CLINICAL MICROSCOPY

B. Diabetes mellitus

1. Urine from a patient with polyuria has a high specific gravity. The patient should be evaluated for:

A. Urinary tract infection
C. Diabetes insipidus
B. Diabetes mellitus
D. Uremia

C. 1 and 2 only

2. An unpreserved specimen collected at 8 AM and remaining at room temperature until the afternoon shift arrives can be expected to have:

3. Decreased glucose and ketones

4. Decreased pH and turbidity

5. Increased bacteria and nitrite

6. Increased cellular elements

A. 1, 2 and 3
B. 1, 2 and 4
C. 1 and 2 only
D. 4 only

D. Dilute and alkaline

3. Red cells will disintegrate more rapidly in a urine that is:

A. Concentrated and acidic
C. Dilute and acidic
B. Concentrated and alkaline
D. Dilute and alkaline

B. First morning specimen

4. A negative urine pregnancy performed on a random specimen may need to be repeated using a:

A. Clean-catch specimen
C. Fasting specimen
B. First morning specimen
D. 24-hour specimen

B. Polyuria

5. Persons taking diuretics can be expected to produce:

A. Proteinuria
B. Polyuria
C. Pyuria
D. Oliguria

B. 160 - 180 mg/dL

6. The renal threshold for glucose is:

A. 50 - 100 mg/dL
B. 160 - 180 mg/dL
C. 220 - 240 mg/dL
D. Over 240 mg/dL

A. Produces a low urine volume

7. Increased production of vasopressin:

A. Produces a low urine volume
C. Increased ammonia excretion
B. Produces a high urine volume
D. Affects proximal convoluted tubule transport

B. 1 osmole of nonionizing substance dissolve in 1 kilogram of water lowers the freezing point 1.86oC

8. Osmometers utilizing the freezing point colligative property of solutions are based on the principle that:

A. 1 osmole of nonionizing substance dissolve in 1 kilogram of water raises the freezing point 1.86oC

B. 1 osmole of nonionizing substance dissolve in 1 kilogram of water lowers the freezing point 1.86oC

C. Increased solute concentration will raise the freezing point of water in direct proportion to NaCl standard

D. Decreased solute concentration will decrease the freezing point of water in direct proportion to NaCl standard

A. 1 and 3

8. The PAH test is dependent on:
9. Renal blood flow
10. Tubular secretion
11. Tubular reabsorption
12. Glomerular filtration

A. 1 and 3
B. 2 and 4
C. 1 only
D. 4 only

C. Bilirubin

10. Which biochemical component would be present in an increased amount in dark yellow-amber-colored urine?

A. Biliverdin
B. Drugs
C. Bilirubin
D. Urobilin

B. Viscous and orange

11. Specimens from patients receiving treatment for UTI, frequently appear:

A. Clear and red
C. Dilute and pale yellow
B. Viscous and orange
D. Cloudy and red

C. 2 hours after eating

12. When should a 2-hour postprandial urine be collected?

A. 2 hours after fluid ingestion
C. 2 hours after eating
B. 2 hours after voiding a fasting specimen
D. 2 hours after fluid ingestion

