Urinalysis exam 3: CSF and semen

Which condition does not produce elevated CSF protein?

Fluid leakage

Meningitis

Multiple sclerosis

Hemorrhage

Fluid leakage

When choroid plexus cells are present in the CSF, they:

Are clinically significant

Represent demyelination of neural tissue

May resemble clusters of malignant cells

Indicate a breakdown of the blood-brain barrier

May resemble clusters of malignant cells

The presence of xanthochromia and an increased D-dimer test in the CSF is indicative of:

A traumatic tap

Multiple sclerosis

A cerebral hemorrhage

Viral meningitis

A cerebral hemorrhage

To determine the WBC count on a cloudy CSF specimen that contains both RBCs and WBCs, it is necessary to:

Dilute the specimen using glacial acetic acid

Dilute the specimen using saline

Determine the percentage of polynuclear and mononuclear cells in the counting chamber

Centrifuge the specimen before diluting with saline and gentian violet

Dilute the specimen using glacial acetic acid

A report of many gram-positive cocci on a clear CSF specimen with a normal cell count may be the result of:

An incorrect cell count

Effective antibiotic treatment

Use of contaminated albumin in the cytocentrifuge

Use of recycled cytocentrifuge chambers

Use of contaminated albumin in the cytocentrifuge

A slightly hazy CSF specimen is diluted 1:10 with acetic acid. A total of 50 cells are counted in five large squares on both sides of the Neubauer counting chamber. The count is reported as:

50 cells/µL

55 WBCs/µL

250 cells/µL

500 WBCs/µL

500 WBCs/µL

An IgG index greater than 0.77 indicates:

Synthesis of IgG within the CNS

Alterations of the blood-brain barrier

Active demyelination of neural tissue

Increased reabsorption of IgG from the peripheral blood

Synthesis of IgG within the CNS

Normal CSF protein differs from serum protein by the:

Presence of IgG

Presence of haptoglobin

Presence of ceruloplasmin

Absence of fibrinogen

Absence of fibrinogen

The CSF glucose in a patient with a blood glucose of 90 mg/dL is 60 mg/dL. These results are representative of:

An improperly preserved specimen

Bacterial meningitis

Normal CSF

Damage to the blood-brain barrier

Normal CSF

A CSF specimen, in which there is uneven distribution of blood among the three tubes and clots are detected, is an indication of:

Meningitis

Cerebral hemorrhage

Multiple sclerosis

Traumatic tap

Traumatic tap

Dilution of CSF before performing a total cell count should be made using:

Normal saline

Deionized water

Acetic acid

Acetic acid containing methylene blue

Normal saline

PCR can be used to detect meningitis.

True

False

True

Oligoclonal bands are significant in the diagnosis of multiple sclerosis when:

They are seen in both the serum and CSF

At least five bands are seen in the CSF

They are seen in the CSF and not in the serum

They appear in both the albumin and globulin fractions of serum and CSF

They are seen in the CSF and not in the serum

The CSF/serum albumin index is performed to determine:

The amount of albumin in the CSF

Synthesis of IgG within the CNS

The integrity of the blood-brain barrier

If an unknown fluid is in the CSF

The integrity of the blood-brain barrier

The normal CSF glucose is:

25 to 50 mg/dL

80 to 120 mg/dL

60% to 70% of the blood glucose

10% to 20% higher than the blood glucose

60% to 70% of the blood glucose

Calculate the WBC count using a 1:10 dilution, 64 cells are counted in five large squares on both sides of the hemocytometer.

