Urinalysis and Body Fluids | Quizlet

1. Why is the first-voided morning urine

specimen the most desirable specimen for

routine urinalysis?

A. Most dilute specimen of the day and

therefore any chemical compounds

present will not exceed the detectability

limits of the reagent strips

B. Least likely to be contaminated with

microorganisms because the bladder is

a sterile environment

C. Most likely to contain protein because

the patient has been in the orthostatic

position during the night

D. Most concentrated specimen of the

day and therefore it is more likely that

abnormalities will be detected

D. The first-voided morning urine specimen is

the most desirable for chemical and microscopic

analysis because it is the most concentrated specimen

of the day. Protein and nitrite testing is better

performed on a concentrated specimen, as are

the specific gravity determination and the examination

of urinary sediment. However, because of

the lack of food and fluid intake during the night,

glucose metabolism may be better assessed on

the basis of a postprandial specimen.

2. The physical characteristic of color

is assessed when a routine urinalysis

is performed. What substance is

normally found in urine that is principally

responsible for its yellow coloration?

A. Bilirubin

B. Melanin

C. Carotene

D. Urochrome

D. Urochrome, a yellow-brown pigment derived

from urobilin, is principally responsible for the

yellow coloration of normal urine. Urochrome is

excreted at a constant rate, showing no diurnal

variation. Therefore, the color of normal urine,

which may range from straw to deep amber, is

dependent on the concentrating ability of the kidney

and the volume of urine excreted

3. In certain malignant disorders, what

substance is found in the urine that turns

the urine dark brown or black on exposure

of the urine to air?

A. Urobilinogen

B. Indican

C. Melanin

D. Porphyrin

C. Melanin, a substance derived from tyrosine,

is responsible for the pigmentation of the eyes,

skin, and hair.

4. What is the expected pH range of a freshly

voided urine specimen?

A. 3.5-8.0

B. 3.5-9.0

C. 4.0-8.5

D. 4.5-8.0

D. pH is a representative symbol for the hydrogen

ion concentration. The kidney plays an

important role in the maintenance of the acidbase

balance of body fluids by either excreting

or retaining hydrogen ions. A normally functioning

kidney will excrete urine with a pH between

4.5 and 8.0, depending on the overall acid-base

needs of the body

5. Urine specimens should be analyzed as

soon as possible after collection. If urine

specimens are allowed to stand at room

temperature for an excessive amount of

time, the urine pH will become alkaline

because of bacterial decomposition of

A. Protein

B. Urea

C. Creatinine

D. Ketones

B. At room temperature, the amount of bacteria

present in a urine sample will increase. The bacteria

are capable of metabolizing the urinary urea

to ammonia. The ammonia formed through this

process will cause an alkalinization of the urine

6. Which term is defined as a urine volume

in excess of 2000 mL excreted over a

24-hour period?

A. Anuria

B. Oliguria

C. Polyuria

D. Hypersthenuria

C. On the average, a normal adult excretes

1200-1500 mL of urine daily. "Polyuria" is a

term used to describe the excretion of a urine

volume in excess of 2000 mL/day

7. The reagent test strips used for the

detection of protein in urine are most

reactive to

A. Albumin

B. Hemoglobin

C. Alpha-globulins

D. Beta-globulins

A. In healthy individuals the amount of protein

excreted in the urine should not exceed 150

mg/24 hr. When

8. A urine specimen that exhibits yellow

foam on being shaken should be suspected

of having an increased concentration of

A. Protein

B. Hemoglobin

C. Bilirubin

D. Nitrite

C. Normal urine does not foam on being shaken.

However, urine containing bilirubin will exhibit

yellow foaming when the specimen is shaken

9. How should controls be run to ensure the

precision and accuracy of the reagent test

strips used for the chemical analysis of

urine?

A. Positive controls should be run on a

daily basis and negative controls when

opening a new bottle of test strips.

B. Positive and negative controls should

be run when the test strips' expiration

date is passed.

C. Positive and negative controls should

be run on a daily basis.

D. Positive controls should be run on a

daily basis and negative controls on a

weekly basis.

C. For quality control of reagent test strips, it is

recommended that both positive and negative

controls be used daily. It is necessary that any

deterioration of the strips

10. The colorimetric reagent strip test for

protein is able to detect as little as 5-20 nig

of protein per deciliter. What may cause a

false-positive urine protein reading?

A. Uric acid concentration is greater than

0.5 g/day.

B. Vitamin C concentration is greater

than 0.5 g/day.

C. Glucose concentration is greater than

130mg/day.

D. pH is greater than 8.0

D. The principle of the reagent strip method for

the detection of protein in urine is based on a

color change in an indicator system, such as

tetrabromophenol blue, that is buffered to pH 3.

11. "Isosthenuria" is a term applied to a series

of urine specimens from the same patient

that exhibit a

A. Specific gravity of exactly 1.000

B. Specific gravity less than 1.007

C. Specific gravity greater than 1.020

D. Fixed specific gravity of approximately

1.010

D. "Isosthenuria" is a term applied to a series of

urine specimens that exhibit a fixed specific gravity

of approximately 1.010

12. A urine specimen is tested by a reagent

strip test and the sulfosalicylic acid test to

determine whether protein is present. The

former yields a negative protein, whereas

the latter results in a reading of 2+

protein. Which of the following statements

best explains this difference?

