TEST BANK For Urinalysis and Body Fluids, 7thEditionbyStrasinger

TEST BANK For Urinalysis and Body Fluids, 7th Edition by
Strasinger | Verified Chapters 1 - 17 | Complete Newest Version
TEST BANK
URINALYSIS AND BODY FLUIDS 7TH EDITION TEST BANK
Chapter 1: Safety and Quality Management
Multiple Choice
1. An example of a chemical hazard is:

A. Carcinogen exposure
B. Strained back
C. Viral infection
D. Shock
ANS: A
DIF: Level 1
OBJ: 1-1
TOP: Safety hazards
2. Centrifuging an uncapped tube of urine is most likely to produce a/an:

A. Electrical shock
B. Broken tube
C. Unbalancing
D. Aerosol
ANS: D
DIF: Level 2
OBJ: 1-1
TOP: Safety hazards
3. Laboratory equipment and other inanimate objects serve as what in the chain of infection?
A. Host
B. Reservoir
C. Point of entry
D. Point of exit
ANS: B
DIF: Level 1
OBJ: 1-2
TOP: Chain of infection
4. The chain of infection includes all of the following except a:
A. Source
B. Host
C. Disinfectant
D. Transmission method
ANS: C
DIF: Level 1
OBJ: 1-2
5. You arrive to work in the clinical laboratory with a small cut on your hand. Your supervisor
removes you from specimen collection (phlebotomy) duties for the day, citing chain of infection
protocols. Why is your supervisor concerned about the cut on your hand?
A. Because you will not have the mobility in your hand to properly collect blood.
B. Because you are going to have to wear a bandage all day long.
C. Because you have a point of entry that could expose you to infectious agents.
D. Because you are going to be an active transmitter of infection onto general surfaces.
ANS: C
DIF: Level 3
OBJ: 1-2
6. Which of the following guidelines states that laboratory personnel should consider all patients
as possible carriers of blood-borne pathogens?
A. Urinalysis precautions
B. Blood-borne pathogen precautions
C. Standard precautions
D. Body fluid precautions
ANS: C
DIF: Level 1
OBJ: 1-3
TOP: Standard precautions
7. The Centers for Disease Control and Prevention (CDC) recommends that universal
precautions be followed when encountering:
A. Specimens containing visible blood
B. Patients who are infected with blood-borne pathogens
C. All body fluid specimens
D. Specimens that may produce aerosols
ANS: A
DIF: Level 1
OBJ: 1-3
8. Which of the following CDC guidelines considers all moist body substances to be potentially
infectious and stresses hand washing?
A. Universal precautions
B. Body fluid precautions
C. Standard precautions
D. Health-care personnel standards
ANS: C
DIF: Level 1
OBJ: 1-4
TOP: Blood-borne pathogens
9. The Occupational Exposure to Blood-Borne Pathogens Standard is:

A. A guideline developed by the Food and Drug Administration (FDA)
B. Guidelines recommended by the Clinical and Laboratory Standards Institute (CLSI)
C. A guideline recommended by the Centers for Disease Control and Prevention (CDC)
D. A law enforced by the Occupational Safety and Health Administration (OSHA)
ANS: D
DIF: Level 1
OBJ: 1-4
10. A laboratory worker who observes a red hand rash after removing gloves should:
A. Avoid wearing gloves for 2 days
B. Wash the hands with antimicrobial soap
C. Apply cortisone cream to the hands
D. Avoid wearing latex gloves in the future
ANS: D
DIF: Level 2
OBJ: 5
TOP: Protective equipment
11. Plexiglas shields are used in the laboratory when urine tube specimens are being:
A. Sorted according to laboratory
B. Uncapped for analysis
C. Centrifuged for analysis
D. Observed for color characteristics
ANS: B
DIF: Level 2
OBJ: 1-5
12. A urine specimen received in the laboratory is leaking in a transport bag. What is the next
course of action?
A. It should be relabeled.
B. It should be rejected.
C. It should be processed with no special handling.
D. It should be poured into a clean container.
ANS: B
DIF: Level 2
OBJ: 1-7
TOP: Specimen handling
13. Laboratory coats worn in the urinalysis laboratory should:

A. Be worn loosely over uniforms
B. Have short sleeves
C. Be completely buttoned
D. Be worn at all times in and outside of the laboratory
ANS: C
DIF: Level 2
OBJ: 1-5
14. Proper hand washing includes all of the following procedures except:
A. Rubbing to create a lather
B. Using warm water
C. Rinsing hands in a downward position
D. Using a paper towel to turn on the water faucet
ANS: D
DIF: Level 2
OBJ: 1-6
TOP: Biological hazards
15. Disinfection of the sink in the urinalysis laboratory should be performed:

A. On a daily basis
B. When a positive bilirubin is detected
C. Following an accidental spill
D. By using dilute hydrochloric acid
ANS: A
DIF: Level 2
OBJ: 1-7
16. The acceptable method for disposing of urine specimens is:

A. Autoclaving the entire urine specimen
B. Pouring the urine specimen down the sink followed by copious amounts of water
C. Placing the urine specimen in a biohazard bag
D. Diluting urine with sodium hypochlorite
ANS: B
DIF: Level 2
OBJ: 1-7
17. Safety precautions observed in the urinalysis laboratory include all of the following except:
A. Wearing goggles or a face shield
B. Checking tube balance in the centrifuge
C. Centrifuging only uncapped tubes
D. Wearing a fluid-resistant laboratory coat
ANS: C
DIF: Level 2
OBJ: 7
18. The source, method of transmission, and host are all deemed:
A. Steps of standard precautions
B. Components of the chain of infection
C. Components of the chemical hygiene plan
D. Considerations in urine specimen transport
ANS: B
DIF: Level 1
OBJ: 1-2
19. Which of the following is a practice that all laboratory workers must avoid?
A. Changing gloves that are soiled
B. Centrifuging conical tubes
C. Moving puncture-resistant containers
D. Manually recapping needles
ANS: D
DIF: Level 1
OBJ: 1-7
TOP: Sharp hazards
20. Before using a water hose on a burning chemical cabinet, a firefighter would visually check
that what is posted on the outside of the cabinet?
A. National Fire Protection Association (NFPA) symbol
B. Safety Data Sheet (SDS)
C. Chemical Hygiene Plan
D. Occupational Safety and Health Administration manual
ANS: A
DIF: Level 2
OBJ: 1-11
TOP: Chemical hazards
21. Immediate information concerning the health hazards, flammability, and reactivity of a
chemical can be obtained from the:
A. SDS
B. NFPA symbol
C. CDC
D. OSHA
ANS: B
DIF: Level 2
OBJ: 1-11
22. Laboratory personnel wear special monitory badges when working frequently with which of
the following hazards?
A. Biological
B. Chemical
C. Radioactive
D. Explosive
ANS: C
DIF: Level 1
OBJ: 1-12
TOP: Radioactive hazards
23. When encountering a person experiencing an electrical shock, the first thing to do is:
A. Turn off the circuit breaker for the area
B. Lower the person’s head below the heart
C. Wrap the person in a wet fire blanket
D. Move the person away from the electrical object
ANS: A
DIF: Level 2
OBJ: 1-12
TOP: Electrical hazards
24. When a fire is discovered in the laboratory, you should do all of the following except:
A. Activate the fire alarm
B. Evacuate the area using the stairs
C. Use an appropriate fire extinguisher
D. Leave the door open when evacuating
ANS: D
DIF: Level 2
OBJ: 13
TOP: Fire hazards
25. The acronym RACE is used when encountering a/an:

A. Fire
B. Chemical spill
C. Electrical shock
D. Needlestick
ANS: A
DIF: Level 1
OBJ: 1-13
TOP: Fire hazards
26. Which of the following items found in the laboratory should be securely fastened to a
nonmovable object?
A. Biohazard bags
B. Compressed gas cylinders
C. Chemical spill kits
D. Radiation detectors
ANS: B
DIF: Level 1
OBJ: 1-12
TOP: Fire hazards
27. The most commonly available fire extinguisher in a hospital is:

A. Type A
B. Type B
C. Type C
D. Type ABC
ANS: D
DIF: Level 1
OBJ: 1-12
TOP: Fire hazards
28. Which type of fire distinguisher would be used on combustible metals?
A. Type A
B. Type B
C. Type C
D. Type D
ANS: D
DIF: Level 1
OBJ: 1-12
TOP: Fire hazards
29. When using a fire extinguisher, which action do you perform first?
A. Point the nozzle
B. Pull the pin
C. Protect the patient specimens
D. Position the extinguisher
ANS: B
DIF: Level 2
OBJ: 1-13
TOP: Fire hazards
30. Variables that are included in a quality management program include all of the following
except:
A. Preexamination
B. Clinical
C. Examination
D. Postexamination
ANS: B
DIF: Level 1
OBJ: 1-15
TOP: Quality management
31. Clinical laboratory personnel have the least control over which of the following conditions?
A. Preexamination variables
B. Examination variables
C. Postexamination variables
D. Postdischarge variables
ANS: A
DIF: Level 2
OBJ: 1-15
32. When you receive a specimen and a requisition form that do not match, you should:
A. Notify the personnel who collected the specimen
B. Test the specimen and note the error on the requisition form
C. Immediately discard the specimen
D. Analyze the error and make appropriate changes to the label
ANS: A
DIF: Level 2
OBJ: 1-15
33. When a critical value is obtained in the laboratory:

A. The test should be repeated
B. The pathologist should be notified
C. A new specimen must be requested
D. The result must be reported to the health-care provider
ANS: D
DIF: Level 2
OBJ: 1-15
34. The ability to obtain the published result on a control specimen is referred to as:
A. Precision
B. Accuracy
C. Standardization
D. Reliability
ANS: B
DIF: Level 1
OBJ: 1-16
TOP: Quality assessment
35. Obtaining the same result after testing the same specimen three times is called test:
A. Reliability
B. Quality control
C. Precision
D. Accuracy
ANS: C
DIF: Level 1
OBJ: 1-16
36. The highest acceptable range for confidence limits in the clinical laboratory is:
A. ±1 SD
B. ±2 SD
C. ±3 SD
D. ±4 SD
ANS: C
DIF: Level 1
OBJ: 1-16
37. A procedure with a coefficient of variation of 10% is considered:

A. Reliable
B. Precise
C. Confident
D. Imprecise
ANS: D
DIF: Level 2
OBJ: 1-16
38. When plotted on a Levy-Jennings chart, a control specimen that has been left on the counter
overnight instead of being refrigerated might show a/an:
A. Shift
B. Increased CV
C. Trend
D. Change in precision
ANS: A
DIF: Level 2
OBJ: 1-16
39. Proficiency testing should be performed:

A. When control results exceed the confidence limits
B. By personnel performing the tests routinely
C. By the laboratory supervisor only
D. During an accreditation site inspection
ANS: B
DIF: Level 2
OBJ: 1-16
40. Which mode of infection transmission can occur through a sneeze?

A. Direct contact
B. Vehicle contact
C. Droplet contact
D. Indirect contact
ANS: C
DIF: Level 1
OBJ: 1-2
41. Testing of unknown specimens from an outside agency that provides validation of the quality
patient results is:
A. Electronic Quality Control
B. Internal Quality Control
C. Proficiency Testing
D. External Quality Control
ANS: C
DIF: Level 1
OBJ: 1-16
42. The Globally Harmonized System is:
A. A component of the Exposure Control Plan
B. An evaluation of Blood-Borne Pathogens Standard
C. The handling and use of hazard chemicals
D. Classifications of fire extinguishers
ANS: C
DIF: Level 1
OBJ: 1-9
TOP: Globally harmonized system
43. What does the Globally Harmonized System symbol pictured below represent?
A. Flammable
B. Skin irritant
C. Corrosive
D. Biological
ANS: B
DIF: Level 1
OBJ: 1-9
44. Quality management (QM) refers to:

A. Workplace practices
B. Entire testing processes
C. Quality control (QC)
D. Reagent performance
ANS: B
DIF: Level 1
OBJ: 14
45. What should not be included in a quality management plan?

A. Procedure manual
B. Education requirements
C. Personnel attendance
D. Equipment maintenance
ANS: C
DIF: Level 1
OBJ: 1-14
46. Identify the symbol below:
A. Radiation
B. Sharps
C. Chemical
D. Biological
ANS: a
DIF: Level 1
OBJ: 1-10
TOP: Hazard warning
True/False
47. Personnel in the urinalysis laboratory are best protected from blood-borne pathogen exposure
when following standard precautions.
ANS: True
DIF: Level 2
OBJ: 1-4
48. It is not necessary to change gloves when performing tasks on the same patient.
ANS: False
DIF: Level 1
OBJ: 1-5
49. OSHA requires employers to provide free immunization for hepatitis B virus (HBV) to
workers in urinalysis.
ANS: True
DIF: Level 1
OBJ: 1-5
50. Hands should be sanitized before and after testing each urine specimen.
ANS: False
DIF: Level 2
OBJ: 1-6
TOP: Hand hygiene
51. It is acceptable to recap a needle on a syringe containing urine, but not blood.
ANS: False
DIF: Level 2
OBJ: 1-7
TOP: Sharp hazards
52. Only nontoxic chemicals can be pipetted by mouth.
ANS: False
DIF: Level 1
OBJ: 1-7
53. The SDS should be provided to laboratories by chemical manufacturers or vendors.
ANS: True
DIF: Level 1
OBJ: 1-8
TOP: Safety data sheets
54. Electrical current can pass through glass and wood.
ANS: False
DIF: Level 2
OBJ: 1-12
TOP: Electrical hazards
55. Flammable chemicals must be stored in explosion-proof cabinets.
ANS: True
DIF: Level 1
OBJ: 1-8
TOP: Fire hazards
56. When lifting heavy objects, laboratory workers should bend their knees.
ANS: True
DIF: Level 1
OBJ: 1-1
TOP: Safety hazards
57. Droplet is a means of transmission.
ANS: True
DIF: Level 1
OBJ: 1-2
58. Employees are responsible for laundering nondisposable laboratory coats.
ANS: False
DIF: Level 1
OBJ: 1-2
59. HCV is a blood-borne pathogen.
ANS: True
DIF: Level 1
OBJ: 1-4
60. What document does OSHA require all laboratories to have on file when using hazardous
chemicals?
ANS: Chemical hygiene plan
DIF: Level 1
OBJ: 1-7
61. NFPA are the diamond-shaped, color-coded labels that should be placed on chemical
cabinets.
ANS: True
DIF: Level 2
OBJ: 1-10
TOP: Hazard warnings
62. A laboratory worker who is pregnant should avoid areas designated by a radioactive hazard
symbol.
ANS: True
DIF: Level 1
OBJ: 1-10
TOP: Hazards warnings
63. The function of Quality Management is to monitor, evaluate, and improve laboratory
services.
ANS: True
DIF: Level 1
OBJ: 1-14
64. A Levy-Jennings chart is considered postexamination.

ANS: False
DIF: Level 1
OBJ: 1-15
65. Globally Harmonized System standardizes all biological hazards.

ANS: False
DIF: Level 1
OBJ: 1-9
66. Hand hygiene includes both hand washing and the use of alcohol-based cleaners.
ANS: True
DIF: Level 1
OBJ: 1-6
Case Study 1
The morning medical laboratory scientist (MLS) has come to work and is assigned to urinalysis.
The night shift left urine specimens that were not tested at the workstation. The laboratory aide
places today’s urine specimens at the workstation also.
1. Before beginning the testing, the MLS should:

A. Wipe down the area with soap and water
B. Wipe down the area with an alcohol-based cleaner
C. Wipe down the area with a 1:10 bleach solution
D. Wear gloves so no cleaning is necessary
ANS: C
DIF: Level 2
OBJ: 1-3
2. The cleaning of workstations is considered a/an

A. Work practice control
B. Environmental control
C. Chemical hygiene control
D. External quality control
ANS: A
DIF: Level 1
OBJ:1-3
3. Urinalysis testing is performed by the MLS. The first task is to:

A. Test all the urines that are marked stat
B. Test two levels of quality control
C. Test the urines that were left previously
D. Start with a new bottle of urine strips
ANS: B
DIF: Level 2
OBJ: 1-16
Case Study 2
The morning medical laboratory scientist (MLS) has come to work and is assigned to urinalysis.
The night shift left urine specimens that were not tested at the workstation. The laboratory aide
places today’s urine specimens at the workstation also.
1. Before beginning the testing, the MLS should:

A. Wipe down the area with soap and water
B. Wipe down the area with an alcohol-based cleaner
C. Wipe down the area with a 1:10 bleach solution
D. Wear gloves so no cleaning is necessary
ANS: C
DIF: Level 2
OBJ: 1-3
2. The cleaning of workstations is considered a/an

A. Work practice control
B. Environmental control
C. Chemical hygiene control
D. External quality control
ANS: A
DIF: Level 1
OBJ:1-3
3. Urinalysis testing is performed by the MLS. The first task is to:

A. Test all the urines that are marked stat
B. Test two levels of quality control
C. Test the urines that were left previously
D. Start with a new bottle of urine strips
ANS: B
DIF: Level 2
OBJ: 1-16
Chapter 2: Urine and Body Fluid Analysis Automation
Multiple Choice
1. Semiautomated analyzers for the chemical analysis of urine use the test principle of:
A. Enzyme immunochemistry
B. Laser light scattering
C. Reflectance photometry
D. Electrical resistance
ANS: C
DIF: Level 1
OBJ: 2-1
TOP: Reflectance photometry
2. The principle of reflectance photometry is:

A. Laser light that causes a deflection of the light beam to measure color
B. Electrical current that causes a change in electrical resistance to measure color
C. Enzymes utilizing chemical pads to generate light to measure color
D. A light-emitting diode for a specific wavelength to measure color
ANS: D
DIF: Level 1
OBJ: 2-1
3. What does a fully automated analyzer provide that a semiautomated analyzer does not?
A. Specific gravity
B. Chemical analysis
C. Minimal specimen handling
D. Ease of use
ANS: C
DIF: Level 1
OBJ: 2-2
TOP: Automated analyzers
4. A major advantage of a fully automated analyzer versus a semiautomated analyzer is:
A. Quick turnaround
B. Cost
C. Ease of use
D. Walk-away capability
ANS: D
DIF: Level 1
OBJ: 2-2
5. In a fully automated analyzer, clarity is measured by:

A. Light scatter
B. Turbidity
C. Laser light
D. Reflectance
ANS: A
DIF: Level 1
OBJ: 2-2
6. Which of the following is not an advantage of automated microscopy?

A. Standardization
B. Reduced turnaround time (TAT)
C. Cost effectiveness
D. High variation of results
ANS: D
DIF: Level 1
OBJ: 2-3
TOP: Automated microscopy
7. Which is not a disadvantage of performing the manual microscopic analysis?

A. Centrifugation
B. Standardization
C. Variability
D. Time saving
ANS: D
DIF: Level 1
OBJ: 2-3
8. A method for performing automated urine sediment analysis is:

A. Fluorescence light
B. Electrical resistance
C. Reflectance
D. Immunochemical
ANS: A
DIF: Level 1
OBJ: 2-4
TOP: Flow cytometry
9. Which of the following urine elements if flagged by automated microscopy would need to be
confirmed by a manual examination?
A. Red blood cells
B. White blood cells
C. Crystals
D. Bacteria
ANS: C
DIF: Level 2
OBJ: 2-4
10. Automated urine particle digital imaging does not measure:

A. Particle length
B. Particle density
C. Particle volume
D. Particle complexity
ANS: B
DIF: Level 1
OBJ: 2-4
11. Which of the following fluids are not FDA cleared to be evaluated using XN-Series?
A. Pleural
B. Peritoneal
C. Amniotic
D. Cerebrospinal
ANS: C
DIF: Level 1
OBJ: 2-5
TOP: Automated body fluids
12. Which of the following cells need further intervention when analyzed by automated body
fluid instruments?
A. Malignant cells
C. Red blood cells
D. Mesothelial cells
ANS: A
DIF: Level 2
OBJ: 2-5
13. Lamellar bodies are analyzed by:

A. Sysmex XN Series
B. ADVIA 2120i
C. Sysmex GloCyte
D. Beckman Coulter iQ200
ANS: B
DIF: Level 1
OBJ: 2-5
True or False
14. Reflectance photometry uses the principle that light reflection from the reagent test pads
decreases in proportion to the intensity of the color produced.
ANS: True
DIF: Level 1
OBJ: 2-1
15. Semiautomated instruments are operator free.
ANS: False
DIF: Level 1
OBJ: 2-2
16. Automated Urine Particle Digital Imaging measures the total amount of nucleic acid
contained within a particle.
ANS: True
DIF: Level 1
OBJ: 2-4
17. Both low and high cell counts can be done by using automated body fluid analysis.
ANS: False
DIF: Level 2
OBJ: 2-5
18. The Fuchs-Rosenthal, Nageotte, and Neubauer hemocytometers are calibrated the same for
manual body fluid counting.
ANS: False
DIF: Level 1
OBJ: 2-5
TOP: Body fluid counting
19. Centrifugation of the urine is needed when using semiautomated analyzers.
ANS: True
DIF: Level 1
OBJ: 2-5
20. Scattergrams for microscopic analysis use forward scatter, side scatter, and fluorescence.
ANS: True
DIF: Level 1
OBJ: 2-4
Case Study
A urine sample from a 35-year-old woman is received in the laboratory for analysis. The
specimen was run on the Sysmex UF 1000i. The laboratory results are as follows: color: yellow;
clarity: cloudy; pH: 7.0; specific gravity: 1.010; protein: 100 mg/dL; blood: moderate; nitrite:
positive; leukocyte esterase: positive; glucose, ketones, bilirubin, and urobilinogen: negative.
Microscopic examination: red blood cells: 5 per hpf; white blood cells: 25 per hpf; bacteria:
moderate, amorphous, and casts present.
1. In reviewing the microscopic results, what would be flagged by the analyzer?

A. White blood cells
B. Red blood cells
C. Casts
D. Bacteria
ANS: C
DIF: Level 2
OBJ: 2-4
2. When microscopic elements are flagged by the Sysmex UF 1000i, the corrective action is:
A. Call the physician’s office
B. Ask for a new specimen
C. Rerun the specimen
D. Confirm by manual examination
ANS: D
DIF: Level 2
OBJ: 2-4
Chapter 3: Introduction to Urinalysis
Multiple Choice
1. Urea is a product of:

A. Creatine metabolism by muscles
B. Nucleic acid breakdown
C. Protein and amino acid metabolism
D. Fluid acidity regulation
ANS: C
DIF: Level 1
OBJ: 3-1
TOP: Urinalysis composition
2. To determine whether a specimen is urine, measure the concentrations of:

A. Glucose and protein
B. Urea and creatinine
C. Uric acid and amino acids
D. Protein and amino acids
ANS: B
DIF: Level 2
OBJ: 3-2
3. The average daily volume of urine produced by a normal adult is approximately:

A. 200 mL
B. 500 mL
C. 1,200 mL
D. 2,500 mL
ANS: C
DIF: Level 1
OBJ: 3-3
TOP: Urine volume
4. A person exhibiting oliguria would have a urine volume of:
A. 200 to 500 mL
B. 600 to 1,000 mL
C. 1,000 to 1,500 mL
D. More than 1,500 mL
ANS: A
DIF: Level 2
OBJ: 3-3
TOP: Urine volume
5. Which of the following terms is correctly matched with urine output?

A. Anuria: 400 mL in 24 hours
B. Oliguria: 1,000 mL in 24 hours
C. Polyuria: 3,000 mL in 24 hours
D. Nocturia: no urine output
ANS: C
DIF: Level 1
OBJ: 3-3
TOP: Urine volume
6. The polyuria associated with diabetes mellitus is caused by:

A. The presence of excess glucose in the urine
B. A defect in the production of antidiuretic hormone (ADH)
C. The diuretic effect of insulin
D. Failure of the collecting duct to respond to ADH
ANS: A
DIF: Level 2
OBJ: 3-3
TOP: Urine volume
7. Urine from a patient with diabetes insipidus has:

A. Decreased volume and decreased specific gravity
B. Decreased volume and increased specific gravity
C. Increased volume and increased specific gravity
D. Increased volume and decreased specific gravity
ANS: D
DIF: Level 2
OBJ: 3-3
TOP: Urine volume
8. A patient with polyuria shows a high specific gravity in the urine. The patient should be
evaluated for:
A. Renal tubular acidosis
B. Diabetes mellitus
C. Diabetes insipidus
D. Prostatic infection
ANS: B
DIF: Level 2
OBJ: 3-3
TOP: Urine volume
9. Persons taking diuretics can be expected to produce:

A. Anuria
B. Polyuria
C. Nocturia
D. Oliguria
ANS: B
DIF: Level 2
OBJ: 3-3
TOP: Urine volume
10. A urine specimen may be rejected by the laboratory because:

A. Nonmatching label and requisition form
B. 12 mL of urine in the container
C. A sterile container was received
D. Tested within 2 hours
ANS: A
DIF: Level 2
OBJ: 3-4
TOP: Specimen collection/handling
11. An unpreserved urine specimen left at room temperature overnight will have decreased:
A. Bacteria
B. Specific gravity and pH
C. Glucose and ketones
D. Color and specific gravity
ANS: C
DIF: Level 2
OBJ: 3-6
12. Which of the following will be least affected in an unpreserved specimen left at room
temperature overnight?
A. Bilirubin
B. Urobilinogen
C. Red blood cells
D. Protein
ANS: D
DIF: Level 2
OBJ: 3-7
13. Red blood cells will disintegrate more rapidly in urine that is:
A. Concentrated and acidic
B. Concentrated and alkaline
C. Dilute and acidic
D. Dilute and alkaline
ANS: D
DIF: Level 1
OBJ: 3-7
14. The primary cause of the changes that take place in unpreserved urine is:
A. Bacterial growth
B. Excessive exposure to light
C. Oxidation of chemical constituents
D. Precipitation of crystals
ANS: A
DIF: Level 2
OBJ: 3-8
15. Which of the following urine chemicals will deteriorate when exposed to light?
A. pH
B. Leukocytes esterase
C. Bilirubin
D. Specific gravity
ANS: C
DIF: Level 2
OBJ: 3-7
16. Which of the following is least likely to occur if a urine specimen stands at room temperature
for more than 2 hours?
A. Deterioration of formed elements
B. Increased bacteria
C. Decreased pH
D. Decreased glucose
ANS: C
DIF: Level 1
OBJ: 3-7
17. Sodium fluoride used as a preservative for urinalysis best protects:

A. Glucose
B. Blood
C. Drugs
D. Leukocytes
ANS: C
DIF: Level 1
OBJ: 3-8
18. A urine specimen containing a large amount of precipitated amorphous material may have
been preserved using:
A. Refrigeration
B. Phenol
C. Formalin
D. Toluene
ANS: A
DIF: Level 2
OBJ: 3-7
19. In the laboratory, the preferred method of urine preservation is:

A. Refrigeration
B. Boric acid
C. Sodium fluoride
D. Commercial tablets
ANS: A
DIF: Level 1
OBJ: 3-9
20. A specimen for routine urinalysis and culture can be preserved using:
A. Sodium fluoride
B. Boric acid
C. Formalin
D. Toluene
ANS: B
DIF: Level 1
OBJ: 3-9
21. All of the following are good preservatives of urinary cellular elements except:
A. Boric acid
B. Formalin
C. Sodium fluoride
D. Thymol
ANS: C
DIF: Level 1
OBJ: 3-9
22. Before analysis, a refrigerated urine specimen must be:

A. Warmed to 37C
B. Examined for crystal formation
C. Examined for changes in color
D. Returned to room temperature
ANS: D
DIF: Level 1
OBJ: 3-9
23. The recommended specimen for routine urinalysis testing is the:

A. Random specimen
B. Timed specimen
C. First morning specimen
D. Catheterized specimen
ANS: C
DIF: Level 1
OBJ: 3-11
TOP: Types of specimens
24. The required specimen for quantitative analysis of urinary constituents is the:
A. Midstream clean-catch specimen
B. First morning specimen
C. Random specimen
D. Timed specimen
ANS: D
DIF: Level 1
OBJ: 3-11
25. A first morning specimen is frequently requested to confirm:

A. Orthostatic proteinuria
B. Fanconi’s syndrome
C. Urinary tract infection
D. Antidiuretic hormone (ADH) deficiency
ANS: A
DIF: Level 1
OBJ: 3-11
26. The first morning specimen from a patient with no history of symptoms for diabetes is
positive for glucose. The patient should:
A. Be given a glucose tolerance test
B. Be asked to collect the second morning specimen
C. Be asked to collect a timed specimen
D. Be tested for renal tubular damage
ANS: B
DIF: Level 2
OBJ: 3-11
27. The specimen of choice for routine urinalysis is the first morning urine because it:
A. Has a high volume
B. Is produced while the body is in a resting state
C. Is more dilute to prevent false-positive reactions
D. Is more concentrated to better detect abnormalities
ANS: D
DIF: Level 2
OBJ: 3-11
28. All of the following specimens are acceptable for a urine culture except:
A. Catheterized specimen
B. Timed specimen
C. Suprapubic aspiration
D. Midstream clean-catch specimen
ANS: B
DIF: Level 1
OBJ: 3-11
29. Quantitation of a substance that varies with daily activities should be performed on a:
A. Timed overnight specimen
C. 24-hour specimen
D. 2-hour postprandial specimen
ANS: C
DIF: Level 2
OBJ: 13-1
30. Failure to empty the bladder before beginning the collection of a timed urine specimen will:
A. Cause falsely increased results
B. Affect the preservation of glucose
C. Cause falsely decreased results
D. Adversely affect culture results
ANS: A
DIF: Level 2
OBJ: 3-10
31. An alternative to the catheterized specimen is the:

A. Fasting specimen
C. Midstream clean-catch specimen
D. Three glass collection
ANS: C
DIF: Level 1
OBJ: 3-11
32. The least contaminated specimen for bacterial culture is the:

A. Catheterized specimen
B. Suprapubic aspiration
C. Three glass collection
D. Midstream clean-catch specimen
ANS: B
DIF: Level 2
OBJ: 3-11
33. The three-glass collection is used for the diagnosis of:

A. Bladder cancer
B. Urinary tract infection
C. Diabetes mellitus
D. Prostate infection
ANS: D
DIF: Level 1
OBJ: 3-11
34. Documentation of appropriate handling of specimens for drug analysis is provided by the:
A. Urinalysis supervisor
B. Physician
C. Temperature readings
D. Chain of custody form
ANS: D
DIF: Level 1
OBJ: 3-11
35. The liver breaks down protein to form what waste product?
A. Urea
B. Amino acids
C. Sodium
D. Chloride
ANS: A
DIF: Level 1
OBJ: 3-1
36. An increase in urine production during the night is described as:

A. Anuria
B. Oliguria
C. Polyuria
D. Nocturia
ANS: D
DIF: Level 1
OBJ: 3-3
TOP: Urine volume
37. Where should labels on urine specimen containers be placed?

A. Container
B. Lid
C. Bottom
D. Placement does not matter
ANS: A
DIF: Level 1
OBJ: 3-6
38. Increased turbidity in urine stored at room temperature is usually caused by:
A. Evaporation
C. Bacterial growth
D. Protein precipitation
ANS: C
DIF: Level 1
OBJ: 3-7
39. What is the maximum length of time a urine specimen can remain unpreserved at room
temperature before testing?
A. 30 minutes
B. 2 hours
C. 3 hours
D. 6 hours
ANS: B
DIF: Level 1
OBJ: 3-8
40. Which specimen(s) from a three glass collection do(es) not have to be examined
microscopically?
A. #1
B. #2
C. #3
D. All should be examined
ANS: B
DIF: Level 2
OBJ: 3-11
True/False
41. Urine contains organic and inorganic chemicals that can vary with body metabolic functions.
ANS: True
DIF: Level 1
OBJ: 3-1
42. Medical laboratory scientists performing urinalysis can determine whether a specimen is
urine from the presence of formed elements.
ANS: False
DIF: Level 1
OBJ: 3-2
43. Dietary intake does not influence urine volume.
ANS: False
DIF: Level 2
OBJ: 3-3
TOP: Urinalysis volume
44. Polydipsia is a symptom of both diabetes mellitus and diabetes insipidus.
ANS: True
DIF: Level 1
OBJ: 3-3
TOP: Urine volume
45. A urine specimen label should include the date and time of collection.
ANS: True
DIF: Level 1
OBJ: 3-5
46. Urine that remains unpreserved at room temperature will show an increase in the
concentrations of nitrate, glucose, and white blood cells.
ANS: False
DIF: Level 1
OBJ: 3-7
47. A specimen delivered to the laboratory in a gray-top Vacutainer is acceptable for urinalysis.
ANS: False
DIF: Level 2
OBJ: 3-9
48. A urine bacterial culture should not be performed on a catheterized specimen.
ANS: False
DIF: Level 2
OBJ: 3-10
49. Random urines are preferred over first morning for testing.
ANS: False
DIF: Level 1
OBJ: 3-10
50. Chloride is an organic substance found in urine.
ANS: True
DIF: Level 1
OBJ: 3-1
TOP: Urine composition
Case Study
An outpatient brings a urine specimen to the laboratory at 9 a.m. The specimen sits on the
laboratory counter until late afternoon when it is finally tested.
1. What chemical test should be questioned?

A. Increased glucose
B. Decreased protein
C. Increased pH
D. Decreased blood
ANS: C
DIF: Level 1
OBJ: 3-7
2. When the urine is examined microscopically, moderate levels of bacteria are seen with a
negative leukocyte esterase. The action that should be taken is:
A. Report out the bacteria
B. Ask for a new specimen
C. Send the specimen for culture
D. Discard the specimen
ANS: B
DIF: Level 2
OBJ 3-8
3. What type of specimen is best to perform a culture and sensitivity?

