Body Fluids

Waxy casts are most easily differentiated from hyaline casts by their:

• color

• size

• granules

• refractivity

refractivity (waxy casts are more refractile with cracked edges)

The clarity of a urine sample should be determined:

• using glass tubes only, never plastic

• following thorough mixing of the specimen

• after addition of sulfosalicylic acid

• after the specimen cools to room temperature

following thorough mixing of the specimen

A physician attempts to aspirate a knee joint and obtains 0.1 mL of slightly bloody fluid. Addition of acetic acid results in turbidity and a clot. This indicates that:

• the fluid is synovial fluid

• plasma was obtained

• red blood cells caused a false-positive reaction

• the specimen is not adequate

the fluid is synovial fluid (acetic acid will clot with synovial fluid)

Which of the following is the primary reagent in the copper reduction tablet:

• sodium carbonate

• copper sulfate

• copper oxidase

• polymerized diazonium salt

copper sulfate

A 52-year-old man has urine glucose measurements performed as part of a 3-hour glucose tolerance test. The test results are as follows

Time Serum Glucose Urine Glucose

Fasting 82 mg/dL, Negative

½ hour 120 mg/dL, Negative

1 hour 190 mg/dL, Negative

2 hours 115 mg/dL, 1+

3 hours 95 mg/dL, Trace

The best explanation for these findings is that the:

• serum level must exceed the threshold level before glucose is filtered by the renal glomeruli

• serum level must exceed the threshold level before reabsorption of glucose is exceeded

• tested patient probably has renal glucosuria

• tested patient probably has diabetes mellitus

serum level must exceed the threshold level before reabsorption of glucose is exceeded

Which of the following can give a false-negative urine protein reading:

• contamination with vaginal discharge

• heavy mucus

• presence of blood

• very dilute urine

very dilute urine (vaginal discharge and blood can cause false positive, mucous does not impact reading)

Following the addition of acid, white precipitate in a cloudy urine sample dissolves. This most likely indicates the presence of:

• amorphous urates

• WBCs

• amorphous phosphates

• bacteria

amorphous phosphates

Pleural transudates differ from pleural exudates in that transudates have:

• protein values of >4g/100mL

• specific gravity values of >1.020

• LD values of >200 U/L

• relatively low cell counts

relatively low cell counts

Which of the following reagents is used to react with ketones in the urine:

• sodium nitroprusside

• acetoacetic acid

• acetone

• beta-hydroxybutyric acid

sodium nitroprusside

A technologist is having trouble differentiating between red blood cells, oil droplets, and yeast cells on a urine microscopy. Acetic acid should be added to the sediment to:

• lyse the yeast cells

• lyse the red blood cells

• dissolve the oil droplets

• creanate the red blood cells

lyse the red blood cells

Which of the following casts is characteristically associated with acute pyelonephritis:

• red cell

• white cell

• waxy

• fatty

white cell (pyelonephritis is inflammation of the kidneys)

A patient's urinalysis revealed a positive bilirubin and a decreased urobilinogen level. These results are associated with:

• hemolytic disease

• biliary obstruction

• hepatic disease

• urinary tract infection

biliary obstruction (urobilinogen is increased in hemolytic disease and hepatic disease)

The results of a urinalysis on a first-morning specimen are

Specific gravity 1.024

pH 8.5

Protein Negative

Glucose Negative

Microscopic Uric acid crystals

The next step is to repeat the:

• microscopic examination

• protein and glucose

• specific gravity

• pH and microscopic examination

pH and microscopic examination (pH is too alkaline and uric acid crystals are seen in acidic urine)

Isosthenuria is associated with a specific gravity, which is usually:

• variable between 1.001 and 1.008

• variable between 1.015 and 1.022

• fixed around 1.010

• fixed around 1.020

fixed around 1.010

A test area of a urine reagent strip is impregnated with only sodium nitroprusside. This section will react with:

• acetoacetic (diacetic) acid

• leukocyte esterase

• beta-hydroxybutyric acid

• ferric chloride

acetoacetic (diacetic) acid (ketone body)

Glitter cells are a microscopic finding of:

• red blood cells in hypertonic urine

• red blood cells in hypotonic urine

• white blood cells in hypertonic urine

• white blood cells in hypotonic urine

white blood cell in hypotonic urine

Which parts of a microscope magnify the images observed:

• ocular and condenser

• objective and ocular

• aperture and objective

• diaphragm and condenser

objective and ocular

A reagent strip impregnated with stabilized, diazotized 2,4-dichloroaniline will yield a positive reaction with:

• bilirubin

• hemoglobin

• ketones

• urobilinogen

bilirubin

A urinalysis performed on a 2-week-old infant with diarrhea shows a negative reaction with the glucose oxidase reagent strip. A copper reduction tablet test should be performed to check the urine sample for the presence of:

• galactose

• galactose

• bilirubin

• phosphates

galactose

A urine specimen with an elevated urobilinogen and a negative bilirubin may indicate:

• obstruction of the biliary tract

• viral hepatitis

• hemolytic jaundice

• cirrhosis

hemolytic jaundice

After warming to 60 degrees C, a cloudy urine clears. This is due to the presence of:

• urates

• phosphates

• WBCs

• bacteria

urates

Red colored urine may be due to:

• bilirubin

• excess urobilin

• myoglobin

• homogentisic acid

myoglobin

Upon standing at room temperature a urine pH typically:

• decreases

• increases

• remains the same

• changes depending on bacterial contamination

increases (loss of CO2)

Patients with diabetes mellitus have urine with:

• decreased volume and decreased specific gravity

• decreased volume and increased specific gravity

• increased volume and decreased specific gravity

• increased volume and increased specific gravity

increased volume and increased specific gravity

Which of the following urinary parameters are measured during the course of concentration and dilution tests to assess renal tubular function:

• urea, nitrogen, and creatinine

• osmolality and specific gravity

• sodium and chloride

• sodium and osmolality

osmolality and specific gravity

The synovial fluid easily forms small drops from the aspirating syringe. This viscosity is:

• normal

• increased

• associated with inflammation

• associated with hypothyroidism

associated with inflammation (decreased viscosity)

A technologist performed a stat microscopic urinalysis and reported the following

WBCs 10 to 13

RBCs 2 to 6

Hyaline casts 5 to 7

Bacteria 1+

The centrifuge tube was not discarded and the urine sediment was reevaluated microscopically 5 hours after the above results were reported. A second technologist reported the same results, except 2+ bacteria and no hyaline casts were found. The most probable explanation for the second technologist's findings is:

• sediment was not agitated before preparing the microscope slide

• casts dissolved due to decrease in urine pH

• casts dissolved due to increase in urine pH

• casts were never present in this specimen

casts dissolved due to increase in urine pH

Myoglobinuria is MOST likely to be noted in urine specimens from patients with which of the following disorders:

• hemolytic anemias

• lower urinary tract infections

• myocardial infarctions

• paroxysmal nocturnal hemoglobinuria

myocardial infarctions

A clean-catch urine sample is submitted to the laboratory for routine urinalysis and culture. The routine urinalysis is done first, and the specimen is then sent to microbiology for culture. The specimen should:

• be centrifuged and the supernatant cultured

• be rejected due to possible contamination from routine urinalysis

• not be cultured if no bacteria are seen

• be immediately processed for culture regardless of urinalysis results

be rejected due to possible contamination from routine urinalysis (cultures should be performed before routine testing)

All casts typically contain:

• albumin

• globulin

• immunoglobulins G and M

• Tamm-Horsfall glycoprotein

Tamm-Horsfall glycoprotein

When using the sulfosalicylic acid test, false-positive protein results may occur in the presence of:

• ketones

• alkali

• glucose

• radiographic contrast media

radiographic contract media

Which of the following is the best guide to consistent centrifugation:

• potentiometer setting

• armature settings

• tachometer readings

• rheostat readings

tachometer readings

False results in urobilinogen testing may occur if the urine specimen is:

• exposed to light

• adjusted to a neutral pH

• cooled to room temperature

• collected in a nonsterile container

exposed to light

An antidiuretic hormone deficiency is associated with a:

• specific gravity around 1.031

• low specific gravity

• high specific gravity

• variable specific gravity

low specific gravity

Ammonium sulfate was added to red urine. The urine had a positive reaction for blood, but no RBCs were seen on microscopic examination. After centrifugation the supernatant fluid is red. The abnormal color is caused by:

• Pyridium

• hemoglobin

• porphyrins

• myoglobin

myoglobin (ammonium sulfate will precipitate hemoglobin, but not myoglobin so a remaining red urine is due to myoglobin present)

A diabetic woman had the a blood sugar of 295 mg/dl with a negative urine glucose. The urine had a pH of 8.0 and contained many bacteria & yeast. Which of the following is the MOST likely explanation for the negative urine glucose findings:

• There is a false-negative glucose due to oxidizing contaminants.

• There is a false-negative glucose due to the alkaline pH.

• The specimen is probably old and the bacteria and yeast have consumed the glucose.

• Glucose would not be present in the urine specimen since the blood sugar was normal.

The specimen is probably old and the bacteria and yeast have consumed the glucose.

To prepare a solution appropriate for quality control of the refractometer, a technician should use:

• urea with a specific gravity of 1.040

• water with a specific gravity of 1.005

• sodium chloride with a specific gravity of 1.022

• calcium chloride with an osmolarity of 460

sodium chloride with a specific gravity of 1.022

A urinalysis performed on a 27-year-old woman yields the following results

Specific gravity = 1.008 Protein = 2+ Glucose = negative Blood = 3+ Microscopic: 30 - 35 RBCs/HPF Casts: 2-5 RBC/LPF 1-3 granular/LPF The above data is MOST consistent with:

• yeast infections

• pyelonephritis

• bacterial cystitis

• glomerulonephritis

glomerulonephritis

A positive result for bilirubin on a reagent strip should be followed up by:

• notifying the physician

• requesting a new specimen

• performing an Ictotest^TM

• performing a urobilinogen

performing an Ictotest^TM

A turbid cerebrospinal fluid is most commonly caused by:

• increased white blood cells

• increased protein

• increased glucose

• increased bacterial organisms

increased white blood cells

Urine that develops a port wine color after standing may contain:

• melanin

• porphyrins

• bilirubin

• urobilinogen

porphyrins

A microscopic examination of a urine sediment reveals ghost cells. These red blood cells were most likely lysed due to:

• greater than 2% glucose concentrations

• specific gravity less than 1.007

• large amounts of ketone bodies

• neutral pH

specific gravity less than 1.007

Which of the following inorganic substances are excreted in the urine in the largest amount:

• urea and NaCl

• creatine and NaCl

• creatine and ammonia

• urea and glucose

urea and NaCl

Which of the following ketone bodies is excreted in the largest amount in ketonuria:

• acetone

• acetoacetic acid

• cholesterol

• beta-hydroxybutyric acid

beta-hydroxybutyric acid

Urine samples should be examined within 1 hour of voiding because:

• red blood cells, leukocytes, and casts agglutinate after standing for several hours at room temperature

• urobilinogen increases and bilirubin decreases after prolonged exposure to light

• bacterial contamination will cause alkalinization of the urine

• ketones will increase due to bacterial and cellular metabolism

bacterial contamination will cause alkalinization of the urine (RBCs, WBCs, and casts will lyse)

Some regional and public health laboratories carry out mass screening tests on the urine of newborns for a genetic disorder involving metabolism of:

• fructose

• galactose

• glucose

• lactose

galactose

A sperm count is diluted 1:20 and 50 sperm are counted in two large squares of the Neubauer counting chamber. This sperm count in MLs is:

• 5000

• 50,000

• 500,000

• 5,000,000

5,000,000 ([# of sperm x DF x 1,000] / # of squares counted x 0.1)

Microscopic analysis of a urine specimen yields a moderate amount of red blood cells in spite of a negative result for occult blood using a reagent strip. The technologist should determine if this patient has taken:

• vitamin C

• a diuretic

• high blood pressure medicine

• antibiotics

vitamin C

A urine specimen is analyzed for glucose by a glucose oxidase reagent strip and a copper reduction test. If both results are positive, which of the following interpretations is correct:

• Galactose is present.

• Glucose is present.

• Lactose is not present.

• Sucrose is not present.

Glucose is present (glucose oxidase is specific for glucose and copper reduction test is non-specific for sugars)

Which of the following is the average volume of urine excreted by an adult in 24 hours:

• 750 mL

• 1000 mL

• 1500 mL

• 2300 mL

1500 mL

The primary constituent of hyaline casts is:

• fat

• cells

• protein

• mucus

protein

An abdominal fluid is submitted from surgery. The physician wants to determine if this fluid could be urine. The technologist should:

• perform a culture

• smell the fluid

• test for urea, creatinine, sodium, and chloride

• test for protein, glucose, and pH

test for urea, creatinine, sodium, and chloride

The following urine results were obtained on a 25-year-old female

Color = amber Microscopic:

Appearance = cloudy, Bacteria = many

,Specific gravity = 1.015, WBC casts = few

,pH = 5.0, WBC/HPF = 30-40

,Protein = 1+

,Glucose = negative

,Blood = small

,These results are most compatible with:

• glomerulonephritis

• renal calculus

• vaginitis

• pyelonephritis

pyelonephritis (WBC casts indicative of kidney infection)

The method of choice for performing a specific gravity measurement of urine following administration of x-ray contrast dyes is:

• reagent strip

• refractometer

• urinometer

• densitometer

reagent strip

The normal glomerular filtration rate is approximately:

• 1 mL/min

• 120 mL/min

• 660 mL/min

• 1200 mL/min

120 mL/min

An acid urine that contains hemoglobin will darken on standing due to the formation of:

• myoglobin

• sulfhemoglobin

• methemoglobin

• red blood cells

methemoglobin

The presence of leukocytes in urine is known as:

• chyluria

• hematuria

• leukocytosis

• pyuria

pyuria

The protein reagent strip detects:

• albumin + globulins

• albumin only

• globulins only

• Bence jones protein + albumin

albumin only

Which of the following cells is the largest:

• glitter

• WBC

• transitional epithelial

• renal epithelial

transitional epithelial

Which of the following is an abnormal crystal described as a hexagonal plate:

• cystine

• tyrosine

• leucine

• cholesterol

cystine

The confirmatory test for a positive protein result by the reagent strip method uses:

• Ehrlich's reagent

• a diazo reaction

• sulfosalicylic acid

• a copper reduction tablet

sulfosalicylic acid (Elrich’s reagent is for urobilinogen)

The part of the kidney in which there is selective retention and excretion of various substances and in which the concentration of urine occurs is the:

• glomerulus

• papilla

• tubule

• ureter

tubuel

While performing a urinalysis, a technologist notices that the urine specimen has a fruity odor. This patient's urine most likely contains:

• acetone

• bilirubin

• coliform bacilli

• porphyrin

acetone

The volume of urine excreted in a 24-hour period by an adult patient was 500 mL. This condition would be termed:

• anuria

• oliguria

• polyuria

• dysuria

oliguria (decreased urination)

A patient with uncontrolled diabetes mellitus will most likely have:

• pale urine with a high specific gravity

• concentrated urine with a high specific gravity

• pale urine with a low specific gravity

• dark urine with a high specific gravity

pale urine with a high specific gravity

Oval fat bodies are defined as:

• squamous epithelial cell that contain lipids

• renal tubular epithelial cells that contain lipids

• free-floating fat droplets

• white blood cells with phagocytized lipids

renal tubular epithelial cells that contain lipids

Antidiuretic hormone regulates the reabsorption of :

• water

• glucose

• potassium

• calcium

water

A 24-hour urine from a man who had no evidence of kidney impairment was sent to the laboratory for hormone determination. The volume was 600 mL, but there was some question as to the completeness of the 24-hour collection. The next step would be to:

• perform the hormone determination, since 600 mL is a normal urine 24-hour volume

• check the creatinine level; if it is less than 1 g do the procedure

• report the hormone determination in milligrams per deciliter in case the specimen was incomplete

• check the creatinine level; if it is greater than 1 g do the procedure

check the creatinine level; if it is greater than 1 g do the procedure

A 62-year-old patient with hyperlipoproteinemia has a large amount of protein in his urine. Microscopic analysis yields moderate to many fatty, waxy, granular, and cellular casts. Many oval fat bodies are also noted. This is most consistent with:

• nephrotic syndrome

• viral infection

• acute pyelonephritis

• acute glomerulonephritis

nephrotic syndrome

Routine screening of urine samples for glycosuria is performed primarily to detect:

• glucose

• galactose

• bilirubin

• ketones

glucose

A patient has glucosuria, hyperglycemia, and polyuria. These findings would be associated with:

• renal glucosuria

• diabetes mellitus

• emotional stress

• eating a heavy meal

diabetes mellitus

The sequence of light through a microscope is:

• condenser, stage, objective

• iris diaphragm, condenser, ocular

• stage, condenser, iris, objective, ocular

• diaphragm, condenser, objective, ocular

diaphragm, condenser, objective, ocular

The following lab values were obtained on a body fluid sample

Protein 3g/dL

Albumin 2.1 g/dL

Hyaluronate 0.4 g/dL

Glucose 80 mg/dL

Lactate 10 mg/dL

The sample is:

• pleural fluid

• synovial fluid

• urine

• cerebrospinal fluid

synovial fluid (presence of hyaluronate is indicative of synovial fluid)

A 59-year-old man is evaluated for back pain. Urine studies (urinalysis by multiple reagent strip) include

Urinalysis

Specific gravity 1.017

PH 6.5

Protein Negative

Glucose Negative

Blood Negative

Microscopic Rare epithelial cells

Urine protein electrophoresis: Monoclonal spike in gamma globulin region

Which of the following statement best explains these results:

• The urine protein is falsely negative due to the specific gravity.

• The urine protein is falsely negative because the method is not sensitive for Bence Jones protein.

• The microscopic examination is falsely negative due to the specific gravity.

• The electrophoresis is incorrect and should be repeated.

The urine protein is falsely negative because the method is not sensitive for Bence Jones protein. (monoclonal spike indicate Bence Jones proteinuria commonly seen in MM; reagent strip can only detect albumin)

To avoid falsely elevated spinal fluid cell counts:

• use an aliquot from the first tube collected

• use only those specimens showing no turbidity

• centrifuge all specimens before counting

• select an aliquot from the last tube collected

select an aliquot from the last tube collected (least contamination)

When employing the urine reagent strip method, a false-positive protein result may occur in the presence of:

• large amounts of glucose

• x-ray contrast media

• Bence Jones protein

• highly alkaline urine

highly alkaline urine

While performing an analysis of a baby's urine, the technologist notices the specimen to have a "mousy" odor. Of the following substances that may be excreted in urine, the one that MOST characteristically produces this odor is:

• phenylpyruvic acid

• acetone

• coliform bacilli

• porphyrin

phenylpyruvic acid

After receiving a 24-hour urine sample for quantitative total protein analysis, the technician must first:

• subculture the urine for bacteria

• add the appropriate preservative

• screen for albumin using a dipstick

• measure the total volume

measure the total volume

Which of the following casts is most indicative of severe renal disease:

• white blood cell

• granular

• cellular

• waxy

waxy