Chapter 6 -9QUESTIONS1. Macroscopic screening of urine specimens is used to:A. Provide results as soon as possibleB. Predict the type of urinary casts presentC. Increase cost-effectiveness of urinalysisD. Decrease the need for polarized microscopy

2. Variations in the microscopic analysis of urine includeall of the following except:A. Preparation of the urine sedimentB. Amount of sediment analyzedC. Method of reportingD. Identification of formed elements

3. All of the following can cause false-negative microscopicresults except:A. Braking the centrifugeB. Failing to mix the specimenC. Dilute alkaline urineD. Using midstream clean-catch specimens

4. The two factors that determine relative centrifugalforce are:A. Radius of rotor head and rpmB. Radius of rotor head and time of centrifugationC. Diameter of rotor head and rpmD. RPM and time of centrifugation

5. When using the glass slide and coverslip method,which of the following might be missed if the coverslipis overflowed?A. CastsB. RBCsC. WBCsD. Bacteria

6. Initial screening of the urine sediment is performedusing an objective power of:A. 4_B. 10_C. 40_D. 100_

7. Which of the following should be used to reduce lightintensity in bright-field microscopy?A. Centering screwsB. Aperture diaphragmC. RheostatD. Condenser aperture diaphragm

8. Which of the following are reported as number perLPF?A. RBCsB. WBCs

C. CrystalsD. Casts

9. The Sternheimer-Malbin stain is added to urine sedimentsto do all of the following except:A. Increase visibility of sediment constituentsB. Change the constituents refractive indexC. Decrease precipitation of crystalsD. Delineate constituent structures

10. Nuclear detail can be enhanced by:A. Prussian blueB. Toluidine blueC. Acetic acidD. Both B and C

11. Which of the following lipids is/are stained by SudanIII?A. CholesterolB. Neutral fatsC. TriglyceridesD. Both B and C

12. Which of the following lipids is/are capable of polarizinglight?A. CholesterolB. Neutral fatsC. TriglyceridesD. Both A and B

13. The purpose of the Hansel stain is to identify:A. NeutrophilsB. Renal tubular cellsC. EosinophilsD. Monocytes

14. Crenated RBCs are seen in urine that is:A. HyposthenuricB. HypersthenuricC. Highly acidicD. Highly alkaline

15. Differentiation among RBCs, yeast, and oil dropletsmay be accomplished by all of the following except:A. Observation of budding in yeast cellsB. Increased refractility of oil dropletsC. Lysis of yeast cells by acetic acidD. Lysis of RBCs by acetic acid

16. The finding of dysmorphic RBCs is indicative of:A. Glomerular bleedingB. Renal calculiC. Traumatic injuryD. Coagulation disorders

17. Leukocytes that stain pale blue with Sternheimer-Malbin stain and exhibit brownian movement are:A. Indicative of pyelonephritisB. BasophilsC. Mononuclear leukocytesD. Glitter cells

18. Mononuclear leukocytes are sometimes mistaken for:A. Yeast cellsB. Squamous epithelial cellsC. Pollen grainsD. Renal tubular cells

19. When pyuria is detected in a sediment, the slideshould be carefully checked for the presence of:A. RBCsB. BacteriaC. Hyaline castsD. Mucus

20. Transitional epithelial cells are sloughed from the:A. Collecting ductB. VaginaC. BladderD. Proximal convoluted tubule

21. The largest cells in the urine sediment are:A. Squamous epithlial cellsB. Urothelial epithelial cellsC. Cuboidal epithelial cellsD. Columnar epithelial cells

22. A clinically significant squamous epithelial cell is the:A. Cuboidal cellB. Clue cellC. Caudate cellD. Columnar cell

23. Forms of transitional epithelial cells include all of thefollowing except:A. SphericalB. CaudateC. ConvolutedD. Polyhedral

24. Increased transitional cells are indicative of:A. CatheterizationB. MalignancyC. PyelonephritisD. Both A and B

25. A primary characteristic used to identify renal tubularepithelial cells is:A. Elongated structureB. Centrally located nucleus

C. Spherical appearanceD. Eccentrically located nucleus

26. Following an episode of hemoglobinuria, RTE cellsmay contain:A. BilirubinB. Hemosiderin granulesC. PorphobilinogenD. Myoglobin

