CHAPTER 3

1. Which of the following is the urine specimen of choice for cytology studies?
A. First morning specimen
*B. Random specimen
C. Midstream “clean catch” collection
D. Timed collection

2. Which of the following specimens usually eliminates contamination of the urine with entities from the external
genitalia and the distal urethra?
A. First morning specimen
*B. Midstream “clean catch” specimen
C. Random specimen
D. 4-hour timed collection

3. Substances that show diurnal variation in their urinary excretion pattern are best evaluated using a
A. first morning specimen.
B. midstream “clean catch” specimen.
C. random specimen.
*D. timed collection.

4. Which of the following will not cause erroneous results in a 24-hour timed urine collection?
*A. The collection starts and ends in the evening
B. Two first morning specimens are included in the collection
C. Multiple collection containers are not mixed together before specimen testing
D. A portion of the collection is removed before total volume measurement

5. A 25-year-old woman complains of painful urination and is suspected of having a urinary tract infection. Which of the
following specimens should be collected for a routine urinalysis and urine culture?
A. First morning specimen
B. Timed collection
*C. Midstream “clean catch” specimen
D. Random specimen

6. 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-hour postprandial
*B. 12-hour timed collection
*C. 24-hour timed collection
D. Midstream “clean catch”

7. An unpreserved urine specimen collected at midnight is kept at room temperature until the morning hospital shift.
Which of the following changes will most likely occur?
A. Decrease in urine color and clarity
B. Decrease in pH and specific gravity
*C. Decrease in glucose and ketones
D. Decrease in bacteria and nitrite

8. A urine specimen containing the substance indicated is kept unpreserved at room temperature for 4 hours.
All of these parameters are expected to be decreased, except:
A. Bilirubin
B. Glucose
C. Ketones
*D. pH
E. All options are correct
F. None of the options are correct

8. A urine specimen containing the substance indicated is kept unpreserved at room temperature for 4 hours.
Which of these parameters are expected to have no changes?
A. Bilirubin
B. Glucose
C. Ketones
D. pH
E. All options are correct
*F. None of the options are correct
9. Which of the following is the most common method used to preserve urine specimens?
A. Acid addition
B. Thymol addition
C. Freezing
*D. Refrigeration

10. If refrigeration is used to preserve a urine specimen, which of the following may occur?
A. Cellular or bacterial glycolysis will be enhanced.
B. Formed elements will be destroyed.
*C. Amorphous crystals may precipitate.
D. Bacteria will proliferate.

11. Which of the following urine preservatives is acceptable for both urinalysis and urine culture?
*A. Boric acid
B. Chlorhexidine
C. Dowicil 200
D. Formalin

12. How much urine is usually required for a manually performed routine urinalysis?
A. 5 to 10 mL
*B. 10 to 15 mL
C. 20 to 30 mL
D. 50 to 100 mL

13. Which of the following substances is higher in urine than in any other body fluid?
A. Chloride
*B. Creatinine
C. Glucose
D. Protein

CHAPTER 4
2. How many nephrons are found in the average kidney?
A. 13,000
B. 130,000
*C. 1.3 million
D. 13 million

3. Ultrafiltration of plasma occurs in glomeruli located in the renal

*A. cortex.
B. medulla.
C. pelvis.
D. ureter.

4. Which component of the nephron is located exclusively in the renal medulla?

A. Collecting tubule
B. Distal tubule
*C. Loop of Henle
D. Proximal tubule

5. Which of the following is not a vascular characteristic of the kidney?

*A. The afferent arteriole has a narrower lumen than the efferent arteriole.
B. The arteries are primarily end arteries, supplying specific areas of tissue, and they do not interconnect.
C. The arterioles subdivide into a capillary network, rejoin as an arteriole, and subdivide into a second capillary
bed.
D. The vasa recta vessels deep in the renal medulla form the beginning of the venous renal circulation.

6. Formation of the ultrafiltrate in the glomerulus is driven by the

*A. hydrostatic blood pressure.
B. oncotic pressure of the plasma proteins.
C. osmotic pressure of the solutes in the ultrafiltrate.
D. pressures exerted by the glomerular filtration barrier.
7. Which of the following is a characteristic of renin, an enzyme secreted by specialized cells of the juxtaglomerular
apparatus?
A. Renin stimulates the diffusion of urea into the renal interstitium.
B. Renin inhibits the reabsorption of sodium and water in the nephron.
C. Renin regulates the osmotic reabsorption of water by the collecting tubules.
*D. Renin causes the formation of angiotensin and the secretion of aldosterone.

8. The glomerular filtration barrier is composed of the

*A. capillary endothelium, basement membrane, and podocytes.
B. mesangium, basement membrane, and shield of negativity.
C. capillary endothelium, mesangium, and juxtaglomerular apparatus.
D. basement membrane, podocytes, and juxtaglomerular apparatus.

9. The ability of a solute to cross the glomerular filtration barrier is determined by its
1-molecular size.
2-molecular radius.
3-electrical charge.
4-plasma concentration.
*A. 1, 2, and 3 are correct.
B. 1 and 3 are correct.
C. 4 is correct.
D. All are correct.

10. The epithelium characterized by a brush border owing to numerous microvilli is found in the
A. collecting tubules.
B. distal tubules.
C. loops of Henle.
*D. proximal tubules.

11. The kidneys play an important role in the

1-excretion of waste products.
2-regulation of water and electrolytes.
3-maintenance of acid-base equilibrium.
4-control of blood pressure and fluid balance.
A. 1, 2, and 3 are correct.
B. 1 and 3 are correct.
C. 4 is correct.
*D. All are correct.

12. What percent of the original ultrafiltrate formed in the urinary space actually is excreted as urine?
*A. 1%
B. 10%
C. 25%
D. 33%

13. What differentiates tubular reabsorption from tubular secretion in the nephron?
*A. The direction of movement of the substance being absorbed or secreted is different.
B. Reabsorption is an active transport process, whereas secretion is a passive transport process.
C. Cell membrane–binding sites are different for the reabsorption and secretion of a solute.
D. The location of the epithelium in the nephron determines which process occurs.

14. During tubular transport, the movement of a solute against a gradient

A. is called passive transport.
B. requires little to no energy.
*C. involves specific cell membrane–binding sites.
D. may occur paracellularly, that is, between cells through intercellular spaces.

15. Substances bound to plasma proteins in the blood can be eliminated in the urine by
A. glomerular secretion.
B. glomerular filtration.
*C. tubular secretion.
D. tubular reabsorption.
16. Which statement characterizes the ability of the renal system to regulate blood pH?
*A. The renal system has a slow response with complete correction of the pH to normal.
B. The renal system has a fast response with complete correction of the pH to normal.
C. The renal system has a slow response with only partial correction of the pH toward normal.
D. The renal system has a fast response with only partial correction of the pH toward normal.

17. The kidneys excrete excess alkali (base) in the urine as

A. ammonium ions.
B. ammonium salts.
*C. sodium bicarbonate.
D. titratable acids.

18. Which of the following substances is secreted into the tubular lumen to eliminate hydrogen ions?
*A. Ammonia (NH3)
B. Ammonium ions (NH4 +)
C. Disodium phosphate (Na2HPO4)
D. Monosodium phosphate (NaH2PO4)

19. Urine titratable acids can form when the ultrafiltrate contains
A. ammonia.
B. bicarbonate.
*C. phosphate.
D. sodium.