A. The urine contained an excessive

amount of amorphous urates or

phosphates that caused the turbidity

seen with the sulfosalicylic acid test.

B. The urine pH was greater than 8,

exceeding the buffering capacity

of the reagent strip, thus causing

a false-negative reaction.

C. A protein other than albumin must be

present in the urine.

D. The reading time of the reagent strip

test was exceeded (the reading being

taken at 2 minutes), causing a falsenegative

reaction to be detected

C. When globulin, mucoprotein, or Bence Jones

protein is present in a urine specimen, the reagent

strip test may give a negative result because the

strip is more sensitive to the presence of albumin

than to the presence of other proteins in urine

13. Which of the following is the major

organic substance found in urine?

A. Sodium

B. Potassium

C. Glucose

D. Urea

D. Although sodium is the major inorganic molecule

found in urine, urea is the major organic

molecule excreted. Urea is a waste product of

protein/amino acid metabolism.

14. Each of the following is included in the

quality assurance program for a urinalysis

laboratory. Which one represents a

preanalytical component of testing?

A. Setting collection guidelines for

24-hour urines

B. Setting a maintenance schedule for

microscopes

C. Reporting units to be used for crystals

D. Requiring acceptable results for

control specimens before any patient

results are reported out

A. Preanalytical components of laboratory testing

include all variables that can affect the

integrity or acceptability of the patient specimen

prior to analysis, such as correct collection technique.

15. The presence of ketone bodies in urine

specimens may be detected by use of a

reagent strip impregnated with sodium

nitroprusside. This strip test is sensitive

to the presence of

A. Acetoacetic acid and betahydroxybutyric

acid

B. Acetoacetic acid and acetone

C. Diacetic acid and beta-hydroxybutyric

acid

D. Beta-hydroxybutyric acid and acetone

B. Under normal metabolic conditions, the

body metabolizes fat to carbon dioxide and

water. With

16. A routine urinalysis is performed on a

young child suffering from diarrhea. The

reagent test strip is negative for glucose

but positive for ketones. These results may

be explained by which of the following

statements?

A. The child has Type 1 diabetes mellitus.

B. The child is suffering from lactic

acidosis, and the lactic acid has falsely

reacted with the impregnated reagent

area for ketones.

C. The child is suffering from increased

catabolism of fat because of decreased

intestinal absorption.

D. The reagent area for ketones was read

after the maximum reading time

allowed.

C. Although a positive result on a urine test for

ketones is most commonly associated with

increased urinary glucose levels, as in diabetes

mellitus, other conditions may cause the urine

ketone test to show positive results

17. The principle of the colorimetric reagent

strip test for hemoglobin is based on the

peroxidase activity of hemoglobin in

catalyzing the oxidation of a dye with

peroxide to form a colored compound.

This method may yield false-positive

results for the presence of hemoglobin

when the urine specimen contains

A. Ascorbic acid

B. Tetracycline

C. Myoglobin

D. Nitrite

C. The colorimetric reagent strip test for the

detection of hemoglobin in urine utilizes a

buffered test zone impregnated with a dye and

organic peroxide.

18. A reagent test strip impregnated with

a diazonium salt such as diazotized

2,4-dichloroaniline may be used to

determine which analyte?

A. Glucose

B. Ketone

C. Hemoglobin

D. Bilirubin

D. Bilirubin is a compound that is formed as a

result of hemoglobin breakdown. The majority

of bilirubin in the blood is bound to albumin and

is known as unconjugated bilirubin

19. Which of the following will contribute to a

specimen's specific gravity if it is present

in a person's urine?

A. 50-100 RBC/hpf

B. 85 mg/dL glucose

C. 3+ amorphous phosphates

D. Moderate bacteria

B. Only dissolved solutes affect specific gravity

(e.g., glucose). Cells, mucus, crystals, or any

other formed elements will have no effect, regardless

of concentration.

20. With infections of the urinary system,

white blood cells are frequently seen in

the urine sediment. What type of white

blood cell is seen the most frequently in

urine sediment?

A. Eosinophil

B. Lymphocyte

C. Monocyte

D. Neutrophil

D. The majority of renal and urinary tract diseases

are characterized by an increased number

of neutrophilic leukocytes in the urine

21. A random urine is collected from a patient

and the results obtained are as follows:

urine albumin =16 mg/dL and urine

creatinine = 140 mg/dL. These findings

are consistent with

A. Microalbuminuria

B. Macroalbuminuria

C. Nephrotic syndrome

D. Obstructive jaundice

A. The ratio of urine albumin to creatinine in a

random specimen is commonly used to evaluate

microalbuminuria, especially in patients with diabetes

mellitus. This

22. To detect more easily the presence of casts

in urine sediments, which microscopic

method can be used?

A. Fluorescent microscopy

B. Phase-contrast microscopy

C. Polarized microscopy

D. Brightfield microscopy

B. To better diagnose renal and urinary tract

diseases, it is necessary to examine urinary sediment

carefully by the most appropriate microscopic

method available

23. Which substance found in urinary

sediment is more easily distinguished

by use of polarized microscopy?