B. Light velocity in air with light velocity in solutions

13. Refractive index compares:

A. Light velocity in solutions with light velocity in solids

B. Light velocity in air with light velocity in solutions

C. Light scattering in air with light scattering in solutions

D. Light scattering by particles in solution

A. Ionic strength alters pKa of a polyelectrolyte

13. What is the principle of the colorimetric reagent strip determination of specific gravity in urine?

A. Ionic strength alters 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

B. 1.040

15. A urine specimen with a specific gravity of 1.008 has been diluted 1:5. The actual specific gravity is:

A. 1.008 B. 1.040 C. 1.055 D. 5.040

B. Calcium oxalate

16. What are the most common renal stones encountered in the clinical laboratory?

A. Calcium phosphate
C. Cystine
B. Calcium oxalate
D. Uric acid

B. Oval fat bodies

17. When using polarized light microscopy, which urinary sediment component exhibits Maltese cross formation?

A. RBCs
B. Oval fat bodies
C. Yeasts
D. WBCs

D. Positive urobilinogen

18. Which of the following urine biochemical results would be obtained in hemolytic anemia?

A. Positive glucose
C. Positive nitrate
B. Positive bilirubin
D. Positive urobilinogen

B. Consistently alkaline

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

A. Consistently acid
B. Consistently alkaline
C. Neutral
D. Variable, depending upon diet

C. Rifampin

20. What is a commonly used drug noted to produce a bright orange-red color in urine?

A. Furadantin
B. Levodopa
C. Rifampin
D. Riboflavin

A. Pyridium

21. Which of the following would produce a yellow foam in urine when shaken which could be mistaken for bilirubin:

A. Pyridium B. Protein C. Urates D. Glucose

B. Presence of nonglucose reducing sugar

22. A negative glucose oxidase test and a positive test for reducing sugars in urine indicates:

A. True glycosuria
B. Presence of nonglucose reducing sugar
C. A false-negative oxidase reaction
D. A trace quantity of glucose

A. Sodium nitroprusside

23. Acetoacetic acid is detected in urine by reaction with:

A. Sodium nitroprusside
C. m-Dinitrobenzene
B. o-Toluidine
D. m-Dinitrophenylhydrazine

A. 80% ammonium sulfate to precipitate hemoglobin

24. Hemoglobin in urine can be differentiated from myoglobin using:

A. 80% ammonium sulfate to precipitate hemoglobin
B. Sodium dithionite to reduce hemoglobin
C. O-Dianisidine instead of benzidine as the color indicator
D. Microscopic exam

C. p-Dimethylaminobenzaldahyde

24. Which of the following reagents below is used to detect urobilinogen in urine:

A. p-Dinitrobenzene
C. p-Dimethylaminobenzaldahyde
B. p-Aminosalicylate
D. p-Dichloroaniline

B. Orthostatic proteinuria

26. A patient has a 1+ protein reaction on a specimen collected in the doctor's office. The doctor instructs the patient to collect a specimen immediately upon arising the next day, the specimen is negative for protein. This indicates:

A. Nocturnal proteinuria
C. Microalbuminuria
B. Orthostatic proteinuria
D. Diurnal proteinuria

C. Renal calculi

27. The finding of a 2+ reagent strip reaction for blood in the urine of a patient with severe lower back pain can aid in confirming a diagnosis of:

A. Pyelonephritis
B. Appendicitis
C. Renal calculi
D. Multiple myeloma

C. Precipitating when heated at 60oC and dissolving at 100oC

28. Bence Jones protein excreted in urine in cases of multiple myeloma has a unique characteristic of:

A. Reacting with reagent strips and not sulfosalicylic acid

B. Precipitating in acetic acid and heat and not with sulfosalicylic acid

C. Precipitating when heated at 60oC and dissolving at 100oC

D. Precipitating when heated at 100oC and dissolving at 60oC

A. Myoglobin

28. Ammonium sulfate was added to clear urine. After filtration the supernatant remains red and has a positive reaction
    on the blood portion of the reagent strip. This is caused by the presence of:

A. Myoglobin
B. Medication
C. Hemoglobin
D. Methemoglobin

B. Biliary duct obstruction

30. positive urine bilirubin with a normal test for urobilinogen indicates:

A. Intravascular hemolysis
C. Hepatitis
B. Biliary duct obstruction
D. Cirrhosis

A. Abnormal destruction of RBCs in the body

31. A urinalysis report shows:
    Bilurubin: negative Blood: Small
    Urobilinogen: 4 EU Nitrite: negative
    This suggests:

A. Abnormal destruction of RBCs in the body
C. Severe UTI
B. Inflammation of the liver
D. A normal urine specimen

D. No extraction into chloroform or butanol

32. A specimen that produces a cherry-red color with Ehrlich's reagent is extracted with chloroform and butanol. If the positive reaction is caused by porphobilinogen, you would expect the extraction to show:

A. Extraction into chloroform and butanol C. Extraction into chloroform but not butanol
B. Extraction into butanol but not chloroform
D. No extraction into chloroform or butanol

C. Urinary tract infection

33. do the following results suggest:
    Color: yellow hazy
    Bilirubin: negative
    Sp. Gr.: 1.019
    Blood: negative
    pH: 8
    Urobilinogen: 0.1 EU
    Protein: trace
    Nitrite: positive
    Glucose: negative
    Leukocytes: positive
    Ketones: negative

A. Diabetes mellitus
C. Urinary tract infection
B. Unsatisfactory specimen
D. Normal female specimen

D. Reduced light under low power

34. Examination of urine sediment for the presence of casts should be performed with:

A. Increased light under high power
C. Reduced light under high power
B. Increased light under low power
D. Reduced light under low power

B. Crystal violet and safranin

35. Which of the following dyes are used in Sternheimer-Malbin stain?

A. Hematoxylin and eosin
C. Methylene blue and eosin
B. Crystal violet and safranin
D. Methylene blue and safranin

B. Addis count

36. The predecessor of the standardized urine microscopic examination was the:

A. Sternheimer count
C. Kova system
B. Addis count
D. T-system

C. Schistosoma haematobium

37. The ova of which parasite may be found in the urinary sediment?

A. Trichomonas vaginalis
C. Schistosoma haematobium
B. Entamoeba histolytica
D. Trichuris trichiura

B. Nephrotic syndrome

38. Oval fat bodies are often seen in:

A. Chronic glomerulonephritis
C. Acute tubular nephrosis
B. Nephrotic syndrome
D. Renal failure

C. Polarized light

39. Identification of oval fat bodies can be verified using:

A. Bright-field microscopy
C. Polarized light
B. Phase contrast
D. Interference-contrast microscopy

C. Acute glomerulonephritis

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

A. Chronic pyelonephritis
C. Acute glomerulonephritis
B. Nephrotic syndrome
D. Lower urinary tract obstruction

B. Pyelonephritis

41. Urine sediment characterized by pyuria with bacteria and WBC casts indicates:

A. Nephrotic syndrome
C. Polycystic kidney disease
B. Pyelonephritis
D. Cystitis

D. All of the above

42. Hexagonal uric acid crystals can be distinguished from cystine crystals because:

A. Uric acid is insoluble in hydrochloric acid and cystine is not

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

C. Cystine crystals are colorless

D. All of the above

B. Chronic liver disease

42. The presence of tyrosine and leucine crystals together in urine sediment usually indicates:

A. Renal failure
C. Hemolytic anemia
B. Chronic liver disease
D. Hartnup's disease

B. Ammonium biurate

44. Which of the following crystals is considered nonpathological?

A. Hemosiderin
B. Ammonium biurate
C. Bilirubin
D. Cholesterol

B. Hippuric acid

45. Which crystals appear in urine as a long, thin hexagonal plate, and are linked to ingestion of benzoic acid?

A. Cystine
B. Hippuric acid
C. Oxalic acid
D. Uric acid

A. Renal tubular epithelium

46. Oval fat bodies are derived from:

A. Renal tubular epithelium
C. Degenerated WBCs
B. Transitional epithelium
D. Mucoprotein matrix

C. Nephrotic syndrome

47. Which condition is associated with the greatest proteinuria?

A. Acute glomerulonephritis
C. Nephrotic syndrome
B. Chronic glomerulonephritis
D. Acute pyelonephritis

B. Recent strenuous exercise

48. The finding of increased hyaline and granular cast in the urine of an otherwise healthy person may be the result of:

A. Fecal contamination
C. Early UTI
B. Recent strenuous exercise
D. Analyzing an old specimen

A. Bacterial inhibition test

49. The Guthrie test is a:

A. Bacterial inhibition test
B. Fluorometric procedure
C. Chemical procedure measured by spectrophotometer
D. Bacterial agglutination test

