic for:

A. IgA nephropathy

B. Wegener granulomatosis

C. Henoch-Schönlein purpura

D. Goodpasture syndrome

B

6. Respiratory and renal symptoms are associated with all of the following except:

A. IgA nephropathy

B. Wegener granulomatosis

C. Henoch-Schönlein purpura

D. Goodpasture syndrome

D

7. The presence of fatty casts is associated with all of the following except:

A. Nephrotic syndrome

B. Focal segmental glomerulosclerosis

C. Nephrogenic diabetes insipidus

D. Minimal change disease

C

8. The highest levels of proteinuria are seen with:

A. Alport syndrome

B. Diabetic nephropathy

C. IgA nephropathy

D. Nephrotic syndrome

D

9. Ischemia frequently produces:

A. Acute renal tubular necrosis

B. Minimal change disorder

C. Renal glycosuria

D. Goodpasture's syndrome

A

10. A disorder associated with polyuria and low specific gravity is:

A. Renal glucosuria

B. Minimal change disease

C. Nephrogenic diabetes insipidus

D. Focal segmental glomerulosclerosis

C

11. An inherited disorder producing a generalized defect in tubular reabsorption is:

A. Alport syndrome

B. Acute interstitial nephritis

C. Fanconi syndrome

D. Renal glycosuria

C

12. A teenage boy who develops gout in his big toe and has a high serum uric acid should be monitored for:

A. Fanconi syndrome

b. Renal calculi

C. Uromodulin-associated kidney disease

D. Chronic interstitial nephritis

C

13. The only protein produced by the kidney is:

A. Albumin

B. Uromodulin

C. Uroprotein

D. Globulin

B

14. The presence of renal tubular epithelial cells and casts is an indication of:

A. Acute interstitial nephritis

B. Chronic glomerulonephritis

C. Minimal change disease

D. Acute tubular necrosis

D

15. Differentiation between cystitis and pyelonephritis is aided by the presence of:

A. WBC casts

B. RBC casts

C. Bacteria

D. Granular casts

A

16. The presence of WBCs and WBC casts with no bacteria is indicative of:

A. Chronic pyelonephritis

B. Acute tubular necrosis

C. Acute interstitial nephritis

D. Both B and C

C

17. End-stage renal disease is characterized by all of the following except:

A. Hypersthenuria

B. Isosthenuria

C. Azotemia

D. Electrolyte imbalance

A

18. Prerenal acute renal failure could be caused by:

A. Massive hemorrhage

B. Acute tubular necrosis

C. Acute interstitial nephritis

D. Malignant tumors

A

19. The most common composition of renal calculi is:

A. Calcium oxalate

B. Magnesium ammonium phosphate

C. Cystine

D. Uric acid

A

20. Urinalysis on a patient with severe back pain being evaluated for renal calculi would be most beneficial if it showed:

A. Heavy proteinuria

B. Low specific gravity

C. Uric acid crystals

D. Microscopic hematuria

D

1. All states require newborn screening for PKU for early:

A. Modifications of diet

B. Administration of antibiotics

C. Detection of diabetes

D. Initiation of gene therapy

A

2. All of the following disorders can be detected by newborn screening except:

A. Tyrosyluria

B. MSUD

C. Melanuria

D. Galactosemia

C

3. The best specimen for early newborn screening is a:

A. Timed urine specimen

B. Blood specimen

C. First morning urine specimen

D. Fecal specimen

B

4. Abnormal urine screening tests categorized as an overflow disorder include all of the following except:

A. Alkaptonuria

B. Galactosemia

C. Melanuria

D. Cystinuria

C

5. Which of the following disorders is not associated with the phenylalanine-tyrosine pathway?

A. MSUD

B. Alkaptonuria

C. Albinism

D. Tyrosinemia

A

6. The least serious form of tyrosylemia is:

A. Immature liver function

B. Type 1

C. Type 2

D. Type 3

A

7. An overflow disorder of the phenylalanine-tyrosine pathway that would produce a positive reaction with the reagent strip test for ketones is:

A. Alkaptonuria

B. Melanuria

C. MSUD

D. Tyrosyluria

C

8. An overflow disorder that could produce a false-positive reaction with Clinitest procedure is:

A. Cystinuria

B. Alkaptonuria

C. Indicanuria

D. Porphyrinuria

B

9. A urine that turns black after sitting by the sink for several hours could be indicative of:

A. Alkaptonuria

B. MSUD

C. Melanuria

D. Both A and C

D

10. Ketonuria in a newborn is an indication of:

A. MSUD

B. Isovaleric acidemia

C. Methylmalonic acidemia

D. All of the above

D

11. Urine from a newborn with MSUD will have a significant:

A. Pale color

B. Yellow precipitate

C. Milky appearance

D. Sweet odor

D

12. Hartnup disease is a disorder associated with the metabolism of:

A. Organic acids

B. Tryptophan

C. Cystine

D. Phenylalanine

B

13. 5-HIAA is a degradation product of:

A. Heme

B. Indole

C. Serotonin

D. Melanin

C

14. Elevated urinary levels of 5-HIAA are associated with:

A. Carcinoid tumors

B. Hartnup disease

C. Cystinuria

D. Platelet disorders

A

15. False-positive levels of 5-HIAA can be caused by a diet high in:

A. Meat

B. Carbohydrates

C. Starch

D. Bananas

D

16. Place the appropriate letter in front of the following statements.

A. Cystinuria

B. Cystinosis

____ IEM

____ Inherited disorder of tubular reabsorption

____ Fanconi syndrome

____ Cystine deposits in the cornea

____ Early renal calculi formation

B, A, B, B, A

17. Blue diaper syndrome is associated with:

A. Lesch-Nyhan syndrome

B. Phenylketonuria

C. Cystinuria

D. Hartnup disease

D

18. Homocystinuria is caused by failure to metabolize:

A. Lysine

B. Methionine

C. Arginine

D. Cystine

B

19. The Ehrlich reaction will only detect the presence of:

A. Uroporphyrin

B. Porphobilinogen

C. Coproporphyrin

D. Protoporphyrin

B

20. Acetyl acetone is added to the urine before performing the Ehrlich test when checking for:

A. Aminolevulinic acid

B. Porphobilinogen

C. Uroporphyrin

D. Coproporphyrin

B

21. The classic urine color associated with porphyria is:

A. Dark yellow

B. Indigo blue

C. Pink

D. Port wine

D

22. Which of the following specimens can be used for porphyrin testing?

A. Urine

B. Blood

C. Feces

D. All of the above

D

23. The two stages of heme formation affected by lead poisoning are:

A. Porphobilinogen and uroporphyrin

B. Aminolevulinic acid and porphobilinogen

C. Coproporphyrin and protoporphyrin

D. Aminolevulinic acid and protoporphyrin

D

24. Hurler, Hunter, and Sanfilippo syndromes are hereditary disorders affecting metabolism of:

A. Porphyrins

B. Purines

C. Mucopolysaccharides

D. Tryptophan

C

25. Many uric acid crystals in a pediatric urine specimen may indicate:

A. Hurler syndrome

B. Lesch-Nyhan disease

C. Melituria

D. Sanfilippo syndrome

B

26. Deficiency of the GALT enzyme will produce a:

A. Positive Clinitest

B. Glycosuria

C. Galactosemia

D. Both A and C

D

27. Match the metabolic urine disorders with their classic urine abnormalities. ____ PKU A. Sulfur odor

____ Indicanuria B. Sweaty feet odor

____ Cystinuria C. Orange sand in diaper

____ Alkaptonuria D. Mousy odor

____ Lesch-Nyhan disease E. Black color

____ Isovaleric acidemia F. Blue color

D, F, A, E, C, B

1. The functions of the CSF include all of the following except:

A. Removing metabolic wastes

B. Producing an ultrafiltrate of plasma

C. Supplying nutrients to the CNS

D. Protecting the brain and spinal cord

B

2. The CSF flows through the:

A. Choroid plexus

B. Pia mater

C. Arachnoid space

D. Dura mater

C

3. Substances present in the CSF are controlled by the:

A. Arachnoid granulations

B. Blood-brain barrier

C. Presence of one-way valves

D. Blood-CSF barrier

B