64 cells/µL

128 cells/µL

640 cells/µL

1280 cells/µL

640 cells/µL

Myelin basic protein is measured in the CSF to assess the condition of patients with:

Cerebral hemorrhage

Multiple sclerosis

Bacterial meningitis

Neurosyphilis

Multiple sclerosis

Three tubes of CSF are submitted to the laboratory. They are numbered 1, 2, and 3 and show blood in all tubes but decreasing in amount as one inspects tubes 1 through 3. This observation should be interpreted as:

The tubes were numbered in the wrong sequence, as one would expect increasing amounts of blood

A traumatic or bloody tap is suspected and, in all likelihood, no pathogenic significance should be attached to the presence of the blood

The pathological presence of RBCs and reported to the supervisor immediately

A pathological presence of RBCs, but because the RBC morphology is normal there is minimal importance

A traumatic or bloody tap is suspected and, in all likelihood, no pathogenic significance should be attached to the presence of the blood

Neutrophils may be present in normal CSF.

True

False

True

Increased CSF eosinophils are associated with:

Multiple sclerosis

Introduction of foreign material

Human immunodeficiency virus

Viral meningitis

Introduction of foreign material

Melanoma cells in the CSF must be differentiated from:

Macrophages containing hemosiderin

Noncleaved lymphoma cells

Medulloblastoma cells

Ependymal cells

Macrophages containing hemosiderin

An unknown bodily fluid can be identified as CSF by determining the:

Lactate content

Albumin content

Presence of "tau" transferrin

Presence of oligoclonal banding

Presence of "tau" transferrin

The lowest levels of CSF lactate can be found in patients with:

Bacterial meningitis

Viral meningitis

Tubercular meningitis

Fungal meningitis

Bacterial meningitis

CSF is formed in the _______________ and reabsorbed by the _______________.

Ventricles, spinal cord

Choroid plexus, arachnoid granulations

Arachnoid space, blood-brain barrier

Blood-brain barrier, arachnoid granulations

Choroid plexus, arachnoid granulations

An IgG index of 1.10 would most likely be seen in a patient diagnosed with:

Meningitis

Cerebral hemorrhage

Leukemia

Multiple sclerosis

Multiple sclerosis

Examination of a CSF shows 1000 WBCs, of which 75% are lymphocytes and 25% are monocytes. This finding is consistent with:

Normal spinal fluid

Bacterial meningitis

Viral meningitis

Multiple sclerosis

Viral meningitis

CSF is produced primarily by:

Secretion by cells of the arachnoid villi

Diffusion from the plasma into the central nervous system (CNS)

Selective filtration of plasma in the choroid plexus

Excretions from the ependymal cells lining the CNS

Selective filtration of plasma in the choroid plexus

A xanthochromic CSF specimen will appear:

Crystal clear

White and turbid

Yellow and clear

Red and turbid

Yellow and clear

If protein electrophoresis was performed on both serum and CSF, which of the following components would have a higher ratio to total protein in the CSF than in the serum?

Transferrin

Ceruloplasmin

Albumin

Prealbumin

Prealbumin

The primary cause of a decreased CSF glucose in bacterial meningitis is:

Utilization of glucose by the microorganisms present in the fluid

Rapid glycolysis

Utilization of glucose by leukocytes present in the fluid

Alteration of blood-brain glucose transport

Alteration of blood-brain glucose transport

Calculate the sperm concentration and sperm count using a 1:20 dilution of a specimen with a volume of 3 mL, an average of 86 sperm are counted in the five RBC counting squares of the Neubauer hemocytometer.

43 million/mL and 129 million/specimen

86 million/mL and 258 million/specimen

17 million/mL and 52 million/specimen

69 million/mL and 206 million/specimen

86 million/mL and 258 million/specimen

Sperm motility after 1 hour should be at least:

50%

60%

70%

80%

50%

Semen analysis on postvasectomy patients should be performed:

Within 1 week postvasectomy

Within 1 month postvasectomy

Until two consecutive monthly specimens show no sperm

Until two consecutive monthly specimens show no viable sperm

Until two consecutive monthly specimens show no sperm

Yellow color in a semen specimen may be caused by all of the following except:

Urine

Preservation at room temperature

Medications

Prolonged abstinence

Preservation at room temperature

Spermatogenesis takes place in the:

Epididymis

Seminiferous tubules

Bulbourethral glands

Seminal vessels

Seminiferous tubules

Which is not included in the motility component of a sperm analysis evaluation?