A. Random urine
B. First morning
C. Twenty-four hour
D. Midstream clean catch
ANS: D
DIF: Level 1
OBJ 2-11
Chapter 4: Renal Function
Multiple Choice
1. Normal functions of the kidney include all of the following except:

A. Regulating body hydration
B. Elimination of nitrogenous wastes
C. Regulating electrolyte balance
D. Elimination of serum proteins
ANS: D
DIF: Level 1
OBJ: 4-3
TOP: Renal physiology
2. The approximate number of nephrons contained in each kidney is:

A. 100,000
B. 500,000
C. 1,000,000
D. 5,000,000
ANS: C
DIF: Level 1
OBJ: 4-1
3. The order of blood flow through the nephron is:

A. Afferent arteriole, peritubular capillaries, vasa recta, efferent arteriole
B. Efferent arteriole, peritubular capillaries, vasa recta, afferent arteriole
C. Peritubular capillaries, vasa recta, afferent arteriole, efferent arteriole
D. Afferent arteriole, efferent arteriole, peritubular capillaries, vasa recta
ANS: D
DIF: Level 2
OBJ: 4-2
4. The total renal blood flow is approximately:
A. 40 mL/min
B. 120 mL/min
C. 600 mL/min
D. 1200 mL/min
ANS: D
DIF: Level 1
OBJ: 4-2
5. The total renal plasma flow is approximately:

A. 60 mL/min
B. 120 mL/min
C. 600 mL/min
D. 1200 mL/min
ANS: C
DIF: Level 2
OBJ: 4-2
6. The glomerular filtrate is described as a:

A. Plasma filtrate containing glucose and protein
B. Protein-free ultrafiltrate of plasma
C. Selective filtrate of plasma containing urea
D. Plasma filtrate without glucose and protein
ANS: B
DIF: Level 1
OBJ: 4-3
7. Increased production of aldosterone causes:

A. Decreased plasma sodium levels
B. Decreased glomerular blood pressure
C. Increased plasma sodium levels
D. Increased urine volume
ANS: C
DIF: Level 2
OBJ: 4-4
8. The primary chemical affected by the renin-angiotensin-aldosterone system is:

A. Glucose
B. Potassium
C. Chloride
D. Sodium
ANS: D
DIF: Level 1
OBJ: 4-4
9. The specific gravity of the glomerular ultrafiltrate is:

A. 1.002
B. 1.010
C. 1.020
D. 1.030
ANS: B
DIF: Level 1
OBJ: 4-3
10. All of the following substances are reabsorbed from the glomerular filtrate by active
transport except:
A. Glucose
B. Water
C. Sodium
D. Amino acids
ANS: B
DIF: Level 1
OBJ: 4-3
11. For active transport to occur, a substance:
A. Must combine with a carrier protein to create electrochemical energy
B. Must be filtered through the proximal convoluted tubule
C. Must be in higher concentration in the filtrate than in the blood
D. Must be in higher concentration in the blood than in the filtrate
ANS: A
DIF: Level 2
OBJ: 4-5
TOP: Reabsorption mechanisms
12. Water is passively reabsorbed in all parts of the nephron except the:
A. Proximal convoluted tubule
B. Descending loop of Henle
C. Ascending loop of Henle
D. Collecting duct
ANS: C
DIF: Level 1
OBJ: 4-5
13. Most of the sodium filtered by the glomerulus is reabsorbed in the:

C. Distal convoluted tubule
D. Collecting duct
ANS: A
DIF: Level 1
OBJ: 4-5
14. The enzyme renin is produced by the kidney:

A. To activate antidiuretic hormone
B. In response to low plasma sodium levels
C. When too much sodium is being reabsorbed
D. To regulate secretion of hydrogen ions
ANS: B
DIF: Level 2
OBJ: 4-7
TOP: Renin-angiotensin-aldosterone system
15. Concentration of the tubular filtrate by the countercurrent mechanism is dependent on all of
the following except:
A. High salt concentration in the medulla
B. Water-impermeable walls of the ascending loop of Henle
C. Reabsorption of sodium and chloride from the ascending loop of Henle
D. Active transport reabsorption of sodium and glucose in the proximal convoluted tubule
ANS: D
DIF: Level 2
OBJ: 4-4
TOP: Tubular concentration
16. The osmotic gradient of the medulla:

A. Controls the permeability of the walls of the collecting duct
B. Affects passive reabsorption of water in the descending loop of Henle
C. Stimulates sodium reabsorption in the proximal convoluted tubule
D. Controls ammonia production by the distal convoluted tubule
ANS: C
DIF: Level 2
OBJ: 4-7
TOP: Tubular concentration
17. Aldosterone regulates sodium reabsorption in the:

C. Ascending loop of Henle
D. Distal convoluted tubule
ANS: D
DIF: Level 1
OBJ: 4-4
TOP: Renin-angiotensin-aldosterone system
18. Decreased production of aldosterone:
A. Produces a low urine volume
B. Produces a high urine volume
C. Increases ammonia excretion
D. Affects active transport of sodium
ANS: B
DIF: Level 2
OBJ: 4-4
TOP: Collecting duct concentration
19. Production of antidiuretic hormone is controlled by the:

A. Osmotic gradient of the medulla
B. Renin-angiotensin-aldosterone system
C. State of body hydration
D. Cells of the renal cortex
ANS: C
DIF: Level 1
OBJ: 4-6
TOP: Collecting duct concentration
20. Substances removed from the blood by tubular secretion include primarily:
A. Protein, hydrogen, and ammonia
B. Protein, hydrogen, and potassium
C. Amino acids, urea, and glucose
D. Protein-bound substances, hydrogen, and potassium
ANS: D
DIF: Level 1
OBJ: 4-8
21. Kidneys with impaired production of ammonia will consistently produce urine with a:
A. High pH
B. High volume
C. Low pH
D. Low volume
ANS: A
DIF: Level 2
OBJ: 4-2
TOP: Acid-base balance
22. To enhance the excretion of hydrogen ions, ammonia is produced by the cells of the:
B. Loop of Henle
D. Collecting duct
ANS: C
DIF: Level 1
OBJ: 4-7
23. To maintain the buffering capacity of the blood, hydrogen ions combine with:
A. Filtered phosphate ions
B. Filtered bicarbonate ions
C. Secreted ammonia
D. Secreted ammonium ions
ANS: B
DIF: Level 1
OBJ: 4-7
24. Clearance tests used to determine the glomerular filtration rate must measure substances that
are:
A. Not filtered by the glomerulus
B. Completely reabsorbed by the proximal convoluted tubule
C. Secreted in the distal convoluted tubule
D. Neither reabsorbed nor secreted by the tubules
ANS: D
DIF: Level 1
OBJ: 4-9
TOP: Glomerular filtration tests
25. Results for glomerular filtration tests are reported in:
A. Milliliters per minute
B. Milliliters per 24 hours
C. Milligrams per deciliter
D. Milliequivalents per liter
ANS: A
DIF: Level 1
OBJ: 11
26. All of the following are endogenous clearance test substances except:
A. Urea
B. Creatinine
C. Inulin
D. Beta2 microglobulin
ANS: C
DIF: Level 1
OBJ: 4-11
27. Performing a clearance test using radionucleotides:

A. Requires the patient to abstain from all food
B. Does not require an infusion
C. Provides visualization of the filtration
D. Requires patient hospitalization
ANS: C
DIF: Level 1
OBJ: 4-11
TOP: Clearance tests
28. If a substance is completely filtered by the glomerulus and then completely reabsorbed by the
tubules, the clearance of that substance will be:
A. Falsely decreased
B. Falsely increased
C. Normal
D. Zero
ANS: D
DIF: Level 2
OBJ 4-11
TOP: Clearance tests
29. The most routinely used laboratory method for measuring the glomerular filtration rate is the:
A. Inulin clearance
B. Estimated glomerular filtration rate
C. Creatinine clearance
D. Beta2 microglobulin clearance
ANS: B
DIF: Level 1
OBJ: 4-9
30. Calculate the creatinine clearance for a patient of average size from the following data:
Urine volume: 720 mL for 12 hours
Urine creatinine: 120 mg/dL
Serum creatinine: 1.5 mg/dL
A. 60 mL/min
B. 80 mL/min
C. 100 mL/min
D. 120 mL/min
ANS: B
DIF: Level 2
OBJ: 4-10
TOP: Creatinine clearance
31. Performing an estimated glomerular filtration rate is helpful for determining:

A. Renal concentrating ability
B. The feasibility of administering medications
C. Early renal disease
D. Renal blood flow
ANS: B
DIF: Level 1
OBJ: 4-9
TOP: Glomerular filtration rate
32. John White donates one of his two healthy kidneys to his twin brother. His glomerular
filtration rate can be expected to:
A. Decrease by 50%
B. Increase by 50%
C. Decrease gradually over 1 year
D. Remain within a normal range
ANS: D
DIF: Level 1
OBJ: 4-11
33. The renal function that is most frequently the first affected by early renal disease is:
A. Renal blood flow
B. Glomerular filtration
C. Tubular reabsorption
D. Tubular secretion
ANS: C
DIF: Level 1
OBJ: 4-10
TOP: Tubular reabsorption tests
34. For accurate evaluation of renal tubular concentrating ability, patient preparation should
include:
A. Fasting
B. Fluid deprivation
C. Increased hydration
D. Abstaining from all medications
ANS: B
DIF: Level 1
OBJ: 14-1
TOP: Tubular reabsorption tests
35. Measurement of urine osmolality is a more accurate measure of renal concentrating ability
than specific gravity because:
A. Osmolality is measured by instrumentation
B. Specific gravity is not influenced by urea and glucose molecules
C. Osmolality is influenced equally by small and large molecules
D. Specific gravity measures only urea and glucose molecules
ANS: C
DIF: Level 1
OBJ: 4-13
TOP: Osmolality
36. In the measurement of osmolality, a solute that is dissolved in solvent will:

A. Decrease the boiling point
B. Decrease the freezing point
C. Raise the vapor pressure
D. Raise the dew point
ANS: B
DIF: Level 1
OBJ: 4-14
TOP: Osmolality
37. Clinical osmometers use NaCl as a reference solution because:

A. 1 g molecular weight of NaCl will lower the freezing point 1.86C
B. NaCl is readily frozen and vaporized
C. NaCl is partially ionized similar to the composition of urine
D. 1 g equivalent weight of NaCl will lower the freezing point 1.86C
ANS: C
DIF: Level 2
OBJ: 4-14
TOP: Freezing-point osmometers
38. Substances that can interfere with serum osmolality readings include all of the following
except:
A. Lipids
B. Lactic acid
C. Ethanol
D. Sodium
ANS: D
DIF: Level 1
OBJ: 4-13
TOP: Freezing-point osmometers
39. The results of a serum osmolality performed by both freezing-point and vapor-pressure
osmometry do not agree. A possible cause of this discrepancy would be:
A. Increased ethanol
B. Increased lipids
C. Decreased lactic acid
D. Decreased potassium
ANS: A
DIF: Level 2
OBJ: 4-14
TOP: Technical factors
40. A technical error that could cause a discrepancy between freezing-point and vapor-pressure
osmometry readings is:
A. Failure to refrigerate the sample
B. Evaporation of the sample
C. Failure to separate cells and serum
D. Fluid deprivation of the patient
ANS: C
DIF: Level 3
OBJ: 4-14
TOP: Technical factors
41. The normal serum osmolality is:

A. 50 to 100 mOsm
B. 275 to 300 mOsm
C. 400 to 500 mOsm
D. Three times urine osmolality
ANS: B
DIF: Level 1
OBJ: 4-13
TOP: Osmolality clinical significance
42. The extent to which the kidney concentrates the glomerular filtrate can be determined by
measuring:
A. Serum creatinine
B. Urine creatinine
C. Serum osmolality
D. Urine and serum osmolality
ANS: D
DIF: Level 1
OBJ: 4-12
TOP: Osmolality clinical significance
43. Following fluid deprivation, a patient has a serum osmolality of 276 mOsm and a urine
osmolality of 1,000 mOsm. This patient:
A. Has normal concentration ability
B. May have defective antidiuretic hormone (ADH) production
C. May have insufficient tubular ADH response
D. Has a high serum lipid concentration
ANS: A
DIF: Level 2
OBJ: 4-13
TOP: Free water clearance
44. Which of the following tests provides information similar to specific gravity?
A. Total colloid content
B. Protein concentration
C. Absorbance
D. Osmolality
ANS: D
DIF: Level 1
OBJ: 4-13
45. The serum osmolality of a patient with hyponatremia:

A. Will be similar to the urine osmolality
B. Should be greater than 300 mOsm
C. Should be lower than 275 mOsm
D. Will be falsely increased
ANS: C
DIF: Level 2
OBJ: 4-13
TOP: Tubular secretion and renal blood flow
46. Following injection of ADH, a patient has a serum osmolality of 290 mOsm and a urine
osmolality of 450 mOsm. The patient:
A. Continued to observe water deprivation
B. Lacks tubular response to ADH
C. May have ingested excess alcohol
D. Should be evaluated with a creatinine clearance
ANS: B
DIF: Level 2
OBJ: 12
47. To determine the amount of water that must be cleared to produce urine with the same
osmolality as the ultrafiltrate, one should perform:
A. A free water clearance
B. A Mosenthal test
C. An osmolar clearance
D. A urine-to-plasma ratio
ANS: C
DIF: Level 1
OBJ: 4-15
48. Which of the following tests should be used to determine the ability of the kidneys to respond
to filtrate osmolality?
A. Free water clearance
B. Fishberg test
C. Urine-to-plasma osmolality
D. p-Aminohippuric acid (PAH) test
ANS: A
DIF: Level 1
OBJ: 4-15
49. A free water clearance of 2.5 could be indicative of:

A. Lack of renal concentration and dilution
B. Decreased ADH production
C. Hyponatremia
D. Dehydration
ANS: D
DIF: Level 2
OBJ: 4-15
50. Given the following laboratory data, calculate the free water clearance: volume = 2,800
mL/24 hour; urine osmo = 1,200 mOsm; plasma osmo = 400 mOsm.
A. +2 mL/min
B. +4 mL/min
C. 2 mL/min
D. 4 mL/min
ANS: D
DIF: Level 3
OBJ: 4-15
51. A patient with insufficient production of ADH would have which of the following results?
A. Urine volume—2 mL/min; osmolar clearance—2 mL/min
B. Urine volume—5 mL/min; osmolar clearance—2 mL/min
C. Urine volume—3 mL/min; osmolar clearance—4 mL/min
D. Urine volume—1 mL/min; osmolar clearance—3 mL/min
ANS: B
DIF: Level 2
OBJ: 4-15
52. The p-aminohippuric acid (PAH) test is used to measure:
A. Glomerular filtration
B. Tubular reabsorption
C. Albumin excretion
D. Renal blood flow
ANS: D
DIF: Level 2
OBJ: 4-16
TOP: PAH test
53. To provide an accurate measure of renal blood flow, a test substance should be:
A. Filtered by the glomerulus
B. Reabsorbed by the tubules
C. Secreted by the distal convoluted tubule
D. Cleared on each contact with functional renal tissues
ANS: D
DIF: Level 2
OBJ: 16
TOP: Renal blood flow tests
54. PAH (p-aminohippuric acid) is secreted by the:

D. Collecting duct
ANS: A
DIF: Level 1
OBJ: 4-16
TOP: PAH test
55. A PAH test result showing a renal plasma flow of 400 mL/min:
A. Is a normal result
B. May be falsely decreased from impaired tubular secretion
C. Should be corrected to correspond to the patient’s body size
D. Indicates glomerular filtration of PAH
ANS: B
DIF: Level 3
OBJ: 4-16
TOP: PAH test
56. Which of the following is not associated with the elimination of hydrogen ions?
A. Protein
B. Phosphate
C. Ammonia
D. Bicarbonate
ANS: A
DIF: Level 1
OBJ: 4-1
57. Renal tubular acidosis can be caused by the:

A. Production of excessively acidic urine due to increased filtration of hydrogen ions
B. Production of excessively acidic urine due to increased secretion of hydrogen ions
C. Inability to produce an acid urine due to impaired production of ammonia
D. Inability to produce an acid urine due to increased production of ammonia
ANS: C
DIF: Level 2
OBJ: 4-1
TOP: Acid–base balance
58. Tests to measure the tubular secretion of hydrogen ions include all of the following except:
A. pH
B. Titratable acidity
C. Urinary bicarbonate
D. Urinary ammonia
ANS: C
DIF: Level 1
OBJ: 4-17
59. Following administration of oral ammonium chloride, a patient with renal tubular acidosis
will produce:
A. Highly concentrated urine
B. Urine with a low pH
C. Urine with a high pH
D. Very dilute urine
ANS: C
DIF: Level 2
OBJ: 4-17
60. Total acidity of a urine specimen is a combination of:

A. Titratable acidity and pH
B. Titratable acidity and ammonium ion
C. pH and total acidity
D. Total acidity and ammonium ion
ANS: B
DIF: Level 2
OBJ: 4-17
61. Which of the following clearance substances does not require urine collection?
A. Creatinine
B. Cystatin C
C. Inulin
D. 5-HIAA
ANS: B
DIF: Level 2
OBJ: 4-11
TOP: Cystatin C
62. A 12-hour urine specimen with a volume of 360 mL is collected for a creatinine clearance.
What is the volume (V) used to calculate the clearance?
A. 0.5 mL/min
B. 1.0 mL/min
C. 1.5 mL/min
D. 2.0 mL/min
ANS: A
DIF: Level 2
OBJ: 4-15
63. Using the following values, calculate the creatinine clearance: urine volume—1,200 mL/12
hr, urine creatinine—60 mg/dL, and serum creatinine—0.8 mg/dL.
A. 60 mL/min
B. 75 mL/min
C. 112 mL/min
D. 128 mL/min
ANS: D
DIF: Level 2
OBJ: 4-15
64. Can a patient with the following results be given a nephrotoxic medication: urine volume—
720 mL/24 hr, urine creatinine—100 mg/dL, and serum creatinine—2.5 mg/dL?
A. No, clearance is 20 mL/min
B. No, clearance is 40 mL/min
C. Yes, clearance is 80 mL/min
D. Yes, clearance is 120 mL/min
ANS: A
DIF: Level 3
OBJ: 4-15
65. Given the following information, calculate the osmolar clearance: urine volume—720 mL in
24 hours, urine osmolality—700 mOsm, and plasma osmolality—300 mOsm.
A. 1.0 mL/min
B. 1.2 mL/min
C. 1.8 mL/min
D. 2.0 mL/min
ANS: B
DIF: Level 2
OBJ: 4-15
TOP: Osmolality
66. Given the following information, calculate the patient’s free water clearance: urine volume—
360 mL in 12 hours, urine osmolality—1,400 mOsm, and plasma osmolality—275 mOsm.
A. +0.5 mL/min
B. 1.5 mL/min
C. 1.0 mL/min
D. 2.0 mL/min
ANS: D
DIF: Level 2
OBJ: 4-15
TOP: Osmolality
67. Following a 2-hour infusion of p-aminohippuric acid (PAH), during which 200 mL of urine
is collected, the urine PAH is 260 mg/dL, and the patient’s plasma PAH is 0.8 mg/dL. Calculate
the renal plasma volume.
A. 525 mL/min
B. 553 mL/min
C. 614 mL/min
D. 765 mL/min
ANS: B
DIF: Level 2
OBJ: 4-16
TOP: PAH test
68. What is the physical property measured by a vapor-pressure osmometer?

A. Vapor temperature
B. Dew point temperature
C. Osmotic pressure
D. Oncotic pressure
ANS: B
DIF: Level 1
OBJ: 4-14
TOP: Osmolality
True/False
69. The afferent and efferent arterioles have the ability to vary in size.
ANS: True
DIF: Level 1
OBJ: 4-1
70. Blood pressure within the glomerulus varies directly with systemic blood pressure.
ANS: False
DIF: Level 2
OBJ: 2
71. A decrease in plasma sodium produces an increase in blood volume.
ANS: False
DIF: Level 2
OBJ: 4-2
72. The filtrate leaving the ascending loop of Henle is highly concentrated.
ANS: False
DIF: Level 2
OBJ: 4-2
73. A substance that is not filtered by the glomerulus will not be found in the urine.
ANS: False
DIF: Level 1
OBJ: 4-2
74. Hydrogen ions are filtered by the glomerulus and reabsorbed and secreted by the renal
tubules.
ANS: True
DIF: Level 1
OBJ: 4-2
75. An increase in the plasma level of beta2 microglobulin correlates with decreased glomerular
filtration.
ANS: True
DIF: Level 2
OBJ: 4-3
76. To calculate a creatinine clearance using the MDSD formula, the patient must collect at least
a 2-hour urine specimen.
ANS: False
DIF: Level 2
OBJ: 4-9
77. The nephrons with the longest loops of Henle are the cortical nephrons.
ANS: False
DIF: Level 2
OBJ: 4-2
TOP: Renal anatomy
78. The formation of urine begins in the bladder.

ANS: False
DIF: Level 1
OBJ: 4-2
TOP: Renal anatomy
Case Study 1
A 65-year-old man is seen by his physician showing symptoms of impaired renal function. The
physician orders several laboratory tests to be performed. Results are:
Serum creatinine: 2.0 mg/dL
Urine creatinine: 150 mg/dL
Serum osmolality: 270 mOsm
Urine osmolality: 100 mOsm
24-hour urine volume: 2000 mL
1. Using the information provided, calculate the creatinine clearance.

A. 50 mL/min
B. 85 mL/min
C. 105 mL/min
D. 110 mL/min
ANS: C
DIF: Level 2
OBJ: 4-10
TOP: Renal function case study
2. Using the information provided, calculate the osmolar clearance.

A. 0.5
B. 1.0
C. 2.0
D. 2.5
ANS: A
DIF: Level 2
OBJ: 4-15
3. Based on the case information provided, calculate the free water clearance.
A. 0.5
B. 1.0
C. +0.6
D. +0.9
ANS: D
DIF: Level 2
OBJ: 4-15
4. Based on the information provided, which renal function is abnormal in this patient?
C. Tubular secretion
D. Renal blood flow
ANS: B
DIF: Level 3
OBJ: 4-15
5. Based on the case information provided, can this patient be safely given a nephrotoxic
antibiotic?
A. Yes
B. No
ANS: A
DIF: Level 3
OBJ: 4-15
6. Based on the case information provided, would increasing the patient’s intake of fluids
alleviate this problem?
A. Yes
B. No
ANS: B
DIF: Level 3
OBJ: 14-5
Case Study 2
A laboratory supervisor is authorized to purchase a new osmometer. The supervisor must decide
between a freezing-point and a vapor-pressure model.
1. Based on the information provided, if this is a pediatric hospital, which model is better?
A. Freezing-point
B. Vapor-pressure
ANS: B
DIF: Level 3
OBJ: 4-14
TOP: Osmolality technical factors case study
2. Which model is more likely to be affected by technical errors?

A. Freezing-point
B. Vapor-pressure
ANS: B
DIF: Level 3
OBJ: 4-14
3. Which model is affected by lipemic serum but not elevated ethanol levels?
A. Freezing-point
B. Vapor-pressure
ANS: A
DIF: Level 3
OBJ: 4-14
4. What substance is used as a reference standard in both models?

A. KCl
B. Distilled water
C. NaCl
D. Deionized water
ANS: C
DIF: Level 2
OBJ: 4-14
Case Study 3
A physician is treating a patient exhibiting symptoms of impaired renal function following a

massive hemorrhage. The physician orders a serum sodium and a PAH clearance test. The
patient has a serum PAH of 1.0 mg/dL, urine PAH of 200 mg/dL, and urine volume of 240 mL in
2 hours. The serum sodium is decreased.
1. Based on the tests ordered, what renal function is the physician’s primary concern?
C. Tubular secretion
D. Renal blood flow
ANS: D
DIF: Level 3
OBJ: 4-16
2. . Calculate the patient’s renal blood flow using the information provided.
A. 100 mL/min
B. 200 mL/min
C. 300 mL/min
D. 400 mL/min
ANS: D
DIF: Level 2
OBJ: 4-16
3. Would it be better for this patient to have an increased or a decreased serum renin level?
A. Increased
B. Decreased
ANS: A
DIF: Level 2
OBJ: 4-16
Chapter 5: Physical Examination of Urine
Multiple Choice
1. The primary pigment responsible for normal urine color is:

A. Uroerythrin
B. Urochrome
C. Hemoglobin
D. Bilirubin
ANS: B
DIF: Level 1
OBJ: 5-1
TOP: Normal urine color
2. A dark yellow urine producing yellow foam may contain:

A. Hemoglobin
B. Protein
C. Red blood cells
D. Bilirubin
ANS: D
DIF: Level 1
OBJ: 5-3
TOP: Abnormal urine color
3. Which of the following urine colors and causes match?

A. Red—carotene
B. Dark yellow—porphyrins
C. Black—melanin
D. Green—pyridium
ANS: C
DIF: Level 2
OBJ: 5-5
4. The color of a urine specimen containing blood can be attributed to all of the following except
the:
A. Amount of blood
B. Blood type of patient
C. pH of the urine
D. Length of contact
ANS: B
DIF: Level 2
OBJ: 5-4
5. A urine specimen that turns black after standing may contain:

A. Porphobilinogen
B. Homogentisic acid
C. Carboxyhemoglobin
D. Myoglobin
ANS: B
DIF: Level 1
OBJ: 5-5
6. Which of the following specific gravity readings correlates with a pale yellow urine?
A. 1.005
B. 1.015
C. 1.025
D. 1.035
ANS: A
DIF: Level 2
OBJ: 5-11
TOP: Urine color
7. Specimens that contain intact red blood cells can be visually distinguished from specimens
that contain hemoglobin because:
A. Hemoglobin produces a brighter red color
B. Hemoglobin produces a cloudy pink specimen
C. Intact red blood cells produce a cloudy specimen
D. Intact red blood cells are rapidly converted to hemoglobin
ANS: C
DIF: Level 2
OBJ: 5-10
TOP: Urine clarity
8. Urine from a patient diagnosed with hepatitis will appear:

A. Pale yellow
B. Amber
C. Red
D. Brown
ANS: B
DIF: Level 2
OBJ: 5-3
TOP: Urine color
9. The pigment responsible for a pink precipitate in refrigerated urine is:

A. Uroerythrin
B. Urochrome
C. Bilirubin
D. Biliverdin
ANS: A
DIF: Level 1
OBJ: 5-9
TOP: Urine clarity
10. The presence of a white precipitate in freshly voided urine can be caused by:
A. Amorphous urates in alkaline urine
B. Amorphous urates in acid urine
C. Amorphous phosphates in alkaline urine
D. Amorphous phosphates in acid urine
ANS: C
DIF: Level 1
OBJ: 5-9, 5-10
TOP: Nonpathological turbidity
11. The addition of dilute acetic acid to a cloudy urine specimen will dissolve:
A. Amorphous urates
C. Yeast
D. Amorphous phosphate
ANS: D
DIF: Level 1
OBJ: 5-9
12. Slightly warming a turbid urine specimen may dissolve:

A. Talcum powder
B. Amorphous urates
C. Amorphous phosphate
D. Radiographic contrast media
ANS: B
DIF: Level 1
OBJ: 5-9
13. An antidiuretic hormone deficiency is associated with a:

A. Specific gravity close to 1.025
B. Low specific gravity
C. High specific gravity
D. Variable specific gravity
ANS: B
DIF: Level 2
OBJ: 5-11
TOP: Specific gravity
14. The specific gravity of urine is directly proportional to its:

A. Turbidity
B. Dissolved solids
C. Salt content
D. Glucose content
ANS: B
DIF: Level 1
OBJ: 5-11
15. A patient who has been diagnosed with diabetes mellitus will produce urine with:
A. Increased volume and decreased specific gravity
B. Decreased volume and decreased specific gravity
C. Increased volume and increased specific gravity
D. Decreased volume and increased specific gravity
ANS: C
DIF: Level 2
OBJ: 5-11
16. If a refractometer reads 1.003 with distilled water, the medical laboratory scientist should:
A. Subtract 0.003 from the specimen results
B. Add 0.003 to the specimen results
C. Use a reagent strip to measure the specific gravity
D. Calibrate the refractometer by adjusting the set screw
ANS: D
DIF: Level 2
OBJ: 5-12
17. A urine with the same specific gravity as the ultrafiltrate is called:
A. Isosthenuric
B. Hyposthenuric
C. Ultrasthenuric
D. Hypersthenuric
ANS: A
DIF: Level 1
OBJ: 5-11
18. A specimen with a specific gravity of 1.040 and a 1+ glucose and a negative reagent strip
protein is most likely caused by:
A. Glucose
B. Protein
ANS: D
DIF: Level 2
OBJ: 5-14
19. A patient with phenylketonuria has an odor of:

A. Fruity
B. Mousy
C. Ammonia
D. Cabbage
ANS: B
DIF: Level 1
OBJ: 5-16
TOP: Urine odor
20. What color would a Pseudomonas infection cause?

A. Green
B. Amber
C. Dark yellow
D. Black
ANS: A
DIF: Level 1
OBJ: 5-3
TOP: Urine Color
21. The 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 by air with light scattering by solutions
D. Light scattering by particles in solutions
ANS: B
DIF: Level 1
OBJ: 5-12
22. Specific gravity is a measure of:

A. Particle numbers
B. Molecular weight
C. Molarity
D. Density
ANS: D
DIF: Level 1
OBJ: 5-12
23. A clinically significant cause of turbidity is:

A. Amorphous urates
B. Squamous epithelial cells
C. Lipids
D. Mucus
ANS: C
DIF: Level 1
OBJ: 5-7
TOP: Urine clarity
24. Which of the following statements concerning measurement of specific gravity by

refractometer is not true?
A. The refractometer must be calibrated after every specimen.
B. This method is not affected by the temperature of the specimen.
C. This method measures dissolved particles in the urine.
D. The method requires less than 1 mL of urine.
ANS: A
DIF: Level 1
OBJ: 5-12
25. Which of the urinalysis results needs further investigation?

A. A clear, pale yellow specimen with a specific gravity of 1.010
B. A port wine–colored specimen with a negative test for blood
C. A hazy urine that was refrigerated overnight
D. A cloudy, brown urine with a positive test for blood
ANS: B
DIF: Level 2
OBJ: 5-4
TOP: Specimen color
26. Results of a specific gravity reading obtained by refractometer in the urology clinic do not
agree with the readings obtained by the laboratory’s automated reagent strip reader. The
laboratory should:
A. Recalibrate the reagent strip reader
B. Check the calibration of the refractometer in the clinic
C. Request the clinic to collect new specimens
D. Report the results from the reagent strip reader
ANS: D
DIF: Level 3
OBJ: 5-12
27. Bacterial decomposition of urea produces urine that has an odor resembling:
A. Aromatic amines
B. Asparagus
C. Ammonia
D. Bleach
ANS: C
DIF: Level 1
OBJ: 5-16
TOP: Urine odor
28. A specific gravity was performed by the refractometer and the reagent strip method. The
refractometer reading was 1.033 and the reagent strip was 1.10. The difference in the two
readings is caused by:
A. Refractometer measures only nonionizing substances
B. Clinical laboratory scientist error
C. Reagent strip measures any substance in urine
D. Refractometer error
ANS: A
DIF: Level 2
OBJ: 5-12
True/False
29. A urine specimen that remains at room temperature for several hours may develop a darker
yellow color.
ANS: True
DIF: Level 1
OBJ: 5-3
TOP: Urine color
30. A pale yellow urine is a primary indication of impaired renal function.
ANS: False
DIF: Level 1
OBJ: 5-2
TOP: Urine color
31. Clear red urine and red plasma are associated with myoglobinuria.
ANS: False
DIF: Level 1
OBJ: 5-4
32. Collection of a midstream clean-catch specimen can affect the clarity of a urine specimen.
ANS: True
DIF: Level 2
OBJ: 5-7
TOP: Urine clarity
33. A clear yellow urine will not contain any pathologically significant constituents.
ANS: False
DIF: Level 1
OBJ: 5-7
TOP: Urine clarity
34. Urine specific gravity can be measured by both physical and chemical methods.
ANS: True
DIF: Level 1
OBJ: 5-11
35. Urine specific gravity is equally influenced by the presence of glucose and sodium.
ANS: False
DIF: Level 1
OBJ: 5-13
36. The density of a urine specimen can affect the frequency of a sound wave.
ANS: True
DIF: Level 1
OBJ: 5-11
37. A supervisor should be concerned if a specific gravity reading of 1.008 is reported on a

turbid urine specimen.
ANS: False
DIF: Level 3
OBJ: 5-10
TOP: Specimen quality
38. A urine that turns black on standing is an indication of myoglobin.
ANS: False
DIF: Level 1
OBJ: 5-5
TOP: Abnormal color
39. Urine with a strong ammonia odor is an indication of a urinary tract infection.
ANS: True
DIF: Level 1
OBJ: 5-16
TOP: Urine odor
40. Osmolality is affected only by the number of particles present in urine.

ANS: True
DIF: Level 1
OBJ: 5-15
TOP: Osmolality
41. Clarity of urine is described as hazy.

ANS: True
DIF: Level 1
OBJ: 5-8
TOP: Clarity
42. Phenazopyridine causes urine to have a green color.

ANS: False
DIF: Level 1
OBJ: 5-6
TOP: Urine color
Case Study
A patient’s urine is sent to the laboratory for testing. Upon standing the urine turns black,
develops a cloudy white precipitate, and has a specific gravity of 1.010.
1. The primary concern about this specimen is:

A. Color
B. Turbidity
C. Specific gravity
D. Clarity
ANS: A
DIF: Level 2
OBJ: 5-2
2. The most likely cause of the black color in this specimen is:
A. Methemoglobin
B. Methyldopa
C. Melanin
D. Homogentisic acid
ANS: D
DIF: Level 3
OBJ: 5-5
3. The most probable cause of the white precipitate is:

A. Amorphous urates
B. Lipids
C. Amorphous phosphates
ANS: C
DIF: Level 2
OBJ: 5-9
TOP: Urine clarity
4. The primary basis for the changes that took place in this specimen is:
A. Photo-oxidation
B. Exposure over time to ambient air
C. Specimen contamination during handling
D. Evaporation of specimen
ANS: B
DIF: Level 3
OBJ: 5-5
TOP: Urine clarity
Chapter 6: Chemical Examination of Urine
Multiple Choice
1. Which would compromise the proper care of reagent strips?