20. The renal threshold level for glucose is 160 to 180 mg/dL. This corresponds to the
A. rate of glucose reabsorption by the renal tubules.
B. concentration of glucose in the tubular lumen fluid.
C. plasma concentration above which tubular reabsorption of glucose occurs.
*D. plasma concentration above which glucose is excreted in the urine.

21. When too much protein is presented to the renal tubules for reabsorption, it is excreted in the urine because
A. the renal threshold for protein has not been exceeded.
*B. the maximal tubular reabsorptive capacity for protein has been exceeded.
C. protein is not normally present in the ultrafiltrate and cannot be reabsorbed.
D. the glomerular filtration barrier allows only abnormal proteins to pass.

22. More than 66% of filtered water, sodium, and chloride and 100% of filtered glucose, amino acids, and proteins are
reabsorbed in the
A. collecting tubules.
B. distal tubules.
C. loops of Henle.
*D. proximal tubules.

23. Water reabsorption occurs throughout the nephron except in the

A. cortical collecting tubules.
B. proximal convoluted tubules.
*C. ascending limb of the loops of Henle.
D. descending limb of the loops of Henle.

24. The process solely responsible for water reabsorption throughout the nephron is
*A. osmosis.
B. the urea cycle.
C. the countercurrent exchange mechanism.
D. the countercurrent multiplier mechanism.

25. Hypertonicity of the renal medulla is maintained by

1-the countercurrent multiplier mechanism.
2-the countercurrent exchange mechanism.
3-the urea cycle.
4-osmosis.
A. 1, 2, and 3 are correct.
*B. 1 and 3 are correct.
C. 4 is correct.
D. All are correct.
26. Which of the following is not a feature of the renal countercurrent multiplier mechanism?
A. The ascending limb of the loop of Henle is impermeable to water.
B. The descending limb of the loop of Henle passively reabsorbs water.
*C. The descending limb of the loop of Henle actively reabsorbs sodium and urea.
D. The fluid in the ascending and descending limbs of the loop of Henle flows in opposite directions.

27. The purpose of the renal countercurrent multiplier mechanism is to

A. concentrate the tubular lumen fluid.
B. increase the urinary excretion of urea.
*C. preserve the gradient hypertonicity in the medulla.
D. facilitate the reabsorption of sodium and chloride.

28. Which vascular component is involved in the renal countercurrent exchange mechanism?
A. Afferent arteriole
B. Efferent arteriole
C. Glomerulus
*D. Vasa recta

29. Antidiuretic hormone regulates the reabsorption of

*A. water in the collecting tubules.
B. sodium in the collecting tubules.
C. sodium in the distal convoluted tubule.
D. water and sodium in the loop of Henle.

30. Which of the following describes the tubular lumen fluid that enters the collecting tubule compared with the tubular
lumen fluid in the proximal tubule?
A. Hypo-osmotic
*B. Isosmotic
C. Hyperosmotic
D. Counterosmotic

31. The final concentration of the urine is determined within the

*A. collecting ducts.
B. distal convoluted tubules.
C. loops of Henle.
D. proximal convoluted tubules.

CHAPTER 5
1. Which of the following solutes are present in the largest molar amounts in urine?
*A. Urea, chloride, and sodium
B. Urea, creatinine, and sodium
C. Creatinine, uric acid, and ammonium
D. Urea, uric acid, and ammonium

2. Renal excretion is not involved in the elimination of

A. electrolytes and water.
*B. normal by-products of fat metabolism.
C. soluble metabolic wastes (e.g., urea, creatinine).
D. exogenous substances (e.g., drugs, x-ray contrast media).

3. 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

4. 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 liter of solvent
5. The osmolality of a solution containing 1.0 mole of urea is equal to that of a solution containing
A. 1.0 mole of HCl.
B. 1.0 mole of H2PO4.
*C. 0.5 mole of NaCl.
D. 0.5 mole of glucose.

6. The maximum osmolality that urine can achieve is determined by the

A. quantity of solutes ingested in the diet.
B. presence of antidiuretic hormone in the collecting tubules.
*C. osmolality of the medullary interstitium.
D. osmolality of fluid entering the collecting tubules.

7. Serum osmolality remains relatively constant, whereas the urine osmolality ranges from
A. one-third to one-half that of serum.
B. one-third to equal that of serum.
*C. one to three times that of serum.
D. three to five times that of serum.

8. Another name for excessive thirst is

*A. polydipsia.
B. polyuria.
C. hydrophilia.
D. hydrostasis.

9. Specific gravity measurements are not affected by

A. temperature.
*B. solute charge.
C. solute mass.
D. solute number.

10. Osmolality is a measure of solute

A. density.
B. mass.
*C. number.
D. weight.

11. Which of the following solutes, if added to pure water, affects the specific gravity more than it affects its osmolality?
A. Sodium
B. Chloride
C. Potassium
*D. Glucose

12. Occasionally the specific gravity of a urine specimen exceeds that physiologically possible (i.e., >1.040). Which of the
following substances when found in urine could account for such a high value?
A. Creatinine
B. Glucose
*C. Mannitol
D. Protein

13. The excretion of large volumes of urine (>3 L/day) is called

A. glucosuria.
B. hyperuria.
C. polydipsia.
*D. polyuria.

14. The daily volume of urine excreted normally ranges from

A. 100 to 500 mL/day.
B. 100 to 1800 mL/day.
*C. 500 to 1800 mL/day.
D. 1000 to 3000 mL/day.
15. When the body is dehydrated, the kidneys
A. excrete excess solutes in a constant volume of urine.
*B. excrete solutes in as small a volume of urine as possible.
C. decrease the quantity of solutes excreted and decrease the urine volume.
D. increase the quantity of solutes excreted while holding the urine volume constant.

16. The excretion of less than 400 mL of urine per day is called
A. anuria.
B. hypouria.
C. nocturia.
*D. oliguria.

17. The ultrafiltrate in the urinary space of the glomerulus has a specific gravity of
A. 1.005 and a lower osmolality than the blood plasma.
*B. 1.010 and the same osmolality as the blood plasma.
C. 1.015 and a higher osmolality than the blood plasma.
D. 1.035 and a higher osmolality than the blood plasma.

18. All of the following conditions may produce nocturia except

*A. anuria.
B. pregnancy.
C. chronic renal disease.
D. fluid intake at night.

19. Which renal function is assessed using specific gravity and osmolality measurements?
*A. Concentrating ability
B. Glomerular filtration ability
C. Tubular excretion ability
D. Tubular secretion ability

20. A fluid deprivation test is used to

A. determine renal plasma flow.
B. investigate the cause of oliguria.
*C. assess renal concentrating ability.
D. measure the glomerular filtration rate.

21. A fluid deprivation test involves the measurement of serum and urine
A. density.
*B. osmolality.
C. specific gravity.
D. volume.

22. The volume of plasma cleared per minute in excess of that required for solute elimination is called the
A. creatinine clearance.
*B. free-water clearance.
C. osmolar clearance.
D. renal clearance.