Progressive and Brownian movement

Percentage of motile sperm

Quality of movement

Motility of normal and abnormal sperm

Motility of normal and abnormal sperm

Semen specimens can contain HIV and hepatitis viruses.

True

False

True

A semen specimen in which clumping of sperm is observed should be further tested using the:

Fructose test

Eosin-nigrosin stain

Immunobead test

Computer-assisted semen analysis

Immunobead test

When performing sperm morphology analysis, the minimum number of sperm that should be evaluated is:

50

100

200

500

200

Which is not proper for collection of a semen specimen?

In a sterile container

After a 3-day period of sexual abstinence

At the laboratory followed by 1 hour of refrigeration

At home and delivery to the laboratory within 1 hour

At the laboratory followed by 1 hour of refrigeration

Antisperm antibodies are produced by both males and females.

True

False

True

The normal sperm concentration is:

140 to 200 million/mL

10 to 90 million/mL

20 to 160 million/mL

50 to 100 million/mL

20 to 160 million/mL

Which is the part of the male reproductive system that neutralizes vaginal acidity?

Prostate

Bulbourethral glands

Seminal vessels

Epididymis

Bulbourethral glands

Which of the following cannot be used to evaluate continued infertility with a normal sperm count?

Semen fructose level

Eosin-nigrosin stain

Plasma and semen agglutination

Immunobead test

Semen fructose level

The World Health Organization has standardized the performance and reporting of semen analysis.

True

False

True

Normal semen should liquefy:

Immediately after ejaculation

Within 1 hour

Within 3 hours

After exposure to diluting fluid

Within 1 hour

Using a 1:20 dilution of semen, a student counts 70 sperm in the five RBC squares on one side of the Neubauer hemocytometer and 82 sperm on the other side. The student should:

Use a new chamber

Report the count as 70 million/mL

Repeat the count

Load only one side of the counting chamber

Repeat the count

Absence of a normal sperm acrosome can:

Decrease sperm motility

Affect ovum penetration

Affect semen liquefaction

Decrease sperm concentration

Affect ovum penetration

Which cannot be used to immobilized sperm before performing a sperm concentration?

Heat

Normal saline

Sodium bicarbonate

Tap water

Normal saline

In which part of the male reproductive system does the maturation of sperm take place?

Prostate

Bulbourethral glands

Seminal vessels

Epididymis

Epididymis

If the first portion of the ejaculation is not collected, which parameter of the semen analysis is most critically affected?

Sperm concentration

pH

Sperm motility

Morphology

Sperm concentration

Which is included in computer-assisted semen analysis?

Sperm count

Trajectory of sperm motion

Velocity of sperm motility

All of above

All of the above

The immunobead test detects:

Male antisperm antibodies

Female antisperm antibodies

Abnormal sperm acrosomes

Both male and female antisperm antibodies

Male antisperm antibodies

When an abnormally low sperm count is encountered in a fertility examination, the follow-up test of choice is:

Male agglutination studies

Semen fructose level

Female agglutination studies

Eosin-nigrosin stain

Female agglutination studies

While performing a sperm morphology examination, a medical laboratory scientist counts 10 neutrophils per 100 mature sperm. To determine whether this observation is significant, the medical laboratory scientist must also know the:

Specimen volume

Sperm concentration

Patient's white blood cell (WBC) count

Sperm count

Sperm concentration

The finding of 3 million neutrophils per milliliter in a semen specimen is:

A normal result

Normal when using Kruger's strict criteria

Indicative of increased prostatic fluid

Indicative of infection

Indicative of infection

The semen analysis is classified as a moderately complexity test by the Clinical Laboratory Improvement Amendments (CLIA).