A. Checking the expiration date
B. Storing in a clear container
C. Preventing exposure to toxic fumes
D. Storing with a desiccant
ANS: B
DIF: Level 1
OBJ: 6-2
TOP: Reagent strips
2. Quality control on reagent strips must be performed whenever a/an:

A. Abnormal result is obtained
B. Different person performs the test
C. New bottle of strips is opened
D. Student is training in the laboratory
ANS: C
DIF: Level 1
OBJ: 6-3
TOP: Quality control reagent strips
3. The reagent strip reaction that should be read at 2 minutes is the:

A. Nitrite
B. Bilirubin
C. Protein
D. Leukocyte esterase
ANS: D
DIF: Level 1
OBJ: 6-1
TOP: Reagent strip technique
4. Failure to blot the edge of the reagent strip may result in errors in color interpretation caused
by:
A. Excess dilution
B. Run over
C. Reagent leaching
D. Chemical concentration
ANS: B
DIF: Level 1
OBJ: 6-1
TOP: Reagent strip technique
5. Reagent strip chemical tests may be inaccurate if the specimen is:

A. Mixed before delivery
B. Tested immediately after refrigeration
C. Tested immediately after it is voided
D. Collected by catheter
ANS: B
DIF: Level 2
OBJ: 6-1
TOP: Improper technique or reagent strip technique
6. Quality control must be

A. Run at the beginning of each shift
B. Run only when a new bottle is opened
C. Run once a week
D. Run using distilled water
ANS: A
DIF: Level 2
OBJ: 6-3
TOP: Quality control reagent strips
7. The principle of the reagent strip test for pH is:

A. A double indicator reaction
B. The protein error of indicators
C. The diazo reaction
D. A Greiss reaction
ANS: A
DIF: Level 1
OBJ: 6-5
TOP: pH
8. Which food type will produce an acidic urine?

A. Lettuce
B. Cranberry juice
C. Green beans
D. Tomatoes
ANS: B
DIF: Level 1
OBJ: 6-4
TOP: pH
9. The normal range of urine pH is:

A. 4.5 to 6.0
B. 5.0 to 7.0
C. 4.5 to 8.0
D. 4.5 to 9.0
ANS: C
DIF: Level 1
OBJ: 6-4
TOP: pH
10. A urine specimen with a pH of 9.0 indicates that the patient should be:
A. Tested further for metabolic or respiratory alkalosis
B. Changed to a high meat diet to lower the pH
C. Placed on medication to lower the pH
D. Asked to collect a new specimen
ANS: D
DIF: Level 2
OBJ: 6-4
TOP: pH
11. Urinary pH provides valuable information for the:
A. Identification of urinary crystals
B. Controlling of antidiuretic hormone production
C. Monitoring of diabetes mellitus
D. Evaluation of renal concentration
ANS: A
DIF: Level 2
OBJ: 6-4
TOP: pH
12. A urine with a high pH reading can contain a:

A. High concentration of chloride ions
B. High concentration of hydrogen ions
C. Low concentration of chloride ions
D. Low concentration of hydrogen ions
ANS: D
DIF: Level 2
OBJ: 6-4
TOP: pH
13. Which of the following results is unusual for a urine specimen from an uncontrolled diabetic?
A. Positive ketones
B. Positive glucose
C. Increased specific gravity
D. High pH
ANS: D
DIF: Level 3
OBJ: 6-4
TOP: pH
14. Which of the following is a cause of prerenal proteinuria?

A. Prostatitis
B. Multiple myeloma
C. Preeclampsia
D. Diabetes mellitus
ANS: B
DIF: Level 1
OBJ: 6-6
TOP: Protein
15. The protein section of the reagent strip is most sensitive to:
A. Albumin
B. Mucoprotein
C. Bence Jones protein
D. Globulin
ANS: A
DIF: Level 1
OBJ: 6-7
TOP: Protein
16. When performing a reagent strip test for protein, false-positive results may be obtained in the
presence of:
A. Ketones bodies
B. Alkali specimen
C. Glucose present
ANS: B
DIF: Level 1
OBJ: 6-7
TOP: Protein
17. When using the reagent strip microalbumin method, false-negative results may occur in the
presence of:
A. Large amounts of glucose
B. Radiographic contrast media
C. Bence Jones protein
D. Highly dilute urine
ANS: D
DIF: Level 1
OBJ: 6-8
TOP: Protein
18. To detect the presence of early renal disease, diabetic patients are tested for:
A. Bence Jones protein
B. Microalbuminuria
C. Orthostatic protein
D. Glucose and ketones
ANS: B
DIF: Level 1
OBJ: 6-8
TOP: Protein
19. A possible cause of postrenal proteinuria is:

A. Prostatitis
B. Multiple myeloma
C. Glomerulonephritis
D. Posture
ANS: A
DIF: Level 1
OBJ: 6-6
TOP: Protein
20. The principle of the reagent strip test for protein is the:
A. Acid precipitation of protein
B. Salting out of proteins
C. pH effect on bromothymol blue
D. Protein “error of indicators”
ANS: D
DIF: Level 1
OBJ: 6-7
TOP: Protein
21. Orthostatic proteinuria is caused by:

A. Exposure to toxic substances
B. Immune complexes
C. Increased pressure on the renal vein
D. Bacterial and fungal infections
ANS: C
DIF: Level 1
OBJ: 6-6
TOP: Protein
22. Which of the following will not detect the presence of microalbuminuria?
A. Multistix Pro
B. Sulfosalicylic acid (SSA) test
C. Micral-Test
D. Clinitek 50
ANS: B
DIF: Level 1
OBJ: 6-8
TOP: Protein
23. The microalbumin test should be performed on:

A. All urine specimens with negative reagent strip protein
B. A 24-urine collection
C. Urine that has been refrigerated
D. A first morning collection
ANS: D
DIF: Level 1
OBJ: 6-8
TOP: Testing for microalbumin
24. The type of proteinuria least likely to be detected by reagent strip is:
A. Orthostatic
B. Prerenal
C. Renal
D. Postrenal
ANS: B
DIF: Level 2
OBJ: 6-6
TOP: Protein
25. Following a prehospital rotation physical, a medical laboratory science student is requested
to collect a first morning urine specimen. The physician is checking for:
A. Bence Jones proteinuria
B. Nocturnal proteinuria
C. Orthostatic proteinuria
D. Glomerulonephritis
ANS: C
DIF: Level 2
OBJ: 6-6
TOP: Protein
26. The type of protein that precipitates at 60F and dissolves at 100F is a/an:
A. Abnormal protein associated with urinary tract infection
B. Abnormal protein associated with hemolysis
C. Abnormal globulin associated with multiple myeloma
D. Normal serum albumin–type protein
ANS: C
DIF: Level 2
OBJ: 6-6
TOP: Protein
27. Which of the following best describes the chemical principle of the protein reagent strip?
A. Protein reacts with an immune complex on the pad, which results in a color change.
B. Protein causes a pH change on the reagent strip pad that results in a color change.
C. Protein accepts hydrogen ions from an indicator dye, which results in a color change.
D. Protein causes protons to be released from a polyelectrolyte, resulting in a color change.
ANS: C
DIF: Level 2
OBJ: 6-7
TOP: Protein
28. The albumin-to-creatinine ratio may be elevated in patients whose urine contains:
A. Leukocytes
B. Glucose
C. Blood
D. Bilirubin
ANS: B
DIF: Level 2
OBJ: 6-6
TOP: Protein
29. The pseudoperoxidase reaction is the principle for the reagent strip test(s) for:
A. Blood
B. Nitrite
C. Specific gravity
D. Urobilinogen
ANS: A
DIF: Level 2
OBJ: 6-15
TOP: Blood
30. Microalbumin tests are frequently used to screen patients with:

A. Fanconi’s syndrome
B. Porphyrinuria
C. Diabetes mellitus
D. Diabetes insipidus
ANS: C
DIF: Level 2
OBJ: 6-8
TOP: Protein | Glucose
31. A random urine specimen and plasma glucose test that are to be drawn and collected at the
same time can be used to confirm:
A. Glomerulonephritis
B. Nonpathogenic glycosuria
D. Fanconi’s syndrome
ANS: B
DIF: Level 2
OBJ: 6-9
TOP: Glucose
32. Which of the following chemical compounds is for glucose using the urine reagent strip?
A. Glucose oxidase
B. Iron ions
C. Sodium hydroxide
D. Citrate buffers
ANS: A
DIF: Level 1
OBJ: 6-10
TOP: Glucose
33. The appearance of glucose in the urine of a patient with an elevated blood sugar indicates:
A. Diabetes mellitus
B. Renal tubular damage
D. Cylindroiduria
ANS: A
DIF: Level 1
OBJ: 6-9
TOP: Glucose
34. The chemical reaction for the reagent strip reaction for glucose uses a:
A. Double sequential enzyme reaction
B. Sodium nitroprusside reaction
C. Diazonium salt reaction
D. Pyrrole amino acid ester reaction
ANS: A
DIF: Level 2
OBJ: 6-10
TOP: Glucose
35. Pediatric urine specimens are additionally tested for the presence of:
A. Glucose using Clinitest
B. Galactose using Multistix
C. Lactose using Chemstrip
D. Galactose using Clinitest
ANS: D
DIF: Level 1
OBJ: 6-11
TOP: Glucose
36. 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?
A. Galactose only is present
B. Glucose only is present
C. Lactose only is present
D. Ascorbic acid only is present
ANS: B
DIF: Level 2
OBJ: 6-10
TOP: Glucose
37. A laboratory error that can result in an infant developing severe mental retardation could be
attributed to failure to perform a/an:
A. Acetest
B. SSA test
C. Ictotest
D. Clinitest
ANS: D
DIF: Level 2
OBJ: 6-11
TOP: Glucose
38. Which of the following will not interfere with glucose detection in a urine specimen?
A. Galactose
B. Ascorbic acid
C. Bleach
D. Old specimen
ANS: A
DIF: Level 2
OBJ: 6-10
TOP: Glucose
39. Glucosuria occurring in conjunction with myocardial infarction may be caused by:
A. Epinephrine inhibiting insulin secretion
B. Epinephrine increasing insulin secretion
C. Norepinephrine inhibiting insulin secretion
D. Norepinephrine increasing insulin secretion
ANS: A
DIF: Level 2
OBJ: 6-9
TOP: Glucose
40. Glucosuria not accompanied by hyperglycemia is seen in patients with:

A. Renal disease
B. Gestational diabetes
C. Cushing’s syndrome
D. Hyperthyroidism
ANS: A
DIF: Level 2
OBJ: 6-9
TOP: Glucose
41. Which of the following statements is/are correct for glucose testing by reagent strip?
A. Glucose oxidase reacts with glucose in the urine.
B. Peroxidase activity of glucose.
C. Ehrlich aldehyde reaction with glucose.
D. Sodium nitroprusside reacts with glucose
ANS: A
DIF: Level 2
OBJ: 6-10
TOP: Glucose
42. Galactose will react with:

A. Multistix but not Clinitest
B. Multistix but not Chemstrip
C. Multistix and Chemstrip
D. Clinitest but not Chemstrip
ANS: D
DIF: Level 2
OBJ: 6-11
TOP: Glucose
43. While performing a Clinitest, you observe that the color changes rapidly from blue to orange
and then back to blue. You should:
A. Report the test as negative, because the final reaction color is blue
B. Report the test as negative, because the brief orange color was contamination
C. Repeat the test using fewer drops of urine to check for “pass through”
D. Repeat the test using more drops of urine to prevent “pass through”
ANS: C
DIF: Level 2
OBJ: 6-11
TOP: Glucose
44. A 1+ reagent strip reaction and a 4+ Clinitest reaction could indicate the presence of:
A. Glucose and other reducing substances
B. Glucose only
C. Non–glucose-reducing substances only
D. Contamination by a strong oxidizing agent
ANS: A
DIF: Level 2
OBJ: 6-11
TOP: Glucose
45. A negative reagent strip test for glucose with a positive Clinitest indicates the possibility of:
A. Juvenile diabetes
B. Glycosuria
C. Galactosuria
D. Peroxide contamination
ANS: C
DIF: Level 2
OBJ: 6-11
TOP: Glucose
46. Which of the following is not a ketone produced in normal adult metabolism?
A. Acetone
B. Phenylketones
C. Acetoacetic acid
D. Beta-hydroxybutyric acid
ANS: B
DIF: Level 1
OBJ: 6-12
TOP: Ketones
47. Which of the following will not cause ketonuria?

A. Inability to use carbohydrates
B. Inadequate intake of carbohydrates
C. Increased metabolism of carbohydrates
D. Excessive loss of carbohydrates
ANS: C
DIF: Level 1
OBJ: 6-12
TOP: Ketones
48. Reagent strip reactions for ketones react primarily with:

A. Acetone
B. Acetoacetic acid
C. Beta-hydroxybutyric acid
D. Phenylacetone
ANS: B
DIF: Level 1
OBJ: 6-13
TOP: Ketones
49. Excessive fat metabolism is indicated by the urinary presence of:

A. Cholesterol
B. Glucose
C. Ketones
D. Protein
ANS: C
DIF: Level 1
OBJ: 6-12
TOP: Ketones
50. The reagent strip test for ketones may detect the urinary presence of:
A. Acetoacetic acid and beta-hydroxybutyric acid
B. Acetone and beta-hydroxybutyric acid
C. Beta-hydroxybutyric acid and diacetic acid
D. Acetoacetic acid and acetone
ANS: D
DIF: Level 1
OBJ: 6-13
TOP: Ketones
51. An advantage in using the Acetest tablet test for ketones is the ability to:
A. Detect beta-hydroxybutyric acid
B. Quantitate positive reagent strip ketones results
C. Detect acetone and acetoacidic acid
D. Confirm a positive Clinitest result
ANS: C
DIF: Level 1
OBJ: 6-13
TOP: Ketones
52. Sodium nitroprusside and an alkaline buffer are used to test for:
A. Bilirubin
B. Ketones
C. Glucose
D. Protein
ANS: B
DIF: Level 1
OBJ: 6-13
TOP: Ketones
53. A urine sample that tests positive for ketones and negative for glucose is most likely from a
patient suffering from:
A. Diabetes insipidus
C. Polydipsia
D. Starvation
ANS: D
DIF: Level 2
OBJ: 6-12
TOP: Ketones
54. Reagent strip reactions for blood are based on the:

A. Peroxidase activity of hemoglobin
B. Oxidation of hemoglobin peroxidase
C. Reaction of hemoglobin with bromothymol blue
D. Reduction of a chromogen by hemoglobin
ANS: A
DIF: Level 1
OBJ: 6-14
TOP: Blood
55. Myoglobinuria may be caused by:

A. A “crushing” injury
B. Incompatible blood transfusions
C. Chronic renal disease
D. Biliary obstruction
ANS: A
DIF: Level 1
OBJ: 6-14
TOP: Blood
56. The urine specimen had a positive reaction for blood, but there were no red blood cells in the
sediment. The abnormal color is caused by:
A. Pyridium
B. Bilirubin
C. Porphyrins
D. Myoglobin
ANS: D
DIF: Level 2
OBJ: 6-14
TOP: Blood
57. The detection of hemosiderin in the urine can be associated with:

A. Myoglobinuria
B. Hematuria
C. Albuminuria
D. Hemoglobinuria
ANS: D
DIF: Level 2
OBJ: 6-14
TOP: Blood
58. A spotted reaction on the reagent strip reaction for blood can indicate:
A. Hematuria
B. Hemoglobinuria
C. Myoglobinuria
D. Porphyrinuria
ANS: A
DIF: Level 2
OBJ: 6-14
TOP: Blood
59. A reagent strip test for blood is reported positive. No red blood cells are seen on the
microscopic examination. The patient’s condition is called:
A. Hematuria
B. Oliguria
C. Hemoglobinuria
D. Hemosiderinuria
ANS: C
DIF: Level 2
OBJ: 6-14
TOP: Blood
60. 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
ANS: C
DIF: Level 2
OBJ: 6-14
TOP: Blood
61. The chemical principle of the reagent strip test for bilirubin is that bilirubin:
A. Causes a color change when it binds to a buffered pH indicator
B. Combines with a diazonium salt to form a colored complex
C. Is oxidized to biliverdin
D. Causes a pH change detected by the reagent pad indicator
ANS: B
DIF: Level 1
OBJ: 6-18
TOP: Bilirubin
62. When bilirubin is detected in the urine, it can be assumed that:

A. It is attached to protein
B. It has passed through the small intestine
C. The patient is diabetic
D. It has been conjugated in the liver
ANS: D
DIF: Level 1
OBJ: 6-16
TOP: Bilirubin
63. Ascorbic acid interferes with the reactions for bilirubin and nitrite by:
A. Reducing the oxidized chromogen
B. Binding with the diazonium salt
C. Neutralizing the buffer
D. Oxidizing the aromatic amine
ANS: B
DIF: Level 2
OBJ: 6-18
TOP: Bilirubin
64. Bilirubin that concentrates on the surface of an absorbent pad is the principle of which of the
following tests?
A. Nitrite
B. Acetest
C. Clinitest
D. Ictotest
ANS: D
DIF: Level 2
OBJ: 6-18
TOP: Bilirubin
65. The Ictotest is a more sensitive test for urinary bilirubin because:
A. The tablets contain a more sensitive diazonium salt
B. Sulfosalicylic acid is included in the tablets
C. Bilirubin remains on the surface of the mat
D. Water is used to dissolve the tablet
ANS: C
DIF: Level 2
OBJ: 6-18
TOP: Bilirubin
66. With biliary duct obstruction, it is common for reagent strip tests to show which of the
following scenarios?
A. Bilirubin: 0; urobilinogen: 0.1 EU
B. Bilirubin: ++; urobilinogen: 0.1 EU
C. Bilirubin: 0; urobilinogen: 4 EU
D. Bilirubin: ++; urobilinogen: 4 EU
ANS: B
DIF: Level 2
OBJ: 6-17
TOP: Bilirubin
67. Urobilinogen is formed from the:

A. Conjugation of bilirubin in the liver
B. Reduction of conjugated bilirubin in the bile
C. Reduction of bilirubin by intestinal bacteria
D. Oxidation of urobilin by intestinal bacteria
ANS: C
DIF: Level 1
OBJ: 6-19
TOP: Urobilinogen
68. Specimens for urobilinogen testing are collected between 2 p.m. and 4 p.m. because:
A. They have a higher volume
B. An alkaline tide occurs following lunch
C. Protein is less likely to be present
D. The urine will be more acidic
ANS: B
DIF: Level 1
OBJ: 6-19
TOP: Urobilinogen
69. Reagent strip results associated with hemolytic disease would correspond with which of the
following?
A. Bilirubin = 0; urobilinogen = 1 EU
B. Bilirubin = ++; urobilinogen = 1 EU
C. Bilirubin = 0; urobilinogen = 8 EU
D. Bilirubin = ++; urobilinogen = 8 EU
ANS: C
DIF: Level 2
OBJ: 6-17
TOP: Urobilinogen
70. Tests for nitrite tend to be positive:
A. When gram-positive bacteria are present
B. When the urine sits in the bladder for less than 2 hours
C. When gram-negative bacteria are present
D. When a renal transplant rejection occurs
ANS: C
DIF: Level 1
OBJ: 6-20
TOP: Nitrite
71. The reagent strip test for nitrite is based on the:

A. Use of nitrite by bacteria present in the urine
B. Reaction of nitrite with the cell wall of gram-negative bacteria
C. Reduction of nitrate in urine to nitrite by bacteria
D. Reaction of bacterial nitrite with an aromatic amine to produce a pH change
ANS: C
DIF: Level 1
OBJ: 6-20
TOP: Nitrite
72. Which of the following can produce a negative nitrite test in the presence of significant
bacteriuria?
A. The presence of many non–nitrate-reducing bacteria
B. Performing the test on a first morning specimen
C. Increased dietary nitrate
D. Decreased ascorbic acid
ANS: A
DIF: Level 2
OBJ: 6-21
TOP: Nitrite
73. Which of the following will be detected by the reagent strip nitrite reaction?
A. Staphylococcus saprophyticus
B. Candida albicans
C. Streptococcus faecalis
D. Escherichia coli
ANS: D
DIF: Level 3
OBJ: 6-21
TOP: Nitrite
74. All of the following will produce a positive leukocyte esterase (LE) reaction except:
A. Monocytes
B. Trichomonas
C. Neutrophils
D. Lymphocytes
ANS: D
DIF: Level 1
OBJ: 6-23
TOP: Leukocyte esterase
75. Major advantages of the leukocyte esterase reagent strip test include all of the following
except:
A. It will detect the presence of lysed leukocytes
B. It can be used to screen specimens before bacterial culturing
C. It is a more standardized method for detecting leukocytes than the microscopic method
D. It will accurately quantitate the leukocytes present
ANS: D
DIF: Level 1
OBJ: 22
76. Reagent strip reactions for white blood cells are based on the detection of:
A. Bacterial peroxidase activity
B. Esterase activity
C. Reduction of indoxyl blue
D. Binding of a diazonium salt
ANS: B
DIF: Level 1
OBJ: 6-22
77. The cells most frequently associated with urinary tract infection are:
A. Monocytes
B. Basophils
C. Neutrophils
D. Lymphocytes
ANS: C
DIF: Level 2
OBJ: 6-22
78. A false-negative LE reaction may be caused by:

A. The presence of eosinophils and basophils
B. Increased bacteria
C. Lysed leukocytes
D. Failure to wait 2 minutes to read the reaction
ANS: D
DIF: Level 2
OBJ: 6-23
79. The principle of the reagent strip test for specific gravity is:
A. Ionization of the indicator bromothymol blue, producing a pH change
B. Ionization of a polyelectrolyte, producing a pH change detected by bromothymol blue
C. Reaction of dissociated polyelectrolyte with bromothymol blue to produce a pH change
D. Change in the pKa of bromothymol blue to produce a pH change
ANS: B
DIF: Level 1
OBJ: 6-24
80. A student is having difficulty interpreting the reagent strip color reactions on a thick orange
urine specimen. What is the probable cause?
A. Vegetarian diet
B. Elevated urobilinogen
C. Phenazopyridium
D. Cloudy specimen
ANS: C
DIF: Level 3
OBJ: 6-26
TOP: Clinical significance
81. In review of the following results, what do the results most likely suggest?
Color: Dark yellow Protein: Negative Blood: Negative

Clarity: Clear Glucose: Negative Urobilinogen: 0.2
Specific gravity: 1.028 Ketones: Large Nitrite: Negative
pH: 5.0 Bilirubin: Negative Leukocyte esterase: Negative
A. A child with uncontrolled diarrhea and vomiting

B. An uncontrolled diabetic patient
C. An adult maintaining adequate fluid intake
D. A woman with a urinary tract infection
ANS: A
DIF: Level 3
OBJ: 6-26
TOP: Urinalysis case study
82. Which of the following reagent strip tests does not use a diazonium salt?
A. Bilirubin
B. Nitrite
C. Specific gravity
D. Leukocyte esterase
ANS: C
DIF: Level 2
OBJ: 6-24
TOP: Reagent strips
83. What do the urine results suggest?

Color: Yellow Protein: Trace Blood: Negative
Clarity: Cloudy Glucose: Negative Urobilinogen: 0.1 EU
Specific gravity: 1.019 Ketones: Negative Nitrite: Positive
pH: 8.0 Bilirubin: Negative Leukocyte esterase: Positive
A. Diabetes mellitus
B. Unsatisfactory specimen
D. Normal female specimen
ANS: C
DIF: Level 3
OBJ: 6-26
TOP: Urinalysis case study
84. A dark blue color in the reagent strip pad for specific gravity indicates:
A. A low specific gravity
B. A contaminated specimen
C. Increased protein is interfering
D. A high specific gravity
ANS: A
DIF: Level 2
OBJ: 6-25
85. The reagent strip reaction most critically affected by failure to blot the strip is the:
A. pH
B. Protein
C. Blood
D. Bilirubin
ANS: A
DIF: Level 1
OBJ: 6-26
TOP: Improper technique
86. Which of the following is not affected by increased intake of ascorbic acid?
A. Blood
B. Bilirubin
C. Nitrite
D. Ketones
ANS: D
DIF: Level 1
OBJ: 6-26
TOP: Reagent strips | Ketones
87. The urinalysis result most closely associated with renal disease is a positive:
A. Bilirubin
B. Glucose
C. Nitrite
D. Protein
ANS: D
DIF: Level 1
OBJ: 6-26
TOP: Protein clinical significance
88. Which of the following substances recirculates to the liver?

A. Urobilinogen
B. Unconjugated bilirubin
C. Stercobilinogen
D. Conjugated bilirubin
ANS: A
DIF: Level 2
OBJ: 6-17
TOP: Urobilinogen
89. The substance converted to urobilin is:

A. Urobilinogen
C. Stercobilinogen
ANS: D
DIF: Level 2
OBJ: 6-17
TOP: Urobilinogen
90. The substance bound to albumin is:
A. Urobilinogen
C. Stercobilinogen
ANS: B
DIF: Level 2
OBJ: 6-17
TOP: Urobilinogen
91. The substance that produces the brown color associated with normal feces is:
A. Urobilinogen
C. Stercobilin
ANS: C
DIF: Level 2
OBJ: 6-17
TOP: Urobilinogen
92. What causes a patient with a vegetarian diet to have false-positive readings for blood on
routine urine specimens?
A. Ketone interference
B. Dilute specimen
C. Increased leukocytes
D. Vegetable peroxidase
ANS: D
DIF: Level 3
OBJ: 6-15
TOP: Clinical significance
93. What can cause a test on a yellow-green urine specimen from a jaundiced patient to be
negative for bilirubin?
A. Bilirubin oxidized to biliverdin
B. Glucose interference
C. Bilirubin reduced to urobilinogen
D. Presence of iodine
ANS: A
DIF: Level 3
OBJ: 6-16
TOP: Bilirubin
True/False
94. Reagent strips provide quantitative urine chemistry results.
ANS: False
DIF: Level 1
OBJ: 6-1
TOP: Reagent strips
95. The Multistix and Chemstrip color charts are interchangeable.
ANS: False
DIF: Level 1
OBJ: 6-1
TOP: Reagent strips
96. A person with respiratory acidosis is expected to have a low urine pH.
ANS: True
DIF: Level 2
OBJ: 6-4
TOP: pH
97. Orthostatic proteinuria is a form of renal proteinuria.
ANS: True
DIF: Level 2
OBJ: 6-6
TOP: Protein
98. Myoglobin is removed from the blood more rapidly than hemoglobin.
ANS: True
DIF: Level 1
OBJ: 6-14
TOP: Blood
99. The nitrite test is not reliable unless specimens are collected using the midstream clean-catch
technique.
ANS: False
DIF: Level 1
OBJ: 6-20
TOP: Nitrite
100. Ascorbic acid will bind with diazonium salts.
ANS: True
DIF: Level 1
OBJ: 6-26
TOP: Reagent strips
Case Study
An outpatient who is a vegetarian and supplements her diet with megavitamins is feeling poorly.
She is having complaints of having to urinate frequently. She is seen by her physician who
orders a routine urinalysis. The results are as follows:
Color: Dark yellow Protein: 1+ Blood: Trace

Clarity: Cloudy Glucose: Negative Urobilinogen: 4 EU
Specific gravity: 1.009 Ketones: Negative Nitrite: Negative
pH: 8.0 Bilirubin: Negative Leukocyte esterase: Trace
Microscopic
40–50 WBCs/hpf Many bacteria
10–12 RBCs/hpf
1. Why is there a discrepancy between the urine color and specific gravity?
A. An old specimen
C. Increased beta carotene
D. Increased bacteria
ANS: C
DIF: Level 3
OBJ: 6-26
TOP: General case study
2. What is the most probable cause of the discrepancies in the chemical and microscopic results?
A. Dilute specimen
B. Increased ascorbic acid
C. Specimen color
D. Specimen clarity
ANS: B
DIF: Level 3
OBJ: 6-26
3. The elevated pH may be caused by:

A. Bacterial metabolism
B. Vitamins
C. Inadequate fluid intake
D. Increased fluid intake
ANS: A
DIF: Level 3
OBJ: 6-26
4. The positive protein is caused by:

A. Glomerular damage
B. Lower urinary tract infection
C. Upper urinary tract infection
D. Prerenal disorder
ANS: B
DIF: Level 3
OBJ: 6-26
5. What is the patient’s probable diagnosis?

A. Renal calculi
B. Glomerulonephritis
C. Allergic reaction
D. Urinary tract infection
ANS: D
DIF: Level 3
OBJ: 6-26
Chapter 7: Microscopic Examination of Urine
Multiple Choice
1. The recommended centrifugation setting for preparation of the urine sediment is:
A. 400 RPM for 10 minutes
B. 1,000 RPM for 5 minutes
C. 400 RCF for 5 minutes
D. 1,000 RCF for 10 minutes
ANS: C
DIF: Level 1
OBJ: 7-3
TOP: Centrifugation
2. The number of fields that should be examined when quantitating urinary sediment constituents
is:
A. 2
B. 5
C. 10
D. 20
ANS: C
DIF: Level 1
OBJ: 7-3
TOP: Examination of the sediment
3. The predecessor of the standardized urine microscopic examination was the:

A. Sternheimer count
B. Addis count
C. Kova system
D. T-system
ANS: B
DIF: Level 1
OBJ: 7-3
TOP: Technique
4. The two factors that determine relative centrifugal force are:
A. Radius of rotor head and revolutions per minute (RPM)
B. Radius of rotor head and time of centrifugation
C. Diameter of rotor head and RPM
D. RPM and time of centrifugation
ANS: A
DIF: Level 1
OBJ: 7-3
TOP: Centrifugation
5. A lipid droplet that does not stain with Sudan III may be composed of:
A. Triglycerides
B. Cholesterol
C. Neutral fats
D. Chylomicrons
ANS: B
DIF: Level 1
OBJ: 7-4
TOP: Sediment stains
6. A urine specimen is referred for cytodiagnostic urine testing to detect the presence of:
A. Trichomonas vaginalis
B. Glitter cells
C. Malignant cells
D. Spermatozoa
ANS: C
DIF: Level 1
OBJ: 7-5
TOP: Examining the sediment
7. To standardize the sediment concentration for microscopic analysis one must:

A. Centrifuge the entire urine collection
B. Use only the urine tubes and pipettes for a single commercial system
C. Interchange the urine tubes and pipettes from several commercial systems
D. Use only the parts of the commercial system that you want
ANS: B
DIF: Level 1
OBJ: 7-3
TOP: Commercial systems
8. The purpose of scanning the perimeter of urine sediment placed under a conventional glass
slide is to:
A. Identify types of casts
B. Detect renal tubular epithelial cells
C. Evaluate the overall sediment composition
D. Detect the presence of casts
ANS: D
DIF: Level 1
OBJ: 7-2
TOP: Examining the sediment
9. Which of the following are reported as the quantity per low-power field?
A. Casts
B. Red blood cells
C. White blood cells
D. Bacteria
ANS: A
DIF: Level 1
OBJ: 7-3
TOP: Microscopic examination
10. The most probable structures to be stained by the Prussian blue stain are:
A. Renal tubular epithelial cells
B. WBCs
C. Transitional epithelial cells
D. Urothelial cells
ANS: A
DIF: Level 2
OBJ: 7-4
11. The purpose of including glucose as a significant chemical parameter by a laboratory that
performs macroscopic screening is to check for the presence of:
A. WBC casts
B. Hyaline casts
C. Trichomonas vaginalis
D. Candida albicans
ANS: D
DIF: Level 2
OBJ: 7-3
TOP: Macroscopic screening
12. 10 mL of urine is centrifuged, and 9.5 mL of urine is decanted. The sediment concentration
factor is:
A. 5
B. 12
C. 20
D. 24
ANS: C
DIF: Level 2
OBJ: 7-3
TOP: Commercial systems
13. Which of the following is not needed for the calculation of the number of RBCs per milliliter
of urine?
A. Number of high-power fields per milliliter of urine
B. Speed of centrifugation
C. Number of high-power fields per viewing area
D. Area of a high-power field
ANS: B
DIF: Level 2
OBJ: 7-3
TOP: Technique
14. A medical laboratory science student consistently obtains lower RBC counts than the
instructor. A possible reason for this might be:
A. Failure to completely resuspend the sediment specimen
B. Reading the same cells twice
C. Counting all crenated cells twice
D. Using too much stain
ANS: A
DIF: Level 3
OBJ: 7-3
TOP: Technique
15. Centrifugation of less than the recommended 12 mL of urine for the microscopic
examination will:
A. Produce a false-negative sulfosalicylic acid (SSA)
B. Produce a false-positive SSA
C. Increase the number of cellular elements
D. Decrease the number of cellular elements
ANS: D
DIF: Level 3
OBJ: 7-3
TOP: Technique
16. Substances found in the urinary sediment that can be confirmed using polarized light are:
A. WBCs
B. Casts
C. Ketone bodies
D. Lipids
ANS: D
DIF: Level 1
OBJ: 7-6
TOP: Microscopy
17. Using polarized microscopy, which of the following is/are birefringent?