A. Homogentisic acid

49. The abnormal metabolite that is present in the urine in alkaptonuria is:

A. Homogentisic acid
C. Phenylpyruvate
B. Alkaptonpyruvate
D. Tyrosine

A. Phenylketonuria

51. A mousy odor in the urine is associated with:

A. Phenylketonuria
B. Isovaleric acidemia
C. Cystinuria
D. Cystinosis

D. Carcinoid tumor invol. argentaffin cells

52. The finding of increased amount of the serotonin degradation product 5-HIAA in the urine is indicative of:

A. Platelet disorders
B. Intestinal obstruction
C. Malabsorption
D. Carcinoid tumor invol. argentaffin cells

D.Mucopolysaccharides

53. Hurler's and Sanfilippo's syndromes present with mental retardation and increased urinary:

A.Porphyrins
B.Amino acids
C.Maltose
D.Mucopolysaccharides

C. Xanthochromia

54. Regarding CSF, all of the following are indications of a traumatic tap, EXCEPT:
    A. Clearing of the fluid as it is aspirated C. Xanthochromia
    B. A clear supernatant after centrifugation D. Presence of clot in the sample

C. Pleocytosis

55. term used to denote high WBC count in the CSF is:

A. Empyemia
C. Pleocytosis
B.Neutrophilia
D.Hyperpycorrhachia

C. Gram-negative bacterial endotoxin

56. The limulus lysate test on CSF is a sensitive assay for:

A. Demyelinating diseases of the spinal cord
C. Gram-negative bacterial endotoxin
B. Cryptococcal meningitis
D. Open neural tube defects

A. Viral meningitis

57. Pronounced reduction of CSF glucose can be seen in the following conditions, EXCEPT:

A. Viral meningitis
C. Fungal meningitis
B. Bacterial meningitis
D. Tuberculous meningitis

A. Multiple sclerosis

An elevated IgG level in CSF and an abnormal band on electrophoresis of CSF are findings consistent with the diagnosis of:

A. Multiple sclerosis
C. Meningeal involvement in leukemia
B. Muscular dystrophy
D. Secondary stage of syphilis

C. Cell count

59. CSF specimen is usually collected in 3 sterile tubes labeled in the order they are drawn. What laboratory test is done with tube number 3?

A. Chemistry
B. Microbiology
C. Cell count
D. Serology

B. 140-170 mL

60. Total volume of CSF in adults:

A. 20 mL
B. 140-170 mL
C. 10-60 mL
D. 220-280 mL

A. 15 to 45 mg/dL

61. The normal CSF protein is:

A. 15 to 45 mg/dL
B. 15 to 45 g/dL
C. 50 to 100 mg/dL
D. 50 to 100 g/dL

B. Electrophoresed for the presence of transferring isoforms

62. To determine if fluid draining from the ear of the patient with severe head injury is CSF, the fluid should be:

A. Centrifuged and examined for the presence of ependymal cells

B. Electrophoresed for the presence of transferring isoforms

C. Analyzed for the presence of glutamine

D. Tested for low protein concentration

B. Glutamine

62. A major CSF chemical that is measured in suspected cases of Reye's syndrome is:

A. Glucose
B. Glutamine
C. Lactate
D. Lactate dehydrogenase

A. Peritoneal

64. Which of the following terms is another name for ascitic fluid?

A. Peritoneal
B. Pericardial
C. Synovial
D. Pleural

B. Thoracentesis refers the collection of pericardial fluid

65. All of the following statements about serous fluids are true, EXCEPT:

A. An effusion is an abnormal accumulation of a serous fluid
B. Thoracentesis refers the collection of pericardial fluid
C. Ascites refer specifically to peritoneal fluid
D. The term 'chest fluid" usually refers to pleural fluid