23. A free-water clearance value of −1.2 would be expected from a patient experiencing
A. polyuria.
*B. dehydration.
C. water diuresis.
D. excessive fluid intake.

25. Which of the following is an endogenous substance used to measure glomerular filtration rate?
A. Urea
B. Inulin
*C. Creatinine
D. p-Aminohippurate

26. Renal clearance is defined as the volume of

A. urine cleared of a substance per minute.
*B. plasma cleared of a substance in a time interval.
C. plasma flowing through the kidney per minute.
D. plasma containing the same amount of substance in 1 mL of urine.
27. Creatinine is a good substance to use for a renal clearance test because it
A. is exogenous.
B. is reabsorbed.
C. is affected by fluid intake.
*D. has a constant plasma concentration.

28. Which of the following groups would be expected to have the greatest 24-hour excretion of creatinine?
A. Infants
B. Children
C. Women
*D. Men

29. 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.

31. A 24-hour urine collection is preferred for determination of creatinine clearance because of diurnal variation in the
*A. glomerular filtration rate.
B. plasma creatinine.
C. creatinine excretion.
D. urine excretion.

32. Which of the following situations results in an erroneous creatinine clearance measurement?
A. A 24-hour urine collection from an individual on a vegetarian diet
*B. A 24-hour urine collection maintained at room temperature throughout the collection
C. A plasma sample drawn at the beginning instead of during the 24-hour urine collection
D. Creatinine determinations made using the nonspecific alkaline picrate method (Jaffe reaction)

33. A 45-year-old female African American had her serum creatinine determined using a creatinine method that is NOT
calibrated to an IDMS reference method. Her serum creatinine was 1.5 mg/dL; what is her eGFR using the appropriate
MDRD equation?
A. 40 mL/min/1.73 m2
*B. 48 mL/min/1.73 m2
C. 51 mL/min/1.73 m2
D. 54 mL/min/1.73 m2

34. The glomerular filtration rate is controlled by

*A. the renal blood flow.
B. the renal plasma flow.
C. the countercurrent mechanism.
D. hormones (e.g., aldosterone, antidiuretic hormone).

35. For measurement of renal plasma flow, p-aminohippurate is an ideal substance to use because it
A. is easily measured in urine and plasma.
B. is endogenous and does not require an infusion.
*C. is secreted completely in its first pass through the kidneys.
D. maintains a constant plasma concentration throughout the test.

36. What percentage of the total cardiac output is received by the kidneys?
A. 8%
B. 15%
*C. 25%
D. 33%

37. Measuring the quantity of hydrogen ion excreted as titratable acids and ammonium salts in urine provides a
measure of
*A. tubular secretory function.
B. tubular reabsorptive function.
C. glomerular filtration ability.
D. renal concentrating ability.
38. The oral ammonium chloride test evaluates the ability of the tubules to secrete
A. ammonium and chloride.
B. phosphate and sodium.
C. bicarbonate and chloride.
*D. ammonia and hydrogen.

CHAPTER 6
1. The color of normal urine is due to the pigment
A. bilirubin
B. urobilin
C. uroerythrin
*D. urochrome

2. A single substance can impart different colors to urine depending on the

1-amount of the substance present.
2-storage conditions of the urine.
3-pH of the urine.
4-structural form of the substance.
A. 1, 2, and 3 are correct.
B. 1 and 3 are correct.
C. 4 is correct.
*D. All are correct.

3. Which of the following urine characteristics provides the best rough indicator of urine concentration and body
hydration?
*A. Color
B. Clarity
C. Foam
D. Volume

4. Which of the following pigments deposits on urate and uric acid crystals to form a precipitate described as “brick
dust”?
A. Bilirubin
B. Urobilin
*C. Uroerythrin
D. Urochrome

5. Uroerythrin pigment will result to what color of urine?

*A. Pink
B. Red
C. Purple
D. Brown
E. Yellow

5. Porphobilinogen pigment will result to what color of urine?

A. Pink
B. Green
*C. Purple
D. Brown
E. Colorless

6. Urobilinogen pigment will result to what color of urine?

A. Yellow
B. Green
C. Purple
D. Brown
*E. Colorless
6. Which of the following criteria should one use to consistently evaluate urine color and clarity?
1-Mix all specimens well.
2-Use the same depth or volume of a specimen.
3-Evaluate the specimens at the same temperature.
4-View the specimens against a dark background with good lighting.
*A. 1, 2, and 3 are correct.
B. 1 and 3 are correct.
C. 4 is correct.
D. All are correct.

7. Select the urine specimen that does not indicate the possible presence of blood or hemoglobin.
A. Clear, red urine
B. Cloudy, brown urine
C. Clear, brown urine
*D. Cloudy, amber urine

8. A urine that produces a large amount of white foam when mixed should be suspected to contain increased
amounts of
A. bilirubin.
*B. protein.
C. urobilin.
D. urobilinogen.

9. Which of the following substances can change the color of a urine and its foam?
*A. Bilirubin
B. Hemoglobin
C. Myoglobin
D. Urobilin

10. The clarity of a well-mixed urine specimen that has visible particulate matter and through which news print can be
seen but not read should be described as
*A. cloudy.
B. flocculated.
C. slightly cloudy.
D. turbid.

11. All of the following is considered as nonpathologic substance present in urine, EXCEPT:
A. Urate crystals
B. Radiographic contrast media
*C. Renal epithelial cells
D. Squamous epithelial cells
E. Bacteria (old urine)

12. Which of the following urine specimens is considered normal?

A. A freshly voided urine that is brown and clear
B. A freshly voided urine that is yellow and cloudy
C. A clear yellow urine specimen that changes color upon standing
*D. A clear yellow urine specimen that becomes cloudy upon refrigeration

13. A white or beige precipitate in a “normal” alkaline urine most likely is caused by
*A. amorphous phosphates.
B. amorphous urates.
C. uric acid crystals.
D. radiographic contrast media.

14. Which of the following condition may cause a sweet and fruity odor of urine?
I-Specimen adulteration
II-Starvation
III- Urinary tract infection
IV- Diabetes mellitus
*A. II and IV
B. I and III
C. I, II and III
D. IV only
E. None of the options
14. Which of the following condition may cause an ammonia-like odor of urine?
I-Old improperly stored urine
II-Specimen adulteration
III- Urinary tract infection
IV- Normal urine
A. II and IV
*B. I and III
C. I, II and III
D. IV only
E. None of the options

15. Which of the following methods used to determine the specific gravity of urine does not detect the presence of
urine protein or glucose?
A. Harmonic oscillation densitometry
*B. Reagent strip
C. Refractometry
D. Urinometry

16. A small ion and a large uncharged molecule have the same effect when urine concentration is determined by
A. urinometry.
*B. osmolality.
C. reagent strip.
D. refractometry.