A. Cholesterol
B. Triglycerides
C. Fatty acids
D. Neutral fats
ANS: A
DIF: Level 1
OBJ: 7-6
TOP: Microscopy
18. Identification of oval fat bodies can be verified using:

A. Bright-field microscopy
B. Phase contrast
C. Polarized light
D. Interference-contrast microscopy
ANS: C
DIF: Level 1
OBJ: 7-6
TOP: Microscopy
19. Using a bright-field microscope, the final magnification of a high-power field is:
A. 10
B. 40
C. 400
D. 1,000
ANS: C
DIF: Level 1
OBJ: 7-6
TOP: Microscopy
20. To detect the presence of casts, the sediment is examined using:

A. Increased light under high power
B. Increased light under low power
C. Reduced light under high power
D. Reduced light under low power
ANS: D
DIF: Level 2
OBJ: 7-6
TOP: Microscopy
21. Optimal viewing is obtained by performing Köhler illumination adjustment to the:

A. Field diaphragm
B. Condenser
C. Operative diaphragm
D. Rheostat
ANS: B
DIF: Level 2
OBJ: 7-6
TOP: Microscopy
22. To increase the probability of detecting urine sediment constituents that have a low refractive
index, clinical laboratories often use:
A. Phase-contrast microscopy
B. Polarizing microscopy
C. Interference-contrast microscopy
D. Bright-field microscopy
ANS: A
DIF: Level 2
OBJ: 7-6
TOP: Microscopy
23. The presence of crenated RBCs in the urine sediment is associated with:
A. Trauma
B. Hypersthenuria
C. Hyposthenuria
D. Urinary tract infection
ANS: B
DIF: Level 1
OBJ: 7-8
TOP: RBCs
24. Dilute alkaline urine should be examined carefully for the presence of:
A. Yeast
B. Renal tubular epithelial cells
C. Ghost RBCs
D. Fatty casts
ANS: C
DIF: Level 1
OBJ: 7-8
TOP: RBCs
25. A patient with severe back pain and 15 to 20 RBCs/hpf in the urine sediment may have:
A. Renal calculi
B. Acute glomerulonephritis
C. Nephrotic syndrome
D. Osteomyelitis
ANS: A
DIF: Level 2
OBJ: 7-8
TOP: RBCs
26. Which would not help differentiation among RBCs, yeast, and oil droplets?
A. Observation of budding in yeast cells
B. Increased refractivity of oil droplets
C. Lysis of yeast cells by acetic acid
D. Lysis of RBCs by acetic acid
ANS: C
DIF: Level 2
OBJ: 7-8
TOP: RBCs
27. Ghost RBCs most frequently occur with a urine specimen that exhibits the following:
A. High pH, high specific gravity
B. High pH, low specific gravity
C. Low pH, high specific gravity
D. Low pH, low specific gravity
ANS: B
DIF: Level 2
OBJ: 7-8
TOP: RBCs
28. The presence of hypochromic, irregularly shaped RBCs in the urine sediment can indicate:
A. A coagulation disorder
B. Menstrual contamination
D. Glomerular bleeding
ANS: D
DIF: Level 2
OBJ: 7-8
TOP: RBCs
29. Glitter cell is a term used to describe a specific type of:

A. Ketone body
B. Renal tubular epithelial cell
C. Neutrophil
D. Oval fat body
ANS: C
DIF: Level 1
OBJ: 7-9
TOP: WBCs
30. An increase in urinary WBCs is called:

A. Pyelonephritis
B. Cystitis
C. Urethritis
D. Pyuria
ANS: D
DIF: Level 1
OBJ: 7-9
TOP: WBCs
31. Urine sediments containing increased WBCs should be observed closely for the presence of:
A. Hyaline casts
B. Granular casts
C. Bacteria
D. Urothelial cells
ANS: C
DIF: Level 1
OBJ: 7-9
TOP: WBCs
32. Eosinophils are found in the urine in cases of:

A. Nephrotic syndrome
B. Cystitis
C. Acute interstitial nephritis
D. Renal lithiasis
ANS: C
DIF: Level 2
OBJ: 7-9
TOP: WBCs
33. Leukocytes that stain pale blue with Sternheimer-Malbin stain and exhibit brownian
movement are:
A. Indicative of pyelonephritis
B. Basophils
C. Mononuclear leukocytes
D. Glitter cells
ANS: D
DIF: Level 2
OBJ: 7-9
TOP: WBCs
34. Oval fat bodies are:

A. Squamous epithelial cells that contain lipids
B. Renal tubular epithelial cells that contain lipids
C. WBCs that have phagocytized lipids
D. People who fail to work out regularly
ANS: B
DIF: Level 1
OBJ: 7-10
TOP: Epithelial cells
35. The type of cells that line the bladder and ureters are called:
A. Squamous
B. Renal tubular
C. Transitional
D. Basal
ANS: C
DIF: Level 1
OBJ: 7-10
36. Initial microscopic focusing on the urinary sediment is frequently performed by referencing:
A. Mucus
B. Squamous epithelial cells
C. RBCs
D. Hyaline casts
ANS: B
DIF: Level 1
OBJ: 7-10
37. In ascending order, the location of epithelial cells in the urinary tract is:
A. Squamous, transitional, renal tubular
B. Transitional, renal tubular, squamous
C. Renal tubular, transitional, squamous
D. Squamous, renal tubular, urothelial
ANS: A
DIF: Level 1
OBJ: 7-10
38. Clue cells are derived from:

B. Trichomonas vaginalis
C. Histiocytes
D. Squamous epithelial cells
ANS: D
DIF: Level 1
OBJ: 7-10
39. The organisms attached to a clue cell are:

A. Gardnerella vaginalis
B. Trichomonas vaginalis
C. Escherichia coli
D. Candida albicans
ANS: A
DIF: Level 1
OBJ: 7-10
40. Which shape is not usually seen with urothelial cells?

A. Spherical
B. Cylindroid
C. Polyhedral
D. Caudate
ANS: B
DIF: Level 1
OBJ: 7-10
41. Which of the following cells found in increased numbers in the urine sediment is only
indicative of nephron damage?
A. Erythrocytes
B. WBCs
C. Squamous epithelial cells
D. Renal tubular cells
ANS: D
DIF: Level 2
OBJ: 7-10
42. The type of cell most likely to appear stained with bilirubin is:
A. Renal tubular
B. Neutrophil
C. Squamous
D. Transitional
ANS: A
DIF: Level 2
OBJ: 7-10
43. Collection of a midstream clean-catch specimen will alleviate contamination by:

B. RBCs
C. Transitional epithelial cells
D. Squamous epithelial cells
ANS: D
DIF: Level 2
OBJ: 7-10
44. Which of the following cells can be found in both a vaginal wet prep and in urine sediment?
A. Yeast cell and clue cell
B. Transitional and renal epithelial cell
C. Clue cell and squamous cell
D. Renal and squamous cells
ANS: A
DIF: Level 2
OBJ: 7-10
45. Spherical transitional epithelial cells can be differentiated from renal tubular epithelial cells
by observing the:
A. Centrally located nucleus in renal tubular cells
B. Granular cytoplasm in renal tubular cells
C. Centrally located nucleus in transitional cells
D. Granular cytoplasm in transitional cells
ANS: C
DIF: Level 2
OBJ: 7-10
46. The finding of renal tubular epithelial cells containing yellow-brown granules correlates with
a positive reagent strip test for:
A. Blood
B. Bilirubin
C. Glucose
D. Nitrite
ANS: A
DIF: Level 2
OBJ: 7-10
47. The primary factor that favors the formation of urinary casts is:
A. Urinary stasis
B. High pH
C. Positive blood
D. Low specific gravity
ANS: A
DIF: Level 1
OBJ: 7-12
TOP: Casts
48. The major constituent of urinary casts is:

A. Lipoprotein
B. Bence Jones protein
C. Uromodulin protein
D. Amino acids
ANS: C
DIF: Level 1
OBJ: 7-12
TOP: Casts
49. Waxy casts are most easily differentiated from hyaline casts by their:
A. Color
B. Size
C. Granules
D. Refractivity
ANS: D
DIF: Level 1
OBJ: 7-13
TOP: Casts
50. Urinary casts are formed in the:

A. Distal and collecting tubules
B. Distal tubules and loops of Henle
C. Proximal and distal tubules
D. Proximal tubules and loops of Henle
ANS: A
DIF: Level 1
OBJ: 7-13
TOP: Casts
51. Which of the following elements would most likely be found in an acidic concentrated urine
that contains protein?
A. Ghost RBCs
B. Casts
C. Bacteria
D. Triple phosphate crystals
ANS: B
DIF: Level 1
OBJ: 7-13
TOP: Casts
52. Sediment constituents that are used to differentiate between upper and lower urinary tract
infections are:
A. WBCs
B. WBC clumps
C. RBCs and WBCs
D. WBC casts
ANS: D
DIF: Level 1
OBJ: 7-13
TOP: Casts
53. To differentiate a bacterial cast from a granular cast, a clinical laboratory scientist could:
A. Perform a Gram stain
B. Use polarizing microscopy
C. Perform a Hansel stain
D. Add acetic acid to the sediment
ANS: A
DIF: Level 2
OBJ: 7-13
TOP: Casts
54. The type of cast most closely associated with tubular damage is the:
A. WBC cast
B. Epithelial cell cast
C. RBC cast
D. Fatty cast
ANS: B
DIF: Level 1
OBJ: 7-13
TOP: Casts
55. The only type of cast capable of polarization is the:

A. Waxy cast
B. Hyaline cast
C. Fatty cast
D. Granular cast
ANS: C
DIF: Level 1
OBJ: 7-13
TOP: Casts
56. Broad casts may form as a result of:
A. Extreme urinary stasis
B. Strenuous exercise
C. Increase in loss of amino acids
D. Dehydration
ANS: A
DIF: Level 1
OBJ: 7-13
TOP: Casts
57. The finding of increased hyaline and granular casts in the urine of an otherwise healthy
person may be the result of:
A. Fecal contamination
B. Recent strenuous exercise
C. Early urinary tract infection
D. Analyzing an old specimen
ANS: B
DIF: Level 2
OBJ: 7-13
TOP: Casts
58. Hyaline casts may degenerate into:

A. Granular casts
B. Fatty casts
C. Broad casts
D. Waxy casts
ANS: D
DIF: Level 2
OBJ: 7-13
TOP: Casts
59. Waxy casts can be found in the urine sediment:

A. In patients with renal failure
B. Of an alkaline urine
C. Whenever abnormal protein is present
D. When urine is not correctly preserved
ANS: A
DIF: Level 2
OBJ: 7-13
TOP: Casts
60. The urinary sediment constituent most closely associated with bleeding within the nephron is
the:
A. RBC
B. RBC cast
C. WBC cast
D. Hyaline cast
ANS: B
DIF: Level 2
OBJ: 7-13
TOP: Casts
61. Which of the following differentiates a waxy cast from a fiber most effectively?
A. Waxy casts do not polarize light, and fibers do.
B. Waxy casts are more refractile than fibers.
C. Waxy casts have rounded ends, and fibers do not.
D. Waxy casts are thicker on the edge, and fibers are thicker in the center.
ANS: A
DIF: Level 2
OBJ: 7-13
TOP: Casts
62. Which of the following is not seen after strenuous exercise?

A. Protein
B. Glucose
C. Hyaline casts
D. Granular casts
ANS: B
DIF: Level 2
OBJ: 7-13
TOP: Casts
63. To distinguish a cellular cast from a clump of cells, the clinical laboratory scientist should:
A. Check for dysmorphic cells
B. Look carefully for a cast matrix
C. Determine whether free-standing cells are present
D. Examine the sediment using polarizing microscopy
ANS: B
DIF: Level 2
OBJ: 7-13
TOP: Casts
64. Granular casts present in the urine after strenuous exercise can:
A. Represent disintegration of cellular casts
B. Contain cellular lysosomes
C. Be pathogenic for renal disease
D. Represent a prerenal condition
ANS: B
DIF: Level 2
OBJ: 7-13
TOP: Casts
65. Which of the following is not associated with severe urinary stasis?
A. Granular casts
B. Waxy casts
C. Hyaline casts
D. Broad casts
ANS: C
DIF: Level 2
OBJ: 7-13
TOP: Casts
66. Identification of urinary crystals is based on shape and:

A. Urine pH and crystal solubility
B. Urine protein and crystal size
C. Urine bilirubin and glucose
D. Urine pH and crystal size
ANS: A
DIF: Level 1
OBJ: 7-14
TOP: Urinary crystals
67. Urinary crystals that appear yellow to reddish-brown are:

A. Calcium oxalate
B. Triple phosphate
C. Cholesterol
D. Uric acid
ANS: D
DIF: Level 1
OBJ: 7-14
68. To dissolve amorphous urates, you could:

A. Warm the specimen to body temperature
B. Add concentrated sodium hydroxide
C. Add dilute hydrochloric acid
D. Add dilute acetic acid
ANS: A
DIF: Level 1
OBJ: 7-14
69. Nonpathogenic or “normal” crystals found in acidic urine include:

A. Calcium oxalate, uric acid, amorphous urates
B. Calcium oxalate, uric acid, sulfonamides
C. Uric acid, amorphous urates, triple phosphate
D. Uric acid, calcium carbonate, bilirubin
ANS: A
DIF: Level 1
OBJ: 7-14
70. Which of the following crystals can usually be found in an alkaline urine?
A. Cholesterol
B. Tyrosine
C. Cystine
D. Ammonium biurate
ANS: D
DIF: Level 1
OBJ: 7-14
71. Abnormal crystals are most frequently seen in urine that is:
A. Acid
B. Neutral
C. Alkaline
D. Collected for 24 hours
ANS: A
DIF: Level 1
OBJ: 7-14
72. Which of the following would not aid in the identification of crystals?
A. Urine temperature
B. Urine pH
C. Crystal solubility
D. Crystal birefringence
ANS: A
DIF: Level 1
OBJ: 7-14
73. Which of the following crystals occurs in two very distinct forms?
A. Ammonium biurate
B. Calcium oxalate
C. Leucine
D. Cholesterol
ANS: B
DIF: Level 1
OBJ: 7-14
74. Nonpathogenic or “normal” crystals found in alkaline urine include:

A. Calcium oxalate, uric acid, amorphous urates
B. Calcium oxalate, uric acid, sulfonamides
C. Uric acid, amorphous urates, calcium carbonate
D. Triple phosphate, calcium carbonate, ammonium biurate
ANS: D
DIF: Level 2
OBJ: 7-15
75. Crystals found in the urine that are associated with pathogenic disease include:
A. Calcium oxalate and uric acid
B. Leucine and tyrosine
C. Heavy amorphous phosphates
D. Triple phosphate and ammonium biurate
ANS: B
DIF: Level 2
OBJ: 7-16
76. Which of the following crystals is associated with ethylene glycol ingestion?
A. Uric acid
B. Calcium oxalate monohydrate
C. Triple phosphate
D. Calcium oxalate dihydrate
ANS: B
DIF: Level 2
OBJ: 7-14
77. A urine specimen refrigerated overnight is cloudy and has a pH of 6. The turbidity is
probably due to:
A. Amorphous phosphates
B. Amorphous urates
C. Triple phosphate crystals
D. Calcium oxalate crystals
ANS: B
DIF: Level 2
OBJ: 7-14
78. Which of the following does not affect the formation of crystals?
A. Urine specific gravity
B. Urine pH
C. Urinary casts
D. Urine temperature
ANS: C
DIF: Level 2
OBJ: 7-14
79. Cystine crystals are often confused with:

A. Cholesterol crystals
B. Leucine crystals
C. Uric acid crystals
D. Triple phosphate crystals
ANS: C
DIF: Level 2
OBJ: 7-16
80. Formation of crystals due to medications is most frequently caused by:

A. Inadequate hydration
B. Incorrect timing of medication doses
C. Medication overdoses
D. Use of expired antibiotics
ANS: A
DIF: Level 2
OBJ: 7-16
81. Calcium carbonate crystals can be distinguished from bacteria by:

A. Warming the sediment
B. Refrigerating the specimen
C. Checking the pH of the specimen
D. Adding acetic acid
ANS: D
DIF: Level 2
OBJ: 7-15
82. Which of the following results should have testing repeated?

A. Positive blood and protein
B. pH 7.0 with uric acid crystals
C. Positive bilirubin and urobilinogen
D. pH 8.0, WBCs, and triple phosphate crystals
ANS: B
DIF: Level 3
OBJ: 7-14
83. The significance of seeing bacteria in the urine sediment is increased when:
A. RBCs and casts are present
B. The patient has an elevated temperature
C. The specimen is cloudy
D. WBCs are present
ANS: D
DIF: Level 1
OBJ: 7-18
TOP: Urinary sediment artifacts
84. What yeast shape would not be seen in urine sediment?
A. Mycelial
B. Biconcave
C. Oval
D. Budding ovals
ANS: B
DIF: Level 1
OBJ: 7-17
85. Schistosoma haematobium would most likely be found in the urine from a:
A. Foreign-service employee
B. Marathon runner
C. Diabetic patient
D. Health-care worker
ANS: A
DIF: Level 1
OBJ: 7-17
86. Motility by which of the following is most noticeable during the urine sediment
examination?
A. Spermatozoa
B. Candida albicans
D. Escherichia coli
ANS: C
DIF: Level 1
OBJ: 7-18
87. Urine sediment artifacts frequently differ from true sediment constituents by their:
A. Location in the specimen
B. Appearance
C. Refractility
D. Number present
ANS: C
DIF: Level 1
OBJ: 7-18
88. Under polarized light, all of the following will exhibit the Maltese cross formation except:
A. Starch granules
B. Oval fat bodies
C. Pollen grains
D. Fatty casts
ANS: C
DIF: Level 2
OBJ: 7-17
89. In an unpreserved and old urine specimen, there could be difficulty differentiating between
bacteria and:
A. Yeast
B. Mucus
C. Amorphous phosphates
D. Pollen grains
ANS: C
DIF: Level 2
OBJ: 7-17
90. Which of the following is most likely to be found in the urine of a diabetic patient?
A. Trichomonas vaginalis
B. Escherichia coli
C. Staphylococcus saprophyticus
D. Candida albicans
ANS: D
DIF: Level 2
OBJ: 7-18
91. Specimens containing mucus may be erroneously reported as containing:
A. Bacteria
B. Yeast
C. Hyaline casts
D. Oval fat bodies
ANS: C
DIF: Level 2
OBJ: 7-17
92. Which stain can help identify oval fat bodies?

A. Sudan III
B. Hansel stain
C. Prussian blue
D. Sternheimer-Malbin
ANS: A
DIF: Level 1
OBJ: 7-4
93. Which stain can help identify hemosiderin granules?

A. Hansel stain
B. Prussian blue
C. Toluidine blue
D. Sternheimer-Malbin
ANS: B
DIF: Level 1
OBJ: 7-4
94. What part of the microscope controls light intensity?

A. Condenser
B. Oculars
C. Diopter adjustment knob
D. Rheostat
ANS: D
DIF: Level 1
OBJ: 7-6
TOP: Microscopy
95. What part of the microscope increases object resolution?

A. Condenser
B. Oculars
C. Diopter adjustment knob
D. Rheostat
ANS: B
DIF: Level 1
OBJ: 7-6
TOP: Microscopy
96. Which crystal appears as a thorny apple?

A. Ammonium biurate
B. Calcium carbonate
C. Triple phosphate
D. Cystine
ANS: A
DIF: Level 1
OBJ: 7-15
97. Which crystal appears to have notched corners?

A. Ammonium biurate
B. Cholesterol
C. Triple phosphate
D. Cystine
ANS: B
DIF: Level 1
OBJ: 7-16
98. Which crystal has a hexagonal shape?
A. Ammonium biurate
C. Cystine
D. Cholesterol
ANS: C
DIF: Level 1
OBJ: 7-16
99. Which crystal has a dumbbell shape?

A. Uric acid
C. Triple phosphate
D. Cystine
ANS: B
DIF: Level 1
OBJ: 7-15
100. Which crystal has a lemon or wedge shape?

A. Ammonium biurate
C. Cystine
D. Uric acid
ANS: D
DIF: Level 1
OBJ: 7-15
101. Which crystal appears as coffin lids?

A. Ammonium biurate
C. Triple phosphate
D. Cystine
ANS: C
DIF: Level 1
OBJ: 7-15
102. Which of the following should be investigated further?

A. RBC casts in a specimen with a negative reagent strip test for blood
B. Triple phosphate crystals in a specimen with a pH of 8.0
C. Squamous epithelial cells in a specimen with slight turbidity
D. In a refrigerated specimen containing many amorphous crystals
ANS: A
DIF: Level 2
OBJ: 7-13
TOP: Microscopic Case
True/False
103. To adjust the intensity of light in a bright-field microscope, the condenser should be raised
or lowered.
ANS: False
DIF: Level 1
OBJ: 7-6
TOP: Microscopy
104. When changing magnification using a par focal microscope, focusing is performed using
the coarse adjustment knob.
ANS: False
DIF: Level 1
OBJ: 7-6
TOP: Microscopy
105. In the urinalysis laboratory, a bright-field microscope can be converted to a polarizing

microscope.
ANS: True
DIF: Level 1
OBJ: 7-6
TOP: Microscopy
106. The finding of increased urinary WBCs is not significant unless increased bacteria are also
present.
ANS: False
DIF: Level 2
OBJ: 7-9
TOP: WBCs
107. Renal tubular epithelial cells from the distal convoluted tubule are smaller than those from
the proximal convoluted tubule.
ANS: True
DIF: Level 2
OBJ: 7-10
108. A structure resembling a cast but having a tapered end is called a cylindroid.
ANS: True
DIF: Level 1
OBJ: 7-12
TOP: Casts
109. WBC casts should always be accompanied by significant bacteriuria.
ANS: False
DIF: Level 1
OBJ: 7-13
TOP: Casts
110. To be considered significant, yeast cells in the urine sediment should be accompanied by
leukocytes.
ANS: True
DIF: Level 1
OBJ: 7-17
111. Trichomonas vaginalis is not found in urine from male patients.
ANS: False
DIF: Level 1
OBJ: 7-17
Case Study 1
A student athlete was asked to submit a urine specimen for a part of the physical requirement to
be allowed back on the team to play sports. The student runs every day to stay in good shape.
The following urinalysis results were obtained.
Color: Dark yellow Protein: 2+ Blood: Trace

Clarity: Cloudy Glucose: Negative Urobilinogen: 1 EU
Microscopic
15–20 crenated RBCs/hpf 2–3 hyaline casts/lpf
Rare squamous epithelial cell 1–2 granular casts/lpf
1. Based on the results given, what is causing the crenated RBCs?

A. Elevated protein
B. Presence of hyaline casts
C. High specific gravity
D. Presence of granular casts
ANS: C
DIF: Level 2
OBJ: 7-18
TOP: Microscopic case study
2. Based on the results given, why is only a trace of blood detected by reagent strip?
A. Protein inhibition
B. Acid pH
C. Crenated RBCs
D. Dilute specimen
ANS: C
DIF: Level 3
OBJ: 7-18
3. Based on the information provided, why are casts present?

A. Sports injury
B. Glomerular damage
C. Strenuous exercise
D. Dehydration
ANS: C
DIF: Level 2
OBJ: 7-18
4. Based on the information provided, name another form of RBC that could be present in this
urine sediment.
A. Glitter cells
B. Spherocytes
C. Hypochromic
D. Dysmorphic
ANS: D
NAR: 06-nar-02
DIF: Level 3
OBJ: 7-18
5. Based on the results provided, what is the most probable cause of the abnormal results?
A. Sports injury
B. Glomerular damage
C. Strenuous exercise
D. Dehydration
ANS: C
NAR: 06-nar-02
DIF: Level 3
OBJ: 7-18
6. Based on the information provided, what type of specimen should the student be asked to
collect for retesting?
A. First morning
B. Timed 8-hour
C. Midstream clean-catch
D. Second morning
ANS: A
DIF: Level 3
OBJ: 7-18
Case Study 2
A hospitalized patient is complaining of needing to urinate constantly. Other complaints were

back pain, burning sensation, and pressure on the bladder. A urinalysis was ordered by the
physician and the following results were obtained.
Color: Yellow Protein: 1+ Blood: Trace

Specific gravity: 1.015 Ketones: Negative Nitrite: Positive
pH: 7.0 Bilirubin: Negative Leukocyte esterase: 2+
Microscopic
80–100 WBCs/hpf 1–15 RTE cells/hpf
5–10 RBCs/hpf Many bacteria
1. Based on results provided, what is the possible diagnosis?

A. Acute glomerulonephritis
B. Acute cystitis
C. Acute pyelonephritis
D. Kidney obstruction
ANS: B
DIF: Level 2
OBJ: 7-18
2. Based on the results provided, which of these results would concern a physician?
A. Elevated protein
C. Blood
D. Absence of WBC casts
ANS: B
DIF: Level 2
OBJ: 7-18
3. In reviewing the results, what has caused the alkaline pH?

A. Protein
B. Blood
C. Bacteria
D. Nitrite
ANS: C
DIF: Level 2
OBJ: 7-18
4. The positive nitrite test result on the test strip is caused by:
A. An infection from gram-negative bacteria
B. The WBCs and RTEs
C. An infection from gram-positive bacteria
D. False positive due to the alkaline pH
ANS: A
DIF: Level 2
OBJ: 7-18
5. If the nitrite was negative, would the patient have the same diagnosis?
A. Yes
B. No
ANS: A
DIF: Level 2
OBJ: 7-18
Scenario 3
A patient was scheduled for abdominal surgery. During surgery the patient received blood.
Several hours later the patient was being monitored for an adverse reaction. A urine specimen
was received in the laboratory. These are the urinalysis results.
Color: Red brown Protein: 1+ Blood: Large

Microscopic
6–10 RTE cells/hpf
(intracellular yellow-brown
granules)
3–4 homogenous RBC
casts/lpf
1–2 dirty, brown casts/lpf
1–2 RTE casts/lpf
Many yellow-brown granules
1. Based on the results provided, what substance is causing the positive reagent strip reaction for
blood?
A. Hemoglobin
B. Myoglobin
C. RBCs
D. Peroxide contamination
ANS: A
DIF: Level 3
OBJ: 7-18
2. Based on the information provided, what is the significance of the elevated urobilinogen
reading?
A. Kidney infection
B. Liver damage
C. Intravascular hemolysis
D. Urine color
ANS: C
DIF: Level 3
OBJ: 7-18
3. Based on the information provided, what is the composition of the dirty, brown casts?
A. Melanin
B. Methemoglobin
C. Coarse granules
D. RBCs
ANS: B
DIF: Level 3
OBJ: 7-13
4. What is the significance of the RTE cells and casts based on the information provided?
A. Tubular damage
B. Decreased urine flow
C. Glomerular damage
D. Possible malignancy
ANS: A
DIF: Level 3
OBJ: 7-13
5. What is the probable composition of the yellow-brown granules based on the information
provided?
A. Hemoglobin
B. Uric acid
C. Hemosiderin
D. Disintegrating RTE cells
ANS: C
DIF: Level 3
OBJ: 7-17
6. What is the indication of the red cells casts seen in the microscope?
B. Acute pyelonephritis
C. Drug induced nephritis
D. Acute glomerulonephritis
ANS: D
DIF: Level 3
OBJ: 7-13
Chapter 8: Renal Disease
Multiple Choice
1. Diseases affecting the glomerulus are primarily caused by:

A. Trauma
B. Diabetes
C. Immunological disorders
D. Toxic chemicals
ANS: C
DIF: Level 1
OBJ: 8-2
TOP: Glomerular disorders
2. Which is not a symptom of acute glomerulonephritis?

A. Periorbital edema
B. Hematuria
C. Proteinuria
D. Hypoalbuminemia
ANS: D
DIF: Level 1
OBJ: 8-4
3. The major cause of the nephrotic syndrome in children is:

A. IgA nephropathy
B. Minimal change disease
C. Membranous glomerulonephritis
D. Rapidly progressive glomerulonephritis
ANS: B
DIF: Level 1
OBJ: 8-4
4. Which does not cause damage to the glomerulus?
A. Increased filtration of electrolytes
B. Deposition of immune complexes
C. Deposition of amyloid materials
D. Cellular infiltration
ANS: A
DIF: Level 1
OBJ: 8-4
5. The buildup of crescentic formations on the glomerular capillaries is characteristic of:

A. Goodpasture syndrome
B. Rapidly progressive glomerulonephritis
C. Wegener’s granulomatosis
D. IgA nephropathy
ANS: B
DIF: Level 1
OBJ: 8-4
6. The most common cause of end-stage renal disease is:

B. Diabetic nephropathy
C. Minimal change disease
D. Alport syndrome
ANS: B
DIF: Level 1
OBJ: 8-15
7. A renal disorder associated with heroin abuse is:

B. Membranoproliferative glomerulonephritis
C. Chronic glomerulonephritis
D. Focal segmental glomerulosclerosis
ANS: D
DIF: Level 1
OBJ: 8-9
8. Blood tests can be used to confirm the diagnosis of acute glomerulonephritis because of the
detection of:
A. M protein
B. Electrolyte imbalance
C. Antistreptococcal antibodies
D. Decreased serum albumin
ANS: C
DIF: Level 2
OBJ: 8-4
TOP: Glomerulonephritis
9. Goodpasture syndrome and Wegener’s granulomatosis are associated with the presence of
which of the following in the urine sediment?
A. Hyaline casts
B. Red blood cell casts
C. Waxy casts
D. White blood cell casts
ANS: B
DIF: Level 2
OBJ: 8-4
TOP: Glomerulonephritis
10. The presence of which of the following crystals can be associated with nephrotic syndrome?
A. Cholesterol
B. Tyrosine
C. Cystine
D. Ampicillin
ANS: A
DIF: Level 2
OBJ: 8-8
11. A patient with symptoms of pulmonary hemoptysis and urinary hematuria should be tested
for:
A. Antiglomerular basement membrane antibody
B. Antistreptolysin O antibody
C. Antistreptococcal antibody
D. Anti-IgM antibody
ANS: A
DIF: Level 2
OBJ: 8-4
12. Which of the following disorders has the most favorable patient prognosis?
A. Rapidly progressive glomerulonephritis
B. Henoch-Schönlein purpura
C. IgA nephropathy
D. Goodpasture syndrome
ANS: B
DIF: Level 3
OBJ: 8-4
13. Glomerular basement membrane thickening occurs in membranous glomerulonephritis as a

result of deposition of:
A. IgA immune complexes
B. IgG immune complexes
C. Protein components
D. Amyloid material
ANS: B
DIF: Level 2
OBJ: 8-6
14. The presence of heavy proteinuria is most characteristic of:

B. Acute interstitial nephritis
C. Pyelonephritis
D. Nephrotic syndrome
ANS: D
DIF: Level 2
OBJ: 8-8
15. The pronounced edema associated with nephrotic syndrome is related to the:
A. Lipidemia
B. Hypoalbuminemia
C. Decreased glomerular filtration rate
D. Lipiduria
ANS: B
DIF: Level 2
OBJ: 8-8
16. Oval fat bodies and fatty casts are characteristic urine sediment constituents in patients with:
A. Chronic glomerulonephritis
D. Wegener’s granulomatosis
ANS: C
DIF: Level 2
OBJ: 8-8
17. A decrease in systemic blood flow affects the renal tubules by producing:
A. Nephrotoxins
B. Ischemia
C. Electrolyte imbalance
D. Inflammation
ANS: B
DIF: Level 1
OBJ: 8-10
TOP: Tubular disorders
18. Glucosuria and generalized aminoaciduria are characteristics of:
A. Fanconi syndrome
B. Nephrotic syndrome
C. Focal segmental glomerulosclerosis
D. Diabetes mellitus
ANS: A
DIF: Level 1
OBJ: 8-12
19. Which inherited renal disorder manifests itself in the development of gout in teenage years?
A. Fanconi syndrome
C. Uromodulin-associated kidney disease
D. Chronic glomerulonephritis
ANS: C
DIF: Level 1
OBJ: 8-12
20. In which part of the kidney is uromodulin produced?

A. Proximal and distal tubules
B. Descending and ascending loop of Henle
C. Bowman’s capsule and nephrons
D. Nephrons and collecting duct
ANS: A
DIF: Level 1
OBJ: 8-12
21. Which of the following renal disorders is most likely to be inherited?

C. Acute tubular necrosis
D. Fanconi syndrome
ANS: D
DIF: Level 1
OBJ: 8-12
22. Administration of a nephrotoxic antibiotic to a patient with a decreased glomerular filtration

rate may cause:
A. Acute tubular necrosis
D. Nephrotic syndrome
ANS: A
DIF: Level 2
OBJ: 8-10
23. The presence of increased renal tubular epithelial cell casts is most indicative of:
B. Fanconi syndrome
D. Acute pyelonephritis
ANS: C
DIF: Level 2
OBJ: 8-10
24. Infection of the bladder is termed:

A. Pyelitis
B. Nephritis
C. Cystitis
D. Bacteriuria
ANS: C
DIF: Level 1
OBJ: 8-14
TOP: Interstitial disorders
25. Cystitis can be differentiated from pyelonephritis by:
A. Performing a cystoscopy
B. The presence of white blood cell casts
C. Performing blood cultures
D. The presence of bacteriuria
ANS: B
DIF: Level 1
OBJ: 8-14
26. In diabetic nephropathy, solid material deposited around the capillary tufts includes:
A. IgG
B. Glycosylated IgA
C. Glycosylated protein
D. IgM complexes
ANS: C
DIF: Level 1
OBJ: 8-14
27. The finding of bacterial casts can be associated with:

A. Acute pyelonephritis
C. Cystitis
ANS: A
DIF: Level 1
OBJ: 8-14
28. The most serious tubulointerstitial disorder is:

A. Acute interstitial nephritis
B. Acute pyelonephritis
C. Chronic pyelonephritis
D. Cystitis
ANS: C
DIF: Level 2
OBJ: 8-14
29. An increased number of urinary eosinophils are diagnostic for:

A. Acute pyelonephritis
D. Chronic pyelonephritis
ANS: B
DIF: Level 2
OBJ: 14
30. Which microscopic urinalysis finding is not characteristic of a patient with acute interstitial
nephritis?
A. Bacteria
C. Red blood cells
D. White blood cell casts
ANS: A
DIF: Level 2
OBJ: 8-14
31. Acute renal failure may be classified as all of the following except:
A. Rapidly progressive
B. Prerenal
C. Renal
D. Postrenal
ANS: A
DIF: Level 1
OBJ: 15
TOP: Renal failure
32. In which of the following disorders would waxy and broad casts be most likely to be seen?
A. Chronic pyelonephritis
B. Acute renal failure
C. Chronic renal failure
D. Acute interstitial nephritis
ANS: C
DIF: Level 2
OBJ: 8-15
TOP: Renal failure
33. Which is not a cause of acute renal failure?

A. Malignancy
B. Goodpasture syndrome
D. Renal calculi
ANS: B
DIF: Level 2
OBJ: 8-15
TOP: Renal failure
34. Most renal calculi are composed of:

A. Ammonium phosphate
B. Magnesium
C. Uric acid
D. Calcium
ANS: D
DIF: Level 1
OBJ: 8-16
TOP: Renal lithiasis
35. Lithotripsy is a procedure that is performed to:

A. Prevent the formation of renal calculi
B. Determine the composition of renal calculi
C. Aid in the remove of renal calculi
D. Identify the presence of renal calculi
ANS: C
DIF: Level 1
OBJ: 8-16
36. The microscopic hematuria associated with renal lithiasis is caused by:
A. Glomerular damage
B. Tubular inflammation
C. Tissue irritation
D. Bacterial infection
ANS: C
DIF: Level 2
OBJ: 8-16
37. Which may not be helpful in preventing the formation of renal calculi?
A. Increased hydration
B. Increased exercise
C. Dietary restrictions
D. Adjustment of urine pH
ANS: B
DIF: Level 2
OBJ: 8-16
38. Which disorder has a positive antineutrophilic cytoplasmic antibody test and is associated
with pulmonary hemoptysis and urinary hematuria?
B. Rapidly progressive glomerulonephritis
C. Goodpasture syndrome
D. Wegener’s granulomatosis
ANS: D
DIF: Level 3
OBJ: 8-4
39. An HIV-positive patient develops edema, elevated cholesterol and triglyceride levels,
hematuria, and proteinuria. This is indicative of:
B. Interstitial disease
D. Fanconi syndrome
ANS: C
DIF: Level 3
OBJ: 8-12
40. A patient with a history of intermittent hematuria following strenuous exercise has an
elevated serum immunoglobulin A level. This is indicative of:
A. Minimal change disease
B. IgA nephropathy
C. Acute glomerulonephritis
D. Alport’s disease
ANS: B
DIF: Level 3
OBJ: 8-7
41. Following ingestion of mushrooms found growing in his garden, a man develops symptoms
of oliguria, lethargy, and edema. Many renal tubular epithelial (RTE) cells are observed in his
urinalysis. This is a case of:
A. Fanconi syndrome
B. Acute tubular necrosis
D. Acute renal failure
ANS: B
DIF: Level 3
OBJ: 8-10
42. An intravenous pyelogram is performed on a child with a history of episodes of urinary

frequency and burning and the presence of WBCs and bacterial casts. This is an example of
which of the following disorders?
C. Acute pyelonephritis
D. Chronic pyelonephritis
ANS: D
DIF: Level 3
OBJ: 8-14
43. A patient who works in a steel-processing plant has consistently elevated reagent strip urine
glucose readings with normal plasma glucose levels. What is a possible disorder?
A. Nephrogenic diabetes insipidus
B. Renal glycosuria
C. Fanconi syndrome
ANS: C
DIF: Level 3
OBJ: 8-12
TOP: Renal failure
44. A patient whose microalbuminuria has progressed to a 2+ urine protein is an indication of:
A. Alport syndrome
B. Diabetic nephropathy
C. Acute renal failure
D. Nephrogenic diabetes insipidus
ANS: B
DIF: Level 3
OBJ: 8-13
TOP: Diabetic nephropathy
45. What type of renal failure is indicated for a patient with a trauma requiring transfusion of 8
units of blood?
A. Prerenal
B. Renal
C. Postrenal
ANS: A
DIF: Level 3
OBJ: 8-15
46. What type of renal failure is indicated with an untreated cystitis?