True

False

False

A yellow semen specimen with a normal sperm concentration and decreased motility may contain:

Bilirubin

Carotene

Bacteria

Urine

Urine

When there is a lack of prostatic fluid, which of the following chemicals is not decreased in the semen?

Alpha-glucosidase

Zinc

Citrate

Acid phosphatase

Alpha-glucosidase

Which of the following will not cause the development of male antisperm antibodies?

Vasovasostomy

Infection

Prolonged abstinence

Trauma

Prolonged abstinence

In this CSF specimen, identify the cell pointed to by the arrow.

Lymphocyte

Neutrophil

Macrophage

Malignant cell

Neutrophil

In this CSF specimen, identify the cell pointed to by the arrow.

Lymphocyte

Malignant cell

Macrophage

Neutrophil

Malignant cell

The red color of this cerebrospinal fluid is due to what process?

Traumatic tap

Rigorous shaking of the tubes

Hemorrhage

Stroke

Traumatic tap

What process might give rise to the population of cells seen in this image of CSF?

Bacterial meningitis

Normal

Hemorrhage

Viral meningitis

Viral meningitis

In bacterial meningitis, the level of glucose in CSF relative to normal is typically:

Unchanged

Decreased

Increased

Markedly increased

Decreased

The arrow is pointing to which type of cell in this CSF specimen?

Macrophage

Neutrophil

Lymphocyte

Malignant cell

Macrophage

This CSF would most likely be seen in what condition?

Hemorrhage

Traumatic tap

Infarction

Normal

Normal

The cellular infiltrate seen in this CSF specimen is most likely due to what process?

Viral meningitis

Hemorrhage

Bacterial meningitis

Normal

Bacterial meningitis

This CSF infiltrate is likely a result of what process?

Interventricular shunt

Bacterial meningitis

Viral meningitis

Cryptococcal meningitis

Interventricular shunt

Identify this cell from a CSF specimen.

Macrophage

Neutrophil

Reactive lymphocyte

Blast

Blast

An increase in neutrophils with pyknotic nuclei can be seen in which situation?

Patient with bacterial meningitis

Patient with fungal meningitis

Traumatic tap specimen

Patients on medication

Traumatic tap specimen

A CSF glutamine level is an indirect measure of CSF:

Lactate

Hypoxia

Ammonia

Creatine kinase

Ammonia

The presence of macrophages containing hematoidin crystals indicates a recent hemorrhage.

True

False

False

Measurement of CSF lactate is useful for monitoring cases of:

Multiple sclerosis

Bacterial meningitis

Reye syndrome

Tertiary syphilis

Bacterial meningitis

Oligoclonal bands are located in the gamma region of the CSF protein electrophoresis.

True

False

True

Bacterial antigen tests have replaced the Gram stain as the method of choice for detecting meningitis.

True

False

False

White blood cell (WBC) counts on clear CSF specimens are performed:

Using centrifuged specimens

Only if multiple sclerosis is suspected

On undiluted specimens if there is no cell overlapping

On specimens diluted 1:200 with gentian violet

On undiluted specimens if there is no cell overlapping

Gram stains performed on CSF specimens are helpful in the:

Diagnosis of tubercular meningitis

Diagnosis of bacterial meningitis

Detection of viral meningitis

Detection of bacterial and fungal meningitis

Detection of bacterial and fungal meningitis

A CSF protein report of 32 g/dL:

Is normal

Indicates possible multiple sclerosis

Is an erroneous report

Should be followed by electrophoresis

Is an erroneous report

A positive serum FTA-ABS and a negative VDRL on CSF indicate:

Neurosyphilis

An improperly collected specimen

Successfully treated syphilis

Outdated VDRL reagents

Successfully treated syphilis

The CSF circulates through the brain and spinal cord in the:

Arachnoid mater

Choroid plexuses

Dura mater

Subarachnoid space

Subarachnoid space

India ink preparations are useful in the diagnosis of:

Fungal meningitis

Bacterial meningitis

Tubercular meningitis

Multiple sclerosis

Fungal meningitis

Which of the following tests has the best sensitivity and specificity for detecting meningitis?