17. Which of the following specific gravity values is physiologically impossible?

*A. 1.000
B. 1.010
C. 1.020
D. 1.030

18. Which of the following specific gravity methods follow/s the principle of density?
I- Harmonic oscillation densitometry
II- Reagent strip
III- Urinometry
IV- Refractometry
*A. I and III
B. II and IV
C. I, II and III
D. IV only
E. None of the options

19. Which of the following specific gravity methods follow/s the principle of pKa changes?
I- Harmonic oscillation densitometry
II- Reagent strip
III- Urinometry
IV- Refractometry
A. I and III
B. II and IV
C. I, II and III
*D. IV only
E. None of the options

19. Which of the following methods is an indirect measure of specific gravity?

1. Reagent strip
2. Urinometry
3. Refractometry
4. Harmonic oscillation densitometry A. 1, 2, and 3 are correct.
B. 1 and 3 are correct.
C. 4 is correct.
D. All are correct.
20. The refractive index of a solution is affected by the
1-wavelength of light used.
2-size and number of the solutes present.
3-concentration of the solution.
4-temperature of the solution.
A. 1, 2, and 3 are correct.
B. 1 and 3 are correct.
C. 4 is correct.
*D. All are correct.

21. Refractometry is preferred for specific gravity measurements because it

1-uses a small amount of sample.
2-is fast and easy to perform.
3-automatically compensates for temperature.
4-measures only ionic solutes.
*A. 1, 2, and 3 are correct.
B. 1 and 3 are correct.
C. 4 is correct.
D. All are correct.

22. The principle of the reagent strip method for measuring specific gravity is based on
*A. the pKa of a polyelectrolyte decreasing in proportion to the ionic concentration of the specimen.
B. the pH of a polyelectrolyte decreasing in proportion to the ionic concentration of the specimen.
C. the pKa of a polyelectrolyte increasing in proportion to the ionic concentration of the specimen.
D. the pH of a polyelectrolyte increasing in proportion to the ionic concentration of the specimen.

23. Ionic specific gravity (SGionic) measurements obtained using reagent strips provide useful clinical information
because
A. all of the urinary solutes present are measured.
B. the quantity of nonionic solutes in urine relative to ionic solutes is significant.
C. excretion of nonionic solutes (e.g., urea, glucose, protein) does not reflect renal dysfunction.
*D. the ability of the kidneys to concentrate urine is reflected in the reabsorption and secretion of ionic solutes.

24. Which of the following as described is not a colligative property?

A. Boiling point elevation
B. Freezing point depression
*C. Osmotic pressure depression
D. Vapor pressure depression

25. An advantage of freezing point osmometry over vapor pressure osmometry is its
A. increased turnaround time.
B. use of a smaller volume of sample.
*C. ability to detect volatile substances.
D. decreased interference from plasma lipids.

26. Osmolality measurements are considered to be a more accurate assessment of solute concentration in body fluids
than are specific gravity measurements because
*A. all solutes contribute equally.
B. heavy molecules do not interfere.
C. they are not temperature dependent.
D. they are less time-consuming to perform.

27. The freezing point of a urine specimen is determined to be −0.90° C. What is the osmolality of the specimen?
A. 161 mOsm/kg
*B. 484 mOsm/kg
C. 597 mOsm/kg
D. 645 mOsm/kg

28. Which of the following will not influence the volume of urine produced?
A. Diarrhea
B. Exercise
C. Caffeine ingestion
*D. Carbohydrate ingestion
CHAPTER 7
1. To preserve the integrity of reagent strips, it is necessary that they are
A. humidified adequately.
B. stored in a refrigerator.
*C. stored in a tightly capped container.
D. protected from the dark.

2. Using quality control materials, one should check reagent strip performance
1-at least once daily.
2-when a new bottle of strips or tablets is opened.
3-when a new lot number of strips or tablets is placed into use.
4-once each shift by each laboratorian performing urinalysis testing.
*A. 1, 2, and 3 are correct.
B. 1 and 3 are correct.
C. 4 is correct.
D. All are correct.

3. Which of the following is not checked by quality control materials?

A. The technical skills of the personnel performing the test
*B. The integrity of the specimen, that is, that the specimen was collected and stored properly
C. The test protocol, that is, that the procedure was performed according to written guidelines
D. The functioning of the equipment used, for example, the refractometer and the reagent strip readers

4. Quality control materials used to assess the performance of reagent strips and tablet tests must
A. be purchased from a commercial manufacturer.
B. yield the same results regardless of the commercial brand used.
*C. contain chemical constituents at realistic and critical detection levels.
D. include constituents to assess the chemical and microscopic examinations.

5. Which of the following is not a source of erroneous results when reagent strips are used?
A. Testing a refrigerated urine specimen
B. Timing using a clock without a second hand
C. Allowing excess urine to remain on the reagent strip
*D. Dipping the reagent strip briefly into the urine specimen.

6. Select the primary reason why tablet (e.g., Ictotest) and chemical tests (e.g., sulfosalicylic acid precipitation test)
generally are performed.
A. They confirm results suspected about the specimen.
B. They are alternative testing methods for highly concentrated urines.
*C. Their specificity differs from that of the reagent strip test.
D. They are more sensitive to the chemical constituents in urine.

7. In a patient with chronic renal disease, in whom the kidneys can no longer adjust urine concentration, the urine
specific gravity would be
A. 1.000.
*B. 1.010.
C. 1.020.
D. 1.030.

8. Urine pH normally ranges from

A. 4.0 to 9.0.
B. 4.5 to 7.0.
*C. 4.5 to 8.0.
D. 5.0 to 6.0.

9. Urine pH can be modified by all of the following except

A. diet.
*B. increased ingestion of water.
C. ingestion of medications.
D. urinary tract infections.
10. The double-indicator system used by commercial reagent strips to determine urine pH uses which two indicator
dyes?
A. Methyl orange and bromphenol blue
*B. Methyl red and bromthymol blue
C. Phenol red and thymol blue
D. Phenolphthalein and litmus

11. All of the following can result in inaccurate urine pH measurements except
*A. large amounts of protein present in the urine.
B. double-dipping of the reagent strip into the specimen.
C. maintaining the specimen at room temperature for 4 hours.
D. allowing excess urine to remain on the reagent strip during the timing interval.

12. Which of the following aids in the differentiation of hemoglobinuria and hematuria?
A. Urine pH
B. Urine color
C. Leukocyte esterase test
*D. Microscopic examination

13. Select the correct statement(s).

1-Myoglobin and hemoglobin are reabsorbed readily by renal tubular cells.
2-Hemosiderin, a soluble storage form of iron, is found in aqueous solutions.
3-When haptoglobin is saturated, free hemoglobin passes through the glomerular filtration barrier.
4-Hemosiderin is found in the urine during a hemolytic episode.
A. 1, 2, and 3 are correct.
*B. 1 and 3 are correct.
C. 4 is correct.
D. All are correct.

14. Which statement about hemoglobin and myoglobin is true?

*A. They are heme-containing proteins involved in oxygen transport.
B. Their presence is suspected when urine and serum appear red.
C. Their presence in serum is associated with high creatine kinase values.
D. They precipitate out of solution when the urine is 80% saturated with ammonium sulfate.

15. On the reagent strip test for blood, any heme moiety (e.g., hemoglobin, myoglobin) present in urine catalyzes
A. oxidation of the chromogen and hydrogen peroxide.
B. reduction of the chromogen in the presence of hydrogen peroxide.
C. reduction of the pseudoperoxidase while the chromogen undergoes a color change.
*D. oxidation of the chromogen while hydrogen peroxide is reduced.