A. Lipids

B. Casts

C. Red blood cells

D. Ketone bodies

A. Fatty materials in urinary sediment may be

identified by means of staining techniques using

Sudan III and oil red O or by means of polarized

microscopy. Polarized

24. "Glitter cell" is a term used to describe

a specific type of

A. Ketone body

B. Oval fat body

C. Fatty droplet

D. Neutrophil

D. When neutrophils are exposed to hypotonic

urine, their physical appearance becomes altered.

Under hypotonic conditions, the neutrophils

tend to swell and the cytoplasmic granules contained

within the cells exhibit Brownian movement.

25. The final phase of degeneration that

granular casts undergo is represented

by which of the following casts?

A. Fine

B. Coarse

C. Cellular

D. Waxy

D. Waxy casts represent the final phase of granular

cast degeneration. As the fine granules of

the granular casts lyse, highly refractive, smooth,

blunt-ended waxy casts are formed.

26. A 40-year-old female patient with a history

of kidney infection is seen by her physician

because she has felt lethargic for a few

weeks. She has decreased frequency of

urination and a bloated feeling. Physical

examination shows periorbital swelling

and general edema, including a swollen

abdomen. Significant urinalysis results

show the following: color = yellow;

appearance = cloudy/frothy; specific

gravity = 1.022;pH = 7.0; protein =

4+; 0-3 WBC/hpf; 0-1 RBC/hpf; 0-2

renal epithelial cells/hpf; 10-20 hyaline

casts/lpf; 0-1 granular casts/lpf; 0-1 fatty

casts/lpf; occasional oval fat bodies. Her

serum chemistries show significantly

decreased albumin, increased urea

nitrogen, and increased creatinine. These

findings suggest which condition?

A. Multiple myeloma

B. Glomerulonephritis

C. Nephrotic syndrome

D. Chronic renal failure

C. Nephrotic syndrome is suggested by the

increased urine protein (with serum albumin significantly

decreased), the hyaline and fatty casts,

and the presence of oval fat bodies

27. A 47-year-old female patient with

controlled type 2 diabetes mellitus

complains of urinary frequency and

burning. She provides a first-morning,

clean-catch specimen. Results show

color = yellow; appearance = cloudy;

pH = 6.5; a representative microscopic

high-power field is shown in Color

Plate 46B. Which of the following is true

for this patient?

A. The number of bacteria seen would

result in a positive nitrite.

B. The major formed elements are white

blood cells and yeast.

C. The type and number of epithelial

cells suggest incorrect sample

collection.

D. The red blood cells would be sufficient

to give a positive blood result on the

reagent strip.

B. There are minimal bacteria present in Color

Plate 46B. Both budding yeast and white blood

cells predominate this microscopic field

28. Alkaptonuria, a rare hereditary disease, is

characterized by the urinary excretion of

A. Alkaptone

B. Phenylalanine

C. 5-Hydroxyindole acetic acid

D. Homogentisic acid

D. Alkaptonuria is a rare hereditary disease that

is characterized by excessive urinary excretion

of homogentisic acid. T

29. A 22-year-old female clinical laboratory

student performs a urinalysis on her own

urine as part of a lab class. Significant

results include: color = yellow;

appearance = cloudy; pH = 7.5;

nitrite = positive; leukocyte

esterase - 2+; 25^0 WBC/hpf;

0-3 RBC/hpf; 2-5 squamous epithelial

cells/hpf; moderate bacteria. All other

chemistries and microscopic results

were normal. These findings suggest

A. Glomerulonephritis

B. Upper urinary tract infection

C. Lower urinary tract infection

D. Nephrolithiasis

C. This student has a lower urinary tract infection

(UTI), also known as cystitis.

30. Metastatic carcinoid tumors arising from

the enterochromaffin cells of the gastrointestinal

tract are characterized by

increased excretion of urinary

A. Serotonin

B. 5-Hydroxytryptophan

C. Homogentisic acid

D. 5-Hydroxyindole acetic acid

D. The intestinal enterochromaffin cells, sometimes

called the argentaffin cells, produce a substance

known as serotonin from the amino acid

tryptophan.

31. Some clinical conditions are characterized

by unique urinalysis result patterns.

Which of the following shows such a

relationship?

A. Nephrotic syndrome: positive protein

on reagent strip, negative protein with

sulfosalicylic acid

B. Intensive dieting: increased ketones,

negative glucose

C. Multiple myeloma: positive protein

by both reagent strip and sulfosalicylic

acid

D. Cystitis: positive nitrite and protein

B. Because of increased lipid metabolism in

long-term, intensive dieting, ketone body formation

will increase

32. Nitrite in a urine specimen suggests the

presence of

A. White blood cells

B. Red blood cells

C. Bacteria

D. Yeasts

C. Bacteria of the Enterobacter, Citrobacter,

Escherichia, Proteus, Klebsiella, and Pseudomonas

species produce enzymes that catalyze

the reduction of nitrate, a substance normally

found in urine, to nitrite.

33. If a fasting plasma glucose level of 100

mg/dL is obtained on an individual, what

is the expected fasting cerebrospinal fluid

(CSF) glucose level in mg/dL?