B. Malignancy

66. A transudative effusion is usually caused by all of the following, EXCEPT:

A. Congestive heart failure
C. Nephrotic syndrome
B. Malignancy
D. Cirrhosis

D. All of the above

67. An exudative pleural fluid can be caused by:

A. Malignancy
C. SLE or rheumatoid arthritis
B. Pulmonary infarction or infection
D. All of the above

B. Ruptured bladder

68. Measurement of blood urea nitrogen and creatinine in peritoneal fluid are requested when there is a concern about:

A. Tubercular peritonitis
C. Malignancy
B. Ruptured bladder
D. Gastrointestinal perforations

A. Exudate

69. These fluid have high protein content:

A. Exudate
B. Urates
C. Sulfates
D. Transudates

C. Adenosine deaminase activity

70. Useful adjunct test for tuberculous pericarditis in cases with negative stains when tuberculosis is suspected:

A. Lactate dehydrogenase activity
C. Adenosine deaminase activity
B. Bilirubin level
D. Lactate level

C. Joint fluid resembles plasma in viscosity

71. All of the statements below about synovial fluid are true, EXCEPT:

A. Arthrocentesis is performed only to evaluate arthritis.
B. Synovial fluid is present only in movable joints
C. Joint fluid resembles plasma in viscosity
D. Joint fluid has approximately the same glucose as plasma

A. Uric acid or monosodium urate

71. Which of the following crystals is the cause of gout?

A. Uric acid or monosodium urate
C. Calcium oxalate
B. Calcium pyrophosphate
D. Cholesterol

B. Calcium pyrophosphate

73. Which crystal causes "pseudogout"?

A. Oxalic acid
C. Calcium oxalate
B. Calcium pyrophosphate
D. Cholesterol

A. Uric acid

74. Using compensated polarized microscopy, which synovial fluid crystals appear yellow when observed with the long axes of the crystals parallel to the optical field?

A. Uric acid
B. Ca pyrophosphate
C. Cysteine
D. Cholesterol

C. Hemorrhagic arthritis

75. The synovial fluid glucose level is low in all of the following types of arthritis, EXCEPT:

A. Septic arthritis
C. Hemorrhagic arthritis
B. Inflammatory arthritis
D. Gout

C. Ragocytes

76. Neutrophils that contain precipitated rheumatoid factor in their cytoplasm are called:

A. LE cells
B. Reiter cells
C. Ragocytes
D. Macrophages

C. Amniotic fluid bilirubin

77. Which test correlates with the severity of hemolytic disease of the newborn?

A. Rh antibody titer of the mother
C. Amniotic fluid bilirubin
B. L/S ratio
D. Urinary estradiol

C. Creatinine

78. The best available guide in the assessment of gestational age is the amniotic fluid determination of:

A. Bilirubin
B. Uric acid
C. Creatinine
D. Protein

D. Fluorescence polarization

79. Microviscosity of amniotic fluid is measured by:

A. Thin-layer chromatography
C. Spectrophotometer
B. Immunologic agglutination
D. Fluorescence polarization

D. Pneumocystis carinii

80. Bronchoalveolar lavage may be performed in patients with AIDS to detect presence of:

A. Increased helper T cells
C. Kaposi sarcoma
B. Bacterial pneumonitis
D. Pneumocystis carinii

C. Macrophage

81. The most abundant cell seen in a bronchoalveolar lavage is the:

A. Neutrophil
B. Ciliated columnar bronchial epithelial cell
C. Macrophage
D. Lymphocyte

A. Prostate

82. The milky fluid that that contains acid phosphatase and proteolytic enzymes in the seminal fluid comes from which part of the male genitalia?