27. The predecessor of the oval fat body is the:A. HistiocyteB. Urothelial cellC. MonocyteD. Renal tubular cell

28. A structure believed to be an oval fat body produceda Maltese cross formation under polarized light butdoes not stain with Sudan III. The structure:A. Contains cholesterolB. Is not an oval fat bodyC. Contains neutral fatsD. Is contaminated with immersion oil

29. The finding of yeast cells in the urine is commonlyassociated with:A. CystitisB. Diabetes mellitusC. PyelonephritisD. Liver disorders

30. The primary component of urinary mucus is:A. Bence Jones proteinB. MicroalbuminC. Tamm-horsfall proteinD. Orthostatic protein31. The majority of casts are formed in the:

A. Proximal convoluted tubulesB. Ascending loop of HenleC. Distal convoluted tubulesD. Collecting ducts

32. Cylindroiduria refers to the presence of:A. Cylindrical renal tubular cellsB. Mucus resembling castsC. Hyaline and waxy castsD. All types of casts

33. A person submitting a urine specimen following astrenuous exercise routine can normally have all ofthe following in the sediment except:A. Hyaline castsB. Granular castsC. RBC casts

D. WBC casts

34. Prior to identifying an RBC cast, all of the followingshould be observed except:A. Free-floating RBCsB. Intact RBCs in the castC. Presence of a cast matrixD. A positive reagent strip blood reaction

35. WBC casts are primarily associated with:A. PyelonephritisB. CystitisC. GlomerulonephritisD. Viral infections

36. The shape of the RTE cell associated with renal tubularepithelial casts is primarily:A. ElongatedB. CuboidalC. RoundD. Columnar

37. When observing RTE casts, the cells are primarily:A. Embedded in a clear matrixB. Embedded in a granular matrixC. Attached to the surface of a matrixD. Stained by components of the urine filtrate

38. The presence of fatty casts is associated with:A. Nephrotic syndromeB. Crush injuriesC. Diabetes mellitusD. All of the above

39. Nonpathogenic granular casts contain:A. Cellular lysosomesB. Degenerated cellsC. Protein aggregatesD. Gram-positive cocci

40. All of the following are true about waxy casts exceptthey:A. Represent extreme urine stasisB. May have a brittle consistencyC. Require staining to be visualizedD. Contain degenerated granules

41. The observation of broad casts represents:A. Destruction of tubular wallsB. Dehydraton and high feverC. Formation in the collecting ductsD. Both A and C

42. All of the following contribute to the formation of

urinary crystals except:A. Protein concentrationB. phC. Solute concentrationD. Temperature

43. The most valuable initial aid for the identification ofcrystals in a urine specimen is:A. phB. SolubilityC. StainingD. Polarized microscopy

44. Crystals associated with severe liver disease includeall of the following except:A. BilirubinB. LeucineC. CystineD. Tyrosine

45. All of the following crystals routinely polarize except:A. Uric acidB. CholesterolC. Radiographic dyeD. Cystine

46. Differentiation between casts and fibers can usuallybe made using:A. Solubility characteristicsB. Patient historyC. Polarized lightD. Fluorescent light

47. Match the following crystals seen in acidic urine withtheir description/identifying characteristics:____Amorphous urates 1. Envelopes____Uric acid 2. Thin needles____Calcium oxalate 3. Yellow-brown,monhydrate whetstone____Calcium oxalate 4. Pink sedimentDehydrate 5. Ovoid

48. Match the following crystals seen in alkaline urinewith their description/identifying characteristics:____Triple phosphate 1. Yellow granules____Amorphous phosphate 2. Thin prisms____Calcium phosphate 3. “Coffin lids”____Ammonium biurate 4. Dumbbell shape____Calcium carbonate 5. White precipitate

6. Thorny apple

Chapter 61. C2. D3. D4. C5. A6. B7. C8. D9. C10. D11. D12. A13. C14. B15. C16. A17. D18. D19. B20. C21. A22. B23. C24. D25. D26. B27. D

28. A

29. B30. C31. C32. D33. D34. B35. A36. C37. C38. D39. A40. C41. D42. A43. A44. C45. D46. C47. 4, 3, 5, 148. 3, 5, 2, 6, 449. 4, 8, 7, 6, 1, 5, 350. 3, 5, 2, 1, 7, 4