Gram stain

Blood culture

PCR

ELISA

PCR

The presence of hemosiderin containing macrophages in CSF indicates:

Fungal meningitis

Cerebral hemorrhage

Reye syndrome

Multiple sclerosis

Cerebral hemorrhage

When using the cytocentrifuge, a daily control slide of saline and albumin is prepared to check:

The correct centrifuge speed

For the presence of WBCs

For bacterial contamination

The pH of staining buffer

For bacterial contamination

PCR testing for meningitis is based on:

Amplification of RNA

Amplification of DNA

Nuclear acids

Antibodies

Amplification of RNA

Crystals with a bright yellow color seen in macrophages are called:

Unconjugated bilirubin

Hemosiderin

Hematoidin

Conjugated bilirubin

Hematoidin

CSF electrophoresis can be used to confirm the diagnosis of multiple sclerosis and would be expected to show which of the following?

Increased IgG with oligoclonal bands not seen on serum electrophoresis

Increased IgG with oligoclonal bands similar to those seen on serum electrophoresis

Decreased IgG with antibody-specific oligoclonal bands

Decreased IgG with oligoclonal bands resembling those seen on serum electrophoresis

Increased IgG with oligoclonal bands not seen on serum electrophoresis

When a CSF specimen is received in the microbiology laboratory, the first thing the technologist should do is:

Perform a Gram stain

Perform an India ink preparation

Centrifuge the specimen

Streak the fluid on chocolate agar

Centrifuge the specimen

Damage to the blood-brain barrier by Mycobacterium tuberculosis may cause the CSF to:

Appear blood-streaked

Appear xanthochromic

Contain a pellicle or clot

Contain decreased protein

Contain a pellicle or clot

Which is not a function of the cerebrospinal fluid (CSF)?

Nutritional enrichment of nervous tissue

Transmission of neurological impulses

Removal of metabolic waste products

Protection of neurological tissue from trauma

Transmission of neurological impulses

Greater than 1 million spermatids per milliliter indicates reproductive tract infection.

True

False

False

An increased amount of prostatic fluid in a semen specimen will:

Lower the pH

Raise the pH

Increase the motility

Decrease the motility

Lower the pH

Calculate using a 1:20 dilution and the five RBC counting squares of the Neubauer counting chamber, an average of 54 sperm is counted. The sperm concentration is:

54,000/cc

54,000,000/mL

108,000/cc

108,000,000/mL

54,000,000/mL

When performing sperm morphology analysis on a semen specimen with a sperm concentration of 20 million, 10 spermatids are seen. This result is:

A normal finding

Associated with infection

Normal in a postvasectomy specimen

Indicative of abnormal sperm maturation

Indicative of abnormal sperm maturation

A sperm motility report graded 2.0 is interpreted as:

Average motility and Brownian movement

Slow forward motility with noticeable lateral movement

Slow forward motion in a straight line

Abnormal motility with normal direction

Slow forward motility with noticeable lateral movement

When using Kruger's strict morphology criteria, the normal value is greater than:

14% normal forms

25% normal forms

30% normal forms

55% normal forms

14% normal forms

Semen specimens should be processed for analysis:

Immediately on receipt in the laboratory

Before complete liquefaction

After complete liquefaction

1 hour after arriving in the laboratory

After complete liquefaction

Which of the following is a normal finding in an eosin-nigrosin stain?

75% of the cells appear bluish white

75% of the cells appear red

30% of the cells appear red

30% of the cells appear bluish white

75% of the cells appear bluish white

Which of the following parameters directly relates to and provides a check on the sperm motility evaluation?

Agglutination testing

Morphology

Sperm count

Viability stain

Viability stain