A. Prerenal
B. Renal
C. Postrenal
ANS: B
DIF: Level 3
OBJ: 8-15
47. What type of renal failure is indicated with a patient who has positive blood cultures for
Staphylococcus aureus?
A. Prerenal
B. Renal
C. Postrenal
ANS: A
DIF: Level 3
OBJ: 8-15
48. What type of renal failure is indicated with a child who has ingested ethylene glycol?
A. Prerenal
B. Renal
C. Postrenal
ANS: B
DIF: Level 3
OBJ: 15
49. What type of renal failure is indicated with a patient with increased transitional epithelial
cells in the urine sediment?
A. Prerenal
B. Renal
C. Postrenal
ANS: C
DIF: Level 3
OBJ: 8-15
Case Study 1
Following recovery from an upper respiratory infection, a 5-year-old boy develops numerous
petechiae. It is noted that when he urinates the color is red. He is seen by his physician and a
urinalysis is ordered. Results of his urinalysis are:
Color: Red Protein: 2+ Blood: Large

pH: 6.0 Bilirubin: Negative Leukocyte esterase: Trace
Microscopic
6–8 WBCs/hpf 1–3 hyaline casts/lpf
 100 RBCs/hpf 2–4 RBC casts/lpf
1. Based on the information provided, what other specimen(s) could be collected and tested for
the presence of blood?
A. Sputum
B. Cerebrospinal fluid
C. Bronchial washing
D. Abdominal fluid
ANS: A
DIF: Level 3
OBJ: 8-4
TOP: Glomerular disorders case study
2. Based on the information provided, how does the presence of petechiae relate to the abnormal
results?
A. Allergic reaction
B. Decreased vascular integrity
C. Increased platelets
D. Increased destruction of red cells
ANS: B
DIF: Level 3
OBJ: 8-4
3. Based on the information given, what is the most probable diagnosis?
A. Henoch-Schönlein purpura
C. Wegener’s granulomatosus
ANS: A
DIF: Level 3
OBJ: 8-4
4. What is the indication of the red cell casts and positive protein?
B. Glomerulonephritis
C. Tubular disorder
D. Pyelonephritis
ANS: B
DIF: Level 3
OBJ: 8-4
Case Study 2
A patient was diagnosed with a hepatitis B infection. From his infection he then developed
membranous glomerulonephritis. A urinalysis was ordered. The analysis results are as follows:
Color: Yellow Protein: 4+ Blood: Moderate

Microscopic
2–3 WBCs/hpf 1–2 oval fat bodies/hpf
20–30 RBCs/hpf 2–3 fatty casts/lpf
Moderate fat droplets
1. What is the most probable disorder associated with these results?
B. Focal segmental glomerulosclerosis
D. Renal failure
ANS: C
DIF: Level 3
OBJ: 8-6
2. How do these results relate to the diagnosis of membranous glomerulonephritis?

A. Urinalysis results are similar.
B. Membranous glomerulonephritis progression to an advanced disorder.
C. They are not related.
D. The original diagnosis of membranous glomerulonephritis was wrong.
ANS: B
DIF: Level 3
OBJ: 8-6
3. What is/are the primary structure(s) in the glomerulus that has/have been affected to cause
these results?
A. Endothelial cells
B. Capillary tufts
C. Basement membrane
D. Podocytes
ANS: D
DIF: Level 3
OBJ: 8-6
4. What blood test is not characteristically abnormal in this disorder?

A. Albumin
B. Cholesterol
C. Triglyceride
D. Lactate
ANS: D
DIF: Level 3
OBJ: 8-6
5. Oval fat bodies are:

A. Fatty cast
B. Renal tubular epithelial
C. Squamous epithelial
D. Transitional epithelial
ANS: B
DIF: Level 3
OBJ: 8-6
Case Study 3
A 40-year-old female tennis player with tendonitis is taking large doses of an over-the-counter
nonsteroidal antiinflammatory agent. After taking the medication for several weeks, she develops
a skin rash and observes a decrease in urine volume. Results of her urinalysis are:
Color: Dark yellow Protein: 3+ Blood: Large

pH: 6.0 Bilirubin: Negative Leukocyte esterase: 2+
Microscopic
 100 WBCs/hpf 1–2 hyaline casts/lpf
60 –70 RBCs/hpf 5–6 WBC casts/lpf
1–2 RTE cells/lpf
1. Correlating the reagent strip and the microscopic results, what does the negative nitrite
indicate?
A. Nitrite was not in the bladder long enough
B. Gram-positive bacteria present
C. Gram-negative bacteria positive
D. No indication of bacteria
ANS: D
DIF: Level 3
OBJ: 8-14
TOP: Interstitial disorders case study
2. The patient’s positive protein is probably caused by:

A Glomerular damage
B. Acute cystitis
D. Tubular damage
ANS: D
DIF: Level 3
OBJ: 8-14
3. What additional test might be requested on this specimen?

A. Creatinine clearance
B. Prussian blue stain
C. Urine eosinophil stain
D. Fungal culture
ANS: C
DIF: Level 3
OBJ: 8-14
4. What is the probable diagnosis?

B. Fanconi syndrome
ANS: A
DIF: Level 3
OBJ: 8-14
Chapter 9: Urine Screening for Metabolic Disorders
Multiple Choice
1. Phenylketonuria is caused by:

A. Excessive ingestion of milk products containing phenylalanine
B. Inability to metabolize tyrosine
C. Lack of the enzyme phenylalanine hydroxylase
D. A mousy odor in the urine
ANS: C
DIF: Level 1
OBJ: 9-3
TOP: Phenylketonuria
2. In patients with alkaptonuria, the abnormal metabolite that is present in the urine is:
A. Homogentisic acid
B. Alkaptonpyruvate
C. Phenylpyruvate
D. Tyrosine
ANS: A
DIF: Level 1
OBJ: 9-5
TOP: Alkaptonuria
3. Accumulation of large amounts of homogentisic acid in the urine is the result of which of the
following disorders?
A. Alkaptonuria
B. Tyrosyluria
C. PKU
D. Homocystinuria
ANS: A
DIF: Level 1
OBJ: 9-5
TOP: Alkaptonuria
4. Which of these disorders is not caused by defects in the phenylalanine-tyrosine pathway?
A. Alkaptonuria
B. Hartnup disease
C. Tyrosyluria
D. PKU
ANS: B
DIF: Level 1
OBJ: 9-3
TOP: Phenylalanine-tyrosine disorders
5. Initial screening for PKU performed on newborns before their discharge from the hospital uses
a blood specimen rather than a urine specimen because:
A. Urine specimens are more difficult to collect
B. Serum bilirubin levels are routinely measured on all newborns
C. It is easier to measure phenylalanine than phenylpyruvic acid
D. Increased serum phenylalanine can be detected earlier
ANS: D
DIF: Level 1
OBJ: 9-3
6. A routine urinalysis is performed on a specimen that has turned dark after standing in the
laboratory. The urine is acidic and has negative chemical tests except for the appearance of a red
color on the ketone area of the reagent strip. One should suspect:
A. PKU
B. Diabetic ketosis
C. Alkaptonuria
D. Melanuria
ANS: D
DIF: Level 2
OBJ: 9-6
TOP: Melanuria
7. A positive Guthrie test is interpreted by observing:

A. Bacterial growth occurs around the positive control disc and the patient disc
B. Bacterial growth occurs around the positive control disc but not around the patient disc
C. No bacterial growth occurs around either disc
D. Bacterial growth occurs only around the negative control disc
ANS: A
DIF: Level 2
OBJ: 9-3
8. Patients who have unusually fair complexions can be indicative for phenylketonuria because:
A. Phenylalanine is not produced
B. Tyrosine is not available for conversion to melanin
C. Melanin is converted to homogentisic acid
D. Phenylalanine disrupts liver function
ANS: B
DIF: Level 2
OBJ: 9-3
9. A false-positive reaction for urinary ketones could be present in patients who have:
A. Maple syrup urine disease
B. PKU
C. Melanuria
D. Organic acidemia
ANS: C
DIF: Level 2
OBJ: 9-6
TOP: Melanuria
10. A positive urine Clinitest reaction can be seen in patients with:

A. Alkaptonuria
B. Melanuria
C. Cystinuria
D. Tyrosyluria
ANS: A
DIF: Level 2
OBJ: 9-6
TOP: Alkaptonuria
11. Confirmation of maple syrup urine disease is made on the basis of:
A. Urine color
B. A positive 2,4-dinitrophenylhydrazine test
C. A positive ferric chloride test
D. MS/MS
ANS: D
DIF: Level 1
OBJ: 2
TOP: Maple syrup urine disease
12. A disease that causes large amounts of branched-chain amino acids to be excreted in the
urine is:
A. Hurler syndrome
B. Cystinuria
C. Maple syrup urine disease
D. Alkaptonuria
ANS: C
DIF: Level 1
OBJ: 9-7
13. Urine with the characteristic odor of “sweaty feet” and a positive ketone test indicates:
A. Cystinuria
B. Alkaptonuria
C. Isovaleric acidemia
D. Tyrosyluria
ANS: C
DIF: Level 1
OBJ: 9-1
TOP: Branched-chain amino acid disorders
14. Which of the following is not an organic acidemia?

A. 5-HIAA
B. Isovaleric
C. Propionic
D. Methylmalonic
ANS: A
DIF: Level 1
OBJ: 9-10
TOP: Tryptophan disorders
15. Which of the following foods contain serotonin, which can interfere with 5-HIAA testing?
A. Apples
B. Pineapples
C. Watermelons
D. Oranges
ANS: B
DIF: Level 1
OBJ: 9-10
TOP: 5-hydroxyindoleacetic acid
16. The finding of persistent ketonuria in a newborn is:

A. Of no significance
B. Indicative of juvenile diabetes mellitus
C. Associated with methylmalonic aciduria
D. Seen with severe lead poisoning
ANS: C
DIF: Level 2
OBJ: 9-8
TOP: Organic acidemias
17. A urinalysis and a dinitrophenylhydrazine (DNPH) test are performed on an infant who is
failing to thrive. If the DNPH test is positive, what result in the urinalysis will also be positive?
A. Ketones
B. Glucose
C. Protein
D. Bilirubin
ANS: A
DIF: Level 3
OBJ: 9-8
18. The presence of maple syrup urine disease is first suspected by the presence of abnormal
urine:
A. Color
B. Protein
C. Odor
D. Amino acids
ANS: C
DIF: Level 2
OBJ: 9-7
19. Under normal conditions, tryptophan that is not reabsorbed in the intestine is removed from
the body as:
A. Indican in the urine
B. Indole in the liver
C. Indole in the feces
D. Serotonin in the urine
ANS: C
DIF: Level 1
OBJ: 9-9
20. The presence of argentaffin cell tumors can be detected by the presence in the urine of:
A. 5-HIAA
B. Melanin
C. Homogentisic acid
D. Serotonin
ANS: A
DIF: Level 1
OBJ: 9-10
21. The finding of a “blue diaper” is indicative of a defect in the metabolism of:
A. Phenylalanine
B. Tyrosine
C. Tryptophan
D. Cystine
ANS: C
DIF: Level 1
OBJ: 9-10
22. Analysis of urine from an infant whose mother reported a blue staining on the diapers
showed increased levels of indican and a generalized aminoaciduria. On the basis of these
findings, the infant was diagnosed as having:
A. An intestinal obstruction
B. A protein malabsorption syndrome
C. Fanconi syndrome
D. Hartnup disease
ANS: D
DIF: Level 2
OBJ: 9-9
23. A false-positive test for 5-HIAA may result if the patient:

A. Does not collect a complete 24-hour urine
B. Does not receive appropriate diet instructions
C. Fails to fast before specimen collection
D. Stores the specimen in the refrigerator overnight
ANS: B
DIF: Level 2
OBJ: 9-10
24. Abnormal amounts of indigo blue in the urine are indicative of a defect in the metabolism of:
A. Phenylalanine
B. Tyrosine
C. Tryptophan
D. Cystine
ANS: C
DIF: Level 2
OBJ: 9-9
25. The finding of increased amounts of the serotonin degradation product 5-HIAA in the urine
indicates:
A. Platelet disorders
B. Intestinal obstruction
C. Malabsorption syndromes
D. Argentaffin cell tumors
ANS: D
DIF: Level 2
OBJ: 9-10
26. The silver nitroprusside test detects the presence of:

A. Propionic acid
B. Homocystine
C. Uroporphyrin
D. Cystine
ANS: B
DIF: Level 1
OBJ: 9-11
TOP: Cystine disorders
27. To differentiate between cystinuria and homocystinuria, the urine should be tested with:
A. Cyanide nitroprusside
B. Ferric chloride
C. Clinitest
D. Silver nitroprusside
ANS: D
DIF: Level 2
OBJ: 9-11
28. Patients who produce kidney stones at an early age should be tested for the presence of:
A. Organic acidemia
B. Cystinuria
D. PKU
ANS: B
DIF: Level 2
OBJ: 9-11
29. Chemical screening tests for cystine can produce false-positive results in the presence of
urinary ketones because:
A. Cystine is not reduced by sodium cyanide
B. Cystine should be tested using only chromatography
C. The test reagent is nitroprusside
D. Cystinuria causes diabetic ketosis
ANS: C
DIF: Level 3
OBJ: 9-11
30. Porphyrins are intermediary compounds in the formation of:

A. Amino acids
B. Serotonin
C. Heme
D. Bilirubin
ANS: C
DIF: Level 1
OBJ: 9-12
TOP: Porphyrin disorders
31. The specimen of choice when testing for protoporphyrin is:

A. Blood
B. Urine
C. Bile
D. Feces
ANS: A
DIF: Level 1
OBJ: 9-12
32. Which of the following is not a porphyrin?

A. Uroporphyrin
B. Porphobilinogen
C. Protoporphyrin
D. Coproporphyrin
ANS: B
DIF: Level 1
OBJ: 9-12
33. Which porphyrin compound will not exhibit fluorescence under ultraviolet light?
A. Protoporphyrin
B. Uroporphyrin
C. Coproporphyrin
D. Porphobilinogen
ANS: D
DIF: Level 1
OBJ: 19-2
34. The most common cause of acquired porphyria is:

A. Alcoholism
B. Lead poisoning
C. Iron-deficiency anemia
D. Liver failure
ANS: B
DIF: Level 1
OBJ: 9-12
35. Which is not a symptom of inherited porphyrias?
A. Fanconi syndrome
B. Neurological
C. Psychiatric
D. Photosensitivity
ANS: A
DIF: Level 1
OBJ: 9-12
TOP: Porphyrins
36. The presence of porphobilinogen in the urine can be suspected when:

A. Acidic urine turns a port wine color after standing
B. Alkaline urine turns a port wine color after standing
C. Freshly excreted urine is acidic and port wine in color
D. Freshly excreted urine is alkaline and port wine in color
ANS: A
DIF: Level 2
OBJ: 9-12
37. Urine from a child suspected of having lead poisoning has a red fluorescence under Wood’s
lamp. This finding is:
A. Inconsistent with lead poisoning because porphobilinogen does not fluoresce
B. Consistent with lead poisoning because coproporphyrin fluoresces under ultraviolet light
C. Consistent with lead poisoning only if uroporphyrin is also increased
D. Consistent only if protoporphyrin can be demonstrated using Ehrlich reagent
ANS: B
DIF: Level 2
OBJ: 9-12
38. Which of the following compounds does not react directly with either Ehrlich reagent or
fluorescence?
A. Uroporphyrin
B. Aminolevulinic acid
C. Coproporphyrin
D. Porphobilinogen
ANS: B
DIF: Level 2
OBJ: 9-12
39. Which of the following porphyrin compounds cannot be found in urine?

A. Aminolevulinic acid
B. Coproporphyrin
C. Protoporphyrin
D. Uroporphyrin
ANS: C
DIF: Level 2
OBJ: 9-12
40. A pink color in the Hoesch test indicates the presence of:
A. Urobilinogen
B. Myoglobin
C. Porphobilinogen
D. Nitrite
ANS: C
DIF: Level 2
OBJ: 9-12
TOP: Urobilinogen
41. A specimen that produces a cherry red color with Ehrlich’s reagent is extracted into
chloroform, and both the aqueous and chloroform layers are red. You should:
A. Repeat the test with chloroform from a new bottle
B. Extract the aqueous layer into more chloroform
C. Extract the specimen into butanol
D. Report the presence of both urobilinogen and porphobilinogen
ANS: B
DIF: Level 3
OBJ: 9-12
TOP: Urobilinogen
42. The concept of vampires is associated with:

A. Cystinosis
B. Hunter syndrome
C. Sanfilippo syndrome
D. Porphyrias
ANS: D
DIF: Level 1
OBJ: 9-12
43. Which is not an example of a defect in urine due to a defect categorized as an “overflow
type”?
A. Inborn errors of metabolism
B. Serum concentrations exceeding the Tm
C. Abnormalities in the tubular reabsorption mechanism
D. Disruption of normal enzyme function by exposure to toxic substances
ANS: C
DIF: Level 1
OBJ: 9-1
TOP: Overflow versus renal disorders
44. Which disorder is not associated with urine odor?

A. Alkaptonuria
B. PKU
D. Isovaleric acidemia
ANS: A
DIF: Level 1
OBJ: 9-1
TOP: Amino acid disorders
45. Hurler and Sanfilippo syndromes present with mental retardation and an increase in what
urinary constituent?
A. Porphyrins
B. Amino acids
C. Maltose
D. Mucopolysaccharides
ANS: D
DIF: Level 1
OBJ: 9-13
TOP: Mucopolysaccharides
46. The presence of amino acids is of particular concern in which population?

A. Pregnant women
B. Newborns
C. Adolescent males
D. Menopausal women
ANS: B
DIF: Level 1
OBJ: 9-1
47. Which is considered a renal disorder and not a metabolic disorder?

A. Tyrosyluria
B. Maple syrup urine disease
C. Cystinuria
D. Indicanuria
ANS: C
DIF: Level 1
OBJ: 9-11
48. The presence of “orange sand” in an infant’s diaper is indicative of:

A. Cystinuria
B. Bilirubinuria
D. Lesch-Nyhan disease
ANS: D
DIF: Level 1
OBJ: 9-14
49. The acid albumin CTAB test is used to test for:

A. Carbohydrates
B. Fecal fats
C. Mucopolysaccharides
D. Maple syrup urine disease
ANS: C
DIF: Level 1
OBJ: 9-13
TOP: Mucopolysaccharides
50. Which condition would a patient not present with when diagnosed with Lesch-Nyhan
disease?
A. Cystinosis
B. Increase in uric acid
C. Self-destructive tendencies
D. Severe motor defects
ANS: A
DIF: Level 1
OBJ: 9-14
51. Mental retardation is not a symptom of:

A. Hurler syndrome
B. Galactosuria
C. PKU
D. Cystinuria
ANS: D
DIF: Level 2
OBJ: 9-11
52. Melituria refers to an increase in urinary:
A. Melanin
B. Uric acid
C. Cholesterol
D. Sugar
ANS: D
DIF: Level 1
OBJ: 9-15
TOP: Carbohydrate disorders
53. GALT deficiency is a disorder affecting the metabolism of:

A. Glucose
B. Fructose
C. Lactose
D. Galactose
ANS: D
DIF: Level 1
OBJ: 9-15
TOP: Carbohydrate disorders
54. Which disorder has a tendency to form renal calculi?

A. Cystinuria
B. Cystinosis
D. Tyrosyluria
ANS: A
DIF: Level 1
OBJ: 9-11
55. What is the appropriate screening test for PKU?

A. Ferric chloride
B. Clinitest
C. Acetest
D. Nitroso-naphthol
ANS: A
DIF: Level 1
OBJ: 9-3
TOP: Newborn screening tests
56. What is the appropriate screening test for homocystinuria?

A. Cyanide-nitroprusside
B. Acetest
C. Silver nitroprusside
D. Ehrlich reaction
ANS: C
DIF: Level 1
OBJ: 9-11
57. What is the characteristic odor with a phenylketonuria disorder?

A. Sweet
B. Sulfur
C. Mousy
D. Sweaty feet
ANS: C
DIF: Level 1
OBJ: 9-3
58. An employee reports a negative nitroso-napthol test on a suspected case of tyrosyluria. What
action should be taken?
A. Perform an Ehrlich test
B. Collect a blood specimen for MS/MS testing
C. Request a new urine specimen
D. Perform an Acetest
ANS: B
DIF: Level 3
OBJ: 9-3
TOP: Tyrosyluria
59. A positive Clinitest with a yellow precipitate is noted from a patient with liver and cardiac
abnormalities. What should the MLS do next?
A. Repeat the Clinitest with new reagents
B. Check for parenteral feeding
C. Check the patient’s urine for color change
D. Draw blood for plasma glucose
ANS: C
DIF: Level 3
OBJ: 9-5
TOP: Alkaptonuria
60. Many uric acid crystals are reported in the urine of a 15-year-old boy with an unremarkable
medical history, except for previous episodes of renal calculi. What course of action should be
taken?
A. Check for possible cystine crystals
B. Check for specimen mix-up
C. Notify the health-care provider
D. Report possible Lesch-Nyhan disease
ANS: A
DIF: Level 3
OBJ: 9-11
True/False
61. Cystinosis is a true inborn error of metabolism.
ANS: True
DIF: Level 1
OBJ: 8-11
62. Ferric chloride is used for a confirmation test for methylmalonic acidemia.
ANS: False
DIF: Level 1
OBJ: 9-9
63. Maple syrup urine disease has a mousy odor.
ANS: False
DIF: Level 1
OBJ: 9-7
TOP: Maple syrup disease
64. Failure of a metabolic pathway to reach completion may be caused by an inborn error of
metabolism.
ANS: True
DIF: Level 1
OBJ: 9-1
TOP: Overflow versus renal disorders
65. Persons diagnosed with PKU should avoid foods containing the chemical additive aspartame.
ANS: True
DIF: Level 1
OBJ: 9-3
66. Cystinosis is a defective reabsorption of cystine, lysine, ornithine, and arginine.
ANS: False
DIF: Level 1
OBJ: 8-11
67. The 2,4-dinitrophenylhydrazine reaction is the confirmatory test for maple syrup urine
disease.
ANS: False
DIF: Level 1
OBJ: 9-7
68. Cystinosis has an odor of sulfur.
ANS: True
DIF: Level 1
OBJ: 9-11
TOP: Cystinosis
69. Argentaffin cell tumors produce large amounts of serotonin.
ANS: True
DIF: Level 1
OBJ: 9-9
70. Both cystine and leucine crystals are present in the urine of patients with cystinuria.
ANS: False
DIF: Level 1
OBJ: 9-11
71. The free erythrocyte protoporphyrin test is the recommended screening test for lead
poisoning.
ANS: True
DIF: Level 1
OBJ: 9-12
72. Uric acid crystals are frequently seen in the urine of pediatric patients.
ANS: False
DIF: Level 1
OBJ: 9-14
73. The presence of a massive amount of urinary calcium oxalate crystals is indicative of Lesch-
Nyhan disease.
ANS: False
DIF: Level 2
OBJ: 9-13
TOP: Purine disorders
74. A negative reagent strip test for glucose and a positive Clinitest on a pregnant woman are
associated with gestational diabetes.
ANS: False
DIF: Level 2
OBJ: 9-15
Case Study
A newborn presented with failure to thrive. The infant was not gaining weight and seemed to
have little or no response to stimulus. Urinalysis was ordered and the results are as follows:
Color: Dark brown Protein: Negative Blood: Negative

Specific gravity: 1.020 Ketones: Large Nitrite: Negative
Clinitest: Negative
1. Based on the information provided, what additional characteristic of the urine could be helpful
for diagnosis?
A. Uric acid crystals
C. Odor
D. Positive Clinitest
ANS: C
DIF: Level 2
OBJ: 9-7
2. Based on the information provided, what screening test should be performed on this
specimen?
A. p-nitroaniline
B. DNPH
C. Nitroso-naphthol
D. Silver nitroptusside
ANS: B
DIF: Level 3
OBJ: 9-7
3. Based on the information provided, what is the infant’s most probable disorder?
A. Lesch-Nyhan disease
B. Isovaleric acidemia
D. Tyrosyluria
ANS: C
DIF: Level 3
OBJ: 9-7
4. This disorder can be controlled by:

A. Medication
B. Diet
C. Dialysis
D. Phenylalanine
ANS: B
DIF: Level 2
OBJ: 9-7
Chapter 10: Cerebrospinal Fluid
Multiple Choice
1. Which is not a function of the cerebrospinal fluid (CSF)?

A. Nutritional enrichment of nervous tissue
B. Transmission of neurological impulses
C. Removal of metabolic waste products
D. Protection of neurological tissue from trauma
ANS: B
DIF: Level 1
OBJ: 10-1
TOP: Formation and physiology
2. Chemical analysis of CSF shows that the fluid contains:

A. Plasma chemicals in the same concentration as in the plasma
B. Plasma chemicals in concentrations different from those in the plasma
C. More chemicals than are found in plasma
D. Fewer chemicals than are found in plasma
ANS: B
DIF: Level 1
OBJ: 10-1
3. CSF is formed in the and reabsorbed by the .

A. Ventricles, spinal cord
B. Choroid plexus, arachnoid granulations
C. Arachnoid space, blood-brain barrier
D. Blood-brain barrier, arachnoid granulations
ANS: B
DIF: Level 1
OBJ: 10-1
4. CSF is produced primarily by:
A. Secretion by cells of the arachnoid villi
B. Diffusion from the plasma into the central nervous system (CNS)
C. Selective filtration of plasma in the choroid plexus
D. Excretions from the ependymal cells lining the CNS
ANS: C
DIF: Level 1
OBJ: 10-1
5. The CSF circulates through the brain and spinal cord in the:
A. Arachnoid mater
B. Choroid plexuses
C. Dura mater
D. Subarachnoid space
ANS: D
DIF: Level 1
OBJ: 10-1
6. The average volume of CSF in an adult is:

A. 10 to 60 mL
B. 50 to 100 mL
C. 90 to 150 mL
D. 200 to 250 mL
ANS: C
DIF: Level 1
OBJ: 10-1
7. If CSF tubes numbered 2 and 3 cannot be analyzed within 1 hour, the correct procedure is to:
A. Refrigerate both tubes
B. Leave both tubes at room temperature
C. Refrigerate tube 2 and freeze tube 3
D. Refrigerate tube 3 and leave tube 2 at room temperature
ANS: D
DIF: Level 2
OBJ: 10-2
TOP: Specimen collection and handling
8. A xanthochromic CSF specimen will appear:

A. Crystal clear
B. White and turbid
C. Yellow and clear
D. Red and turbid
ANS: C
DIF: Level 1
OBJ: 10-3
TOP: Appearance
9. Cell counts on CSF are performed on:

A. Cells as they are counted in the hemocytometer
B. Cover-slipped wet preparations
C. Stained smears prepared from the undiluted specimen
D. Stained smears prepared from a concentrated specimen
ANS: A
DIF: Level 1
OBJ: 10-6
TOP: Cell counts
10. A broad spectrum of reactive and nonreactive lymphocytes in the CSF is associated with:
A. Bacterial meningitis
B. Allergic reactions
C. Cerebral hemorrhage
D. Viral meningitis
ANS: D
DIF: Level 1
OBJ: 10-7
TOP: CSF cellular constituents
11. The third tube of CSF collected from a lumbar puncture should be used for:
A. Chemistry tests
B. Cytology examination
C. Microbiology tests
D. Hematology tests
ANS: D
DIF: Level 1
OBJ: 10-2
12. Cells seen in the CSF following pneumoencephalography are:

A. Choroid plexus
B. Lymphocytes
C. Highly vacuolated
D. Reactive mesothelial cells
ANS: A
DIF: Level 1
OBJ: 10-3
TOP: Differential count on a CSF specimen
13. The primary disadvantage in using a cytocentrifuge to prepare CSF differential slides is:
A. Frequent bacterial contamination
B. Uneven distribution of cells
C. Cellular distortion
D. Increased cost
ANS: C
DIF: Level 1
OBJ: 10-6
TOP: Cytocentrifugation
14. Nucleated red blood cells (RBCs) seen in the CSF indicate:
A. Recent cerebral hemorrhage
B. Acute leukemia
C. A ventricular rather than a lumbar puncture
D. Bone marrow contamination from the puncture
ANS: D
DIF: Level 1
OBJ: 10-9
TOP: Differential count on a CSF specimen
15. White blood cell (WBC) counts on clear CSF specimens are performed:
A. Using centrifuged specimens
B. Only if multiple sclerosis is suspected
C. On undiluted specimens if there is no cell overlapping
D. On specimens diluted 1:200 with gentian violet
ANS: C
DIF: Level 2
OBJ: 10-6
TOP: WBC count
16. To determine the WBC count on a cloudy CSF specimen that contains both RBCs and
WBCs, it is necessary to:
A. Dilute the specimen using glacial acetic acid
B. Dilute the specimen using saline
C. Determine the percentage of polynuclear and mononuclear cells in the counting chamber
D. Centrifuge the specimen before diluting with saline and gentian violet
ANS: A
DIF: Level 2
OBJ: 10-6
TOP: WBC count
17. An increase in neutrophils with pyknotic nuclei can be seen in which situation?
A. Patient with bacterial meningitis
B. Patient with fungal meningitis
C. Traumatic tap specimen
D. Patients on medication
ANS: C
DIF: Level 2
OBJ: 10-7
TOP: Neutrophils
18. When using the cytocentrifuge, a daily control slide of saline and albumin is prepared to
check:
A. The correct centrifuge speed
B. For the presence of WBCs
C. For bacterial contamination
D. The pH of staining buffer
ANS: C
DIF: Level 2
OBJ: 10-6
TOP: Cytocentrifugation
19. 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:
A. The tubes were numbered in the wrong sequence, as one would expect increasing amounts of
blood
B. A traumatic or bloody tap is suspected and, in all likelihood, no pathogenic significance
should be attached to the presence of the blood
C. The pathological presence of RBCs and reported to the supervisor immediately
D. A pathological presence of RBCs, but because the RBC morphology is normal there is
minimal importance
ANS: B
DIF: Level 2
OBJ: 10-5
TOP: Uneven blood distribution
20. The presence of hemosiderin containing macrophages in CSF indicates:

A. Fungal meningitis
B. Cerebral hemorrhage
C. Reye syndrome
D. Multiple sclerosis
ANS: B
DIF: Level 2
OBJ: 10-5
TOP: Macrophages
21. 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:
A. 50 cells/µL
B. 55 WBCs/µL
C. 250 cells/µL
D. 500 WBCs/µL
ANS: D
DIF: Level 2
OBJ: 10-6
TOP: Calculating CSF cell counts
22. A CSF specimen, in which there is uneven distribution of blood among the three tubes and
clots are detected, is an indication of:
A. Meningitis
C. Multiple sclerosis
D. Traumatic tap
ANS: D
DIF: Level 2
OBJ: 10-5
TOP: Uneven blood distribution
23. The presence of xanthochromia and an increased D-dimer test in the CSF is indicative of:
A. A traumatic tap
B. Multiple sclerosis
C. A cerebral hemorrhage
D. Viral meningitis
ANS: C
DIF: Level 2
OBJ: 10-5
TOP: Xanthochromic supernatant
24. Examination of a CSF shows 1000 WBCs, of which 75% are lymphocytes and 25% are
monocytes. This finding is consistent with:
A. Normal spinal fluid
B. Bacterial meningitis
C. Viral meningitis
ANS: C
DIF: Level 2
OBJ: 10-7
TOP: Lymphocytes and monocytes
25. When choroid plexus cells are present in the CSF, they:
A. Are clinically significant
B. Represent demyelination of neural tissue
C. May resemble clusters of malignant cells
D. Indicate a breakdown of the blood-brain barrier
ANS: C
DIF: Level 2
OBJ: 10-9
TOP: Nonpathologically significant cells
26. Damage to the blood-brain barrier by Mycobacterium tuberculosis may cause the CSF to:
A. Appear blood-streaked
B. Appear xanthochromic
C. Contain a pellicle or clot
D. Contain decreased protein
ANS: C
DIF: Level 2
OBJ: 10-3
TOP: Clot formation
27. Dilution of CSF before performing a total cell count should be made using:
A. Normal saline
B. Deionized water
C. Acetic acid
D. Acetic acid containing methylene blue
ANS: A
DIF: Level 2
OBJ: 10-6
TOP: Total cell count
28. Increased CSF eosinophils are associated with:
A. Multiple sclerosis
B. Introduction of foreign material
C. Human immunodeficiency virus
D. Viral meningitis
ANS: B
DIF: Level 2
OBJ: 10-9
TOP: Eosinophils
29. Melanoma cells in the CSF must be differentiated from:

A. Macrophages containing hemosiderin
B. Noncleaved lymphoma cells
C. Medulloblastoma cells
D. Ependymal cells
ANS: A
DIF: Level 3
OBJ: 10-8
TOP: Malignant cells of nonhematologic origin
30. 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
ANS: A
DIF: Level 1
OBJ: 10-10
TOP: Chemistry tests
31. Which condition does not produce elevated CSF protein?