16. Which of the following blood cells will not be detected by the leukocyte esterase pad because it lacks esterases?
A. Eosinophils
*B. Lymphocytes
C. Monocytes
D. Neutrophils

17. Microscopic examination of a urine sediment revealed an average of 2 to 5 white blood cells per high-power field,
whereas the leukocyte esterase test by reagent strip was negative. Which of the following statements best accounts for
this discrepancy?
A. The urine is contaminated with vaginal fluid.
B. Many white blood cells are lysed, and their esterase has been inactivated.
C. Ascorbic acid is interfering with the reaction on the reagent strip.
*D. The amount of esterase present is below the sensitivity of the reagent strip test.

18. Which of the following statements describes the chemical principle involved in the leukocyte esterase pad of
commercial reagent strips?
A. Leukocyte esterase reacts with a diazonium salt on the reagent pad to form an azo dye.
B. An ester and a diazonium salt combine to form an azo dye in the presence of leukocyte esterase.
C. An aromatic compound on the reagent pad combines with leukocyte esterase to form an azo dye.
*D. Leukocyte esterase hydrolyzes an ester on the reagent pad, then an azocoupling reaction results in the
formation of an azo dye.
19. Which of the following conditions most likely accounts for a negative nitrite result on the reagent strip despite the
presence of large quantities of bacteria?
1-The bacteria present did not have enough time to convert nitrate to nitrite.
2-The bacteria present are not capable of converting nitrate to nitrite.
3-The patient is not ingesting adequate amounts of nitrate in the diet.
4-The urine is dilute and the level of nitrite present is below the sensitivity of the test.
A. 1, 2, and 3 are correct.
B. 1 and 3 are correct.
C. 4 is correct.
*D. All are correct.

20. The chemical principle of the nitrite reagent pad is based on the
A. pseudoperoxidase activity of nitrite.
*B. diazotization of nitrite followed by an azocoupling reaction.
C. azocoupling action of nitrite with a diazonium salt to form an azo dye.
D. hydrolysis of an ester by nitrite combined with an azocoupling reaction.

21. Which of the following substances or actions can produce false-positive nitrite results?
A. Ascorbic acid
B. Vaginal contamination
C. Strong reducing agents
*D. Improper specimen storage

22. Normally, daily urine protein excretion does not exceed

*A. 150 mg/day.
B. 500 mg/day.
C. 1.5 g/day.
D. 2.5 g/day.

23. Which of the following proteins originates in the urinary tract?

A. Albumin
B. Bence Jones protein
C. β2-Microglobulin
*D. Uromodulin

24. All of the following is related to tubular proteinuria, EXCEPT:

A. Defective protein reabsorption in the nephrons
B. Increase in low-molecular-weight proteins in urine
C. Fanconi’s syndrome
D. Hemoglobinuria and myoglobinuria

25. Which of the statements is/are related to overflow proteinuria?

I- Immunoglobulin light chains in the urine
II- Protein excreted only in an orthostatic position
III- Hemoglobinuria and myoglobinuria
IV- Proteins originating from a bladder tumor
*A. I and III
B. II and IV
C. I, II and III
D. IV only
E. All of the above.

26. Which of the following is related to Postrenal proteinuria?

*A. Proteins originating from a bladder tumor
B. Increased urine albumin and mid- to high-molecular-weight proteins
C. Fanconi’s syndrome
D. Immunoglobulin light chains in the urine
E. Protein excreted only in an orthostatic position

25. Which of the following statements about Bence Jones protein is correct?
*A. The protein consists of κ and λ light chains.
B. The protein is often found in the urine of patients with multiple sclerosis.
C. The protein precipitates when urine is heated to 100° C and redissolves when cooled to 60° C.
D. The protein can produce a positive reagent strip protein test and a negative sulfosalicylic acid (SSA) precipitation test.
26. A urine specimen is tested for protein by reagent strip and by the SSA test. The reagent strip result is negative, and
the SSA result is 2+. Which of the following statements best explains this discrepancy?
*A. A protein other than albumin is present in the urine.
B. The reagent strip result is falsely negative because the urine has a pH of 8.0.
C. A large quantity of amorphous urates in the urine caused the false-positive SSA result.
D. The time interval for reading the reagent strip pad was exceeded, causing a false-negative result.

27. Which of the following statements best describes the chemical principle of the protein reagent strip test?
A. The protein reacts with an immunocomplex on the pad, which results in a color change.
B. The protein causes a pH change on the reagent strip pad, which results in a color change.
*C. The protein accepts hydrogen ions from the indicator dye, which results in a color change.
D. The protein causes protons to be released from a polyelectrolyte, which results in a color change.

28. A urine specimen is tested for glucose by a reagent strip and by the Clinitest method. The reagent strip result is 100
mg/dL, and the Clinitest result is 500 mg/dL. Which of the following statements would best account for this
discrepancy?
A. The Clinitest tablets have expired or were stored improperly.
*B. A large amount of ascorbic acid is present in the specimen.
C. A strong oxidizing agent (e.g., bleach) is contaminating the specimen.
D. The reagent strip is exhibiting the pass-through phenomenon, which results in a falsely low value.

29. Which of the following substances if present in the urine results in a negative Clinitest?
A. Fructose
B. Lactose
C. Galactose
*D. Sucrose

30. The glucose reagent strip test is more sensitive and specific for glucose than the Clinitest method because it detects
A. other reducing substances and higher concentrations of glucose.
B. no other substances and higher concentrations of glucose.
C. other reducing substances and lower concentrations of glucose.
*D. no other substances and lower concentrations of glucose.

31. Which of the following statements about glucose is false?

A. Glucose readily passes the glomerular filtration barrier.
*B. Glucose is reabsorbed passively in the proximal tubule.
C. Glucosuria occurs when plasma glucose levels exceed 160 to 180 mg/dL.
D. High plasma glucose concentrations are associated with damage to the glomerular filtration barrier.

32. The pass-through phenomenon observed with the Clinitest method when large amounts of glucose are present in
the urine is due to
A. “carmelization” of the sugar present.
B. reduction of copper sulfate to green-brown cupric complexes.
C. depletion of the substrate, that is, not enough copper sulfate is present initially.
*D. reoxidation of the cuprous oxide formed to cupric oxide and other cupric complexes.

33. The glucose specificity of the double sequential enzyme reaction used on reagent strip tests is due to the use of
A. gluconic acid.
*B. glucose oxidase.
C. hydrogen peroxide.
D. peroxidase.

34. Which of the following ketones is not detected by the reagent strip or tablet test?
A. Acetone
B. Acetoacetate
C. Acetone and acetoacetate
*D. β-Hydroxybutyrate

35. Which of the following can cause false-positive ketone results?

A. A large amount of ascorbic acid in urine
B. Improper storage of the urine specimen
*C. Drugs containing free sulfhydryl groups
D. A large amount of glucose (glucosuria)
36. Which of the following will not cause ketonemia and ketonuria?
A. An inability to use carbohydrates
B. Inadequate intake of carbohydrates
*C. Increased metabolism of carbohydrates
D. Excessive loss of carbohydrates

37. The ketone reagent strip and tablet tests are based on the reactivity of ketones with
A. ferric chloride.
B. ferric nitrate.
C. nitroglycerin.
*D. nitroprusside.

