Urinalysis and Body

Fluids
 Which of the following is inappropriate
when collecting urine for routine bacteria
culture?
a. Container must be sterile
b. Midstream void technique must be used
c. Collected sample must be plated within 2 hours
unless refrigerated
d. Sample may be held at 2-8C for up to 48 hours
prior to plating
 Which urine color is correlated correctly
with the pigment-producing substance?

a. Smoky red urine with homogentisic acid

b. Dark amber urine with myoglobin
c. Deep yellow urine and yellow foam with bilirubin
d. Red-brown urine with biliverdin
 A brown or black pigment in urine can be
caused by:

a. Pyridium
b. Phenolsulfonphthalein
c. Rifampin
d. Melanin
Urine that is dark red or port wine in color
may be caused by:

a. Lead poisoning
b. Porphyria cutanea tarda
c. Alkaptonuria
d. Hemolytic anemia
 Which of the following tests is affected
least by standing or improperly stored
urine?
a. Glucose
b. Protein
c. pH
d. Bilirubin
 Urine production of less than 400 mL/day
is:

a. Consistent with normal renal function

b. Isothenuria
c. Oliguria
d. Associated with diabetes mellitus
 Urine with a SG consistently between
1.002 and 1.003 indicates:

a. Acute glomerulonephritis
b. Renal tubular failure
c. Diabetes insipidus
d. Addisons disease
 Which of the following is most likely to
cause a false-positive dry reagent strip
test for protein?
a. Urine of high SG
b. Highly buffered alkaline urine
c. Bence Jones proteinuria
d. Salicylates
 Which statement best describes the
clinical utility of tests for
microalbuminuria?
a. Testing may detect early renal involvement in
diabetes mellitus
b. Microalbuminuria refers to a specific subfraction
of albumin found only in persons with diabetic
nephropathy
c. A positive result indicates the presence of
orthostatic albuminuria
d. Testing should be part of the routine urinalysis
 In which of the following conditions is
glycosuria most likely?

a. Addisons disease
b. Hypothyroidism
c. Pregnancy
d. Hypopituitarism
 A positive glucose oxidase test and a
negative test for reducing sugars indicate:

a. True glycosuria
b. False-positive reagent strip test
c. False-negative reducing test caused by
ascorbate
d. Galactosuria
 A negative glucose oxidase test and a
positive test for reducing sugars in urine
indicate:
a. True glycosuria
b. False-negative glucose oxidase reaction
c. Presence of a nonglucose reducing sugar such
as galactose
d. Trace quantity of glucose
Ketones are detected in urine by reaction
with:

a. Sodium nitroprusside
b. O-Toluidine
c. Tetrabromphenol blue
d. Double indicator system
 Which ketone body is sodium
nitroprusside specifically reacting with in
the ketone test?
a. Beta-hydroxybutyric acid
b. Acetone
c. Acetoacetic acid
 Which of the following conditions is
associated with a negative blood test and
an increase in urine urobilinogen?
a. Calculi of the kidney or bladder
b. Malignancy of the kidney or urinary sytem
c. Crush injury
d. Extravascular hemolytic anemia
 Which of the following results are
discrepant?

a. Small blood but negative protein

b. Moderate blood but no RBCs in microscopic
examination
c. Negative blood but 6-10 RBCs/high power field
d. Negative blood, positive protein
Which of the following reagents is used to
detect urobilinogen in urine?

a. p-Dinitrobenzene
b. p-Aminosalicylate
c. p-Dimethylaminobenzaldehyde
d. p-Dichloroaniline
 Which statement about the dry reagent
strip test for leukocytes is true?

a. The test detects only intact white blood cells

b. The reaction is based upon the hydrolysis of
substrate by WBC esterases
c. The presence of several antibiotics may give a
false-positive reaction
d. The test is sensitive to 2-3 WBCs per high power
field
 Which of the following statements about
creatinine clearance is correct?

a. Dietary restrictions are required during the 24

hours preceding the test
b. Fluid intake must be restricted to below 600 mL in
the 6 hours preceding the test
c. Creatinine clearance is mainly determined by
renal tubular function
d. Creatinine clearance is dependant on lean body
mass
 All of the following statements regarding
urinary casts are true except:

a. Many hyaline casts may appear in sediment after

jogging or exercise
b. An occasional granular cast may be seen in a
normal sediment
c. Casts can be seen in significant numbers even
when protein tests are negative
d. Hyaline casts dissolve readily in alkaline urine
The mucoprotein that forms the matrix of
a hyaline cast is called:

a. Bence Jones protein

b. Beta-microglobulin
c. Tamm-Horsfall protein
d. Arginine-rich glycoprotein
A sediment with moderate hematuria and
RBC casts most likely results from:

a. Chronic pyelonephritis
b. Nephrotic syndrome
c. Acute glomerulonephritis
d. Lower urinary tract obstruction
 Urine sediment characterized by pyuria
with bacterial and WBC casts indicates:

a. Nephrotic syndrome
b. Pyelonephritis
c. Polycystic kidney disease
d. Cystitis
 Which type of casts signals the presence
of chronic renal failure?

a. Blood casts
b. Fine granular casts
c. Waxy casts
d. Fatty casts
 When examining urinary sediment, which
of the following is considered an abnormal
finding?
a. 0-2 RBCs/hpf
b. 0-1 hyaline casts/lpf
c. 0-1 renal cell casts/lpf
d. 2-5 WBCs/hpf
 Which of the following crystals is
considered nonpathological?

a. Hemosiderin
b. Bilirubin
c. Ammonium biurate
d. Cholesterol
 At which pH are ammonium biurate
crystals usually found in urine?

a. Acid urine only

b. Acid or neutral urine
c. Neutral or alkaline urine
d. Alkaline urine only
 Oval fat bodies are derived from:

a. Renal tubular epithelium

b. Transitional epithelium
c. Degenerated WBCs
d. Mucoprotein matrix
Oval fat bodies are often associated with:

a. Tubular necrosis
b. Acute glomerulonephritis
c. Aminoaciduria
d. Pyelonephritis
Which condition below is associated with
the greatest proteinuria?

a. Acute glomerulonephritis
b. Chronic glomerulonephritis
c. Nephrotic syndrome
d. Acute pyelonephritis
Acute pyelonephritis is commonly caused
by:

a. Bacterial infection
b. Circulatory failure
c. Renal calculi
d. Antigen-antibody reactions within the glomeruli
 Which statement about renal calculi is
true?

a. Calcium oxalate and calcium phosphate account

for about three quarters of all stones
b. Uric acid stones can be seen by x-ray film
c. Triple phosphate stones are found principally in
the ureters
d. Stones are usually made up of single salts
 Which of the following crystals is the
cause of gout?

a. Uric acid or monosodium urate

b. Calcium pyrophosphate
c. Calcium oxalate
d. Cholesterol
 Glitter cell is a term used to describe a
specific type of

a. Ketone body
b. Oval fat body
c. Fatty droplet
d. Neutrophil
 The final phase of degeneration that
granular casts undergo is represented by
which of the following casts?
a. Fine
b. Coarse
c. Cellular
d. Waxy
Alkaptonuria, a rare hereditary disease, is
characterized by the urine excretion of

a. Alkaptone
b. Phenylalanine
c. 5-Hydroxyindole acetic acid (5-HIAA)
d. Homogentisic acid
 Excessive lipid metabolism, as is seen in
diabetes mellitus, is indicated by the
presence in the urine of
a. Hemoglobin
b. Ketone bodies
c. Glucose
d. Protein
 A reagent test strip impregnated with a
diazonium salt may be used to determine
which analyte?
a. Glucose
b. Ketone
c. Hemoglobin
d. Bilirubin
 The reagent strip test for hemoglobin may yield
false positive results for the presence of
hemoglobin when the urine specimen contains

a. Ascorbic acid
b. Tetracycline
c. Myoglobin
d. Nitrite
 With infections of the urinary system,
WBCs are seen in the urine sediment.
Which WBC is most often seen?
a. Eosinophil
b. Lymphocyte
c. Monocyte
d. Neutrophil
 What condition is characterized by increased
urinary excretion of protein during the day while
at night there is a normal excretion of protein?

a. Pathological proteinuria
b. Bence Jones proteinuria
c. Orthostatic proteinuria
d. Functional nocturia
 Nitrite in a urine specimen suggests the
presence of:

a. WBC
b. RBC
c. Yeast
d. Bacteria
 Which is true about the formed element
found in Color Plate 47?

a. May be found in normal alkaline urine

b. Always associated with renal pathology
c. Never found at urine pH 7.0
d. Always associated with lung pathology
Which formed element is not found in the
high-power field in Color Plate 48?

a. WBC
b. Mucus
c. Squamous epithelium
d. Sperm
 Which of the following is true about the
final concentrating of urine in the kidney?

a. Distal convoluted tubule, through active transport,

reabsorbs water
b. Water is reabsorbed under the direct influence of
angiotensin II
c. Vasopressin controls the collecting duct
reabsorption of water
d. Water reabsorption is influenced by urine filtrate
levels of potassium
 If a urine specimen is left standing at
room temperature for several hours, which
of the following changes may occur?
a. Multiplication of bacteria
b. Increase in the glucose concentration
c. Production of an acid urine
d. Deterioration of any albumin present
Phenylketonuria may be characterized by
which of the following statements?

a. It may cause brain damage if untreated

b. It is caused by the absence of the enzyme,
phenylalanine oxidase
c. Phenylpyruvic acid excess appears in the blood
d. Excess tyrosine accumulates in the blood
 What condition is suggested by the number of
formed element that predominates in the low
power field of Color Plate 49?

a. Glomerulonephritis
b. Improperly collected specimen
c. Pyelonephritis
d. Nephrotic syndrome
 All the following would be characterized
by an increased number of the urinary
component in Color Plate 50 except
a. Acute glomerulonephritis
b. Renal calculi
c. Menstrual contamination
d. Nephrotic syndrome
 Patients with diabetes insipidus tend to
produce urine in ______ volume with _______
specific gravity.
a. Increased, decreased
b. Increased, increased
c. Decreased, decreased
d. Decreased, increased
 Which of the following characteristics is
true of the urinary components in Color
Plate 51?
a. Consist of Tamm-Horsfall protein
b. Presence always indicates a disease
c. Can be observed with polarized microscopy
d. Appear yellowish in brightfield microscopy
CSF
 Which of the following findings is
consistent with a subarachnoid
hemorrhage rather than a traumatic tap?
a. Clearing of the fluid as it is aspirated
b. Clear supernatant after centrifugation
c. Xanthochromia
d. Presence of a clot in the sample
 If a fasting glucose level of 100 mg/dL is
obtained, what is the expected fasting
CSF glucose level?
a. 25
b. 50
c. 65
d. 100
 The term used to denote a high WBC
count in the CSF is:

a. Empyema
b. Neutrophilia
c. Pleocytosis
d. Hyperglycorrhachia
 Which of the adult CSF values are
consistent with bacterial meningitis?

WBCs Lymphocytes Monocytes Eosinophils Neutrophils

a. 50/L 44% 55% 0% 0%
b. 300/L 75% 21% 3% 0%
c. 2000/L 5% 15% 0% 80%
d. 2500/L 40% 50% 0% 10%
 The diagnosis of multiple sclerosis is
often based upon which finding?

a. The presence of elevated protein and low

glucose
b. A decreased IgG index
c. The presence of oligoclonal bands by
electrophoresis
d. An increased level of CSF beta-microglobulin
 Which organism is the most frequent
cause of bacterial meningitis in neonates?

a. Neisseria meningitidis
b. Group B streptococci
c. Streptococcus pneumoniae
d. Klebsiella pneumoniae
 Amniotic,
Gastrointestinal, and
Seminal Fluids
 Which test best correlates with the
severity of hemolytic disease of the
newborn (HDN)?
a. Rh antibody titer of the mother
b. Lecithin/sphingomyelin ratio
c. Amniotic fluid bilirubin
d. Urinary estradiol
 Which is the reference method for
determining fetal lung maturity?

a. Human placental lactogen

b. L/S ratio
c. Amniotic fluid bilirubin
d. Urinary estriol
 Which of the following statements
regarding the L/S ratio is true?

a. A ratio of 2:1 or greater usually indicates

adequate pulmonary surfactant to prevent
respiratory distress syndrome
b. A ratio of 1.5:1 indicates fetal lung maturity in
pregnancies associated with diabetes mellitus
c. Sphingomyelin levels increase during the third
trimester, causing the L/S ratio to fall slightly
during the last 2 weeks of gestation
d. A phosphatidylglycerol (PG) spot indicates the
presence of meconium in the amniotic fluid
Which of the following values is the lower
limit of normal for sperm concentration?

a. 20 million/mL
b. 40 million/mL
c. 60 million/mL
d. 100 million/mL
 Which of the following semen analysis
results is abnormal?

a. Volume 1.0 mL
b. Liquefaction 40 minutes
c. pH 7.6
d. Motility 50% rapid progressive movement
 Which of the following sample collection
and processing conditions leads to
inaccurate seminal fluid analysis results?
a. Sample stored at room temperature for 1 hour
before testing
b. Sample collected following coitus
c. Sample collected without an anticoagulant
d. Sample collected without use of a condom
 Which of the following stains is used to
determine sperm viability?

a. Eosin Y
b. Hematoxylin
c. Papanicolaou
d. Methylene blue
 Which condition is most often associated
with gastric ulcers?

a. Cancer of the stomach

b. Helicobacter pylori infection
c. Zollinger-Ellison syndrome
d. Pernicious anemia
 Which of the following is commonly
associated with occult blood?

a. Colon cancer
b. Atrophic gastritis
c. Pernicious anemia
d. Pancreatitis