A. Fluid leakage
B. Meningitis
D. Hemorrhage
ANS: A
DIF: Level 1
OBJ: 10-10
32. When performing protein electrophoresis on CSF, why is it important to also perform a
serum protein electrophoresis?
A. To determine that the correct patient sample is used
B. To determine whether oligoclonal banding in the CSF is due to a neurological inflammation
C. To determine cases of neurosyphilis
D. To determine the stage of a neoplastic disorder
ANS: B
DIF: Level 2
OBJ: 10-10
TOP: Electrophoresis and immunophoretic techniques
33. The normal CSF glucose is:

A. 25 to 50 mg/dL
B. 80 to 120 mg/dL
C. 60% to 70% of the blood glucose
D. 10% to 20% higher than the blood glucose
ANS: C
DIF: Level 1
OBJ: 10-13
TOP: CSF glucose
34. Myelin basic protein is measured in the CSF to assess the condition of patients with:
A. Cerebral hemorrhage
B. Multiple sclerosis
C. Bacterial meningitis
D. Neurosyphilis
ANS: B
DIF: Level 1
OBJ: 10-10
TOP: Myelin basic protein
35. 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?
A. Transferrin
B. Ceruloplasmin
C. Albumin
D. Prealbumin
ANS: D
DIF: Level 1
OBJ: 10-12
36. An IgG index greater than 0.77 indicates:

A. Synthesis of IgG within the CNS
B. Alterations of the blood-brain barrier
C. Active demyelination of neural tissue
D. Increased reabsorption of IgG from the peripheral blood
ANS: A
DIF: Level 1
OBJ: 10-12
TOP: Protein fractions
37. Measurement of CSF lactate is useful for monitoring cases of:

A. Multiple sclerosis
C. Reye syndrome
D. Tertiary syphilis
ANS: B
DIF: Level 1
OBJ: 10-14
TOP: CSF lactate
38. The CSF/serum albumin index is performed to determine:

A. The amount of albumin in the CSF
B. Synthesis of IgG within the CNS
C. The integrity of the blood-brain barrier
D. If an unknown fluid is in the CSF
ANS: C
DIF: Level 1
OBJ: 10-11
39. To determine whether IgG is being produced within the central nervous system, the
laboratory must calculate the:
A. IgG index
B. Serum albumin index
C. IgG/albumin index
D. CSF/albumin index
ANS: A
DIF: Level 1
OBJ: 10-11
40. The lowest levels of CSF lactate can be found in patients with:
A. Bacterial meningitis
B. Viral meningitis
C. Tubercular meningitis
D. Fungal meningitis
ANS: A
DIF: Level 1
OBJ: 10-14
TOP: CSF lactate
41. Normal CSF protein differs from serum protein by the:

A. Presence of IgG
B. Presence of haptoglobin
C. Presence of ceruloplasmin
D. Absence of fibrinogen
ANS: D
DIF: Level 2
OBJ: 10-10
42. Crystals with a bright yellow color seen in macrophages are called:
A. Unconjugated bilirubin
B. Hemosiderin
C. Hematoidin
ANS: C
DIF: Level 1
OBJ: 10-8
43. CSF electrophoresis can be used to confirm the diagnosis of multiple sclerosis and would be
expected to show which of the following?
A. Increased IgG with oligoclonal bands not seen on serum electrophoresis
B. Increased IgG with oligoclonal bands similar to those seen on serum electrophoresis
C. Decreased IgG with antibody-specific oligoclonal bands
D. Decreased IgG with oligoclonal bands resembling those seen on serum electrophoresis
ANS: A
DIF: Level 2
OBJ: 10-12
44. The primary cause of a decreased CSF glucose in bacterial meningitis is:
A. Utilization of glucose by the microorganisms present in the fluid
B. Rapid glycolysis
C. Utilization of glucose by leukocytes present in the fluid
D. Alteration of blood-brain glucose transport
ANS: D
DIF: Level 2
OBJ: 10-13
TOP: CSF glucose
45. Measurement of CSF lactate levels is a valuable aid for all of the following except:
A. Preliminary diagnosis of tubercular meningitis
B. Preliminary diagnosis of viral meningitis
C. Monitoring the effects of antibiotic treatment
D. Distinguishing between viral and fungal meningitis
ANS: D
DIF: Level 2
OBJ: 10-14
TOP: CSF lactate
46. A CSF protein report of 32 g/dL:

A. Is normal
B. Indicates possible multiple sclerosis
C. Is an erroneous report
D. Should be followed by electrophoresis
ANS: C
DIF: Level 2
OBJ: 10-10
TOP: Methodology
47. The presence of increased glutamine in the CSF can indicate:

C. Reye syndrome
ANS: C
DIF: Level 2
OBJ: 10-14
TOP: CSF glutamine
48. An unknown bodily fluid can be identified as CSF by determining the:

A. Lactate content
B. Albumin content
C. Presence of “tau” transferrin
D. Presence of oligoclonal banding
ANS: C
DIF: Level 2
OBJ: 10-12
TOP: Cerebrospinal protein
49. Oligoclonal bands are significant in the diagnosis of multiple sclerosis when:
A. They are seen in both the serum and CSF
B. At least five bands are seen in the CSF
C. They are seen in the CSF and not in the serum
D. They appear in both the albumin and globulin fractions of serum and CSF
ANS: C
DIF: Level 2
OBJ: 10-10
50. The IgG index is a comparison between the:

A. CSF IgG and serum IgG
B. CSF albumin index and serum IgG
C. CSF/serum albumin index and CSF/serum IgG index
D. Serum albumin and CSF/serum IgG index
ANS: C
DIF: Level 2
OBJ: 10-11
51. An IgG index of 1.10 would most likely be seen in a patient diagnosed with:
A. Meningitis
C. Leukemia
ANS: D
DIF: Level 2
OBJ: 10-11
52. The CSF glucose in a patient with a blood glucose of 90 mg/dL is 60 mg/dL. These results
are representative of:
A. An improperly preserved specimen
C. Normal CSF
D. Damage to the blood-brain barrier
ANS: C
DIF: Level 2
OBJ: 10-13
TOP: CSF glucose
53. A CSF glutamine level is an indirect measure of CSF:

A. Lactate
B. Hypoxia
C. Ammonia
D. Creatine kinase
ANS: C
DIF: Level 2
OBJ: 10-14
TOP: CSF glutamine
54. Gram stains performed on CSF specimens are helpful in the:

A. Diagnosis of tubercular meningitis
B. Diagnosis of bacterial meningitis
C. Detection of viral meningitis
D. Detection of bacterial and fungal meningitis
ANS: D
DIF: Level 1
OBJ: 10-17
TOP: Gram stain
55. Specimens from patients suspected of having fungal meningitis should be tested with:
A. Gram stain, acid-fast stain, and India ink
B. Gram stain and India ink
C. India ink only
D. Acid-fast stain and India ink
ANS: B
DIF: Level 1
OBJ: 10-17
TOP: Gram stain
56. India ink preparations are useful in the diagnosis of:
C. Tubercular meningitis
ANS: A
DIF: Level 1
OBJ: 10-16
TOP: Gram stain
57. When a CSF specimen is received in the microbiology laboratory, the first thing the
technologist should do is:
A. Perform a Gram stain
B. Perform an India ink preparation
C. Centrifuge the specimen
D. Streak the fluid on chocolate agar
ANS: C
DIF: Level 1
OBJ: 10-15
TOP: Microbiology tests
58. A questionable India ink preparation on the CSF from an immunocompromised patient
should be further tested using:
A. A cryptococcal antigen test
B. A bacterial antigen panel
C. Counterimmunoelectrophoresis
D. An anaerobic culture
ANS: A
DIF: Level 2
OBJ: 10-15
TOP: Serological testing
59. Which of the following structures contain one-way valves?

A. Choroid plexus
B. Endothelial cells
C. Blood-brain barrier
D. Arachnoid granulations
ANS: D
DIF: Level 2
OBJ: 10-1
TOP: Physiology
60. A report of many gram-positive cocci on a clear CSF specimen with a normal cell count may
be the result of:
A. An incorrect cell count
B. Effective antibiotic treatment
C. Use of contaminated albumin in the cytocentrifuge
D. Use of recycled cytocentrifuge chambers
ANS: C
DIF: Level 3
OBJ: 10-2
TOP: Microbiology tests
61. A positive cryptococcal antigen test with a negative India ink preparation may indicate:
A. Bacterial rather than fungal meningitis
B. Tubercular meningitis
C. The failure to inactivate the CSF
D. The presence of rheumatoid factor
ANS: D
DIF: Level 2
OBJ: 10-15
62. A positive fluorescent treponemal antibody absorption test (FTA-ABS) and a positive CSF
Venereal Disease Research Laboratory test (VDRL) indicate:
A. A false-positive reaction
B. Neurosyphilis
C. Failure to inactivate the CSF
D. The need to perform a rapid plasma reagin test
ANS: B
DIF: Level 2
OBJ: 10-19
63. A false-positive CSF serological test for neurosyphilis in a treated patient can occur if:
A. The VDRL testing method is used
B. Fluid from a traumatic tap is tested by the FTA-ABS test
C. The fluid is frozen before testing
D. Increased protein is present in the fluid
ANS: B
DIF: Level 2
OBJ: 10-19
64. A positive serum FTA-ABS and a negative VDRL on CSF indicate:

A. Neurosyphilis
B. An improperly collected specimen
C. Successfully treated syphilis
D. Outdated VDRL reagents
ANS: C
DIF: Level 2
OBJ: 10-19
65. Which of the following tests has the best sensitivity and specificity for detecting meningitis?
A. Gram stain
B. Blood culture
C. PCR
D. ELISA
ANS: C
DIF: Level 2
OBJ: 10-17
TOP: Molecular testing
66. PCR testing for meningitis is based on:

A. Amplification of RNA
B. Amplification of DNA
C. Nuclear acids
D. Antibodies
ANS: A
DIF: Level 1
OBJ: 10-17
67. Using the following laboratory results, determine what type of meningitis is present:
WBC count: 400/µL WBC count: 400/L

Lymphocytes: 90% Glucose: 70 mg/dL
Monocytes: 8% Blood glucose: 100 mg/dL
Neutrophils: 2% Lactate: 18 mg/dL
A. Bacterial
B. Viral
C. Fungal
D. Tubercular
ANS: B
DIF: Level 3
OBJ: 10-18
WBC count: 300/µL Glucose: 30 mg/dL

Lymphocytes: 70% Blood glucose: 90 mg/dL
Monocytes: 30% Lactate: 30 mg/dL
Protein: 90 mg/dL Pellicle formation
A. Bacterial
B. Viral
C. Fungal
D. Tubercular
ANS: D
DIF: Level 3
OBJ: 10-18
WBC count: 1,000/µL Glucose: 15 mg/dL

Lymphocytes: 10% Blood glucose: 90 mg/dL
Neutrophils: 90% Lactate: 40 mg/dL
Protein: 150 mg/dL
A. Bacterial
B. Viral
C. Fungal
D. Tubercular
ANS: A
DIF: Level 3
OBJ: 10-18
70. Calculate the WBC count using a 1:10 dilution, 64 cells are counted in five large squares on
both sides of the hemocytometer.
A. 64 cells/µL
B. 128 cells/µL
C. 640 cells/µL
D. 1280 cells/µL
ANS: C
DIF: Level 2
OBJ: 10-6
71. Calculate the cell count using an undiluted specimen, 100 cells are counted in the nine large
squares on one side of the hemocytometer.
A. 90 cells/µL
B. 111 cells/µL
C. 901 cells/µL
D. 1111 cells/µL
ANS: B
DIF: Level 2
OBJ: 10-6
72. Calculate the cell count using a 1:10 dilution, 120 cells are counted in the four large corner
squares on one side of the hemocytometer.
A. 120 cells/µL
B. 1200 cells/µL
C. 2000 cells/µL
D. 3000 cells/µL
ANS: D
DIF: Level 2
OBJ: 10-6
True/False
73. Xanthochromic CSF may appear pink, orange, or yellow.
ANS: True
DIF: Level 1
OBJ: 10-4
TOP: Appearance
74. Neutrophils may be present in normal CSF.
ANS: True
DIF: Level 1
OBJ: 10-6
TOP: Neutrophils
75. The formation of clots does not occur in CSF that does not contain blood.
ANS: False
DIF: Level 2
OBJ: 10-5
TOP: Clot formation
76. The presence of macrophages containing hematoidin crystals indicates a recent hemorrhage.
ANS: False
DIF: Level 2
OBJ: 10-8
TOP: Macrophages
77. Oligoclonal bands are located in the gamma region of the CSF protein electrophoresis.
ANS: True
DIF: Level 1
OBJ: 10-12
78. When calculating an IgG index, the serum albumin concentration must be converted to
milligrams per deciliter.
ANS: False
DIF: Level 2
OBJ: 10-11
79. A CSF lactate level should not be performed on a xanthochromic specimen.
ANS: True
DIF: Level 2
OBJ: 10-14
TOP: CSF lactate
80. Bacterial antigen tests have replaced the Gram stain as the method of choice for detecting
meningitis.
ANS: False
DIF: Level 1
OBJ: 10-16
81. The recommended serological test for the diagnosis of neurosyphilis is the rapid plasma
reagin test.
ANS: False
DIF: Level 1
OBJ: 10-19
82. PCR can be used to detect meningitis.
ANS: True
DIF: Level 1
OBJ: 10-17
Case Study 1
A lumbar puncture is performed on a 40-year-old man experiencing symptoms of blurred vision

and numbness in his extremities. Results are:
Appearance: Colorless, clear Albumin: 40 mg/dL (serum: 5 g/dL)

WBC count: 32 cells/L IgG globulin: 15 mg/dL (serum: 2 g/dL)
Protein: 60 mg/dL (serum: 7 g/dL)
1. Using the information provided, based on the symptoms and laboratory tests ordered, what
disorder does the physician suspect?
A. Late cerebral hemorrhage
B. Viral meningitis
D. CSF leakage
ANS: C
DIF: Level 3
OBJ: 10-11
2. Based on the information provided, which laboratory value is not needed to aid in the
diagnosis?
A. CSF albumin
B. CSF IgG
C. Serum albumin
D. CSF WBC count
ANS: C
DIF: Level 3
OBJ: 10-11
3. Based on the information provided, calculate the CSF/serum albumin index for this patient.
A. 0.125
B. 8.0
C. 35.0
D. 200.0
ANS: B
DIF: Level 3
OBJ: 10-11
4. Based on the information provided, calculate the IgG index for this patient.
A. 0.94
B. 1.07
C. 2.1
D. 3.0
ANS: A
DIF: Level 3
OBJ: 10-11
5. Based on the information provided, what abnormality is present in the CNS of this patient if
the IgG index is calculated to be above 0.70?
A. CSF leakage
B. Decreased blood-brain barrier integrity
C. Neural IgG synthesis
D. Bacterial meningitis
ANS: C
DIF: Level 3
OBJ: 10-11
Case Study 2
A patient previously diagnosed with acquired immunodeficiency arrives in the emergency
department with symptoms of fever, headache, and a very stiff neck. A lumbar puncture is
performed. The results are as follows:
Appearance: Clear Glucose: Decreased

Cell count: 200 cells/L Protein: Increased
Differential: 90 % lymphocytes
1. Using the information provided, in addition to Gram stain, what additional testing should be
performed?
A. VDRL
B. Electrophoresis
C. Cryptococcal antigen test
D. Differential of peripheral blood
ANS: C
NAR: 09-nar-03
OBJ: 10-18
2. Based on the information provided, what diagnostically significant observation might be made
on the Gram stain?
A. Gram-positive cocci
B. Gram-negative rods
C. Starburst microbial pattern
D. Fungal mycelia
ANS: C
DIF: Level 3
OBJ: 10-18
3. Based on the information provided, what type of meningitis would most probably be suspected
in this patient?
A. Fungal
B. Viral
C. Bacterial
D. Tubercular
ANS: A
DIF: Level 3
OBJ: 10-18
Chapter 11: Semen
Multiple Choice
1. Semen analysis on postvasectomy patients should be performed:

A. Within 1 week postvasectomy
B. Within 1 month postvasectomy
C. Until two consecutive monthly specimens show no sperm
D. Until two consecutive monthly specimens show no viable sperm
ANS: C
DIF: Level 1
OBJ: 11-1
TOP: Physiology
2. To determine whether a questionable specimen is semen, the specimen should be tested for:
A. Alkaline phosphatase
B. Acid phosphatase
C. DNA
D. Citrate and zinc
ANS: B
DIF: Level 1
OBJ: 11-2
TOP: Physiology
3. Absence of a normal sperm acrosome can:

A. Decrease sperm motility
B. Affect ovum penetration
C. Affect semen liquefaction
D. Decrease sperm concentration
ANS: B
DIF: Level 1
OBJ: 11-1
TOP: Physiology
4. Yellow color in a semen specimen may be caused by all of the following except:
A. Urine
B. Preservation at room temperature
C. Medications
D. Prolonged abstinence
ANS: B
DIF: Level 1
OBJ: 11-2
TOP: Physiology
5. Normal semen should liquefy:

A. Immediately after ejaculation
B. Within 1 hour
C. Within 3 hours
D. After exposure to diluting fluid
ANS: B
DIF: Level 1
OBJ: 11-1
TOP: Physiology
6. An increased amount of prostatic fluid in a semen specimen will:

A. Lower the pH
B. Raise the pH
C. Increase the motility
D. Decrease the motility
ANS: A
DIF: Level 2
OBJ: 11-1
TOP: Physiology
7. If the first portion of the ejaculation is not collected, which parameter of the semen analysis is
most critically affected?
A. Sperm concentration
B. pH
C. Sperm motility
D. Morphology
ANS: A
DIF: Level 2
OBJ: 11-3
TOP: Physiology
8. Semen viscosity is most closely related to:

A. Sperm concentration
B. Specimen volume
C. Specimen collection
D. Specimen liquefaction
ANS: D
DIF: Level 2
OBJ: 11-4
TOP: Physiology
9. Which is not proper for collection of a semen specimen?

A. In a sterile container
B. After a 3-day period of sexual abstinence
C. At the laboratory followed by 1 hour of refrigeration
D. At home and delivery to the laboratory within 1 hour
ANS: C
DIF: Level 1
OBJ: 11-3
TOP: Specimen collection Commented [JM1]: Pub: Per AU request, we deleted the 2
duplicates of this question.
10. Sperm motility after 1 hour should be at least:

A. 50%
B. 60%
C. 70%
D. 80%
ANS: A
DIF: Level 1
OBJ: 11-9
TOP: Semen motility
11. Before reporting a postvasectomy specimen as negative for the presence of sperm, the
specimen must be:
A. Stained
B. Examined under polarized light
C. Diluted
D. Centrifuged
ANS: D
DIF: Level 1
OBJ: 11-7
TOP: Semen analysis
12. Which cannot be used to immobilized sperm before performing a sperm concentration?
A. Heat
B. Normal saline
C. Sodium bicarbonate
D. Tap water
ANS: B
DIF: Level 1
OBJ: 11-7
TOP: Semen analysis
13. Evaluation of sperm motility includes:

A. Determining the appearance of the tail piece
B. Differentiation between forward and lateral movement
C. Two evaluations performed 3 hours apart
D. Two evaluations performed 3 days apart
ANS: B
DIF: Level 1
OBJ: 11-9
TOP: Sperm motility
14. Which is not included in computer-assisted semen analysis?

A. Sperm morphology
B. Sperm count
C. Trajectory of sperm motion
D. Velocity of sperm motility
ANS: A
DIF: Level 1
OBJ: 11-10
TOP: Sperm motility
15. When performing sperm morphology analysis, the minimum number of sperm that should be
evaluated is:
A. 50
B. 100
C. 200
D. 500
ANS: C
DIF: Level 1
OBJ: 11-11
TOP: Sperm morphology
16. When using routine morphology criteria, the normal value is greater than:
A. 15% normal forms
B. 30% normal forms
C. 50% normal forms
D. 70% normal forms
ANS: B
DIF: Level 1
OBJ: 11-11
17. When using Kruger’s strict morphology criteria, the normal value is greater than:
A. 14% normal forms
B. 25% normal forms
C. 30% normal forms
D. 55% normal forms
ANS: A
DIF: Level 1
OBJ: 11-11
18. Semen specimens should be processed for analysis:
A. Immediately on receipt in the laboratory
B. Before complete liquefaction
C. After complete liquefaction
D. 1 hour after arriving in the laboratory
ANS: C
DIF: Level 1
OBJ: 11-9
TOP: Semen analysis
19. The normal sperm concentration is:

A. 140 to 200 million/mL
B. 10 to 90 million/mL
C. 20 to 160 million/mL
D. 50 to 100 million/mL
ANS: C
DIF: Level 1
OBJ: 11-7
TOP: Sperm concentration and sperm count
20. A yellow semen specimen with a normal sperm concentration and decreased motility may
contain:
A. Bilirubin
B. Carotene
C. Bacteria
D. Urine
ANS: D
DIF: Level 2
OBJ: 11-10
TOP: Semen analysis
21. 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:
A. 54,000/cc
B. 54,000,000/mL
C. 108,000/cc
D. 108,000,000/mL
ANS: B
DIF: Level 2
OBJ: 11-7
22. When performing sperm morphology analysis on a semen specimen with a sperm
concentration of 20 million, 10 spermatids are seen. This result is:
A. A normal finding
B. Associated with infection
C. Normal in a postvasectomy specimen
D. Indicative of abnormal sperm maturation
ANS: D
DIF: Level 2
OBJ: 11-10
TOP: Semen morphology
23. A sperm motility report graded 2.0 is interpreted as:

A. Average motility and Brownian movement
B. Slow forward motility with noticeable lateral movement
C. Slow forward motion in a straight line
D. Abnormal motility with normal direction
ANS: B
DIF: Level 2
OBJ: 11-9
TOP: Semen motility
24. 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:
A. Specimen volume
B. Sperm concentration
C. Patient’s white blood cell (WBC) count
D. Sperm count
ANS: B
DIF: Level 2
OBJ: 11-12
25. The finding of 3 million neutrophils per milliliter in a semen specimen is:
A. A normal result
B. Normal when using Kruger’s strict criteria
C. Indicative of increased prostatic fluid
D. Indicative of infection
ANS: D
DIF: Level 2
OBJ: 11-12
TOP: Microbial and chemical testing
26. The purpose of diluting semen specimens with sodium bicarbonate and formalin before
counting is to:
A. Ensure liquefaction of the specimen
B. Allow motility to be determined while performing the count
C. Enhance the cellular morphology
D. Immobilize and preserve the sperm
ANS: D
DIF: Level 2
OBJ: 11-9
TOP: Semen analysis
27. Which is not included in the motility component of a sperm analysis evaluation?
A. Progressive and Brownian movement
B. Percentage of motile sperm
C. Quality of movement
D. Motility of normal and abnormal sperm
ANS: D
DIF: Level 2
OBJ: 11-9
TOP: Semen motility
28. 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:
A. Use a new chamber
B. Report the count as 70 million/mL
C. Repeat the count
D. Load only one side of the counting chamber
ANS: C
DIF: Level 3
OBJ: 11-12
TOP: Calculating sperm concentration and sperm count
29. The sugar of interest in most cases of infertility is:

A. Glucose
B. Maltose
C. Fructose
D. Sucrose
ANS: C
DIF: Level 1
OBJ: 11-12
TOP: Seminal fluid fructose
30. Which of the following will not cause the development of male antisperm antibodies?
A. Vasovasostomy
B. Infection
C. Prolonged abstinence
D. Trauma
ANS: C
DIF: Level 1
OBJ: 11-13
TOP: Antisperm antibodies
31. The immunobead test detects:

A. Male antisperm antibodies
B. Female antisperm antibodies
C. Abnormal sperm acrosomes
D. Both male and female antisperm antibodies
ANS: A
DIF: Level 1
OBJ: 11-13
32. When there is a lack of prostatic fluid, which of the following chemicals is not decreased in
the semen?
A. Alpha-glucosidase
B. Zinc
C. Citrate
D. Acid phosphatase
ANS: A
DIF: Level 1
OBJ: 11-2
TOP: Microbial and chemical testing
33. When examining a specimen for the presence of sperm, the type of microscopy
recommended for use is:
A. Bright-field
B. Phase
C. Polarizing
D. Electron
ANS: B
DIF: Level 1
OBJ: 11-14
TOP: Postvasectomy semen analysis
34. Which of the following is not considered a sperm function test?

A. Hamster egg penetration assay
B. Cervical mucus penetration test
C. Meiosis and mitosis assay
D. In vitro acrosome reaction
ANS: C
DIF: Level 1
OBJ: 11-16
TOP: Sperm function tests
35. Which of the following cannot be used to evaluate continued infertility with a normal sperm
count?
A. Semen fructose level
B. Eosin-nigrosin stain
C. Plasma and semen agglutination
D. Immunobead test
ANS: A
DIF: Level 2
OBJ: 11-9
TOP: Seminal fluid fructose
36. A semen specimen in which clumping of sperm is observed should be further tested using
the:
A. Fructose test
B. Eosin-nigrosin stain
C. Immunobead test
D. Computer-assisted semen analysis
ANS: C
DIF: Level 2
OBJ: 11-12
37. Which of the following parameters directly relates to and provides a check on the sperm
motility evaluation?
A. Agglutination testing
B. Morphology
C. Sperm count
D. Viability stain
ANS: D
DIF: Level 2
OBJ: 11-9
TOP: Sperm motility
38. When an abnormally low sperm count is encountered in a fertility examination, the follow-up
test of choice is:
A. Male agglutination studies
B. Semen fructose level
C. Female agglutination studies
D. Eosin-nigrosin stain
ANS: C
DIF: Level 2
OBJ: 11-5
39. Which of the following is a normal finding in an eosin-nigrosin stain?

A. 75% of the cells appear bluish white
B. 75% of the cells appear red
C. 30% of the cells appear red
D. 30% of the cells appear bluish white
ANS: A
DIF: Level 2
OBJ: 11-9
TOP: Sperm vitality
40. Normal semen analyses accompanied by continued infertility would most probably be caused
by:
A. Male antisperm antibodies
B. Female antisperm antibodies
C. Decreased fructose
D. Increased acid phosphatase
ANS: B
DIF: Level 2
OBJ: 11-13
41. Spermatogenesis takes place in the:

A. Epididymis
B. Seminiferous tubules
C. Bulbourethral glands
D. Seminal vessels
ANS: B
DIF: Level 1
OBJ: 11-1
TOP: Physiology
42. 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.
A. 43 million/mL and 129 million/specimen
B. 86 million/mL and 258 million/specimen
C. 17 million/mL and 52 million/specimen
D. 69 million/mL and 206 million/specimen
ANS: B
DIF: Level 2
OBJ: 11-7
a volume of 4 mL, 30 sperm are counted in two large squares (WBC) of the Neubauer
hemocytometer.
A. 1.5 million/mL and 6 million/specimen
D. 30 million /mL and 120 million/specimen
ANS: A
DIF: Level 2
OBJ: 11-7
a volume of 2 mL, 400 sperm are counted in four large squares (WBC) of the Neubauer
hemocytometer.
A. 5 million/mL and 10 million/specimen
D. 40 million/mL and 80 million/specimen
ANS: B
DIF: Level 2
OBJ: 7
45. In which part of the male reproductive system does the maturation of sperm take place?
A. Prostate
B. Bulbourethral glands
C. Seminal vessels
D. Epididymis
ANS: B
DIF: Level 1
OBJ: 11-1
TOP: Physiology
46. What part of the male reproductive system provides energy for sperm motility?
A. Prostate
C. Seminal vessels
D. Epididymis
ANS: C
DIF: Level 1
OBJ: 11-1
TOP: Physiology
47. Which is the part of the male reproductive system that neutralizes vaginal acidity?
A. Prostate
C. Seminal vessels
D. Epididymis
ANS: B
DIF: Level 1
OBJ: 11-1
TOP: Physiology
48. Which part of the male reproductive system propels sperm through the urethra?
A. Prostate
C. Seminal vessels
D. Epididymis
ANS: A
DIF: Level 1
OBJ: 11-1
TOP: Physiology
True/False
49. A semen pH of 6.0 is associated with a decrease in prostatic fluid.
ANS: False
DIF: Level 2
OBJ: 11-2
TOP: Physiology
50. Semen specimens can contain HIV and hepatitis viruses.
ANS: True
DIF: Level 1
OBJ: 11-2
TOP: Semen analysis
51. Greater than 1 million spermatids per milliliter indicates reproductive tract infection.
ANS: False
DIF: Level 1
OBJ: 11-4
TOP: Semen analysis
52. The size of the acrosome and the presence of vacuoles are included when sperm morphology
is evaluated using Kruger’s strict criteria.
ANS: True
DIF: Level 1
OBJ: 11-11
53. Slides for evaluation of sperm morphology can be stained using Papanicolaou stain.
ANS: True
DIF: Level 1
OBJ: 11-11
54. The semen analysis is classified as a moderately complexity test by the Clinical Laboratory
Improvement Amendments (CLIA).
ANS: False
DIF: Level 1
OBJ: 11-17
TOP: Semen analysis
55. The World Health Organization has standardized the performance and reporting of semen
analysis.
ANS: True
DIF: Level 1
OBJ: 11-15
TOP: Semen analysis
56. Antisperm antibodies are produced by both males and females.
ANS: True
DIF: Level 1
OBJ: 11-13
57. The immunobead test will differentiate between antisperm antibodies directed against the
sperm head and tail.
ANS: True
DIF: Level 1
OBJ: 11-13
Case Study 1
The patient was seen at a fertility clinic for a fertility workup. A specimen was collected on site
at the clinic. The following results were obtained on a semen analysis:
Volume: 2.5 mL Sperm concentration: 40 million/mL

Viscosity: 4 Sperm motility: 20%—grade 1.0
pH: 9.0 Sperm morphology: 30% abnormal
1. Using the information provided, which three of these parameters are abnormal?
A. Viscosity, pH, motility
B. Volume, viscosity, and pH
C. Concentration, motility, and morphology
D. Motility, morphology, and viscosity
ANS: A
DIF: Level 3
OBJ: 11-12
TOP: Semen analysis case study
2. Based on the information provided, which abnormal parameter is affecting the motility?
A. pH
B. Morphology
C. Viscosity
D. Concentration
ANS: C
DIF: Level 3
OBJ: 11-12
3. Based on the information provided, which abnormal parameter is affecting the viscosity?
A. pH
B. Motility
C. Morphology
D. Concentration
ANS: A
DIF: Level 3
OBJ: 11-12
4. Based on the information provided, what is the primary underlying cause of the abnormal
parameters?
A. Decreased fructose
B. Antisperm antibodies
C. Decreased prostatic fluid
D. Infection
ANS: C
DIF: Level 3
OBJ: 11-12
Case Study 2
The patient was seen at a fertility clinic for a fertility workup. A specimen was collected at home
and was brought to the clinic. The following results were obtained on a semen analysis:
Volume: 1.5 mL Sperm concentration: 5 million/mL

Viscosity: 2.0 Sperm motility: 50%—grade 3
pH: 7.6 Sperm morphology: 50% abnormal
1. Based on the information provided, what two parameters are abnormal?

A. Volume and concentration
B. Morphology and concentration
C. Viscosity and pH
D. Motility and concentration
ANS: A
DIF: Level 3
OBJ: 11-12
2. Based on the information provided, what is the sperm count for this specimen?
A. 7.5 million/mL
B. 10 million/mL
C. 12.5 million/mL
D. 20 million/mL
ANS: A
DIF: Level 3
OBJ: 11-12
3. Based on the information provided, is the sperm count on this specimen normal?
A. Yes
B. No
ANS: B
DIF: Level 3
OBJ: 11-12
4. Based on the information provided, what is the most probable cause of the abnormal results?
A. Decreased spermatogenesis
B. Decreased fructose
C. Incomplete specimen
D. Collection in a condom
ANS: C
DIF: Level 3
OBJ: 11-12
Chapter 12: Synovial Fluid
Multiple Choice
1. Which is not a true statement describing synovial fluid?

A. It surrounds all joints in the body.
B. It is found only in the knee.
C. It acts as a lubricant.
D. It supplies nourishment to cartilage.
ANS: B
DIF: Level 1
OBJ: 12-1
TOP: Physiology
2. Which of the following descriptions of synovial fluid does not correlate?

A. Normal: clear, pale yellow
B. Crystals: milky
C. Traumatic tap: blood streaks
D. Sepsis: uniform blood
ANS: D
DIF: Level 2
OBJ: 12-5
TOP: Physiology
3. Crystals that are found in synovial fluid during attacks of gout are most likely:
A. Monosodium urate
B. Calcium pyrophosphate
C. Cholesterol
D. Apatite
ANS: A
DIF: Level 1
OBJ: 12-2
TOP: Physiology
4. In gout, both serum and synovial fluid will have increased levels of:
A. Glucose
B. Protein
C. Uric acid
D. Complement
ANS: C
DIF: Level 1
OBJ: 12-2
TOP: Physiology
5. Synovial fluid is produced by:

A. Selective filtration of plasma
B. Ultrafiltration of plasma
C. Metabolic waste products from synoviocytes
D. Reabsorption of interstitial fluid
ANS: B
DIF: Level 1
OBJ: 12-1
TOP: Physiology
6. The concentration of which of the following chemicals found in synovial fluid differs most
noticeably from the plasma concentration?
A. Protein
B. Glucose
C. Lactate
D. Uric acid
ANS: A
DIF: Level 1
OBJ: 12-2
TOP: Physiology
7. A turbid synovial fluid with yellow-green color indicates:

A. Inflammation
B. Infection
C. Crystals
D. Increased bilirubin
ANS: B
DIF: Level 1
OBJ: 5
TOP: Physiology
8. Which type of cell is not normally seen in normal synovial fluid?

A. Macrophages
B. Neutrophils
C. Monocytes
D. Synovial tissue cells
ANS: B
DIF: Level 1
OBJ: 12-6
TOP: Physiology
9. What does not cause crystals to be present in the synovial fluid?

