Ch. 11 Success Urinalysis and Body fluid

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

2. 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

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

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. 4.5—8.0

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. Urea

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. Polyuria

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. Albumin

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. Bilirubin

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. Positive and negative controls should be run on a daily basis.

10. The colorimetric reagent strip test for protein is able to detect as little as 5—20 mg 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 130 mg/day.

D. pH is greater than 8.0.

D. pH is greater than 8.0.

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. 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 false- negative reaction to be detected.

C. A protein other than albumin must be present in the urine.

13. Which of the following is the major organic substance found in urine?

A. Sodium

B. Potassium

C. Glucose

D. Urea

D. Urea

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. Setting collection guidelines for 24-hour urines

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. Acetoacetic acid and acetone

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. The child is suffering from increased catabolism of fat because of decreased intestinal absorption.

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. Myoglobin

18. A reagent test strip impregnated with a diazonium salt such as diazotized 2,4-dichioroaniline may be used to determine which analyte?

A. Glucose

B. Ketone

C. Hemoglobin

D. Bilirubin

D. 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—lOORBCIhpf

B. 85 mgldL glucose

C. 3+ amorphous phosphates

D. Moderate bacteria

B. 85 mgldL glucose

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 most frequently in urine sediment?

A. Eosinophil

B. Lymphocyte

C. Monocyte

D. Neutrophil

D. Neutrophil

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. Macro albuminuria

C. Nephrotic syndrome

D. Obstructive jaundice

A. Microalbuminuria

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. Phase-contrast microscopy

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. Lipids

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. Neutrophil

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

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 cellslhpf; 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

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 46g. 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. The major formed elements are white blood cells and yeast.

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. Homogentisic acid

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—40 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. Lower urinary tract infection

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. 5-HIAA

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. Intensive dieting: increased ketones, negative glucose

32. Nitrite in a urine specimen suggests the presence of

A. White blood cells

B. Red blood cells

C. Bacteria

D. Yeasts

C. Bacteria

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. 65

It's usually 60-70% of the blood glucose level.

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 (O—2/lpf) and granular (O—l/lpf). 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. Rhabdomyolysis may be a cause for the discrepant chemical/microscopic blood findings.

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 patient is in Stage 3 chronic kidney damage.

Values less than 60 are considered abnormal and need to be followed up.

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. May be found in normal alkaline urine

37. The major formed element in the high- power field shown in Color Plate 48• is most likely a

A. Granular cast

B. Hyaline cast

C. Waxy cast

D. Fiber artifact

D. Fiber artifact

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. Vasopressin controls the collecting duct reabsorption of water.

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. Multiplication of bacteria

40. The formed element shown in Color Plate 49• 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-hydroxy- butyric acid

B. Ornithine and arginine

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 50. 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. Hyaline casts and mucus; normal sediment

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. It may cause brain damage if untreated.

43. What condition is suggested by the number of the formed element that predominates in the high-power field of Color Plate 51 (two calcium oxalate crystals, 5 sperm)?

A. Glomerulonephritis

B. Improperly collected specimen

C. Pyelonephritis

D. Normal sample

D. Normal sample

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. Protein

45. Which of the following will be characterized by an increased number of the urinary component seen in Color Plate 52 (increased RBCs w/ crenaation)?

A. Acute glomerulonephritis

B. Biliary tract obstruction

C. Contamination from vaginal discharge

D. Nephrotic syndrome

A. Acute glomerulonephritis

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. Creatinine concentration

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. Phosphatidyl choline

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. Stool with a much darker brown/black color

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. An exudate

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. Increased; decreased

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

52. Which of the following is characteristic of an exudate effusion?

A. Leukocyte count >1000/pL

B. Clear appearance

C. Protein concentration <3.0 g/dL

D. Absence of fibrinogen

A. Leukocyte count >1000/pL

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. Reagent strip

54. Which methods may be used to quantify protein in both cerebrospinal fluid and urine specimens?

A. Trichioroacetic acid and bromcresol green

B. Ponceau S and Coomassie brilliant blue

C. Bromcresol green and Coomassie brilliant blue

D. Coomassie brilliant blue and trichioroacetic acid

D. Coomassie brilliant blue and trichioroacetic acid

55. Which of the following characteristics is true of the primary urinary components shown in Color Plate 53?

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. Consist of uromodulin 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. Water soluble

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. With low-volume specimens, a culture is performed first, before cell counts are done.

58. Which of the following characteristics is true for the urinary components shown in Color Plate 54? (Uric acid crystals)

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. Can also resemble cysteine crystals

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. Your lab results pattern suggests diabetes mellitus.

60. Which urinalysis reagent strip test will never be reported out as "negative"?

A. Protein

B. Urobilinogen

C. Bilirubin

D. Nitrite

B

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. Bile duct obstruction

In bile duct obstruction, normal production of urobilinogen is decreased because conjugated BR cannot travel to the intestinal tract to be broken down into urobilinogen (n = .2-1). Therefore the urine strip test will indicate a positive BR & normal urobilinogen. Ictotest will be positive.

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. The DNA test is more expensive.

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. Papanicolaou stain may be used.

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

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

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

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