A. 25

B. 50

C. 65

D. 100

C. Cerebrospinal fluid (CSF) is a clear, colorless

liquid that may be described as a modified

ultrafiltrate of blood. Both active transport and

passive diffusion are involved in the passage of

glucose from the blood into the CSF

34. A 35-year-old man has just experienced

severe crush injuries sustained in a car

accident. He has a broken pelvis and right

femur and has numerous abrasions and

contusions. A random urinalysis specimen

shows a brown color and clear appearance.

pH is 6.0, protein is 1 + , and blood is 3+.

There is, however, only 0-1 RBC/hpf,

along with 0-3 WBC/hpf. Casts found

include hyaline (0-2/lpf) and granular

(0-1/Ipf). Other urine results are normal.

Which of the following is true about this

patient?

A. The positive blood result is from a

hemolytic anemia.

B. The bilirubin result should have also

been positive for this patient.

C. Rhabdomyolysis may be a cause for

the discrepant chemical/microscopic

blood findings.

D. The bone crushing led to the increased

protein result.

C. In addition to hemoglobin, the muscle protein

myoglobin can cause a positive blood result

in chemical reagent strip testing

35. A 67-year-old male has routine testing

done and shows an estimated glomerular

filtration rate (eGFR) of 42 mL/min/1.73 m2.

Which of the following is true for this

patient?

A. This test requires a 24-hour urine

collection.

B. The patient does not have chronic

kidney damage, based on these results.

C. Similar results would be obtained

using the Cockgroft-Gault formula.

D. The patient is in Stage 3 chronic

kidney damage.

D. The eGFR calculation is based on the "modification

of diet and renal disease" formula recommended

by the American Kidney Foundation

36. Which is true about the formed element

shown in Color Plate 47 •?

A. May be found in normal alkaline urine

B. Associated with renal pathology

C. Characteristic of glomerulonephritis

D. Associated with lung pathology

A. Normal alkaline (or neutral) urine may contain

triple phosphate crystals, as seen in Color

Plate 47 •. These crystals can be identified by the

characteristic "coffin lid" appearance

37. The major formed element in the highpower

field shown in Color Plate 48 •

is most likely a

A. Granular cast

B. Hyaline cast

C. Waxy cast

D. Fiber artifact

D. Refer to Color Plate 48 •. The fringed appearance

at the one end of the major formed element

strongly suggests that this is a fiber artifact, most

likely placed in the sample at the time of collection.

38. Which of the following is true about the

final concentrating of urine in the kidney?

A. The distal convoluted tubule, through

active transport, reabsorbs water.

B. Water is reabsorbed under the direct

influence of angiotensin II.

C. Vasopressin controls the collecting

duct reabsorption of water.

D. Water reabsorption is influenced by

urine filtrate levels of potassium

C. The distal convoluted tubule and collecting

duct provide water reabsorption through the

action of antidiuretic hormone (vasopressin).

39. If a urine specimen is left standing at room

temperature for several hours, which of

the following changes may occur?

A. Multiplication of bacteria

B. An increase in the glucose concentration

C. Production of an acid urine

D. Deterioration of any albumin present

A. Only freshly voided urine specimens should

be used for urinalysis testing. If the specimen cannot

be examined within 1 hour after collection, it

should be refrigerated to help preserve the

integrity of the specimen

40. The formed element shown in Color

Plate 49B would usually be found in the

patient's urine along with which soluble

biochemicals?

A. Phenylalanine and tyrosine

B. Ornithine and arginine

C. Isoleucine and leucine

D. Acetoacetic acid and (3-hydroxybutyric

acid

B. The presence of cystine crystals in a patient

sample is always a cause for immediate notification

of the physician.

41. A 13-year-old ice skater is having her

routine physical before the school year.

Her first morning urinalysis results

include color = straw; appearance =

hazy; pH = 6.0; protein = trace; a

representative microscopic high-power

field is shown in Color Plate 50B. All

other chemical results were normal. The

major formed elements are and

suggest .

A. Hyaline casts and waxy casts;

nephrotic syndrome

B. Mucus and fibers; no pathology

C. Granular casts and red blood cells;

glomerulonephritis

D. Hyaline casts and mucus; normal

sediment

D. The major formed elements in Color Plate

50B are hyaline casts and mucus fibers, which

are normal in the numbers shown in this field

42. Phenylketonuria may be characterized

by which of the following statements?

A. It may cause brain damage if

untreated.

B. It is caused by the absence of the

enzyme, phenylalanine oxidase.

C. Phenylpyruvic acid excess appears

in the blood.

D. Excess tyrosine accumulates in the

blood.

A. Phenylketonuria is inherited as an autosomal

recessive trait that manifests itself in the homozygous

form.

43. What condition is suggested by the

number of the formed element that

predominates in the high-power field

of Color Plate 5 !•?

A. Glomerulonephritis

B. Improperly collected specimen

C. Pyelonephritis

D. Normal sample

D. Color Plate 51B demonstrates sperm and calcium

oxalate crystals. Both formed elements are

found in correctly collected normal urines from

either gender.