49. Match the following abnormal crystals with theirdescription/identifying characteristics:____Cystine 1. Bundles following refrigeration____Tyrosine 2. Highly alkaline pH____Cholesterol 3. Bright yellow clumps____Leucine 4. Hexagonal plates____Ampicillin 5. Flat plates, high specific gravity____Radiographic 6. Concentric circles, radial

dye striations____Bilirubin 7. Notched corners

8. Fine needles seen in liverdisease

50. Match the following types of microscopy with theirdescriptions:____Bright-field 1. Indirect light is reflected off the

object____Phase 2. Objects split light into two

beams____Polarized 3. Low refractive index objects

may be overlooked____Dark-field 4. Three-dimensional images____Fluorescent 5. Forms halo of light around

object____Interference 6. Detects electrons emitted

contrast from objects7. Detects specific wavelengths of

light emitted from objects

1. Quality assessment refers to:A. Analysis of testing controlsB. Increased productivityC. Precise control resultsD. Quality of specimens and patient care

2. During laboratory accreditation inspections, proceduremanuals are examined for the presence of:A. Critical valuesB. Procedure referencesC. Procedures for specimen preservationD. All of the above

3. Urinalysis procedure manuals are reviewed:A. By the supervisor on each shiftB. Weekly by the pathologistC. Only when a procedure is changedD. Annually by a designated authority

4. As supervisor of the urinalysis laboratory, you havejust adopted a new procedure. You should:A. Put the package insert in the procedure manualB. Put a complete, referenced procedure in the manualC. Notify the microbiology departmentD. Put a cost analysis study in the procedure manual

5. Indicate whether each of the following would be considereda 1) preanalytical, 2) analytical, or 3) postanalyticalfactor by placing the appropriate number in thespace:_____ Reagent expiration date_____ Rejection of a contaminated specimen_____ Construction of a Levy-Jennings chart_____ Telephoning a positive Clinitest result on anewborn_____ Calibrating the centrifuge_____ Collecting a timed urine specimen

6. Deionized water used for the preparation of reagentsshould be checked for:A. Calcium contentB. Bacterial contentC. Filter contaminationD. pH, purity, and bacteria

7. Would a control sample that has accidentally becomediluted produce a trend or a shift in the Levy-Jenningsplot?A. TrendB. Shift

8. A color change that indicates when a patient’s specimenor reagent is added correctly would be an exampleof:A. External QCB. Equivalent QCC. Internal QCD. Proficiency testing

9. What steps are taken when the results of reagentstrip QC are outside of the stated confidence limits?A. Check the expiration date of the reagent stripB. Run a new controlC. Open a new reagent strips containerD. All of the above

10. When a new bottle of qc material is opened, whatinformation is placed on the label?A. The supervisor’s initialsB. The lot numberC. The date and the laboratory worker’s initialsD. The time the bottle was opened

11. When a control is run, what information is documented?A. The lot numberB. Expiration date of the controlC. The test resultsD. All of the above

12. State which of the CLIA categories is assigned to eachof the following laboratory tests by placing the appropriatenumber in front of the test.1. Waived2. PPM3. Moderate complexity4. High complexity____A. Reagent strip urinalysis____B. Urine culture____C. Complete urinalysis using the Clinitek 500____D. Urine microscopic____E. Urine pregnancy test

13. How often does CLIA’ 88 require documentation oftechnical competency?A. Every 6 monthsB. Once a yearC. Twice the first year and then annuallyD. Twice the first year and then every 5 years

14. Who are the laboratory’s “customers” in CQI?A. PhysiciansB. Patients’ family membersC. PatientsD. All of the above

15. What is the primary goal of TQM?A. Increased laboratory productivityB. Improved patient outcomesC. Reliability of test resultsD. Precise test results

16. Match the purpose for developing each of the following:1. Flowcharts2. Cause-and-effect diagrams3. Pareto charts4. Run charts____A. Determine cyclic and seasonal differencescompared to an average____B. Break down a process into steps____C. Identify the major contributors to aproblem____D. Determine the cause of a problem

17. True or False: Most medical errors are the fault ofindividuals, not the system.

Chapter 71. D2. D3. D4. B5. 2, 1, 2, 3, 2, 16. D7. B8. C9. D10. C11. D12. 1, 4, 3, 2, 113. C14. D15. B16. 4, 1, 3, 217. False

1. The majority of glomerular disorders are caused by:A. Sudden drops in blood pressureB. Immunologic disordersC. Exposure to toxic substancesD. Bacterial infections

2. Dysmorphic RBC casts would be a significant findingwith all of the following except:A. Goodpasture syndromeB. Acute glomeruonephritisC. Chronic pyelonephritisD. Henoch-Schönlein purpura

3. Occassional episodes of macroscopic hematuria overperiods of 20 or more years are seen with:A. Crescentic glomerulonephritisB. IgA nephropathyC. Nephrotic syndromeD. Wegener’s granulomatosis

4. Antiglomerular basement membrane antibody is seenwith:A. Wegener’s granulomatosisB. IgA nephropathyC. Goodpasture syndromeD. Diabetic nephropathy

5. Antineutrophilic cytoplasmic antibody is diagnostic for:A. IgA nephropathyB. Wegener’s granulomatosisC. Henoch-Schönlein purpuraD. Goodpasture syndrome

6. Respiratory and renal symptoms are associated with allof the following except:A. IgA nephropathyB. Wegener’s granulomatosisC. Henoch-Schönlein purpuraD. Goodpasture syndrome

7. Broad and waxy casts are most frequently seen with:A. Membranoproliferative glomerulonephritisB. Membranous glomerulonephritisC. Chronic glomerulonephritisD. Rapidly progressive glomerulonephritis

8. The presence of fatty casts is associated with all of thefollowing except:A. Nephrotic syndromeB. Focal segmental glomerulosclerosisC. Nephrogenic diabetes insipidusD. Minimal change disease

9. High levels of proteinuria are early symptoms of:A. Alport syndrome

B. Diabetic nephropathyC. IgA nephropathyD. Nephrotic syndrome

10. Ischemia frequently produces:A. Acute renal tubular necrosisB. Minimal change disorderC. Acute renal failureD. Both A and C

11. A disorder associated with polyuria and low specificgravity is:A. Renal glucosuriaB. CystitisC. Nephrogenic diabetes insipidusD. Focal segmental glomerulosclerosis

12. An inherited or accquired disorder producing a generalizeddefect in tubular reabsorption is:A. Alport syndromeB. Acute interstitial nephritisC. Fanconi syndromeD. Renal glucosuria

13. The presence of renal tubular epithelial cells andcasts is an indication of:A. Acute interstitial nephritisB. Chronic glomerulonephritisC. Minimal change diseaseD. Acute tubular necrosis

14. Differentiation between cystitis and pyelonephritis isaided by the presence of:A. WBC castsB. RBC castsC. BacteriaD. Granular casts

15. The presence of WBCs and WBC casts with no bacteriaseen is indicative of:A. Chronic pyelonephritisB. Acute tubular necrosisC. Acute interstitial nephritisD. Both B and C

16. End-stage renal disease is characterized by all of thefollowing except:A. HypersthenuriaB. IsosthenuriaC. AzotemiaD. Electrolyte imbalance

17. Broad and waxy casts are most likely associated with:A. Nephrotic syndromeB. Chronic renal failure

C. Focal segmental glomerulosclerosisD. Acute renal failure

18. Postrenal acute renal failure could be caused by:A. IschemiaB. Acute tubular necrosisC. Acute interstitial nephritisD. Malignant tumors

19. The most common composition of renal calculi is:A. Calcium oxalateB. Magnesium ammonium phosphateC. CystineD. Uric acid

20. Urinalysis on a patient being evaluated for renal calculiwould be most beneficial if it showed:A. Heavy proteinuriaB. Calcium oxalate crystalsC. Macroscopic hematuriaD. Microscopic hematuria

Chapter 81. B2. C3. B4. C5. B6. A7. C8. C9. D10. D11. C12. C13. D14. A15. A16. A17. B18. D19. A20. D

CHAPTER 9

All states require newborn screening for PKU for early:A. Modifications of dietB. Administration of antibioticsC. Detection of diabetesD. Initiation of gene therapy

2. All of the following disorders can be detected bynewborn screening except:A. TyrosyluriaB. MSUDC. MelanuriaD. Galactosemia

3. The best specimen for early newborn screening is a:A. Timed urine specimenB. Blood specimenC. First morining urine specimenD. Fecal specimen

4. Abnormal urine screening tests categorized as anoverflow disorder include all of the following except:A. AlkaptonuriaB. GalactosemiaC. MelanuriaD. Cystinuria

5. Which of the following disorders is not associatedwith the phenylalanine-tyrosine pathway?A. MSUDB. AlkaptonuriaC. AlbinismD. Tyrosinemia

6. Urine screening tests for PKU utilize:A. Microbial inhibitionB. Nitroso-naptholC. DinitrophenylhydrazineD. Ferric chloride

7. The least serious form of tyrosylemia is:A. Immature liver functionB. Type 1C. Type 2D. Type 3

8. An overflow disorder of the phenylalanine-tyrosinepathway that could produce a false-positive reactionwith the reagent strip test for ketones is:A. AlkaptonuriaB. MelanuriaC. MSUDD. Tyrosyluria

9. An overflow disorder that could produce a falsepositivereaction with clinitest is:A. CystinuriaB. AlkaptonuriaC. IndicanuriaD. Porphyrinuria

10. A urine that turns black after sitting by the sink forseveral hours could be indicative of:A. AlkaptonuriaB. MSUDC. MelanuriaD. Both A and C

11. Ketonuria in a newborn is an indication of:A. MSUDB. Isovaleric acidemiaC. Methylmalonic acidemiaD. All of the above

12. Urine from a newborn with MSUD will have asignificant:A. Pale colorB. Yellow precipitateC. Milky appearanceD. Sweet odor

13. A substance that reacts with p-nitroaniline is:A. Isovaleric acidB. Propionic acidC. Methylmalonic acidD. Indican

14. Which of the following has a significant odor?A. Isovaleric acidemiaB. Propionic acidemiaC. Methylmalonic acidemiaD. Indicanuria

15. Hartnup disease is a disorder associated with themetabolism of:A. Organic acidsB. TryptophanC. CystineD. Phenylalanine

16. 5-HIAA is a degradation product of:A. HemeB. IndoleC. SerotoninD. Melanin

17. Elevated urinary levels of 5-HIAA are associated with:A. Carcinoid tumorsB. Hartnup diseaseC. CystinuriaD. Platelet disorders

18. False-positive levels of 5-HIAA can be caused bya diet high in:A. MeatB. CarbohydratesC. StarchD. Bananas

19. Place the appropriate letter in front of the followingstatements.A. CystinuriaB. Cystinosis____IEM____Inherited disorder of renal tubules____Fanconi syndrome____Cystine deposits in the cornea____Early renal calculi formation

20. Urine from patients with cystine disorders willreact with:A. DinitrophenylhydrazineB. Sodium cyanideC. Ehrlich reagentD. 1-Nitroso-napthol

21. Blue diaper syndrome is associated with:A. Lesch-Nyhan syndromeB. PhenylketonuriaC. CystinuriaD. Hartnup disease

22. Homocystinuria is caused by failure to metabolize:A. LysineB. MethionineC. ArginineD. Cystine

23. Early detection is most valuable for correction of:A. HomocystinuriaB. CystinuriaC. IndicanuriaD. Porphyrinuria

24. The Ehrlich reaction will only detect the presence of:A. Aminolevulinic acidB. PorphobilinogenC. CoproporphyrinD. Protoporphyrin

25. Acetylacetone is added to the urine prior to performingthe Ehrlich test when checking for:A. Aminolevulinic acidB. PorphobilinogenC. UroporphyrinD. Coproporphyrin

26. The classic urine color associated with porphyria is:A. Dark yellowB. Indigo blueC. PinkD. Port wine

27. Which of the following specimens can be used forporphyrin testing?A. UrineB. BloodC. FecesD. All of the above

28. The two stages of heme formation affected by leadpoisoning are:A. Porphobilinogen and uroporphyrinB. Aminolevulinic acid and porphobilinogenC. Coproporphyrin and protoporphyrinD. Aminolevulinic acid and protoporphyrin

29. Hurler, Hunter, and Sanfilippo syndromes are hereditarydisorders affecting metabolism of:A. PorphyrinsB. PurinesC. MucopolysaccharidesD. Tryptophan

30. Many uric acid crystals in a pediatric urine specimenmay indicate:A. Hurler syndromeB. Lesch-Nyhan diseaseC. MelituriaD. Sanfilippo syndrome

31. Deficiency of the GALT enzyme will produce a:A. Positive ClinitestB. GlycosuriaC. GalactosemiaD. Both A and C

32. Match the metabolic urine disorders with their classicurine abonormalities.____PKU A. Sulfur odor____Indicanuria B. Sweaty feet odor____Cystinuria C. Orange sand in diaper____Homogentisic acid D. Mousy odor____Lesch-Nyhan disease E. Black color

F. Blue color

Chapter 91. A2. C3. B4. D5. A6. D7. A8. B9. B10. D11. D12. D13. C14. A15. B16. C17. A18. D19. B, A, B, B, A20. B21. D22. B23. A24. B25. A26. D27. D28. D29. C30. B31. D32. D, F, A, E, C