38. Which of the following statements about bilirubin is true?

A. Conjugated bilirubin is water insoluble.
*B. Bilirubin is a degradation product of heme catabolism.
C. Unconjugated bilirubin readily passes through the glomerular filtration barrier.
D. The liver conjugates bilirubin with albumin to form conjugated bilirubin.

39. The bilirubin reagent strip and tablet tests are based on
A. Ehrlich’s aldehyde reaction.
B. the oxidation of bilirubin to biliverdin.
C. the reduction of bilirubin to azobilirubin.
*D. the coupling of bilirubin with a diazonium salt.

40. Which of the following are characteristic urine findings from a patient with hemolytic jaundice?
A. A positive test for bilirubin and an increased amount of urobilinogen
B. A positive test for bilirubin and a decreased amount of urobilinogen
*C. A negative test for bilirubin and an increased amount of urobilinogen
D. A negative test for bilirubin and a decreased amount of urobilinogen

41. Which of the following results show characteristic urine findings from a patient with an obstruction of the bile duct?
A. A positive test for bilirubin and an increased amount of urobilinogen
*B. A positive test for bilirubin and a decreased amount of urobilinogen
C. A negative test for bilirubin and an increased amount of urobilinogen
D. A negative test for bilirubin and a decreased amount of urobilinogen

42. Which of the following conditions can result in false-positive bilirubin results?
A. Elevated concentrations of nitrite
B. Improper storage of the specimen
C. Ingestion of ascorbic acid
*D. Ingestion of certain medications

43. Urobilinogen is formed from the

A. conjugation of bilirubin in the liver.
B. reduction of conjugated bilirubin in bile.
*C. reduction of bilirubin by intestinal bacteria.
D. oxidation of urobilin by anaerobic intestinal bacteria.

44. 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 photo-oxidizes to urobilin.

45. The classic Ehrlich’s reaction is based on the reaction of urobilinogen with
A. diazotized dichloroaniline.
B. p-aminobenzoic acid.
C. p-dichlorobenzene diazonium salt.
*D. p-dimethylaminobenzaldehyde.

46. Which of the following chemical principles is most specific for the detection of urobilinogen?
*A. Azocoupling reaction
B. Ehrlich’s reaction
C. Hoesch test
D. Watson-Schwartz test
47. Which of the following statements about porphobilinogen is true?
A. Porphobilinogen is red and fluoresces.
*B. Normally, only trace amounts of porphobilinogen are formed.
C. Porphobilinogen is an intermediate product in bilirubin formation.
D. Porphobilinogen production is the rate-limiting step in heme synthesis.

48. A Watson-Schwartz test is performed on a urine specimen. The following results are seen: chloroform tube—red
color in the bottom layer; butanol tube: red color in the top layer. These results indicate the presence of
*A. urobilinogen
B. porphobilinogen
C. urobilinogen and other Ehrlich’s reactive substances
D. porphobilinogen and other Ehrlich’s reactive substances

49. Which of the following features is/are different when the Hoesch and Watson-Schwartz tests are compared?
1-The pH of the reaction mixture
2-The concentration of the Ehrlich’s reagent used
3-The volume ratio of urine to Ehrlich’s reagent in the reaction mixture
4-The sensitivity and specificity for porphobilinogen and urobilinogen
A. 1, 2, and 3 are correct.
B. 1 and 3 are correct.
C. 4 is correct.
*D. All are correct.

50. Which of the following reagent strip tests can be affected by ascorbic acid, resulting in falsely low or false-negative
results?
1-Blood
2-Bilirubin
3-Glucose
4-Nitrite
A. 1, 2, and 3 are correct.
B. 1 and 3 are correct.
C. 4 is correct.
*D. All are correct.

51. Which of the following best describes the mechanism of ascorbic acid interference?
A. Ascorbic acid inhibits oxidation of the chromogen.
B. Ascorbic acid inactivates a reactant, promoting color development.
*C. Ascorbic acid removes a reactant from the intended reaction sequence.
D. Ascorbic acid interacts with the reactants, producing a color that masks the results.

MICROSCOPIC CHAPTER 8
1. Which of the following are not standardized when commercial systems are used for the processing and microscopic
examination of urine sediment?
A. Microscopic variables, such as the number of focal planes
B. The concentration and volume of the urine sediment prepared
C. The volume of the urine sediment dispensed for microscopic viewing
*D. Identification and enumeration of formed elements in the urine sediment

2. When urine sediment is viewed, stains and various microscopic techniques are used to
1-enhance the observation of fine detail.
2-confirm the identity of suspected components.
3-differentiate formed elements that look alike.
4-facilitate the visualization of low-refractile components.
A. 1, 2, and 3 are correct.
B. 1 and 3 are correct.
C. 4 is correct.
*D. All are correct.

3. The microscopic identification of hemosiderin is enhanced when the urine sediment is stained with
A. Gram stain.
B. Hansel stain.
*C. Prussian blue stain.
D. Sudan III stain.
4. When the laboratorian performs the microscopic examination of urine sediment, which of the following are
enumerated using low-power magnification?
A. Bacteria
*B. Casts
C. Red blood cells
D. Renal tubular cells

5. A urine sediment could have which of the following formed elements and still be considered “normal”?
*A. Two or fewer hyaline casts
B. Five to 10 red blood cells
C. A few bacteria
D. A few yeast cells

6. Which of the following statements about red blood cells in urine is true?
A. Red blood cells crenate in hypotonic urine.
B. Red blood cell remnants are called “ghost cells.”
*C. Alkaline and hypotonic urine promotes red blood cell disintegration.
D. Dysmorphic red blood cells often are associated with renal tubular disease.

7. Hemoglobin is a protein and will

A. not react in the protein reagent strip test.
B. interfere with the protein reagent strip test, producing erroneous results.
C. always contribute to the protein reagent strip result, regardless of the amount of hemoglobin present.
*D. contribute to the protein reagent strip result only when large concentrations of hemoglobin are present.

8. Which urinary sediment component(s) when observed microscopically can resemble red blood cells?
1-Yeasts
2-Air bubbles
3-Oil droplets
4-Calcium oxalate crystals
A. 1, 2, and 3 are correct.
B. 1 and 3 are correct.
C. 4 is correct.
*D. All are correct.

9. Which of the following is not a characteristic of neutrophils found in the urine sediment?
A. They are approximately 10 to 14 μm in diameter.
*B. They form “ghost cells” in hypotonic urine.
C. They shrink in hypertonic urine but do not crenate.
D. As they disintegrate, vacuoles and blebs form and their nuclei fuse.

10. How do increased numbers of leukocytes usually get into the urine?
A. Through a renal bleed
B. By passive movement through pores in the vascular epithelium
*C. By active ameboid movement through tissues and epithelium
D. Through damage to the integrity of the normal vascular barrier

11. Which statement regarding lymphocytes found in urine sediment is correct?

A. They are not normally present in the urine.
B. They produce a positive leukocyte esterase test.
C. Their number is increased in patients with drug hypersensitivity.
*D. Their number is increased in patients experiencing kidney transplant rejection.