44. Xanthochromia of cerebrospinal fluid

(CSF) samples may be due to increased

levels of which of the following?

A. Chloride

B. Protein

C. Glucose

D. Magnesium

B. A variety of substances in CSF specimens

have been associated with a xanthochromic

appearance. Among those substances are oxyhemoglobin,

carotenoids, bilirubin, and protein

45. Which of the following will be characterized

by an increased number of the urinary

component seen in Color Plate 52M?

A. Acute glomerulonephritis

B. Biliary tract obstruction

C. Contamination from vaginal discharge

D. Nephrotic syndrome

A. Refer to Color Plate 52B. Erythrocytes or

red blood cells (RBCs) occur in small numbers

(0-2/hpf) in a normal urine. Using brightfield

microscopy, unstained RBCs appear as colorless

discs with an average size of 7 jam in diameter

46. To determine amniotic fluid contamination

with maternal urine, which of the

following measurements could be used?

A. Creatinine concentration

B. Delta absorbance at 410 nm

C. Albumin/globulin ratio

D. Lactate dehydrogenase

A. Because there may be technical problems

associated with amniocentesis, contamination

with maternal urine should be considered in

evaluating specimens submitted for amniotic

fluid analysis.

47. With the development of fetal lung

maturity, which of the following phospholipid

concentrations in amniotic fluid

significantly and consistently increases?

A. Sphingomyelin

B. Phosphatidyl ethanolamine

C. Phosphatidyl inositol

D. Phosphatidyl choline

D. The alveolar concentrations of the various

phospholipids (surfactants) change during fetal

lung development, and because these changes

are reflected directly in the amniotic fluid, a

number of investigations have shown that

analysis of the fluid can provide good predictive

information for the development of respiratory

distress syndrome in the newborn

48. A patient has been diagnosed with an

upper gastrointestinal bleed. Which of the

following would be characteristic for this

condition?

A. Brown stool with streaks of bright red

B. Stool with lack of brown color

("clay-colored")

C. Stool with a much darker brown/black

color

D. Yellow stool with increased mucus

C. The hemoglobin released from red blood

cells in an upper gastrointestinal bleed will have

time to become denatured and oxidized as it

travels the entire intestinal tract

49. A pleural effusion is found to have 3000

white blood cells per microliter and 5 g/dL

total protein. From this it can be determined

that the patient's effusion is

A. A transudate

B. An exudate

C. Noninflammatory

D. Hemorrhagic

B. Effusions can be transudates or exudates, and

the distinguishing characteristics are cell number

and total protein.

50. Patients with diabetes insipidus tend to

produce urine in volume with

specific gravity.

A. Increased; decreased

B. Increased; increased

C. Decreased; decreased

D. Decreased; increased

A. Diabetes insipidus is caused by a deficiency

in antidiuretic hormone. Such deficiencies will

result in the kidney's inability to reabsorb water

at the distal and collecting tubules. This affects

only water reabsorption and not the

51. The estimation of hyaluronic acid

concentration by measurement of

viscosity is useful in evaluating which

type of fluid?

A. Spinal

B. Peritoneal

C. Pleural

D. Synovial

D. Synovial fluid is a form of plasma ultrafiltrate

with added hyaluronic acid. Decreased viscosity

and poor mucin clot formation are indications of

the decreased hyaluronate concentration of synovial

fluid

52. Which of the following is characteristic of

an exudate effusion?

A. Leukocyte count >1000/uL

B. Clear appearance

C. Protein concentration <3.0 g/dL

D. Absence of fibrinogen

A. Effusions result from an imbalance of the

flow of body fluids. Effusions are classified as

exudates or transudates on the basis of certain

characteristics.

53. Which of the following systems utilizes

polyelectrolytes to determine the specific

gravity of urine?

A. Refractometer

B. Osmometer

C. TS meter

D. Reagent strip

D. A clinically useful test for assessing the concentrating

and diluting ability of the kidneys is

the determination of urine specific gravity. The

specific gravity is a measure of the proportion of

dissolved solids in a given volume of solvent

54. Which methods may be used to quantify

protein in both cerebrospinal fluid and

urine specimens?

A. Trichloroacetic acid and bromcresol

green

B. Ponceau S and Coomassie brilliant

blue

C. Bromcresol green and Coomassie

brilliant blue

D. Coomassie brilliant blue and

trichloroacetic acid

D. Trichloroacetic acid is a turbidimetric method

used to quantify small amounts of protein, less

than 100 mg/dL, in cerebrospinal fluid (CSF) and

urine specimens.

55. Which of the following characteristics is

true of the primary urinary components

shown in Color Plate 53B?

A. Consist of uromodulin protein

B. Presence always indicates a disease

process

C. Can be observed with polarized

microscopy

D. Appear yellowish in brightfield

microscopy

A. As seen in Color Plate 53B, hyaline casts are

the most commonly observed cast, and they consist

completely of uromodulin (Tamm-Horsfall)

protein.

56. A characteristic of substances normally

found dissolved in the urine is that they

are all

A. Water soluble

B. Inorganic

C. Organic

D. Waste products

A. To be found in urine, a solute must be water

soluble. Solutes can be inorganic (e.g., sodium)

or organic (e.g., urea).

