UNIT 4: Chapters: 11, 14, 15 plus [chapter 13 in Phlebotomy Essentials] Chapter 11 1. C Epididymis 2. D Prostate gland 3. B Fructose 4.

C Sperm concentration 5. D Viscosity 6. A 1 hour 7. B Antispermicide in the condom 8. D All of the above 9. C Decrease the viscosity 10. B Above 20 million per milliliter 11. B 83 million per milliliter 12. C 16.6 million per milliliter 13. A Immobilize the sperm 14. A Specimen should be rediluted and counted 15. B Within 12 hours of collection 16. D Both A and B 17. B 50% 18. B Rapid lateral movement 19. A Ovum penetration 20. C Midpiece 21. A Head 22. C Oval 23. A >30% normal forms 24. A Viability 25. D Both A and B 26. B 1.5 million 27. D Eosin-nigrosin stain 28. B Seminal fluid fructose 29. D All of the above 30. B Epididymis

31. C A possible rape 32. A Centrifuged and reexamined 33. B WHO Chapter 11 1. a. Sperm concentration, motility, and morphology. b. 21,000,000; no c. 1,800,000; no d. Yes. The normal sperm concentraton is 20 to 60 million/ mL. Spermatid counts over 1 million are considered abnormal. Both of these abnormal results and the abnormal motility are related to defects in sperm maturation. 2. a. Male antisperm antibodies may form following vasovasectomy procedures. b. The MAR test and the immunobead test. c. The MAR test detects the presence of IgG male sperm antibodies. The Immunobead test delineates the areas of the sperm (head, tail, neck) that are affected by the antibodies. d. Clumping, ovuum penetration, and motility. 3. The specimen contains urine, which is toxic to sperm, therefore decreasing viability. 4. The specimen was improperly collected, and the first part of the ejaculation was lost. 5. a. Yes, there is insufficient prostatic fluid present. b. Zinc, citrate, and acid phosphatase. c. Sperm motility is severely affected. 6. a. Acid phosphatase and seminal gycoprotein30 tests. b. Microscopic examination for the presence of sperm.

Chapter 14 1. B Carbon dioxide and oxygen exchange

2. C Fetal urine 3. A Fetus fails to begin swallowing 4. C Differentiate amniotic fluid from maternal urine 5. B Bilirubin 6. A Delivered on ice and refrigerated or frozen 7. D To prolong fetal cell viability and integrity 8. C Phospholipids 9. 2, 4, 1, 3 _2__A. Colorless 1. Fetal death _4__B. Dark green 2. Normal _1__C. Red-brown 3. Presence of bilirubin _3__D. Yellow 4. Presence of meconium 10. A Bilirubin 11. C Moderately affected fetus that requires close monitoring 12. B Increased maternal serum alpha fetoprotein 13. True 14. A AFP levels 15. B Lecithin 16. True 17. C Lecithin twice as concentrated as sphingomyelin 18. True 19. C Aminostat-FLM 20. B Decreased 21. D Fluorescence polarization 22. B The mother has maternal diabetes 23. 1, 4, 2, 3 Principle FLM Test _1__A. Immunologic agglu1. Amniostat-FLM tination test _4__B. Uses albumin as the 2. Lamellar body count internal standard _2__C. Uses the platelet 3. L /S ratio channel on a hematology

instrument _3__D. Uses sphingomyelin 4. Microviscosity test as an internal standard 24. False 25. D OD at 650 nm of 0.150 and an L/S ratio of 2.0 26. A Amniostat-FLM Chapter 14 1. a. Yes. b. FLM c. The level of phosphatidylglycerol present in the fetal lungs. d. Phosphatidylglycerol is essential for FLM, and levels do not always parallel lecithin levels in fetuses of diabetic mothers. 2. a. A neural tube disorder such as spina bifida or anencephaly. b. An acetylcholinesterase level. c. The amniotic fluid specimen contains blood. 3. Increased, because lecithin bound to dye decreases polarization. 4. The results may be falsely decreased because some of the phospholipids may be sedimented. 5. a. False-positive result. b. False-positive result. c. No effect. d. False-positive result. 6. a. False-positive result. b. False-positive result. c. False-postive or test interference. d. No effect. 7. The specimen was exposed to light, possible wrong specimen sent. Chapter 15

1. C Small intestine 2. A Large intestine 3. C Fecal neutrophils 4. B Blood 5. D Quantitative fecal fat testing 6. D Urobilin 7. D Increased reabsorption of intestinal water and electrolytes 8. C Fat 9. D Yellow-green: barium sulfate 10. C Intestinal constriction 11. A Upper GI bleeding 12. C Pilocarpine iontophoresis 13. D Vibrio cholerae 14. B Osmotic diarrhea 15. B Neutrophils are present in conditions that affect the intestinal wall 16. False 17. C Neutral fats 18. C Fatty acids, soaps, and neutral fats 19. C Have two-dimensional striations 20. D Steatorrhea 21. B Fecal occult blood 22. A There is less interference from dietary hemoglobin 23. C Is not visibly apparent in the stool specimen 24. B Two samples taken from different parts of three stools 25. B Hemoquant 26. A Colorectal cancer 27. B Pseudoperoxidase activity of hemoglobin 28. B Fetal hemoglobin is present 29. A Converted to fatty acids prior to titrating with sodium hydroxide 30. C Cystic fibrosis

31. C Positive Clinitest 32. B D-xylose test

Chapter 15 1. a. Secretory diarrhea. b. Stool culture. c. Probable: Salmonella, Shigella, Campylobactor, Yersinia, E. coli; Improbable: Staphylococcus, Vibrio. d. Osmotic diarrhea. 2. a. Microscopic examination for fecal fats. b. Neutral fats stain directly and appear as large, orangered droplets; soaps and fatty acids appear as smaller orange-red droplets after pretreatment of the specimen with heat and acetic acid. c. Quantitative fecal fat test. d. Bulky and frothy. e. Muscle fiber screening and the gelatin test for trypsin. f. Muscle fiber: failure to include red meat in the diet; gelatin test: intestinal degradation of trypsin or the presence of trypsin inhibitors. g. Chymotrypsin or elastase I. 3. a. Patient Number One: gastric reflux medication containing bismuth may produce black stools; Patient Number Two: medications such as aspirin and other NSAIDs may cause gastric bleeding; Patient Number Three: red meat was not avoided for 3 days prior to sample collection. b. Provide dietary and medication instructions to patients. c. The Hemoccult ICT immunochemical test. 4. a. The APT test cannot be performed because the hemoglobin is already denatured.

b. The pH will be low because increased carbohydrates are available for bacterial metabolism. c. The infant had ingested maternal blood. d. Yes, adequate carbohydrates are not present, and fats are being metabolized for energy.

Chapter 13 ANSWERS TO STUDY & REVIEW QUESTIONS 1. d specimen type 2. c Clean catch 3. d Discard the fi rst morning specimen, start the timing, and collect all urine for the next 24 hours including the fi rst specimen voided the following morning. 4. d Urine 5. c Pleural 6. c Sweat 7. d all of the above. 8. a Fecal fat 9. b peptic ulcers 10. b Pleural fl uid ANSWERS TO CASE STUDIES CASE STUDY 13-1 24-hour Urine Specimen Collection 1. No. The specimen is missing a critical portion of urine. 2. The phlebotomist should not accept the specimen without first consulting a supervisor. Whether or not the specimen will be accepted depends upon the type of test and individual lab policy and may require consultation with the patients physician. If it is determined that the specimen will be accepted, the phlebotomist should note the discrepancy in collection time and identify the person who authorized acceptance on the requisition or by computer entry. 3. Patients should be given verbal and written instructions in 24-hour urine collection procedures and verbal feedback should be obtained to ensure that the patient has complete understanding of the procedure. Patients should be made aware of the importance of timing and reminded to set an alarm if necessary.