A. Metabolic disorders
B. Increased ingestion of dairy products
C. Degeneration of cartilage
D. Injection of medications
ANS: B
DIF: Level 1
OBJ: 12-7
TOP: Physiology
10. A cloudy, yellow-green synovial fluid with 100,000 white blood cells (WBCs), a
predominance of neutrophils, and a decreased glucose should be classified as:
A. Noninflammatory
B. Inflammatory
C. Septic
D. Crystal-induced
ANS: C
DIF: Level 2
OBJ: 12-2
TOP: Physiology
11. An arthrocentesis is performed on a patient with lupus erythematosus that produces a cloudy
yellow fluid with 2,000 WBCs, of which 55% is neutrophils. This fluid should be classified as:
A. Noninflammatory
B. Inflammatory
C. Septic
D. Crystal-induced
ANS: B
DIF: Level 2
OBJ: 12-2
TOP: Physiology
12. A clear, pale yellow synovial fluid with good viscosity and a WBC count of 1,000 should be
classified as:
A. Noninflammatory
B. Inflammatory
C. Septic
D. Hemorrhagic
ANS: A
DIF: Level 2
OBJ: 12-2
TOP: Physiology
13. To determine whether an unknown fluid is synovial fluid, the fluid can be tested:
A. By performing a differential
B. Using compensated polarized light
C. By adding acetic acid and observing clot formation
D. By measuring the concentration of uric acid
ANS: C
DIF: Level 2
OBJ: 12-1
TOP: Physiology
14. A milky-appearing synovial fluid can be associated with the presence of:
A. Staphylococcus aureus
B. Increased lymphocytes
C. Increased protein
D. Monosodium urate crystals
ANS: D
DIF: Level 2
OBJ: 12-5
TOP: Physiology
15. Which of the following crystals would most likely be present in conjunction with calcium
pyrophosphate crystals in synovial fluid?
A. Hydroxyapatite
B. Calcium oxalate
C. Monosodium urate
D. Cholesterol
ANS: A
DIF: Level 2
OBJ: 12-6
TOP: Physiology
16. The recommended diluting fluid for synovial fluid cell counts is:
A. Glacial acetic acid
B. Distilled water
C. 0.1 N hydrochloric acid
D. Saline
ANS: D
DIF: Level 1
OBJ: 12-3
17. Neutrophils that contain precipitated rheumatoid factor in their cytoplasm are called:
A. LE cells
B. Reiter’s cells
C. Ragocytes
D. Macrophages
ANS: C
DIF: Level 1
OBJ: 12-6
TOP: Cell counts
18. Which test is not frequently performed on synovial fluid?

A. Gram stain
B. WBC count
C. Uric acid
D. Differential
ANS: C
DIF: Level 1
OBJ: 12-3
TOP: Analysis
19. Vacuolated macrophages containing ingested neutrophils seen in synovial fluid are called:
A. Reiter’s cells
B. Ragocytes
C. LE cells
D. RA cells
ANS: A
DIF: Level 1
OBJ: 12-6
TOP: Differential counts
20. Before performing a cell count on highly viscous synovial fluid, it may be necessary to
incubate the fluid with:
A. Glacial acetic acid
B. Normal saline
C. Hypotonic saline
D. Hyaluronidase
ANS: D
DIF: Level 2
OBJ: 12-3
21. In the Ropes’ or mucin clot test, normal synovial fluid:

A. Forms a solid clot when added to hyaluronidase
B. Forms a solid clot when added to glacial acetic acid
C. Forms a friable clot when added to hydrochloric acid
D. Does not form a clot when added to glacial acetic acid
ANS: B
DIF: Level 2
OBJ: 12-6
TOP: Viscosity
22. Synovial fluid for crystal examination should be:

A. Stained with Wright’s stain and examined with bright-field microscopy
B. Stained with methylene blue and examined under polarized light
C. Examined unstained under direct and red compensated polarized light
D. Examined unstained with phase microscopy
ANS: C
DIF: Level 2
OBJ: 12-7
TOP: Crystal identification
23. Examination of synovial fluid under direct polarized light reveals intracellular needle-shaped
crystals that appear white against the black background. When a red compensator is added and
the crystals are aligned with the slow vibration, they appear yellow against the red background.
These crystals are:
A. Monosodium urate showing positive birefringence
B. Monosodium urate showing negative birefringence
C. Calcium pyrophosphate showing positive birefringence
D. Calcium pyrophosphate showing negative birefringence
ANS: B
DIF: Level 2
OBJ: 12-8
24. Crystals that appear to be rhombic-shaped and are blue when aligned with the slow vibration
of red compensated polarized light are:
A. Monosodium urate
C. Hydroxyapatite
D. Corticosteroid
ANS: B
DIF: Level 2
OBJ: 12-8
25. What test would not be affected with delayed analysis of synovial fluid?
A. Mucin clot test
B. Glucose
C. Crystal examination
D. WBC count
ANS: A
DIF: Level 2
OBJ: 12-5
TOP: Viscosity
26. The presence of neutrophils containing dark granules in the synovial fluid is associated with:
A. Reiter syndrome
B. Pigmented villonodular synovitis
C. Rheumatoid arthritis
D. Crush injuries
ANS: C
DIF: Level 2
OBJ: 12-11
TOP: Differential counts
27. Crystals frequently seen in patients’ joints with chronic inflammation are:
A. Monosodium urate
B. Cholesterol
C. Calcium pyrophosphate
D. Calcium oxalate
ANS: B
DIF: Level 2
OBJ: 12-6
28. In addition to routine culture media, synovial fluid cultures should include:
A. Anaerobic media
B. Cystine dextrose agar
C. Chocolate agar
D. Löwenstein-Jenson agar
ANS: C
DIF: Level 2
OBJ: 12-10
TOP: Microbiological tests
29. Which disease is not considered a joint disorder?

A. Lyme disease
B. Tuberculosis
C. Lupus erythematosus
D. Rheumatoid arthritis
ANS: B
DIF: Level 2
OBJ: 12-10
30. A synovial fluid with a normal WBC count from a patient with a normal serum uric acid
contains extracellular birefringent crystals under polarized light. A possible reason for this
finding is that the:
A. Specimen was anticoagulated with heparin
B. Patient has septic arthritis
C. Patient has gout
D. Specimen was collected in powdered EDTA
ANS: D
DIF: Level 3
OBJ: 12-4
31. Crystals seen in the synovial fluid from a patient previously diagnosed with gout exhibit
positive birefringence when observed under red compensated polarized light. The most probable
cause of this discrepancy is:
A. Failure to use a blue compensator
B. Aligning the crystals parallel to the slow vibration
C. Aligning the crystals perpendicular to the slow vibration
D. The crystals are artifacts
ANS: C
DIF: Level 3
OBJ: 12-8
32. Vacuolated macrophages containing ingested neutrophils are called:

A. Ragocytes
B. Rice bodies
C. Reiter’s cells
D. LE cells
ANS: C
DIF: Level 1
OBJ: 12-6
TOP: Analysis
33. Fat droplets seen in synovial fluid are associated with:

A. Crush injuries
B. Rheumatoid arthritis
C. Sepsis
D. Gout
ANS: D
DIF: Level 2
OBJ: 12-6
TOP: Analysis
34. Synovial fluid crystals seen in patients undergoing renal dialysis most commonly are:
A. Monosodium urate
B. Cholesterol
C. Calcium oxalate
D. Calcium pyrophosphate
ANS: C
DIF: Level 2
OBJ: 12-7
TOP: Analysis
True/False
35. Synovial fluid viscosity is caused by the presence of filtered serum proteins.
ANS: False
DIF: Level 1
OBJ: 12-1
TOP: Physiology
36. The polymerization of hyaluronic acid is decreased when arthritis is present.
ANS: True
DIF: Level 1
OBJ: 12-1
TOP: Physiology
37. Monosodium urate crystals may be present in synovial fluid from patients receiving
chemotherapy for leukemia.
ANS: True
DIF: Level 2
OBJ: 12-8
38. Automated cell counters should not be used for synovial fluid cell counts.
ANS: False
DIF: Level 1
OBJ: 12-3
TOP: Cell counts
39. The predominant cell in normal synovial fluid is the lymphocyte.

ANS: False
DIF: Level 1
OBJ: 12-6
TOP: Differential
40. Monosodium urate crystals are found both extracellularly and intracellularly.
ANS: True
DIF: Level 1
OBJ: 12-8
41. Red compensated polarized microscopy separates light into slow and fast rays.
ANS: True
DIF: Level 1
OBJ: 12-8
42. Synovial fluid should be routinely cultured for the presence of Borrelia burgdorferi.
ANS: False
DIF: Level 2
OBJ: 12-10
43. Normal synovial fluid glucose values are 60% to 70% of the blood glucose.
ANS: False
DIF: Level 2
OBJ: 12-9
44. Fat droplets are seen in chronic inflammation.
ANS: True
DIF: Level 1
OBJ: 12-6
TOP: Analysis
45. Synovial fluid is collected by the procedure called arthrocentesis.
ANS: True
DIF: Level 1
OBJ: 12-4
TOP: Collection
Case Study 1
An arthrocentesis was performed from the elbow of a 40-year-old tennis player. Three tubes of
blood-streaked synovial fluid were delivered to the laboratory with a request for a WBC count,
differential, crystal analysis, glucose, and Gram stain.
1. Based on the information provided, what is the significance of the blood-streaked fluid?
A. Elbow trauma
B. Infection
C. Traumatic collection
D. Membrane damage
ANS: C
DIF: Level 3
OBJ: 12-5
TOP: Analysis case study
2. Based on the information provided, what type of diluting fluid should be used for the WBC
count?
A. Hypotonic saline
B. Methylene blue
C. Glacial acetic acid
D. Normal saline
ANS: A
DIF: Level 3
OBJ: 12-6
3. Based on the laboratory results listed: WBC count = 1,000/µL, the differential has 80%
mononuclear cells and 20% neutrophils, the glucose is normal, and Gram stain is negative. What
classification of joint disorders is indicated?
A. Noninflammatory
B. Inflammatory/crystal-induced
C. Septic
D. Hemorrhagic
ANS: A
DIF: Level 3
OBJ: 12-2
Case Study 2
An arthrocentesis was performed from the knee of a 60-year-old man who has been experiencing
episodes of severe pain for several years. The fluid has the following results:
Appearance: Yellow, slightly milky Glucose: 60 mg/dL (blood glucose: 90 mg/dL)

WBC count: 60,000/L Gram stain: Negative
Differential: Neutrophils
Intracellular and extracellular rhombic-shaped
crystals seen
1. Based on the information provided, what classification of arthritis is indicated by these

results?
A. Noninflammatory
B. Inflammatory/crystal-induced
C. Septic
D. Hemorrhagic
ANS: B
DIF: Level 3
OBJ: 12-2
2. Based on the information provided, what crystals are most probably present?
A. Monosodium urate
C. Calcium oxalate
D. Corticosteroid
ANS: B
DIF: Level 3
OBJ: 12-8
3. Based on the information provided, when aligned with the slow vibration of red compensated
polarized light, what is the most probable color of the crystals?
A. White
B. Yellow
C. Blue
D. Red
ANS: C
DIF: Level 3
OBJ: 12-8
4. Based on the information provided, what is the most probable diagnosis?

A. Infection
B. Inflammation
C. Gout
D. Pseudogout
ANS: D
NAR: 11-nar-02
DIF: Level 3
OBJ: 12-8
5. Based on the information provided, does this patient have a metabolic or degenerative
disorder?
A. Metabolic
B. Degenerative
ANS: B
DIF: Level 3
OBJ: 12-8
Chapter 13: Serous Fluid
Multiple Choice
1. Peritoneal lavage is performed to:

A. Remove ascitic fluid
B. Check for the presence of bile
C. Detect intraabdominal bleeding
D. Provide a sufficient volume of fluid for chemical analysis
ANS: C
DIF: Level 1
OBJ: 13-2
TOP: Formation
2. Exudate fluids usually result from:

A. Cardiac insufficiency
B. Inflammation of the serous membrane
C. Abnormal electrolyte balance
D. Lack of protein in the diet
ANS: B
DIF: Level 1
OBJ: 13-3sce
TOP: Formation
3. The pathological accumulation of fluid in a body cavity is termed a/an:

A. Transudate
B. Abscess
C. Exudate
D. Effusion
ANS: D
DIF: Level 1
OBJ: 13-2
TOP: Formation
4. Which of the following is most often associated with the formation of a transudate?
A. Malignancy
B. Congestive heart failure
C. Pancreatitis
D. Peritonitis
ANS: B
DIF: Level 1
OBJ: 13-3
TOP: Formation
5. The cells lining the pleural cavities are primarily:

A. Neutrophils
B. Mesothelial cells
C. Lymphocytes
D. Spindle-shaped cells
ANS: B
DIF: Level 1
OBJ: 13-7
TOP: Formation
6. The function of serous fluid is to:

A. Provide nutrients to the serous membranes
B. Protect organs from trauma
C. Provide lubrication for the serous membranes
D. Remove excess fluid from body cavities
ANS: C
DIF: Level 1
OBJ: 13-1
TOP: Formation
7. What does not control the production of serous fluid?

A. Lymphatic secretions
B. Hydrostatic pressure
C. Oncotic pressure
D. Capillary permeability
ANS: A
DIF: Level 1
OBJ: 13-1
TOP: Formation
8. Peritoneal fluid is collected by a procedure called:

A. Thoracentesis
B. Asciticentesis
C. Paracentesis
D. Abdominalcentesis
ANS: C
DIF: Level 1
OBJ: 13-2
9. Which is not considered a serous fluid effusion?

A. Congestive heart failure
B. Lymphatic obstruction
C. Increased capillary permeability
D. Dehydration
ANS: D
DIF: Level 2
OBJ: 13-2
TOP: Formation
10. A pleural fluid delivered to the laboratory on ice would be accompanied by a requisition
form to test for:
A. Glucose
B. pH
C. Lactic dehydrogenase
D. Alkaline phosphatase
ANS: B
DIF: Level 1
OBJ: 13-3
11. Pleural fluid can be better classified as to transudative or exudative origin by performing a:
A. Fluid-to-serum cholesterol ratio
B. Fluid-to-serum lactate dehydrogenase (LD) ratio
C. Fluid-to-serum ketone ratio
D. Fluid-to-serum gamma-glutamyltransferase ratio
ANS: A
DIF: Level 1
OBJ: 13-3
TOP: Transudates and exudates
12. A decrease in the number of mesothelial cells seen on a pleural fluid differential indicates:
A. Malignancy
B. Tuberculosis
C. Pneumonia
D. Lupus erythematosus
ANS: B
DIF: Level 1
OBJ: 13-7
TOP: Pleural fluid hematology tests
13. Which is not a characteristic of malignant cells?

A. Hyperchromatic nucleoli
B. Cytoplasmic molding
C. Cellular clumping
D. Abnormal nuclear-to-cytoplasm ratios
ANS: C
DIF: Level 1
OBJ: 13-7
14. Which disorder will not have an elevated pleural fluid amylase?
A. Pancreatitis
B. Esophageal rupture
C. Tuberculosis
D. Malignancy
ANS: C
DIF: Level 1
OBJ: 13-3
15. A blood-streaked pericardial exudate with an increased amount of neutrophils is indicative

of:
A. Bacterial endocarditis
B. Cardiac puncture
C. Tuberculosis
D. Misuse of anticoagulant medication
ANS: A
DIF: Level 1
OBJ: 13-3
TOP: Pericardial fluid
16. Structures seen in peritoneal fluid that may be associated with either benign or malignant
conditions are:
A. Reactive mesothelial cells
B. Lipophages
C. Psammoma bodies
D. Macrophages
ANS: C
DIF: Level 1
OBJ: 13-7
17. A fluid obtained by thoracentesis has a cholesterol result of 100 mg/dL. This would be
classified as a/an:
A. Ascitic exudate
B. Ascitic transudate
C. Pleural exudate
D. Pleural transudate
ANS: C
DIF: Level 2
OBJ: 13-3
18. Differentiation between a hemothorax and a hemorrhagic effusion on a bloody pleural fluid
is done by:
A. Observing the fluid for streaks of blood, because this indicates a hemothorax
B. Performing a hematocrit value, because a hemothorax will give a value close to that of blood
C. Performing a red blood cell (RBC) count, because a hemorrhagic effusion will have a count
over 100,000/L
D. Performing both RBC and white blood cell (WBC) counts, because a hemothorax will have
marked elevations of both cell types
ANS: B
DIF: Level 2
OBJ: 13-4
19. A pleural fluid pH of less than 6.0 is indicative of:

A. Tuberculosis
B. Malignancy
C. Pancreatic disorders
D. Esophageal rupture
ANS: D
DIF: Level 2
OBJ: 13-4
TOP: Pleural fluid chemistry tests
20. Requests for amylase and alkaline phosphatase determinations on ascitic fluid are received in
suspected cases of:
A. Peritonitis
B. Gastrointestinal perforations
C. Ruptured bladder
D. Malignancy
ANS: B
DIF: Level 2
OBJ: 13-8
TOP: Pleural fluid chemistry tests
21. Which statement best describes a pleural fluid as an exudate rather than a transudate?
A. Fluid-to-serum LD ratio is less than 0.6.
B. Fluid-to-serum protein ratio is less than 0.5.
C. WBC count is greater than 1,000.
D. Fluid-to-serum cholesterol ratio is greater than 0.3.
ANS: D
DIF: Level 2
OBJ: 13-3
22. Which of the following tests is valuable in the diagnosis of esophageal rupture?
A. Pleural fluid pH
B. Ascitic fluid pH
C. Pleural fluid amylase
D. Ascitic fluid amylase
ANS: A
DIF: Level 2
OBJ: 13-8
23. Which of the following sets of results most closely indicates an exudate?
A. Clear, fluid-to-serum LD ratio: 0.5; fluid-to-serum protein ratio: 0.5; WBC count: 900/µL
B. Cloudy, fluid-to-serum LD ratio: 0.5; fluid-to-serum protein ratio: 0.4; WBC count: 1,200/µL
C. Cloudy, fluid-to-serum LD ratio: 0.8; fluid-to-serum protein ratio: 0.7; WBC count: 2,500/µL
D. Clear, fluid-to-serum LD ratio: 0.55; fluid-to-serum protein ratio: 0.55; WBC count: 1,000/µL
ANS: C
DIF: Level 2
OBJ: 13-3
24. A milky pleural fluid that stains strongly positive with Sudan III indicates:
A. Thoracic duct leakage
C. Malignancy
D. Chronic inflammation
ANS: A
DIF: Level 2
OBJ: 13-5
25. A milky, green-tinged pleural fluid:

A. Contains primarily lymphocytes
B. Does not contain cholesterol crystals
C. Is indicative of lymphatic drainage
D. Stains weakly with Sudan III
ANS: D
DIF: Level 2
OBJ: 13-5
26. A pericardial exudate from a patient diagnosed with AIDS might be tested with:
A. An India ink preparation
B. An acid-fast stain
C. A Gram stain
D. An immunofixation electrophoresis
ANS: B
DIF: Level 2
OBJ: 13-9
TOP: Microbiological and serological tests
27. Differentiation between an ascitic fluid transudate and exudate is most accurately made using
the:
A. Fluid-to-serum bilirubin ratio
B. Serum-ascites albumin gradient
C. Absolute neutrophil count
D. Fluid-to-serum albumin ratio
ANS: B
DIF: Level 2
OBJ: 13-3
28. The test performed on peritoneal lavage fluid is the:
A. RBC count
B. WBC count
C. Amylase
D. Carcinoembryonic antigen (CEA)
ANS: A
DIF: Level 2
OBJ: 13-10
TOP: Hematology tests
29. An ascitic fluid absolute neutrophil count of 1,000/µL is most indicative of:
A. Cirrhosis
B. Malignancy
C. Bacterial peritonitis
D. Blunt trauma injury
ANS: C
DIF: Level 2
OBJ: 13-6
TOP: Cellular examination
30. A screening test performed on a cloudy, green ascitic fluid would be a/an:
A. Clinitest
B. Albumin
C. Reagent strip nitrite
D. Ictotest
ANS: D
DIF: Level 2
OBJ: 13-12
31. A peritoneal fluid with a positive CEA and a negative CA 125 (cancer antigen) indicates:
A. Gastrointestinal malignancy
B. Ovarian malignancy
C. Tubercular peritonitis
D. Gastrointestinal perforation
ANS: A
DIF: Level 2
OBJ: 13-13
32. What is the significance of an ascitic fluid exudate with a positive CA 125 and a negative
CEA?
A. Gastrointestinal malignancy
B. No significance
C. Tuberculosis
D. Ovarian malignancy
ANS: D
DIF: Level 3
OBJ: 13-13
33. What is the significance of a peritoneal fluid with an elevated creatinine level?
A. Renal malignancy
C. Ruptured bladder
D. No significance
ANS: C
DIF: Level 3
OBJ: 13-8
34. What is the significance of a pleural fluid with a hematocrit value of 30% (blood hematocrit:
34%)?
A. Hemothorax
B. Pneumonia
C. Esophageal rupture
D. Mesothelioma
ANS: A
DIF: Level 3
OBJ: 13-4
35. Which does not cause serous fluid to increase?
A. Lymphatic obstruction
B. Inflammation
C. Increased plasma sodium
D. Increased hydrostatic pressure
ANS: C
DIF: Level 2
OBJ: 13-2
TOP: Formation
36. The finding of a mesothelioma cell in pericardial fluid is indicative of:

A. Primary malignancy
B. Misuse of anticoagulants
C. Endocarditis
D. Metastatic malignancy
ANS: D
DIF: Level 1
OBJ: 13-7
True/False
37. Normal values for chemistry tests on serous fluid are different from values obtained on
serum.
ANS: False
DIF: Level 1
OBJ: 13-8
TOP: Formation
38. Transudate serous fluid effusions are a complication of the nephrotic syndrome.
ANS: True
DIF: Level 2
OBJ: 13-3
TOP: Formation
39. Additional testing is most frequently performed on transudates rather than exudates.
ANS: False
DIF: Level 1
OBJ: 13-3
TOP: Transudates and exudates
40. A significant finding in a serous effusion is an increase in mesothelial cells.
ANS: False
DIF: Level 1
OBJ: 13- 6
41. Reactive mesothelial cells indicate a malignant effusion.
ANS: False
DIF: Level 1
OBJ: 13-7
42. Pleural fluid amylase is elevated in cases of pancreatitis.
ANS: True
DIF: Level 1
OBJ: 13-8
43. Ascitic fluid WBC counts are elevated in peritonitis and decreased in cirrhosis.
ANS: False
DIF: Level 1
OBJ: 13-6
44. Cultures of peritoneal fluid should be routinely incubated both aerobically and anaerobically.
ANS: True
DIF: Level 1
OBJ: 13-10
TOP: Microbiological and serological tests
45. Serous fluid exudates may contain malignant cells of either primary or metastatic origin.
ANS: True
DIF: Level 1
OBJ: 13-7
Case Study 1
Ascitic fluid from a patient with symptoms of severe abdominal pain has an elevated amylase
and alkaline phosphatase, a WBC count of 30,000/µL, an absolute neutrophil count of 80%, and
albumin of 3.5 mg/dL (serum albumin: 4.0 mg/dL).
1. Based on the information provided, calculate the serum-ascites albumin gradient.

A. 0.5
B. 0.5
C. 1.1
D. 7.5
ANS: A
DIF: Level 2
OBJ: 13-11
2. Based on the information provided, is this fluid a transudate or an exudate?

A. Transudate
B. Exudate
ANS: B
DIF: Level 2
OBJ: 13-3
3. Based on the information provided, what disorder is suggested by these results?

A. Cirrhosis
B. Ovarian malignancy
C. Peritonitis
D. Malnutrition
ANS: C
DIF: Level 3
OBJ: 13-6
4. What is the probable cause of the patient’s disorder?

A. Alcoholism
C. Intestinal perforation
D. Bile duct obstruction
ANS: C
DIF: Level 3
OBJ: 13-1
Case Study 2
Pericardial fluid from a patient with nephrotic syndrome appears pale yellow. The fluid-to-LD
ratio is 3.0, the fluid-to-protein ratio is 0.3, and the WBC count is 500/L.

A. Transudate
B. Exudate
ANS: A
DIF: Level 2
OBJ: 13-3
2. Based on the information provided, what complication of nephrotic syndrome is causing this
effusion?
A. Renal failure
B. Hypoalbuminism
C. Hyperalbuminism
D. Increased cholesterol
ANS: B
DIF: Level 3
OBJ: 13-8
Case Study 3
A blood-streaked pleural fluid has a fluid-to-serum cholesterol ratio of 0.45, a WBC count of
20,000/µL, increased neutrophils, glucose: 40 mg/dL (serum 100 mg/dL), and a pH of 6.8.

A. Transudate
B. Exudate
ANS: B
DIF: Level 2
OBJ: 13-3
2. Based on the information given, what is the most probable cause of the effusion?
A. Pneumonia
B. Hemothorax
C. Malignancy
D. Congestive heart failure
ANS: A
DIF: Level 3
OBJ: 13-8
3. Based on the information provided, what is the significance of the pH result?
A. No significance
C. Pancreatitis
D. Need for chest tubes
ANS: D
DIF: Level 3
OBJ: 13-8
Chapter 14: Bronchoalveolar Lavage Fluid
Multiple Choice
1. Which of the following is the most likely reason a physician would collect BAL?
A. Pancreatitis
B. Ulcers
C. Cirrhosis
D. Lung disease
ANS: D
DIF: Level 1
OBJ: 14-1
TOP: Indication
2. Which bronchopulmonary segment is usually the choice of location for a bronchoalveolar

lavage?
A. Right lower
B. Right middle
C. Left lower
D. Left middle
ANS: B
DIF: Level 1
OBJ: 14-2
TOP: Procedure
3. What is the instillation volume for cellular examination and culture?

A. 50 to 100 mL in 10 to 20 aliquots of sterile saline
B. 100 to 200 mL in 10 to 20 aliquots of sterile saline
C. 100 to 300 mL in 20 to 50 aliquots of sterile saline
D. 200 to 400 mL in 20 to 50 aliquots of sterile saline
ANS: C
DIF: Level 1
OBJ: 14-2
TOP: Procedure
4. How should BAL specimens be transported to the laboratory for analysis?
A. Body temperature
B. Cold on ice
C. Room temperature
D. Freeze immediately
ANS: C
DIF: Level 1
OBJ: 14-3
5. If specimens can to be analyzed immediately they should be:

A. Centrifuged, resuspended, and left at room temperature for testing
B Refrigerated at 4C, then brought to room temperature for testing
C. Frozen, thawed at room temperature, and resuspended before testing
D. Centrifuged, resuspended in a nutrient-supplemented media for testing
ANS: D
DIF: Level 1
OBJ: 14-3
6. What color BAL fluid would a heavy smoker have?

A. White
B. Gray
C. Brown
D. Black
ANS: B
DIF: Level 1
OBJ: 14-4
TOP: Appearance
7. A milky or light brown-beige–colored BAL fluid indicates a/an:

A. Pulmonary alveolar proteinosis
B. Alveolar hemorrhage
C. Airway disease
D. Infectious lung disease
ANS: A
DIF: Level 1
OBJ: 14-4
TOP: Appearance
8. What is the most prominent cell type seen in BAL?

A. Neutrophils
B. Lymphocytes
C. Macrophages
D. Eosinophils
ANS: C
DIF: Level 1
OBJ: 14-5
TOP: Cellularity
9. An increase in neutrophils in BAL indicates:

A. Hypersensitivity pneumonitis
B. Aspiration pneumonia
C. Granulomatous lung disease
D. Alveolar hemorrhage
ANS: B
DIF: Level 2
OBJ: 14-5
TOP: Cellularity
10. The presence of red blood cells indicates:

B. Aspiration pneumonia
C. Granulomatous lung disease
D. Alveolar hemorrhage
ANS: D
DIF: Level 2
OBJ: 14-5
TOP: Cellularity
True/False
11. BAL is useful for immunocompromised patients.
ANS: True
DIF: Level 1
OBJ: 14-1
TOP: Indication
12. Oil Red O stain is indicated for lipid-laden alveolar macrophages.
ANS: False
DIF: Level 1
OBJ: 14-5
TOP: Cellularity
13. BAL body fluids may not be counted on the Sysmex instrumentation because of the varied
types of cells present.
ANS: True
DIF: Level 1
OBJ: 14-5
TOP: Cellularity
14. Tuberculosis is associated with a high CD4/CD8 T cell ratio.
ANS: False
DIF: Level 1
OBJ: 14-5
TOP: Cellularity
15. Newer molecular techniques have allowed for a rapid diagnosis of organisms in BAL fluid.
ANS: True
DIF: Level 1
OBJ: 14-5
TOP: Cellularity
Case Study
A construction worker who renovates old buildings is seen by his physician. His concerns are
fatigue, shortness of breath, a persistent cough, and moderate chest pain. He has had some
weight loss also. His physician ordered a battery of tests and a bronchoalveolar lavage. The
laboratory findings were reported as follows: color gray, clarity slight hazy. The differential
reported an increase in neutrophils and columnar bronchial epithelial cells.
1. What other cell type would also be present in large numbers?

A. Lymphocyte
B. Macrophage
C. Eosinophil
D. Squamous
ANS: B
DIF: Level 2
OBJ: 14-5
TOP: Cellularity
2. The report also noted that inclusions were seen. Using the case history, what type of inclusion
would you expect?
A. Hemosiderin
B. Foamy vacuoles
C. Dust-like particles
D. Gold particles
ANS: C
DIF: Level 2
OBJ: 14-5
TOP: Cellularity
3. A CD4/CD8 T-cell ratio was also ordered. What would you expect the result to be?
A. Normal
B. High
C. Low
ANS: B
DIF: Level 1
OBJ: 14-5
TOP: Cellularity
4. What disorder is the patient exhibiting?

B. Interstitial pneumonia
C. Alveolar hemorrhage
D. Asbestos toxicity
ANS: D
DIF: Level 2
OBJ: 14-1
TOP: Indication
Chapter 15: Amniotic Fluid
Multiple Choice
1. Which is an example that does not form amniotic fluid?

A. Fetal urine
B. Fetal cell metabolism
C. Fetal swallowing
D. Transfer of water across the placenta
ANS: C
DIF: Level 1
OBJ: 15-2
TOP: Physiology
2. A dark green amniotic fluid is associated with:

A. Meconium
B. Infection
C. Fetal death
D. Oxidized bilirubin
ANS: A
DIF: Level 1
OBJ: 15-2
TOP: Color and appearance
3. A primary function of amniotic fluid is to:

A. Provide nourishment to the fetus
B. Provide protection for the fetus
C. Remove waste products from the fetus
D. Facilitate oxygen and carbon dioxide exchange
ANS: B
DIF: Level 1
OBJ: 15-1
TOP: Function
4. The volume of amniotic fluid increases after the first trimester as a result of:
A. Increased maternal blood flow to the fetus
B. Diffusion of interstitial fluid
C. Production of fetal urine
D. Increased fetal swallowing
ANS: C
DIF: Level 1
OBJ: 15-2
TOP: Volume
5. Amniotic fluid for fetal lung maturity testing should be preserved:

A. In the refrigerator
B. At room temperature
C. In a dark container
D. At 37C
ANS: A
DIF: Level 1
OBJ: 15-5
TOP: Specimen handling and processing
6. A dark yellow amniotic fluid is caused by:

A. Meconium
B. Bilirubin
C. Phospholipids
D. Urine
ANS: B
DIF: Level 1
OBJ: 15-5
TOP: Color and appearance
7. Measurement of amniotic fluid creatinine levels can be used to:

A. Determine approximate fetal weight
B. Diagnose hydramnios
C. Differentiate between amniotic fluid and maternal urine
D. Differentiate between maternal and fetal urine
ANS: C
DIF: Level 2
OBJ:15-3
TOP: Physiology
8. Failure of the fetus to begin swallowing will result in:

A. Oligohydramnios
B. A positive fern test
C. Polyhydramnios
D. Umbilical cord compression
ANS: C
DIF: Level 1
OBJ: 15-2
TOP: Physiology
9. To differentiate between maternal and fetal blood in blood-streaked amniotic fluid, the fluid is
tested for:
A. Maternal hemoglobin
B. Fetal hemoglobin
C. Maternal plasma
D. Fetal bilirubin
ANS: B
DIF: Level 2
OBJ: 15-5
TOP: Physiology
10. The presence of a fetal neural tube disorder may be detected by:
A. Increased amniotic fluid bilirubin
B. Increased maternal serum alpha fetoprotein
C. Decreased amniotic fluid phosphatidyl glycerol
D. Decreased maternal serum acetylcholinesterase
ANS: B
DIF: Level 1
OBJ: 15-8
TOP: Tests for fetal distress
11. An increased level of alpha fetoprotein in amniotic fluid should be further tested for:
A. Bilirubin
B. Abnormal chromosomes
C. Acetylcholinesterase
D. Phosphatidyl glycerol
ANS: C
DIF: Level 1
OBJ: 15-8
12. Hemolytic disease of the fetus and newborn is caused by:

A. Abnormal maternal hemoglobins
B. Abnormal fetal hemoglobins
C. Maternal antibodies
D. Fetal antibodies
ANS: C
DIF: Level 1
OBJ: 15-6
TOP: Hemolytic disease of the fetus and newborn
13. Analysis of amniotic fluid bilirubin levels is performed using:

A. Fluorescence polarization
B. Spectrophotometry
C. Thin-layer chromatography
D. Immunoassay
ANS: B
DIF: Level 1
OBJ: 15-5
14. Alpha fetoprotein is produced by the fetal:

A. Spinal cord
B. Kidneys
C. Bone marrow
D. Liver
ANS: D
DIF: Level 1
OBJ: 15-8
TOP: Neural tube defects
15. An amniocentesis is performed on a woman whose last two pregnancies have resulted in
stillbirths due to hemolytic disease of the fetus and newborn. A screening test performed at the
hospital is positive for bilirubin, and the specimen is sent to a reference laboratory for a bilirubin
scan. Doctors are concerned when the report comes back negative, and they question if the:
A. Correct specimen was sent
B. Specimen was refrigerated
C. Specimen was exposed to light
D. Specimen reached the reference laboratory within 30 minutes
ANS: C
DIF: Level 2
OBJ: 15-5
TOP: Specimen handling and processing
16. The purpose of plotting amniotic fluid bilirubin on a Liley graph is to:
A. Detect possible fluid contamination
B. Detect exposure to light
C. Determine the optical density difference
D. Determine further treatment
ANS: D
DIF: Level 2
OBJ: 15-7
17. Hemolytic disease of the fetus and newborn endangers the fetus by:
A. Delaying production of red blood cells (RBCs)
B. Affecting liver function
C. Destroying fetal bone marrow
D. Destroying fetal RBCs
ANS: D
DIF: Level 2
OBJ: 15-6
18. The A450 of an amniotic fluid is plotted in zone 3 of a Liley graph. The physician should:
A. Repeat the testing in 3 weeks
B. Immediately induce labor
C. Request testing for fetal lung maturity
D. Tell the mother that the pregnancy is normal
ANS: C
DIF: Level 2
OBJ: 15-7
19. Interference with the amniotic fluid bilirubin analysis on centrifuged fluid is most likely
caused by:
A. Fetal cells
B. Oxyhemoglobin
C. Albumin
D. Creatinine
ANS: B
DIF: Level 2
OBJ: 15-5
20. Which of the following alpha fetoprotein results would be of concern?