57. Which of the following statements applies

to the proper collection and handling of

CSF?

A. The second tube collected should be

used for chemistry analyses.

B. The third tube collected should be

used for bacteriologic studies.

C. CSF collected in the evening should

be refrigerated and assays performed

only by day-shift personnel.

D. With low-volume specimens, a culture

is performed first, before cell counts

are done.

D. Cerebrospinal fluid (CSF) must be collected

in sterile tubes. The first tube is generally used for

chemistry and serology studies, the second tube is

employed for bacteriologic examination, and the

third tube is used for cell counts. Tubes used for

chemistry and bacteriologic studies should be

centrifuged before use

58. Which of the following characteristics is

true for the urinary components shown in

Color Plate 54B?

A. Never should appear in a freshly

collected sample

B. Can also resemble cysteine crystals

C. Appear insoluble in alkaline urine

D. Presence indicates an inborn error of

metabolism

B. Uric acid crystals, as seen in Color Plate 54B,

are commonly encountered in normal acidic urine

but may be observed in neutral urine and rarely in

an alkaline urine, because uric acid is soluble at

alkaline pH.

59. A patient sends the following question to

an online consumer health Web site: "I am

a 22-year-old female who experienced

increasing headaches, thirst, and decreasing

energy. I was studying in the library

when I felt lightheaded and passed out.

I was taken to a hospital emergency

department and they told me that my

serum Acetest® was 40 mg/dL and urine

glucose was 500 mg/dL. What does this

mean?" How would you reply?

A. Your lab results pattern suggests

diabetes mellitus.

B. You probably have been crash dieting

recently.

C. The two results do not fit any disease

pattern.

D. The tests need to be repeated because

they could not possibly occur together

A. A positive urine glucose plus a positive

serum ketone strongly suggest uncontrolled diabetes

mellitus.

60. Which urinalysis reagent strip test will

never be reported out as "negative"?

A. Protein

B. Urobilinogen

C. Bilirubin

D. Nitrite

B. The sensitivity of a method is the lowest

concentration of the analyte that will result in a

detectable reaction signal.

61. The following urinalysis results were

obtained on a 40-year-old white male

whose skin appeared yellowish during the

clinical examination. Color and clarity—

dark brown, clear; protein—negative;

glucose—negative; blood—negative;

ketones—negative; bilirubin— moderate;

urobilinogen—0.2 mg/dL. These results

are clinically significant in which of the

following conditions?

A. Bile duct obstruction

B. Cirrhosis

C. Hepatitis

D. Hemolytic anemia

A. In the hepatic phase of bilirubin metabolism,

bilirubin is conjugated with glucuronic acid to

form water-soluble conjugated bilirubin. The

conjugated bilirubin passes into the bile duct and

on to the intestinal tract.

62. Compared to the fecal occult blood test,

which of the following is a disadvantage

of performing a DNA-based test to detect

colon cancer?

A. The DNA test is more invasive.

B. The DNA test is less sensitive.

C. The DNA test is more expensive.

D. Additional diet restrictions are needed

for the DNA test

C. DNA-based tests for detecting mutations

within colon cells are generally more expensive

than the fecal occult blood (FOB) methods using

the pseudoperoxidase property of hemoglobin

63. Which of the following may be associated

with morphologic examination of

spermatozoa?

A. Evaluation should include assessment

of 1000 spermatozoa.

B. A small number of sperm should have

normal morphologic characteristics.

C. Papanicolaou stain may be used.

D. Presence of red or white cells and

epithelial cells need not be noted

C. The morphologic characteristics of spermatozoa

are best evaluated by means of smears

stained with Papanicolaou stain. Other stains

used include Kemechtrot, Giemsa, basic fuchsin,

crystal violet, and hematoxylin

64. Which condition is characterized by

increased levels of immunoglobulins in

the cerebrospinal fluid, originating from

within the central nervous system and not

from the general blood circulation?

A. Gout

B. Erythroblastosis fetalis

C. Multiple myeloma

D. Multiple sclerosis

D. Immunoglobulins (IgGs) are normally present

at less than 1 mg/dL in the CSF. Increased

CSF IgG can result from increased CSF production

(e.g., multiple sclerosis) or from increased

transport from the blood plasma (compromised

blood-brain barrier).

65. Which of the following statements

pertains to screening methods used to

determine pregnancy?

A. Immunoassays will use reagent

anti-hCG to react with patient hCG.

B. A random urine specimen is the

preferred specimen for pregnancy

screening tests.

C. Internal controls provided within the

kit will assess if the patient's specimen

was collected correctly.

D. External quality control is not needed

with these methods

A. Many simplified yet immunologically sophisticated

methods exist currently for determining

pregnancy. All are based on the reaction between

patient human chorionic gonadotropin (hCG) and

anti-hCG.

66. The following urinalysis biochemical

results were obtained from a 4-month-old

infant who experienced vomiting and

diarrhea after milk ingestion and failed to

gain weight: pH—6; protein—negative;

glucose—negative; ketone—negative;

bilirubin—negative; Clinitest®—2+.

These results are clinically significant in

which of the following disorders?

A. Diabetes mellitus

B. Ketosis

C. Starvation

D. Galactosemia

D. Galactosemia, an inborn error of metabolism,

is characterized by the inability to metabolize

galactose, a monosaccharide that is contained in

milk as a constituent of the disaccharide lactose

67. Which of the following is a true statement?

A. Renal tubular cells originate from the

renal pelvis.

B. Red blood cells in acid urine (pH 4.5)

will usually be crenated because of the

acidity.

C. Bacteria introduced into a urine

specimen at the time of the collection

will have no immediate effect on the

level of nitrite in the specimen.

D. Pilocarpine iontophoresis is the

method of choice for the collection of

pericardial fluid.

C. Renal tubular cells originate from the renal

medulla or cortex. Red blood cell crenation is a

phenomenon reflecting increased solute concentration

(hyperosmolality) and is not caused by

urine pH.

1. Which statement regarding renal function is true?

A. Glomeruli are far more permeable to H2O and

salt than other capillaries

B. The collecting tubule reabsorbs sodium and

secretes potassium in response to antidiuretic

hormone (ADH)

C. The collecting tubule is permeable to H2O only

in the presence of aldosterone

D. The thick ascending limb is highly permeable to

H2O and urea

A. Glomeruli are far more permeable to H2O and

salt than other capillaries

2. Which statement regarding normal salt and H2O

handling by the nephron is correct?

A. The ascending limb of the tubule is highly

permeable to salt but not H2O

B. The stimulus for ADH release is low arterial

pressure in the afferent arteriole

C. The descending limb of the tubule is impermeable

to urea but highly permeable to salt

D. Renin is released in response to high plasma

osmolality

A. The ascending limb of the tubule is highly

permeable to salt but not H2O

3. Which statement concerning renal tubular

function is true?

A. In salt deprivation, the kidneys will conserve

sodium at the expense of potassium

B. Potassium is not excreted when serum

concentration is below 3.5 mmol/L

C. No substance can be excreted into urine at a rate

that exceeds the glomerular filtration rate

D. When tubular function is lost, the specific

gravity of urine will be below 1.005

A. In salt deprivation, the kidneys will conserve

sodium at the expense of potassium

4. Which of the following is inappropriate when

collecting urine for routine bacteriologic culture?

A. The container must be sterile

B. The midstream void technique must be used

C. The collected sample must be plated within

2 hours unless refrigerated

D. The sample may be held at 2°C-8°C for up

to 48 hours prior to plating

D. The sample may be held at 2°C-8°C for up

to 48 hours prior to plating

5. Which statement about sample collection for

routine urinalysis is true?

A. Preservative tablets should be used for collecting

random urine specimens

B. Containers may be washed and reused if rinsed

in deionized H2O

C. Samples may be stored at room temperature for

up to 2 hours

D. First morning voided samples are not acceptable

when renal disease is suspected

C. Samples may be stored at room temperature for

up to 2 hours

6. Which urine color is correlated correctly with the

pigment-producing substance?

A. Smoky red urine with homogentisic acid

B. Dark amber urine with myoglobin

C. Deep yellow urine and yellow foam with

bilirubin

D. Red-brown urine with biliverdin

C. Deep yellow urine and yellow foam with

bilirubin

7. Which of the following substances will cause urine

to produce red fluorescence when examined with

an ultraviolet lamp (360 nm)?

A. Myoglobin

B. Porphobilinogen (PBG)

C. Urobilin

D. Coproporphyrin

D. Coproporphyrin

8. Which of the following conditions is associated

with normal urine color but produces red

fluorescence when urine is examined with an

ultraviolet (Wood's) lamp?

A. Acute intermittent porphyria

B. Lead poisoning

C. Erythropoietic porphyria

D. Porphyria cutanea tarda

B. Lead poisoning

9. Which statement regarding porphyria is accurate?

A. Porphyria is exclusively inherited

B. All types cause an increase in urinary porphyrins

C. All types are associated with anemia

D. Serum, urine, and fecal tests may be needed for

diagnosis

D. Serum, urine, and fecal tests may be needed for

diagnosis

10. Which is the most common form of porphyria?

A. Erythropoietic porphyria

B. Acute intermittent porphyria

C. Variegate porphyria

D. Porphyria cutanea tarda

Body fluids/Apply knowledge

D. Porphyria cutanea tarda

Body fluids/Apply knowledge

11. Which of the following methods is the least

sensitive and specific for measuring PBG in urine?

A. Watson-Schwartz test

B. LC-MS

C. Ion exchange chromatography-Ehrlich's reaction

D. Isotope dilution-MS

A. Watson-Schwartz test

12. A brown or black pigment in urine can be

caused by:

A. Gantrisin (Pyridium)

B. Phenolsulfonphthalein

C. Rifampin

D. Melanin

D. Melanin

13. Urine that is dark red or port wine in color may be

caused by:

A. Lead poisoning

B. Porphyria cutanea tarda

C. Alkaptonuria

D. Hemolytic anemia

B. Porphyria cutanea tarda

14. Which of the following tests is affected least by

standing or improperly stored urine?

A. Glucose

B. Protein

C. pH

D. Bilirubin

Body fluids/Apply

B. Protein

15. Which type of urine sample is needed for a

D-xylose absorption test on an adult patient?

A. 24-hour urine sample collected with 20 mL

of 6 N HCl

B. 2-hour timed postprandial urine preserved with

boric acid

C. 5-hour timed urine kept under refrigeration

D. Random urine preserved with formalin

C. 5-hour timed urine kept under refrigeration

16. Which of the following is inappropriate

when collecting a 24-hour urine sample for

catecholamines?

A. Urine in the bladder is voided and discarded at

the start of the test

B. At 24 hours, any urine in the bladder is voided

and added to the collection

C. All urine should be collected in a single container

that is kept refrigerated

D. Ten mL of 1N sodium hydroxide should be

added to the container before collection

D. Ten mL of 1N sodium hydroxide should be

added to the container before collection

17. Urine production of less than 400 mL/day is:

A. Consistent with normal renal function and

H2O balance

B. Termed isosthenuria

C. Defined as oliguria

D. Associated with diabetes mellitus

Body fluids/Correlate clinical and laboratory

C. Defined as oliguria

18. Which of the following contributes to SG, but

not to osmolality?

A. Protein

B. Salt

C. Urea

D. Glucose

A. Protein

19. Urine with an SG consistently between 1.002

and 1.003 indicates:

A. Acute glomerulonephritis

B. Renal tubular failure

C. Diabetes insipidus

D. Addison's disease

C. Diabetes insipidus

20. In which of the following conditions is the urine

SG likely to be below 1.025?

A. Diabetes mellitus

B. Drug overdose

C. Chronic renal failure

D. Prerenal failure

C. Chronic renal failure

21. Which statement regarding methods for

measuring SG is true?

A. To correct a urinometer, subtract 0.001 per each

3°C below 15.5°C

B. Colorimetric SG tests are falsely elevated when a

large quantity of glucose is present

C. Colorimetric SG readings are falsely elevated

when pH is alkaline

D. Refractometry should be performed before the

urine is centrifuged

A. To correct a urinometer, subtract 0.001 per each

3°C below 15.5°C

22. What is the principle of the colorimetric reagent

strip determination of SG in urine?

A. Ionic strength alters the pKa of a polyelectrolyte

B. Sodium and other cations are chelated by a

ligand that changes color

C. Anions displace a pH indicator from a mordant,

making it water soluble

D. Ionized solutes catalyze oxidation of an azo dye

A. Ionic strength alters the pKa of a polyelectrolyte

23. Which statement regarding urine pH is true?

A. High-protein diets promote an alkaline urine pH

B. pH tends to decrease as urine is stored

C. Contamination should be suspected if urine pH

is less than 4.5

D. Bacteriuria is most often associated with a low

urine pH

C. Contamination should be suspected if urine pH

is less than 4.5

24. In renal tubular acidosis, the pH of urine is:

A. Consistently acid

B. Consistently alkaline

C. Neutral

D. Variable, depending upon diet

B. Consistently alkaline

25. The normal daily urine output for an adult is

approximately:

A. 0.2-0.5 L

B. 0.6-1.6 L

C. 2.7-3.0 L

D. 3.2-3.5 L

Body fluids/Apply

B. 0.6-1.6 L

26. The SG of the filtrate in Bowman's space is

approximately:

A. 1.000-1.002

B. 1.004-1.006

C. 1.008-1.010

D. 1.012-1.014

Body fluids/Apply knowledge

C. 1.008-1.010

27. A patient with partially compensated respiratory

alkalosis would have a urine pH of:

A. 4.5-5.5

B. 5.5-6.5

C. 6.5-7.5

D. 7.5-8.5

D. 7.5-8.5

28. Which of the following is most likely to cause a

false-positive dry reagent strip test for urinary

protein?

A. Urine of high SG

B. Highly buffered alkaline urine

C. Bence-Jones protein

D. Salicylates

B. Highly buffered alkaline urine

29. When testing for urinary protein with

sulfosalicylic acid (SSA), which condition

may produce a false-positive result?

A. Highly buffered alkaline urine

B. The presence of x-ray contrast media

C. Increased urinary SG

D. The presence of red blood cells (RBCs)

Body fluids/Apply knowledge to identify sources

B. The presence of x-ray contrast media

30. A discrepancy between the urine SG determined

by measuring refractive index and urine osmolality

would be most likely to occur:

A. After catheterization of the urinary tract

B. In diabetes mellitus

C. After an intravenous pyelogram (IVP)

D. In uremia

C. After an intravenous pyelogram (IVP)

31. Which of the following is likely to result in a

false-negative dry reagent strip test for

proteinuria?

A. Penicillin

B. Aspirin

C. Amorphous phosphates

D. Bence-Jones protein

D. Bence-Jones protein

32. Daily loss of protein in urine normally does not

exceed:

A. 30 mg

B. 50 mg

C. 100 mg

D. 150 mg

D. 150 mg

33. Which of the following is least likely to cause a

false-positive result with turbidimetric protein

tests?

A. Tolbutamide

B. X-ray contrast media

C. Penicillin or sulfa antibiotics

D. Ascorbic acid

Body fluids/Apply knowledge

D. Ascorbic acid