12. Which of the following urinary tract structures is not lined with transitional epithelium?
A. Bladder
*B. Nephrons
C. Renal pelves
D. Ureters

13. Match the number of the epithelial cell type with its characteristic feature. Only one type is correct for each feature.
1. Collecting tubular cell
2. Distal tubular cell
3. Proximal tubular cell
4. Squamous epithelial cell
5. Transitional epithelial cell
A. Large and flagstone; can be anucleated
B. Oblong or cigar shaped; small eccentric nucleus
C. Polygonal; large nucleus
D. Oval to round; small nucleus that is centered or slightly eccentric
E. Round, pear-shaped, or columnar with a small oval to round nucleus

13. Which of the following correctly describe the microscopic feature of collecting tubular cell?
A. Large and flagstone; can be anucleated
B. Oblong or cigar shaped; small eccentric nucleus
*C. Polygonal; large nucleus
D. Oval to round; small nucleus that is centered or slightly eccentric
E. Round, pear-shaped, or columnar with a small oval to round nucleus

13. Which of the following correctly describe the microscopic feature of distal tubular cell?
A. Large and flagstone; can be anucleated
B. Oblong or cigar shaped; small eccentric nucleus
C. Polygonal; large nucleus
*D. Oval to round; small nucleus that is centered or slightly eccentric
E. Round, pear-shaped, or columnar with a small oval to round nucleus

13. Which of the following correctly describe the microscopic feature of proximal tubular cell?
A. Large and flagstone; can be anucleated
*B. Oblong or cigar shaped; small eccentric nucleus
C. Polygonal; large nucleus
D. Oval to round; small nucleus that is centered or slightly eccentric
E. Round, pear-shaped, or columnar with a small oval to round nucleus

13. Which of the following correctly describe the microscopic feature of squamous epithelial cell?
*A. Large and flagstone; can be anucleated
B. Oblong or cigar shaped; small eccentric nucleus
C. Polygonal; large nucleus
D. Oval to round; small nucleus that is centered or slightly eccentric
E. Round, pear-shaped, or columnar with a small oval to round nucleus

13. Which of the following correctly describe the microscopic feature of transitional epithelial cell?
A. Large and flagstone; can be anucleated
B. Oblong or cigar shaped; small eccentric nucleus
C. Polygonal; large nucleus
D. Oval to round; small nucleus that is centered or slightly eccentric
*E. Round, pear-shaped, or columnar with a small oval to round nucleus

14. Which of the following can be observed in the urine sediment as an intact fragment or sheet of cells?
1-Collecting tubular epithelium
2-Distal tubular epithelium
3-Transitional epithelium
4-Proximal tubular epithelium
A. 1, 2, and 3 are correct.
*B. 1 and 3 are correct.
C. 4 is correct.
D. All are correct.

15. Urinary casts are formed in

*A. the distal and collecting tubules.
B. the distal tubules and the loops of Henle.
C. the proximal and distal tubules.
D. the proximal tubules and the loops of Henle.

16. Urinary casts are formed with a core matrix of

A. albumin.
B. Bence Jones protein.
C. transferrin.
*D. uromodulin.
17. Which of the following does not contribute to the size, shape, or length of a urinary cast?
*A. The concentration of protein in the core matrix of the cast
B. The configuration of the tubule in which the cast is formed
C. The diameter of the tubular lumen in which the cast is formed
D. The duration of time the cast is allowed to form in the tubule

18. All of the following enhance urinary cast formation except

*A. an alkaline pH.
B. urinary stasis.
C. an increase in the solute concentration of the ultrafiltrate.
D. an increase in the quantity of plasma proteins in the ultrafiltrate.

19. When the laboratorian is using brightfield microscopy, a urinary cast that appears homogeneous with well-defined
edges, blunt ends, and cracks is most likely a
A. fatty cast.
B. granular cast.
C. hyaline cast.
*D. waxy cast.

20. All of the following can be found incorporated into a cast matrix except
A. bacteria.
B. crystals.
*C. transitional epithelial cells.
D. white blood cells.

21. Which of the following urinary casts are diagnostic of glomerular or renal tubular damage?
A. Bacterial casts
*B. Red blood cell casts
C. Renal tubular cell casts
D. White blood cell casts

22. Which of the following characteristics best differentiates waxy casts from fibers that may contaminate urine
sediment?
*A. Waxy casts do not polarize light; fibers do.
B. Waxy casts are more refractile than fibers.
C. Waxy casts have rounded ends; fibers do not.
D. Waxy casts are thicker at their margins; fibers are thicker in the middle.

23. Which of the following does not affect the formation of urinary crystals within nephrons?
A. The pH of the ultrafiltrate
*B. The diameter of the tubular lumen
C. The flow of urine through the tubules
D. The concentration of solutes in the ultrafiltrate

24. All these urinary crystals is associated with acidic urine pH, EXCEPT:
A. Amorphous urate
B. Cholesterol
C. Radiographic contrast media
D. Sulfonamides
*E. Ammonium biurate

24. Which of these urinary crystals is associated with alkaline urine pH?
I- Calcium oxalate
II- Radiographic contrast media
III- Amorphous phosphate
IV- Tyrosine
*A. I and III
B. II and IV
C. I, II, and III
D. All of the above
E. IV only
Which of the following matches the microscopic description of ammonium biurate?
A. Colorless “coffin lid” form
B. Colorless hexagonal plates
C. Colorless “envelope” form
D. Colorless rectangular plates with notched corners __
*E. Yellow-brown “thorny apple” form
F. Colorless to yellow; diamonds shaped or rhombic; can form layers
G. Yellow-brown sheaves of wheat

Which of the following matches the microscopic description of calcium oxalate?

A. Colorless “coffin lid” form
B. Colorless hexagonal plates
*C. Colorless “envelope” form
D. Colorless rectangular plates with notched corners __
E. Yellow-brown “thorny apple” form
F. Colorless to yellow; diamonds shaped or rhombic; can form layers
G. Yellow-brown sheaves of wheat

Which of the following matches the microscopic description of cholesterol?

A. Colorless “coffin lid” form
B. Colorless hexagonal plates
C. Colorless “envelope” form
*D. Colorless rectangular plates with notched corners __
E. Yellow-brown “thorny apple” form
F. Colorless to yellow; diamonds shaped or rhombic; can form layers
G. Yellow-brown sheaves of wheat

Which of the following matches the microscopic description of cystine?

A. Colorless “coffin lid” form
*B. Colorless hexagonal plates
C. Colorless “envelope” form
D. Colorless rectangular plates with notched corners __
E. Yellow-brown “thorny apple” form
F. Colorless to yellow; diamonds shaped or rhombic; can form layers
G. Yellow-brown sheaves of wheat

Which of the following matches the microscopic description of sulfonamide?

A. Colorless “coffin lid” form
B. Colorless hexagonal plates
C. Colorless “envelope” form
D. Colorless rectangular plates with notched corners __
E. Yellow-brown “thorny apple” form
F. Colorless to yellow; diamonds shaped or rhombic; can form layers
*G. Yellow-brown sheaves of wheat

Which of the following matches the microscopic description of triple phosphate?