A. 3.0 MoM in amniotic fluid
B. 4.0 mg/dL in amniotic fluid
C. 1.0 MoM in maternal serum
D. 2.0 mg/dL in maternal serum
ANS: A
DIF: Level 2
OBJ: 15-8
TOP: Neural tube defects
21. The foam, or shake, test is a screening test for amniotic fluid:
A. Bilirubin
B. Surfactants
C. Alpha fetoprotein
ANS: B
DIF: Level 1
OBJ: 15-12
TOP: Foam stability index
22. In the determination of fetal lung maturity, which of the following components is produced
by the body at the 35th week of gestation?
A. Lecithin
B. Phosphatidyl glycerol
C. Lamellar body
D. Acetylcholinesterase
ANS: B
DIF: Level 1
OBJ: 15-9
TOP: Fetal lung maturity
23. Amniotic fluid tests for determining fetal lung maturity include:
A. Bilirubin and urea
B. Bilirubin and lecithin/sphingomyelin (L/S) ratio
C. L/S ratio and lamellar bodies
D. Creatinine and urea
ANS: C
DIF: Level 1
OBJ: 15-10
TOP: Lamellar bodies
24. Decreased levels of phosphatidyl glycerol in amniotic fluid can be associated with:
A. Hemolytic disease of the fetus and newborn
B. Toxemia of pregnancy
C. Hyaline membrane disorder SS
D. Intrauterine death
ANS: C
DIF: Level 1
OBJ: 15-10
25. The test for amniotic fluid lamellar bodies uses which of following?
A. Fluorescence
B. Polarizing microscopy
C. A spectrophotometer
D. An automated cell counter
ANS: D
DIF: Level 1
OBJ: 15-11
26. The Amniostat agglutination test is performed on amniotic fluid from pregnant women to
detect the presence of:
A. Lecithin
B. Phosphatidyl glycerol
C. Sphingomyelin
D. Creatinine
ANS: B
DIF: Level 1
OBJ: 15-12
27. The most frequent concern of premature delivery is underdevelopment of the:

A. Liver
B. Kidneys
C. Nervous system
D. Lungs
ANS: D
DIF: Level 1
OBJ: 154
28. The principle of the shake test and foam stability index is that phospholipids:
A. Reduce the surface tension of an alcoholic solution
B. Increase the surface tension of an alcoholic solution
C. Release carbon dioxide in an alcoholic solution
D. Release carbon dioxide when agitated
ANS: A
DIF: Level 1
OBJ: 15-12
TOP: Foam stability index
29. Lamellar bodies contain:

A. Albumin
B. Amniotic fluid
C. Phospholipids
D. Pneumocytes
ANS: C
DIF: Level 1
OBJ: 15-11
TOP: Lamellar bodies
30. When an L/S ratio by thin-layer chromatography is performed, a mature fetal lung will show:
A. Sphingomyelin twice as concentrated as lecithin
B. No sphingomyelin
C. Lecithin twice as concentrated as sphingomyelin
D. Equal concentrations of lecithin and sphingomyelin
ANS: C
DIF: Level 2
OBJ: 15-9
31. The method of choice for testing amniotic fluid contaminated with hemoglobin for fetal lung
maturity is:
A. Bilirubin levels
B. Amniostat
C. Thin-layer chromatography
D. Foam stability
ANS: B
DIF: Level 2
OBJ: 15-12
32. The test of choice for testing amniotic fluid from a diabetic patient for fetal lung maturity is
the:
A. Lamellar body count
B. L/S ratio
C. Foam stability index
D. Amniostat-FLM
ANS: D
DIF: Level 2
OBJ: 15-12
33. Which of the following fetal lung maturity test results correlate?
A. L/S ratio: 1.0, surfactant/albumin ratio: 80
B. L/S ratio: 2.5, foam stability index: 43
C. L/S ratio: 2.2, surfactant/albumin ratio: 75
D. L/S ratio: 1.5, foam stability index: 49
ANS: C
DIF: Level 2
OBJ: 15-9
34. An amniotic fluid optical density at 650 nm of 0.180 correlates with:

A. A lamellar body count over 32,000/L
B. A lack of phosphatidylglycerol
C. Hemoglobin contamination in the specimen
D. An L/S ratio of 1.5
ANS: A
DIF: Level 2
OBJ: 15-11
35. A fern test is performed to differentiate between:

A. Phosphatidyl glycerol and lecithin
B. Urine and amniotic fluid
C. Sphingomyelin and phosphatidyl glycerol
D. Lamellar bodies and meconium
ANS: B
DIF: Level 1
OBJ:15- 3
TOP: Physiology
True/False
36. The volume of amniotic fluid is regulated by fetal swallowing.
ANS: True
DIF: Level 1
OBJ: 15-2
TOP: Physiology
37. Amniotic fluid for cytogenetic analysis should be delivered to the laboratory in ice.
ANS: False
DIF: Level 1
OBJ: 15-5
TOP: Physiology
38. Meconium is composed of bowel constituents.
ANS: True
DIF: Level 1
OBJ: 15-2
TOP: Physiology
39. Acetylcholinesterase testing can be performed on amniotic fluid containing blood, if the
specimen is centrifuged.
ANS: False
DIF: Level 1
OBJ: 15-5
40. Production of both lecithin and sphingomyelin increases after 35 weeks’ gestation.
ANS: False
DIF: Level 1
OBJ: 15-9
41. Most laboratories detect the presence of phosphatidylglycerol using thin-layer

chromatography.
ANS: False
DIF: Level 1
OBJ: 15-10
42. When performing the foam stability index, amniotic fluid is mixed with ethanol.
ANS: True
DIF: Level 1
OBJ: 15-12
43. Pneumocytes in the fetal lungs produce lamellar bodies.
ANS: True
DIF: Level 1
OBJ: 15-11
44. Lamellar bodies are approximately the same size as red blood cells.
ANS: False
DIF: Level 1
OBJ: 15-11
Case Study 1
An amniocentesis is performed on a woman believed to be at approximately 15 weeks’ gestation.

A possible abnormality has been observed on her sonogram, and her serum alpha fetoprotein is
elevated.
1. Using the information provided, what type of fetal distress is suspected?

A. Hemolytic disease of the fetus and newborn
B. Polyhydramnios
C. Oligohydramnios
D. Neural tube disorder
ANS: D
DIF: Level 3
OBJ: 15-8
TOP: Fetal distress case study
2. Using the information provided, what is the normal value of amniotic fluid alpha fetoprotein?
A. 0.5 MoM
B. 1.0 MoM
C. 1.5 MoM
D. 2.0 MoM
ANS: D
DIF: Level 3
OBJ: 15-8
3. Using the information provided, define the units in which the alpha fetoprotein test is reported.
A. Multiples of median
B. Milliliters of median
C. Milliliters of maxim
D. Measurement of median
ANS: A
DIF: Level 3
OBJ: 15-8
4. Based on the information given, what additional test could be performed if the alpha
fetoprotein is elevated?
A. Phosphatidyl glycerol
B. Lamellar body
D. Optical density
ANS: C
DIF: Level 3
OBJ: 15-8
Case Study 2
A second amniocentesis is performed on a diabetic woman believed to be at approximately 35

weeks’ gestation. She is pregnant with her second child, and the bilirubin A450 on the first
amniocentesis was in zone 2 of the Liley graph.
1. Using the information provided, why was a second amniocentesis performed?

A. She is diabetic
B. To determine fetal antibodies
C. To monitor the bilirubin concentration
D. This is her second pregnancy
ANS: C
DIF: Level 3
OBJ: 15-5
2. Based on the information provided, if the bilirubin A450 is now in zone 3, what additional
testing should be performed?
A. Alpha fetoprotein
B. Lamellar bodies
C. Maternal antibody screen
D. Fern test
ANS: B
DIF: Level 3
OBJ: 15-5
3. Based on the information provided, should an L/S ratio or an Amniostat test be performed?
A. L/S ratio
B. Amniostat
ANS: B
DIF: Level 3
OBJ: 15-12
4. Based on the information provided, the presence of what substance is of particular concern
before inducing labor?
A. Lecithin
B. Sphingomyelin
ANS: D
DIF: Level 3
OBJ: 15-10
Chapter 16: Fecal Analysis
Multiple Choice
1. The normal brown color of the feces is produced by:

A. Undigested foodstuffs
B. Urobilin
C. Pancreatic enzymes
D. Cellulose
ANS: B
DIF: Level 1
OBJ: 16-1
TOP: Physiology
2. Stools from persons with steatorrhea contain excess amounts of:

A. Barium sulfate
B. Mucus
C. Blood
D. Fat
ANS: D
DIF: Level 1
OBJ: 16-1
TOP: Diarrhea and steatorrhea
3. Which of the following pairings of stool appearance and cause does not agree?
A. Black, tarry: blood
B. Yellow-green: barium sulfate
C. Pale, frothy: steatorrhea
D. Yellow-gray: bile duct obstruction
ANS: B
DIF: Level 1
OBJ: 16-11
4. A black, tarry looking stool is indicative of:
A. Upper gastrointestinal (GI) bleeding
B. Lower GI bleeding
C. Excess fat
D. Excess carbohydrates
ANS: A
DIF: Level 1
OBJ: 16-1
TOP: Macroscopic screening or color
5. A pale, frothy looking stool is indicative of:

A. Upper GI bleeding
B. Lower GI bleeding
C. Excess fat
D. Excess carbohydrates
ANS: C
DIF: Level 1
OBJ: 16-1
TOP: Macroscopic screening or color
6. Which of the following is not secreted into the small intestine by the pancreas?
A. Bile salts
B. Chymotrypsin
C. Lipase
D. Elastase 1
ANS: A
DIF: Level 1
OBJ: 16-1
TOP: Physiology
7. The recommended specimen for quantitative fecal testing is a:

A. Specimen collected after overnight fasting
B. 24-hour specimen
C. 72-hour specimen
D. Random specimen
ANS: C
DIF: Level 1
OBJ: 16-7
TOP: Specimen collection
8. The presence of amebic dysentery may be suspected when a stool:

A. Has a green color
B. Is coated with blood-streaked mucus
C. Has an extremely foul odor
D. Appears unusually slender
ANS: B
DIF: Level 1
OBJ: 16-9
9. The unpleasant odor associated with fecal analysis is caused primarily by:
A. Undigested foodstuffs
B. Bile salts
C. Bacterial metabolism
D. Pancreatic secretions
ANS: C
DIF: Level 1
OBJ: 16-9
10. Which of the following would not cause diarrhea?

A. Disruption of the normal intestinal bacterial flora
B. Addition of pathogenic organisms to the normal intestinal flora
C. Increased reabsorption of intestinal water and electrolytes
D. Increased concentration of fecal electrolytes
ANS: C
DIF: Level 2
OBJ: 16-3
11. Large orange-red droplets seen on direct microscopic examination of stools that have been
mixed with Sudan III stain can represent:
A. Fatty acids
B. Soaps
C. Neutral fats
D. Cholesterol
ANS: C
DIF: Level 1
OBJ: 16-12
TOP: Qualitative fecal fat testing
12. Microscopic examination of stools mixed with Sudan III stain, glacial acetic acid, and then
heated will show small orange-red droplets that represent:
A. Soaps
B. Fatty acids and soaps
C. Fatty acids and neutral fats
D. Fatty acids, soaps, and neutral fats
ANS: D
DIF: Level 1
OBJ: 16-12
TOP: Qualitative fecal fat testing
13. When performing microscopic examination of a stool for muscle fibers, the structures that
are counted:
A. Are coiled and stain red
B. Contain no visible striations
C. Have vertical and horizontal striations
D. Have horizontal striations and stain blue
ANS: C
DIF: Level 1
OBJ: 16-11
TOP: Muscle fibers
14. Crystals seen in a stool after it has been mixed with acetic acid, Sudan III stain, and heated
may be composed of:
A. Neutral fats
B. Fatty acids
C. Cholesterol
D. Fatty acid soaps
ANS: C
DIF: Level 1
OBJ: 16-12
TOP: Qualitative fecal fats
15. Wet preparations for the detection of fecal neutrophils are stained with:
A. Gram stain
B. Wright’s stain
C. Sudan III
D. Methylene blue
ANS: D
DIF: Level 1
OBJ: 16-10
TOP: Fecal leukocytes
16. Microscopic examination of stools for fecal cells provides preliminary information as to the
cause of diarrhea because:
A. Neutrophils are present in conditions caused by toxin-producing bacteria
B. Neutrophils are present in conditions that affect the intestinal wall
C. Red and white blood cells are present if the cause is malabsorption
D. Neutrophils are present if the condition is of nonbacterial etiology
ANS: B
DIF: Level 2
OBJ: 16-10
17. Increased neutrophils in a stool specimen may indicate that the patient has which of the
following?
A. Staphylococcal food poisoning
B. Pancreatic insufficiency
C. Lower GI bleeding
D. Salmonella infection
ANS: D
DIF: Level 2
OBJ: 16-10
18. A positive lactoferrin latex agglutination test can indicate which of the following?
A. Lower GI bleeding
B. Biliary obstruction
C. Cystic fibrosis
D. Enteroinvasive Escherichia coli
ANS: D
DIF: Level 2
OBJ: 16-10
19. The term occult blood in fecal analysis can indicate which of the following?
A. Blood that is produced in the lower GI tract
B. Blood that is produced in the upper GI tract
C. Blood that is not visibly apparent in the stool specimen
D. Blood that produces a black, tarry stool
ANS: C
DIF: Level 1
OBJ: 16-15
TOP: Chemical testing of feces
20. A negative trypsin test on a fecal specimen can indicate which of the following?
A. Pancreatic insufficiency
B. Lactose intolerance
C. Biliary obstruction
D. Duodenal ulcer
ANS: A
DIF: Level 1
OBJ: 16-17
TOP: Chemical testing of feces
21. To prevent false-positive fecal occult blood results, patients should be instructed to avoid
eating all of the following for 3 days before testing except:
A. Horseradish
B. Chicken
C. Melons
D. Red meat
ANS: B
DIF: Level 1
OBJ: 16-16
TOP: Occult blood
22. Before and during collection of a specimen for quantitative fecal fats, a patient should:
A. Consume 100 g of fat per day
B. Consume less than 10 g of fat per day
C. Increase usual fat intake by 20%
D. Maintain a soft or liquid diet
ANS: A
DIF: Level 1
OBJ: 16-14
TOP: Quantitative fecal fat testing
23. The coefficient of fat retention should be at least:

A. 50%
B. 75%
C. 95%
D. 100%
ANS: C
DIF: Level 1
OBJ: 16-14
24. The most sensitive fecal enzyme test for the diagnosis of pancreatic insufficiency measures:
A. Lipase
B. Trypsin
C. Elastase 1
D. Chymotrypsin
ANS: C
DIF: Level 1
OBJ: 16-17
TOP: Fecal enzymes
25. A bloody stool from a neonate should be emulsified in water, centrifuged, and the
supernatant tested with:
A. Clinitest
B. Guaiac reagent
C. Gelatin
D. NaOH
ANS: D
DIF: Level 1
OBJ: 16-17
TOP: Fetal hemoglobin
26. Tests for the detection of occult blood rely on which chemical reaction?
A. Reaction of hemoglobin with hydrogen peroxide
B. Pseudoperoxidase activity of hemoglobin
C. Reaction of hemoglobin with peroxidase
D. Pseudoperoxidase activity of hydrogen peroxide
ANS: B
DIF: Level 2
OBJ: 16-15
TOP: Guaiac-based fecal occult blood tests
27. In the Van de Kamer method for quantitative fecal fat determinations, fecal lipids are:
A. Homogenized and titrated to a neural end-point with sodium hydroxide
B. Measured gravimetrically after washing
C. Converted to fatty acids before titrating with sodium hydroxide
D. Measured by spectrophotometer after addition of Sudan III
ANS: C
DIF: Level 2
OBJ: 16-14
28. A patient whose stool exhibits increased fats, undigested muscle fibers, and the inability to
digest gelatin may have:
A. Lactose intolerance
B. Cystic fibrosis
C. A duodenal ulcer
D. A bacterial dysentery
ANS: B
DIF: Level 2
OBJ: 16-17
TOP: Qualitative fecal testing
29. A stool pH of 5.0 correlates with a:

A. Positive Apt test
B. Negative trypsin test
C. Positive Clinitest
D. Negative occult blood test
ANS: C
DIF: Level 2
OBJ: 16-17
TOP: Carbohydrates
30. A bloody stool produced by a newborn should:

A. Have an Apt test performed on it
B. Be tested with guaiac reagent
C. Be emulsified and tested for trypsin
D. Have a Clinitest performed on it
ANS: A
DIF: Level 2
OBJ: 16-17
TOP: APT test
31. False-negative results for upper GI bleeding can be caused by:

A. Degradation of hemoglobin to porphyrin
B. Ingestion of excessive red meat
C. Aspirin and nonsteroidal antiinflammatory agents
D. Ingestion of excessive folic acid
ANS: A
DIF: Level 2
OBJ: 16-16
TOP: Occult blood
32. When performing the Apt test, a pink color that remains in the supernatant during testing
indicates:
A. The presence of fetal hemoglobin
B. Denaturation of fetal hemoglobin
C. Denaturation of maternal hemoglobin
D. The presence of maternal hemoglobin
ANS: A
DIF: Level 2
OBJ: 16-17
TOP: APT test
33. Which of the following is not a test for quantitative fecal fat?
A. Van de Kamer
B. Lipocrit capillary test
C. Near-infrared reflectance spectrophotometry
D. Acid steatocrit test
ANS: B
DIF: Level 1
OBJ: 16-14
True/False
34. The electrolyte content of normal feces is similar to that of plasma.
ANS: True
DIF: Level 1
OBJ: 1
TOP: Physiology
35. Microbial infections produce osmotic diarrhea.

ANS: False
DIF: Level 1
OBJ: 16-3
36. A major mechanism to cause diarrhea is intestinal hypermotility.
ANS: True
DIF: Level 1
OBJ: 16-3
37. A stool that appears black and tarry may be associated with bismuth ingestion.
ANS: True
DIF: Level 2
OBJ: 16-8
TOP: Macroscopic appearance
38. The neutral fat and split fat stains are confirmatory tests for steatorrhea.
ANS: False
DIF: Level 1
OBJ: 16-6
39. Staphylococcal food poisoning produces secretory diarrhea and increased fecal neutrophils.
ANS: False
DIF: Level 2
OBJ: 16-3
TOP: Fecal neutrophils
40. The guaiac test detects both hemoglobin and porphyrin.

ANS: False
DIF: Level 1
OBJ: 16-15
TOP: Occult blood
41. The Apt test should not be performed on a black, tarry stool.
ANS: True
DIF: Level 1
OBJ: 16-17
TOP: APT test
42. The D-xylose and lactose tolerance tests are abnormal in persons with malabsorption or
maldigestion disorders.
ANS: True
DIF: Level 1
OBJ: 16-6
TOP: Carbohydrates
43. Steatorrhea is seen in association with decreased elastase 1 in the feces.
ANS: True
DIF: Level 2
OBJ: 16-5
44. Microscopic examination of feces for undigested muscle fibers can help diagnose pancreatic
insufficiency.
ANS: True
DIF: Level 1
OBJ: 16-11
TOP: Microscopic
45. The test for fetal hemoglobin is Elastase.

ANS: False
DIF: Level 1
OBJ: 16-17
TOP: Testing
Case Study 1
State whether or not the following scenarios should be of concern to a laboratory supervisor and
why:
1. An Apt test performed on a black, tarry stool is negative for fetal hemoglobin.
A. Concerned; the hemoglobin is already denatured
B. Not concerned; the black, tarry stool indicates the presence of blood
ANS: A
DIF: Level 3
OBJ: 16-17
TOP: APT test
2. In the evaluation of a stool specimen, the results were abnormal in the trypsin test and normal
in a chymotrypsin test.
A. Concerned; the trypsin test is more sensitive than the chymotrypsin test
B. Not concerned; chymotrypsin is more resistant to degradation
ANS: B
DIF: Level 3
OBJ: 16-17
TOP: Chemical analysis
3. Quantitative fecal fat testing performed on a patient maintained on a diet of 100 g of fat per
day is 5 g per day. The coefficient of fat retention is reported as normal.
A. Concerned; the normal coefficient of fat is 100%
B. Not concerned; 95% retention is normal
ANS: B
DIF: Level 3
OBJ: 16-14
4. An unusual number of positive occult blood tests are reported by a new employee in a satellite
clinic.
A. Concerned; patients may not be receiving dietary instructions
B. Not concerned; the employee has passed the competency test on performing the test
ANS: A
DIF: Level 3
OBJ: 16-16
TOP: Occult blood
5. A strongly positive stool Clinitest performed on an infant is accompanied by a stool pH of 8.0.

A. Concerned; a low pH coincides with a positive Clinitest
B. Not concerned; the result is strongly positive
ANS: A
DIF: Level 3
OBJ: 16-17
TOP: Carbohydrate tests
Case Study 2
State whether each of the following scenarios relates to osmotic diarrhea, secretory diarrhea, or
altered motility:
1. Shigella dysentery
A. Osmotic diarrhea
B. Secretory diarrhea
C. Altered motility
ANS: B
DIF: Level 2
OBJ: 16-3
2. Irritable bowel syndrome

A. Osmotic diarrhea
C. Altered motility
ANS: C
DIF: Level 2
OBJ: 16-3
3. Lactose intolerance
A. Osmotic diarrhea
C. Altered motility
ANS: A
DIF: Level 2
OBJ: 16-3
4. Gastrectomy
A. Osmotic diarrhea
C. Altered motility
ANS: C
DIF: Level 2
OBJ: 16-3
5. Malabsorption
A. Osmotic diarrhea
C. Altered motility
ANS: A
DIF: Level 2
OBJ: 16-3
6. Staphylococcal food poisoning

A. Osmotic diarrhea
C. Altered motility
ANS: B
DIF: Level 2
OBJ: 16-3
Case Study 3
Microscopic screening of a pale, frothy stool from a patient with prolonged diarrhea is performed
for fecal neutrophils, fats, and meat fibers. The fecal neutrophil examination result is negative,
increased large and small orange droplets are seen in the fat stains, and 10 unstriated muscle
fibers are observed.
1. Based on the information provided, what is the significance of the pale, frothy stool?
A. Biliary obstruction
B. Lactose intolerance
C. Malnutrition
D. Dumping syndrome
ANS: A
DIF: Level 3
OBJ: 16-8
TOP: Microscopic analysis case study
2. Based on the information provided, what type of diarrhea is suggested by these results?
A. Secretory
B. Rapid gastric emptying
C. Osmotic
D. Altered motility
ANS: C
DIF: Level 3
OBJ: 16-3
3. Based on the information provided, absence of what substance most likely accounts for the
increased orange droplets?
A. Elastase 1
B. Bile salts
C. Amylase
D. Trypsin
ANS: B
DIF: Level 3
OBJ: 16-13
4. Based on the information provided, what is the condition indicated by the increased orange
droplets?
A. Inflammation
C. Constipation
D. Steatorrhea
ANS: D
DIF: Level 3
OBJ: 16-5
5. Based on the information provided, how long should the slide for muscle fibers be examined?
A. 2 minutes
B. 5 minutes
C. 7 minutes
D. 10 minutes
ANS: B
DIF: Level 3
OBJ: 16-11
Chapter 17: Vaginal Secretions
Multiple Choice
1. Which of the following is the most likely reason a physician would collect vaginal fluid for
analysis?
A. Preeclampsia
B. Vaginitis
C. Pregnancy testing
D. As part of a police rape kit for sexual assault
ANS: B
DIF: Level 1
OBJ: 17-1
TOP: Physiology
2. Which of the following vaginitis conditions is of a noninfectious origin?

A. Chemical irritation
B. Bacterial vaginitis
C. Trichomoniasis
D. Candidiasis
ANS: A
DIF: Level 1
OBJ: 17-1
TOP: Physiology
3. A vaginal secretion collection can be performed to help for all of the following except:
A. Determine causative agent
B. Avoid reinfection
C. Prevent pregnancy
D. Provide a basis for treatment
ANS: C
DIF: Level 2
OBJ: 17-1
TOP: Physiology
4. Vaginal secretion collection kits are specific for which of the following?
A. Temperature in which they must be used
B. Pricing for the medical practice
C. For the organism sought
D. For left- or right-handed medical personnel
ANS: C
DIF: Level 1
OBJ: 17-2
5. Which of the following specimen handling combinations is incorrect?

A. Trichomonas: room temperature
B. N. gonorrhoeae: room temperature
C. Herpes simplex virus (HSV): room temperature
D. C. trachomatis: refrigerated
ANS: C
DIF: Level 1
OBJ: 17-2
6. A vaginal fluid collection kit is dropped off in the laboratory for analysis and the medical
laboratory scientist notices condensation inside the biohazard bag. Which of the following tests
cannot be performed?
A. Trichomonas motility testing
B. HSV testing
C. C. trachomatis testing
D. Atropic vaginitis
ANS: A
DIF: Level 2
OBJ: 17-2
7. You receive a call from a physician’s office asking about “extra swabs” for a vaginal
secretions collection for a possible Neisseria infection. Which of the following swabs cannot be
used and why?
A. Sterile polyester tipped swabs because they are toxic to Neisseria
B. Sterile polyester tipped swabs because they inactivate Neisseria
C. Sterile wood shaft swabs with cotton because they are toxic to Neisseria
D. Sterile wood shaft swabs with cotton because they inactivate Neisseria
ANS: C
DIF: Level 2
OBJ: 17-3
8. Which of the following secretion combinations is considered to be normal?

A. White, curd-like
B. White, flocculent discharge
C. Yellow-green, frothy
D. Yellow, opaque
ANS: B
DIF: Level 1
OBJ: 17-3
9. A vaginal fluid was collected from a 25-year-old female that showed the following results:
appearance is pink with flocculent discharge, pH is 3.9, whiff test is negative, many gram-
positive rods, clue cells are absent. What is your interpretation of these results?
A. Patient has a possible bacterial infection
B. Patient has a possible yeast infection
C. Patient is normal and is menstruating
D. Patient has a possible Trichomonas infection
ANS: C
DIF: Level 2
OBJ: 17-3
10. When testing for vaginal pH, the health-care provider collecting the specimen should:
A. Place the specimen on the pH paper before placing swab into the saline solution
B. Place the specimen on the pH paper after mixing with potassium hydroxide (KOH)
C. Place the pH paper on the swab before collecting from the patient
D. Place the pH paper into the swab collection tube
ANS: A
DIF: Level 1
OBJ: 17-4
TOP: pH
11. A vaginal pH value of 6.0 could indicate which of the following conditions?
A. Normal condition
B. Bacterial infection
C. Yeast infection
D. Increased estrogen production
ANS: B
DIF: Level 1
OBJ: 17-4
TOP: pH
12. Which of the following conditions is not likely if a vaginal pH value is greater than 4.5?
A. Vulvovaginal candidiasis
B. Trichomoniasis
C. Desquamative inflammatory vaginitis
D. Bacterial vaginosis
ANS: A
DIF: Level 2
OBJ: 17-4
TOP: pH
13. Based on the following description, identify the cell: a large irregular shaped cell that ranges
from 25 to 70 microns in diameter with a prominent central nucleus that is 8 to 10 microns in
size, a cytoplasm that contains a granular appearance, with “shaggy” borders.
A. Squamous epithelial cell
B. Clue cell
C. Transitional epithelial cell
D. Renal tubule epithelial cell
ANS: B
DIF: Level 1
OBJ: 17-5
TOP: Diagnostic testing
14. Which diagnostic test uses a 10% solution of potassium hydroxide to detect the volatilization
of amines to produce a distinctive odor?
A. Whiff test
B. KOH test
C. DNA test
D. Western Blot test
ANS: A
DIF: Level 1
OBJ: 17-5
15. Which of the following bacterial characteristics best describes the “normal flora” found in a
vaginal specimen?
A. Gram-positive cocci
B. Gram-variable curved rods
C. Gram-positive large rods
D. Gram-negative rods
ANS: C
DIF: Level 2
OBJ: 17-5
16. Normal flora is predominantly of which genus?

A. Mobiluncus species
B. Gardnerella species
C. Bacteroides species
D. Lactobacillus species
ANS: D
DIF: Level 1
OBJ: 17-5
17. Of the following organisms, which one requires DNA probe amplified by the polymerase
chain reaction (PCR)?
A. G. vaginalis
B. Candida species
D. Bacteroides species
ANS: C
DIF: Level 1
OBJ: 17-5
18. Which cellular element is not seen in patients with desquamative inflammatory vaginitis?
A. Clue cells
B. Basal cells
C. Red blood cells
D. White blood cells
ANS: A
DIF: Level 1
OBJ: 17-6
TOP: Microscopic testing
19. Which cellular element cannot be seen in patients with candidiasis?

A. Clue cells
C. Epithelial cells
D. Budding yeast
ANS: A
DIF: Level 1
OBJ: 17-6
TOP: Microscopic testing
20. A female patient presents to her OB/GYN with the following complaints: genital itching,
dysuria, and an abnormal looking white “chunky” substance on her undergarments. The
immediate next step the physician should take is:
A. Order DNA and PCR testing
B. Perform a saline wet prep
C. Perform a whiff test and KOH test
D. Send the patient home
ANS: B
DIF: Level 2
OBJ: 17-7
TOP: Case study
21. The fetal fibronectin test is used to determine which of the following conditions?
A. Pregnancy
B. Preterm delivery
C. Postpartum status
D. Gestational age
ANS: B
DIF: Level 1
OBJ: 17-8
22. The test for placental alpha-1 microglobulin protein is used to determine:
A. Fetal membrane rupture
B. Pregnancy
C. Bacterial vaginosis
D. Atropic vaginosis
ANS: A
DIF: Level 1
OBJ: 17-8
Case Study
A female patient is seen by her OB/GYN with complaints of pain after sexual intercourse, some
genital redness, and itching. She also noticed a vaginal discharge that was foul smelling. A
specimen was taken and examined. The results are as follows:
Appearance: yellow-green in color

pH: 5.5
WBCs: present
Clue cells: absent
1. Based on the clinical history and laboratory results, what is suspected?

A. Bacterial vaginosis
B. Candidiasis
C. Trichomoniasis
D. Inflammatory vaginitis
ANS: C
DIF: Level 2
OBJ: 17-7
TOP: Vaginitis
2. What would be the next test the physician may request?

A. Wet mount
B. Gram stain
C. Culture
D. DNA testing
ANS: A
DIF: Level 1
OBJ: 17-5
3. Should she just be tested or should her significant other be tested also:
A. Yes
B. No
ANS: A
DIF: Level 1
OBJ: 17-7
TOP: Treatment

TEST BANK For Urinalysis and Body Fluids, 7thEditionbyStrasinger

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TEST BANK For Urinalysis and Body Fluids, 7thEditionbyStrasinger

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TEST BANK For Urinalysis and Body Fluids, 7th Edition by

Strasinger | Verified Chapters 1 - 17 | Complete Newest Version

Chapter 1: Safety and Quality Management

1. An example of a chemical hazard is:

2. Centrifuging an uncapped tube of urine is most likely to produce a/an:

9. The Occupational Exposure to Blood-Borne Pathogens Standard is:

13. Laboratory coats worn in the urinalysis laboratory should:

15. Disinfection of the sink in the urinalysis laboratory should be performed:

16. The acceptable method for disposing of urine specimens is:

25. The acronym RACE is used when encountering a/an:

27. The most commonly available fire extinguisher in a hospital is:

33. When a critical value is obtained in the laboratory:

37. A procedure with a coefficient of variation of 10% is considered:

39. Proficiency testing should be performed:

40. Which mode of infection transmission can occur through a sneeze?

44. Quality management (QM) refers to:

45. What should not be included in a quality management plan?

46. Identify the symbol below:

52. Only nontoxic chemicals can be pipetted by mouth.

53. The SDS should be provided to laboratories by chemical manufacturers or vendors.

54. Electrical current can pass through glass and wood.

55. Flammable chemicals must be stored in explosion-proof cabinets.

57. Droplet is a means of transmission.

58. Employees are responsible for laundering nondisposable laboratory coats.

59. HCV is a blood-borne pathogen.

64. A Levy-Jennings chart is considered postexamination.

65. Globally Harmonized System standardizes all biological hazards.

1. Before beginning the testing, the MLS should:

2. The cleaning of workstations is considered a/an

3. Urinalysis testing is performed by the MLS. The first task is to:

1. Before beginning the testing, the MLS should:

2. The cleaning of workstations is considered a/an

3. Urinalysis testing is performed by the MLS. The first task is to:

2. The principle of reflectance photometry is:

5. In a fully automated analyzer, clarity is measured by:

6. Which of the following is not an advantage of automated microscopy?

7. Which is not a disadvantage of performing the manual microscopic analysis?

8. A method for performing automated urine sediment analysis is:

10. Automated urine particle digital imaging does not measure:

13. Lamellar bodies are analyzed by:

15. Semiautomated instruments are operator free.

1. In reviewing the microscopic results, what would be flagged by the analyzer?

1. Urea is a product of:

2. To determine whether a specimen is urine, measure the concentrations of:

3. The average daily volume of urine produced by a normal adult is approximately:

5. Which of the following terms is correctly matched with urine output?

6. The polyuria associated with diabetes mellitus is caused by:

7. Urine from a patient with diabetes insipidus has:

9. Persons taking diuretics can be expected to produce:

10. A urine specimen may be rejected by the laboratory because:

17. Sodium fluoride used as a preservative for urinalysis best protects:

19. In the laboratory, the preferred method of urine preservation is:

22. Before analysis, a refrigerated urine specimen must be:

23. The recommended specimen for routine urinalysis testing is the:

25. A first morning specimen is frequently requested to confirm:

31. An alternative to the catheterized specimen is the:

32. The least contaminated specimen for bacterial culture is the:

33. The three-glass collection is used for the diagnosis of:

36. An increase in urine production during the night is described as: