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Urinalysis and Body Fluids
Comprehensive Exam -Answered
"Diuretics" are medicines which: a. Are used in treatment of hypotension b. Decrease excretion of urine c. Increase production of insulin d. Decrease production of insulin e. Increase excretion of urine - ANS-e. Increase excretion of urine 90% of uncomplicated U.T.I. is caused by: a. Proteus species b. Streptococcus fecalis c. Enterobacter d. E. coli e. Klebsiella - ANS-d. E. coli A 10-year old boy, two weeks after a bout of scarlet fever begins to pass dark brown urine "like coffee". At this time low grade fever returns. The blood pressure rises to 150/110 and his eyelids are puffy. Microscopic examination of the urinary sediment is most likely to show which of the following: a. Hyaline casts and oval fat bodies b. Red blood cells and blood casts c. Granular and waxy casts d. White blood cells e. Urates - ANS-b. Red blood cells and blood casts A 14-year old girl slowly became edematous. The 24-hour urine contains 30 g. protein. Her serum protein is 4.5 g/dl, and cholesterol is 650 mg/dl. Which of the following is most likely to be seen in the urine sediment? a. White blood cells, white cell casts and "glitter" cells b. Red blood cells and red cell casts c. Granular and waxy casts d. Hyaline casts and oval fat bodies e. Amorphous urates - ANS-c. Granular and waxy casts A 35-year-old diabetic woman is suspected of developing renal insufficiency. Which of the following specimens should be obtained to determine the amount of creatinine being excreted in the urine?
a. 2-hours post prandial b. 12-hours timed collection c. 24-hours timed collection d. Midstream "clean catch" - ANS-c. 24-hours timed collection A clean catch urine specimen is cloudy amber, pH 5.0, specific gravity = 1.015, protein = 1+, glucose negative, occult blood positive, many bacteria and 30-40 white blood cells. These results are compatible with: Select one: a. Nephrosis b. Urinary tract infection c. Nephritis d. Renal calculi e. Anuria - ANS-b. Urinary tract infection A large amount of white foam in the urine would most likely indicate the presence of: Select one: a. Proteins b. Carbohydrates c. Fats - ANS-a. Proteins A patient is in the emergency room and upon examination is suspected of having a urinary tract infection. Which is the preferred method of urine collection? a. A first voided morning specimen b. A 24-hour specimen c. Postprandial specimen d. Clean-voided midstream catch - ANS-d. Clean-voided midstream catch A patient with a urine indicating a strongly positive clinistix probably has: a. Anuria b. Polyuria c. Oliguria - ANS-b. Polyuria A routine urinalysis and a test for urobilinogen is requested on a urine specimen that has been delayed in reaching the laboratory. The microscope reveals a 2+ bacteria, occasional white blood cells. Other results were normal and a test for urobilinogen was negative. You should: a. Request a fresh specimen for all tests to be repeated b. Report test as accurate c. Request a fresh specimen for routine analysis d. Request a fresh specimen for rechecking the urobilinogen - ANS-a. Request a fresh specimen for all tests to be repeated
a. 5 b. 8 c. 50 d. 80 - ANS-a. 5 Acute tubular necrosis is associated most often with: a. Reduced renal blood supply to the renal tubules b. Arteriosclerosis of the renal arteries and arterioles c. An immune response to a previous urinary tract infection d. Acute inflammation of the interstitial tissues - ANS-a. Reduced renal blood supply to the renal tubules An effusion formed as a result of direct injury or change to the serous membranes themselves is known as a/an: a. Exudate b. Transudate - ANS-a. Exudate Bilirubin is a breakdown product of: a. Hemoglobin b. Urobilinogen c. Bile d. Glucuronic acid - ANS-a. Hemoglobin Creatinine clearance results are "normalized" using an individual's body surface area to account for variations in the individual's: a. Age b. Sex c. Dietary intake d. Muscle mass - ANS-d. Muscle mass Crenation of red cells in the urine denotes that the urine is: a. Hypertonic b. Isotonic c. Hypotonic - ANS-a. Hypertonic Crystals in synovial fluid that appear chunky or rhomboid-like and are blue when their long axes lie parallel to the direction of the slow wave vibration of the compensated polarized light are: a. Monosodium urate
b. Corticosteroid c. Hydroxyapatite d. Calcium pyrophosphate dihydrate - ANS-d. Calcium pyrophosphate dihydrate Crystals in synovial fluid that appear needle-like and are yellow when their long axes lie parallel to the direction of the slow wave vibration of the compensated polarized light are: a. Monosodium urate b. Corticosteroid c. Hydroxyapatite d. Calcium pyrophosphate dehydrate - ANS-a. Monosodium urate Glitter cells are seen often in urine with a: a. Normal specific gravity b. High specific gravity c. Low specific gravity d. Fixed specific gravity - ANS-c. Low specific gravity Hematuria is generally absent in: a. Acute glomerulonephritis b. Chronic glomerulonephritis c. Acute pyelonephritis d. The nephrotic syndrome - ANS-d. The nephrotic syndrome Hemosiderin: a. A form of hemoglobin wherein the ferrous iron has been oxidized to ferric iron b. A respiratory pigment in muscle tissue which serves as an oxygen carrier c. The substance which gives urine its characteristic color d. An iron containing pigment derived from a hemoglobin; a storage form of iron - ANS- d. An iron containing pigment derived from a hemoglobin; a storage form of iron Hemosiderinuria is found in association with: a. Ketonuria b. Glycosuria c. Hemoglobinuria - ANS-c. Hemoglobinuria If an infant had a negative clinistix and a positive clinitest, what disease might be suspected? a. Diabetes mellitus b. Diabetes insipidus c. Galactosemia
In synovial fluid, the most characteristic microscopic finding in gouty arthritis is: a. Monosodium urate crystals b. Calcium pyrophosphate crystals c. Cartilage debris d. Intracellular microorganisms - ANS-a. Monosodium urate crystals In the absence of ADH, the patient will tend to: a. Have decreased urinary output b. Have increased urinary output c. Have no changes in urinary output - ANS-b. Have increased urinary output Incompatible blood transfusions, hemolytic anemia, severe burns, and trauma from electric shock would be indicated most likely by: a. Hematuria b. Hemoglobinuria c. Myoglobinuria d. Urobilinogenuria - ANS-b. Hemoglobinuria Increased urinary concentrations of urobilinogen may be indicative of all of the following EXCEPT: a. Viral hepatitis b. Pernicious anemia c. Diabetes insipidus d. Hemolytic states - ANS-c. Diabetes insipidus Labstix may become unreliable if they are: a. Not used immediately b. Subjected to cold c. Allowed to absorb moisture d. Not used at room temperature - ANS-c. Allowed to absorb moisture Leukocytes which have been lysed will not be detected on the chemical strip for leukocytes. True False - ANS-False Lipiduria (in the form of free fat, oval fat bodies or fatty casts) accompanied by massive proteinuria is most commonly associated with which of the following renal disorders? a. Acute glomerulonephritis
b. Acute pyelonephritis c. Lupus nephritis d. The nephrotic syndrome - ANS-d. The nephrotic syndrome Lumbar puncture for cerebrospinal fluid analysis is more essential to diagnose which of the following conditions? a. Subarachnoid hemorrhage b. A malignancy of the central nervous system c. Meningitis d. Multiple sclerosis - ANS-c. Meningitis Obstructive jaundice is predominantly indicated by the presence of which of the following substances in the urine? a. Free bilirubin b. Conjugated bilirubin c. Urobilinogen d. Bilirubinate - ANS-b. Conjugated bilirubin Oliguria is characterized by a: a. Complete absence of urine excretion b. Urine volume less than 400mg/24 hours c. Urine volume of approximately 1200-1500 mg/24 hours d. Urine volume of more than 200 ml/24 hours - ANS-b. Urine volume less than 400mg/24 hours On standing, urine develops an ammoniacal odor. This is due to a breakdown of ________ with formation of NH3. a. Creatine b. Urea c. NaCl d. Nitrates - ANS-b. Urea One of these formed elements may appear without associated kidney disease? a. Waxy cast b. Red blood cast c. Granular cast d. Hyaline cast - ANS-d. Hyaline cast Orthostatic proteinuria is a result of: a. Pyelonephritis
Tests for urine urobilinogen may be used to assess: a. Hormone production b. Kidney function c. Liver function d. Red cell destruction e. More than one of the above - ANS-e. More than one of the above The _________ arteriole breaks up into another capillary network that supplies blood to the tubules (Peritubular Capillaries) a. Afferent b. Efferent - ANS-b. Efferent The chemistry procedure performed on a specimen of amniotic fluid to determine the possible presence of a neural tube defect is: a. Lecithin/sphingomyelin ratio b. Amniotic fluid creatinine c. Alpha-fetoprotein d. Surfactant level - ANS-c. Alpha-fetoprotein The concentration of which of the following substances can be used to positively identify a fluid as seminal fluid? Select one: a. Acid phosphatase b. Citric Acid c. Fructose d. Zinc - ANS-a. Acid phosphatase The concentration of which substances provides the best means of distinguishing urine from other body fluids? a. Creatinine and urea b. Glucose and protein c. Uric Acid and ammonia d. Water and electrolytes - ANS-a. Creatinine and urea The following are initial results obtained during a routine urinalysis. Which results should be investigated further? a. Negative protein; 2-5 waxy casts b. Cloudy, brown urine; 2-5 red blood cells c. Urine pH 7.5; Ammonium biurate crystals
d. Clean, colorless urine; specific gravity 1.010 - ANS-a. Negative protein; 2-5 waxy casts The formation of casts occurs mainly in what portion of the kidney? a. Glomerulus b. Proximal convoluted tubule c. Loop of Henle d. Distal convoluted tubule - ANS-d. Distal convoluted tubule The goal of quality control in urinalysis is to: a. Ensure accurate, reliable test results b. Minimize subjectivity in laboratory test procedures c. Achieve maximum standardization in laboratory test procedures d. All of the above - ANS-d. All of the above The higher the pH level of urine, the: a. Higher the chloride ion concentration in the urine b. Lower the chloride ion concentration in the urine c. Higher the hydrogen ion concentration in the urine d. Lower the hydrogen ion concentration in the urine - ANS-d. Lower the hydrogen ion concentration in the urine The most common substance secreted by the tubular cells is: a. H2O b. K+ c. NH d. H+ - ANS-d. H+ The nitrite test is used to detect significant: a. Ketonuria b. Leukocyturia c. Phenylketonuria d. Bacteriuria - ANS-d. Bacteriuria The observation of a strong ammoniacal odor when performing the urinalysis is most often caused by: a. Diabetes mellitus b. Improper handling and storage c. Ingestion of certain foodstuffs d. Urinary tract infection - ANS-b. Improper handling and storage
a. Density of particles in solution b. Concentration of particles in solution c. Disbursement of particles in solution d. Number of particles in solution - ANS-b. Concentration of particles in solution The solid particles in the urine are preserved: a. Better in acid urine b. Better in neutral urine c. Better in alkaline urine d. Equally well at any pH - ANS-a. Better in acid urine The specific gravity of the glomerular filtrate is: Select one: a. 1. b. 1. c. 1. d. 1.020 - ANS-b. 1. The sulfosalicylic acid test is useful in detecting: a. Salicylates b. Proteins c. Glutelins d. Protamines - ANS-b. Proteins The term "Thornapple" is used to describe which crystal? a. Ammonium biurate b. Leucine c. Sulfa d. Triple phosphate - ANS-a. Ammonium biurate The urinary presence of white blood cells accompanied by proteinuria is indicative of: a. Pyelonephritis b. Cystitis c. Urethritis d. Prostatitis - ANS-a. Pyelonephritis The vessels extending from the glomeruli which nourish the renal tubules and also participate in the countercurrent mechanism for concentrating urine are called: a. Vasa deferential b. Vasa afferentia c. Vasa efferentia
d. Vasa recta (peritubular capillaries) - ANS-d. Vasa recta (peritubular capillaries) The wine red or reddish brown color of urine may be due to: a. Red blood cells b. Hemoglobin pigments c. Porphyrins d. All of the above - ANS-d. All of the above Those casts which have at least two well-defined and distinct components are known as: a. Broad casts b. Mixed casts c. Waxy casts d. Epithelial cellular casts - ANS-b. Mixed casts To definitively identify crystals found in synovial fluid specimens, the best microscopy technique employs the use of a: a. Brightfield microscope b. Phase contrast microscope c. Darkfield microscope d. Compensated polarized light microscope - ANS-d. Compensated polarized light microscope To determine if the red blood cells present in a specimen of amniotic fluid originate in the fetus, as opposed to being of maternal origin, which of the following tests can be used? a. Kleihauer-Betke stain b. Hemoglobin electrophoresis c. Direct antiglobulin test d. A and B e. A and C - ANS-d. A and B To differentiate a serous fluid as an exudate, the following test results would be expected: a. Small numbers of cells present b. Total protein level of 3.0 g/dl or greater c. Large numbers of cells present d. Appearance: pale yellow and clear e. B and C - ANS-e. B and C
d. Ketone bodies - ANS-d. Ketone bodies Vaginal contamination of a urine specimen is indicated by the urinary presence of: a. Squamous epithelial cells b. Transitional epithelial cells c. Renal tubular epithelial cells - ANS-a. Squamous epithelial cells What is the definition of the "osmolality" of a solution? a. the density of solute particles per liter of solvent b. the mass of solute particles per kilogram of solvent c. the number of solute particles per kilogram of solvent d. the weight of solute particles per kilogram of solvent - ANS-c. the number of solute particles per kilogram of solvent What is the most common aminoaciduria? a. Hemogetistic acid b. Cystine c. Tyrosine d. Valine e. Tryptophan - ANS-b. Cystine What type of protein predominates when proteinuria is present? a. Tamm Horsfall b. Globulin c. Bence Jones Protein d. Albumin - ANS-d. Albumin When found together in the urine, tyrosine and leucine crystals may be manifestations of: a. Cystinuria b. Gout c. Liver disease d. Muscular dystrophies, atrophies, or myostatis - ANS-c. Liver disease Which is NOT a function of the nephron: Select one: a. Filtration b. Reabsorption c. Conjugation d. Secretion - ANS-c. Conjugation
Which of the following abnormal crystals is associated with stone formation? a. Cystine b. Hemosiderin c. Leucine d. Sulfonamide - ANS-a. Cystine Which of the following actions can adversely affect the chances of obtaining a positive stain or culture when performing microbiologic studies on infectious serous fluid? a. Using a large volume of serous fluid for the inoculum b. Storing serous fluid specimens at refrigerator temperatures c. Using an anticoagulant in the serous fluid collection container d. Concentrating the serous fluid before preparing smears for staining - ANS-b. Storing serous fluid specimens at refrigerator temperatures Which of the following chemical principles is the most specific for the detection of urobilinogen? a. Azo coupling reaction b. Ehrlich's reaction c. Hoesch test d. Watson-Schwartz test - ANS-b. Ehrlich's reaction Which of the following is NOT a cause of false-negative reagent strip tests for urine glucose? a. Ascorbic acid b. Dilute urine (low specific gravity) c. Moderate ketone with low glucose levels d. Sodium fluoride used as a preservative e. Urine specimen tested at refrigerator temperature - ANS-b. Dilute urine (low specific gravity) Which of the following is NOT a change which occurs during urine decomposition? Select one: a. Abnormal casts appear b. Glucose level is reduced c. Ammonia level increases d. PH fluctuates - ANS-a. Abnormal casts appear? Which of the following is NOT a nitrogenous waste normally found in urine? a. Urea b. Uric acid c. Nitrite d. Creatinine - ANS-B Uric Acid?
c. Shifts in fluid balance (e.g. edema) d. Major hematolytic transfusion reaction - ANS-d. Major hematolytic transfusion reaction Which of the following procedures frequently provides a rapid presumptive diagnosis of bacterial meningitis? a. a blood culture b. a CSF culture c. a CSF gram stain d. immunologic tests on CSF for microbial antigens - ANS-c. a CSF gram stain Which of the following properties is used to determine the osmolality of urine? a. Its boiling point b. Its freezing point c. Its melting point d. Its saturation point - ANS-b. Its freezing point Which of the following should be used to preserve urine samples if they cannot be examined within 30 minutes of collection? a. Addition of ammonia b. Treatment with x-ray c. Overlay with toluene d. Refrigerate at 5°C - ANS-d. Refrigerate at 5°C Which of the following specimens would most likely be used to provide an overall picture of a patient's health? a. Random specimen b. First voided specimen c. 12-hour specimen d. 24-hour specimen - ANS-a. Random Specimen Which of the following statements about urobilinogen is true? a. Urobilinogen is not normally present in urine b. Urobilinogen excretion usually is decreased following a meal c. Urobilinogen excretion is an indicator of renal function d. Urobilinogen is labile and readily photooxidizes to urobilin - ANS-d. Urobilinogen is labile and readily photooxidizes to urobilin Which of the following statements regarding the characteristics of urinary fat is true? a. Cholesterol droplets stain with Sudan III Stain
b. Triglyceride or neutral fat stains with Oil Red O Stain c. Cholesterol droplets do not form a Maltese cross pattern under polarized light d. Triglycerides or neutral fat are anisotropic and form a Maltese cross pattern under polarized light - ANS-b. Triglyceride or neutral fat stains with Oil Red O Stain Which of the following substances contained in urine contributes most to its specific gravity? a. Urea and sodium chloride b. Uric acid and creatinine c. Urea and creatinine d. Uric acid and sodium chloride - ANS-a. Urea and sodium chloride Which of the following substances is secreted by the adrenal cortex to aid in sodium reabsorption? a. ADH b. Angiotensin c. Genin d. Aldosterone - ANS-d. Aldosterone Which of the following substances is used as a measure of the completeness of collection of a timed urine specimen? a. Creatinine b. Salt c. Urea d. Urea nitrogen e. Uric acid - ANS-a. Creatinine Which of the following test results would indicate fetal lung immaturity? I A lecithin/sphingomyelin ratio < 2. II A lecithin/sphingomyelin ratio > 2. III A lecithin/sphingomyelin ratio > 2.0, with phosphatidylglycerol absent IV A lecithin/sphinogomyelin ratio < 2.0, with phosphatidylglycerol present a. I, II, & III are correct b. I & III are correct c. IV is correct d. All are correct - ANS-b. I & III are correct Which of the following types of casts represent the final phase of cellular degeneration? a. Granular casts b. Waxy casts