A. Prostate
B. Testis
C. Seminal vesicles
D. Epididymis

C. ACP

83. To detect the presence of semen, which of the following enzyme activities should be measured?

A. Citric acid
B. ALP
C. ACP
D. AST

B. Fructose

84. Seminal vesicles produce:

A. Glucose
B. Fructose
C. Sucrose
D. Mannose

C. After liquefaction

85. Semen specimens should be analyzed:

A. Immediately upon receipt
C. After liquefaction
B. Prior to liquefaction
D. One hour after collection

A. Lower the pH

86. An abnormal amount of prostatic fluid in a semen specimen will:

A. Lower the pH
B. Raise the pH
C. Increase the viscosity
D. Decrease the viscosity

A. Eosin

87. Which of the following stains is used to determine sperm viability?

A. Eosin
B. Methylene blue
C. Papanicolaou
D. Hematoxylin

B. Zollinger-Ellison syndrome

88. Serum gastrin levels would be greatest in:

A. Atrophic gastritis
B. Zollinger-Ellison syndrome
C. Pernicious anemia
D. Cancer of the stomach

C. Pentagastrin

89. The preferred stimulant of gastric acidity for routine analysis is:

A. Histamine
B. Histalog
C. Pentagastrin
D. Insulin

A. Insulin

90. The gastric stimulant used to determine a successful vagotomy procedure is:

A. Insulin
B. Pepsin
C. Histamine
D. Pentagastrin

A. Pernicious anemia

91. A condition in which a patient shows no response to gastric stimulation is:

A. Pernicious anemia
B. Zollinger-Ellison syn
C. Ulcers
D. Diabetes

B. Sham feeding

92. It is used as a safer alternative for testing vagal stimulation of gastric acid secretion. The procedure also requires gastric intubation, however, instead of administering insulin, patients are given a sandwich to chew and spit out.

A. Sweat test
B. Sham feeding
C. Secretin test
D. Breath test

D.Breath test

93. The test is based on the measurement of 14CO2 in expired air following the ingestion of various 14C-labeled triglycerides. Steatorrhea from either pancreatic or other causes results in a decreased absorption of triglycerides by the digestive system. This in turn results in a decrease in expired CO2 derived from metabolism of triglyceride fatty acids.

A.Sweat test
B.Sham feeding
C.Secretin test
D.Breath test

A. D-xylose test

94. It is a valuable test for the differential diagnosis of malabsorption. In this procedure, a 25 g dose of pentose is administered orally. Blood level is determined two hours later; urine excretion over a five-hour post-administration period is also determined.

A. D-xylose test
B. Sham feeding
C. Secretin test
D. Breath test

A. Celiac disease

95. Most common cause of malabsorption in developed countries:

A. Celiac disease
B. Cystic fibrosis
C. Lactase deficiency
D. None of these

A. Titrimetric method of Van de Kamer

96. It serves as the laboratory procedure for the definitive diagnosis of steatorrhea:

A. Titrimetric method of Van de Kamer
C. Breath test
B. D-Xylose test
D. Sweat test

B. Yellow-green: barium sulfate

97. Which of the following pairings of stool appearance and cause does not match?

A. Black, tarry: blood
B. Yellow-green: barium sulfate
C. Pale, frothy: steatorrhea
D. Yellow-gray: bile duct obstruction

C. Yellow-brown supernatant after standing for 2 minutes

98. In the Apt test, maternal hemoglobin will produce a:

A. Pink solution
B. Yellow-brown precipitate after standing for 2 minutes
C. Yellow-brown supernatant after standing for 2 minutes
D. Red-brown supernatant after standing for 2 minutes

C. The center

98. When testing for occult blood, the portion of the stool specimen used is:

A. The outer surface
B. An emulsion
C. The center
D. The very end

B. 3-day collection

Due to variability in bowel habits, the most representative timed fecal sample is:
A. 2-day collection
B. 3-day collection
C. 4-day collection
D. 5-day collection