*A. Colorless “coffin lid” form
B. Colorless hexagonal plates
C. Colorless “envelope” form
D. Colorless rectangular plates with notched corners __
E. Yellow-brown “thorny apple” form
F. Colorless to yellow; diamonds shaped or rhombic; can form layers
G. Yellow-brown sheaves of wheat

Which of the following matches the microscopic description of uric acid?

A. Colorless “coffin lid” form
B. Colorless hexagonal plates
C. Colorless “envelope” form
D. Colorless rectangular plates with notched corners __
E. Yellow-brown “thorny apple” form
*F. Colorless to yellow; diamonds shaped or rhombic; can form layers
G. Yellow-brown sheaves of wheat
26. Which of the following crystals, when found in the urine sediment, most likely indicates an abnormal metabolic
condition?
*A. Bilirubin
B. Sulfonamides
C. Triple phosphate
D. Uric acid

27. During the microscopic examination of a urine sediment, cystine crystals are found. The laboratorian should perform
which of the following before reporting the presence of these crystals?
1- Perform a confirmatory chemical test
2- Ensure that the urine specimen has an acid pH
3- Assess the number of crystals per high-power field
4- Check the current medications that the patient is taking
*A. 1, 2, and 3 are correct.
B. 1 and 3 are correct.
C. 4 is correct.
D. All are correct.

28. Mucous threads can be difficult to differentiate from

A. fibers.
*B. hyaline casts.
C. pigmented casts.
D. waxy casts.

29. Which of the following is not a distinguishing characteristic of yeast in the urine sediment?
*A. Motility
B. Budding forms
C. Hyphae formation
D. Colorless ovoid forms

30. Fat can be found in the urine sediment in all of the following forms except
A. within casts.
B. within cells.
C. as free-floating globules.
*D. within hemosiderin granules.

31. 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 and neutral fat are anisotropic and form a Maltese cross pattern under polarized light.

32. Which of the following statements regarding the microscopic examination of urine sediment is false?
*A. If large numbers of leukocytes are present microscopically, then bacteria are present.
B. If urinary fat is present microscopically, then the chemical test for protein should be positive.
C. If large numbers of casts are present microscopically, then the chemical test for protein should be positive.
D. If large numbers of red blood cells are present microscopically, then the chemical test for blood should be positive.

33. The following are initial results obtained during a routine urinalysis. Which results should be investigated further?
*A. Negative protein; 2 to 5 waxy casts
B. Cloudy, brown urine; 2 to 5 red blood cells
C. Urine pH 7.5; ammonium biurate crystals
D. Clear, colorless urine; specific gravity 1.010

34. The following are initial results obtained during a routine urinalysis. Which results should be investigated further?
A. Negative protein; 0 to 2 hyaline casts
B. Urine pH 6.0; calcium oxalate crystals
*C. Cloudy, yellow urine; specific gravity 1.050
D. Amber urine with yellow foam; negative bilirubin by reagent strip; positive Ictotest

35. Which of the following when found in the urine sediment from a female patient is not considered a vaginal
contaminant?
*A. Fat
B. Clue cells
C. Spermatozoa
D. Trichomonads
RENAL DISORDER
1. Which of the following statements about renal diseases is true?
*A. Glomerular renal diseases are usually immune mediated.
B. Vascular disorders induce renal disease by increasing renal perfusion.
C. All structural components of the kidney are equally susceptible to disease.
D. Tubulointerstitial renal diseases usually result from antibody-antigen and complement interactions.

2. In glomerular diseases, morphologic changes in the glomeruli include all of the following except
A. cellular proliferation.
*B. erythrocyte congestion.
C. leukocyte infiltration.
D. glomerular basement membrane thickening.

3. When all renal glomeruli are affected by a morphologic change, this change is described as
*A. diffuse.
B. focal.
C. differentiated.
D. segmental.

4. In glomerular renal disease, glomerular damage results from

A. deposition of infectious agents.
B. a decrease in glomerular perfusion.
C. changes in glomerular hemodynamics.
*D. toxic substances induced by immune complex formation.

5. Clinical features that are characteristic of glomerular damage include all of the following except
A. edema.
B. hematuria.
C. proteinuria.
*D. polyuria.

6. Which of the following disorders frequently occurs following a bacterial infection of the skin or throat?
*A. Acute glomerulonephritis
B. Chronic glomerulonephritis
C. Membranous glomerulonephritis
D. Rapidly progressive glomerulonephritis

7. Which of the following disorders is characterized by cellular proliferation into Bowman’s space to form cellular
“crescents”?
A. Chronic glomerulonephritis
B. Membranous glomerulonephritis
C. Minimal change disease
*D. Rapidly progressive glomerulonephritis

8. Which of the following disorders is the major cause of the nephrotic syndrome in adults?
A. IgA nephropathy
B. Membranoproliferative glomerulonephritis
*C. Membranous glomerulonephritis
D. Rapidly progressive glomerulonephritis

9. Which of the following glomerular diseases is the major cause of the nephrotic syndrome in children?
A. IgA nephropathy
*B. Minimal change disease
C. Membranous glomerulonephritis
D. Rapidly progressive glomerulonephritis

10. Which of the following statements regarding IgA nephropathy is true?

*A. It often follows a mucosal infection.
B. It is associated with the nephrotic syndrome.
C. It is characterized by leukocyte infiltration of the glomeruli.
D. It often occurs secondary to systemic lupus erythematosus.
11. Eighty percent of patients who develop chronic glomerulonephritis previously had some type of glomerular disease.
Which of the following disorders is implicated most frequently in the development of chronic glomerulonephritis?
A. IgA nephropathy
B. Membranous glomerulonephritis
C. Poststreptococcal glomerulonephritis
*D. Rapidly progressive glomerulonephritis

12. Chronic renal failure often develops in each of the following diseases except
A. amyloidosis.
B. diabetes mellitus.
*C. diabetes insipidus.
D. systemic lupus erythematosus

13. Which of the following features characterize the nephrotic syndrome?

1- Proteinuria
2- Edema
3- Hypoalbuminemia
4- Hyperlipidemia
A. 1, 2, and 3 are correct.
B. 1 and 3 are correct.
C. 4 is correct.
*D. All are correct.

14. When a patient has the nephrotic syndrome, microscopic examination of their urine sediment often
reveals
A. granular casts.
B. leukocyte casts.
C. red blood cell casts.
*D. waxy casts.

15. Which of the following has not been associated with acute tubular necrosis?
A. Antibiotics
*B. Galactosuria
C. Hemoglobinuria
D. Surgical procedures

16. Which formed element in urine sediment is characteristic of toxic acute tubular necrosis and aids in its
differentiation from ischemic acute tubular necrosis?
A. Collecting tubular cells
B. Granular casts
*C. Proximal tubular cells
D. Waxy casts

17. Which of the following disorders is characterized by the urinary excretion of large amounts of arginine, cystine,
lysine, and ornithine?
A. Cystinosis
*B. Cystinuria
C. Lysinuria
D. Tyrosinuria

18. Generalized loss of proximal tubular function is a characteristic of

*A. Fanconi’s syndrome.
B. nephrotic syndrome.
C. renal glucosuria.
D. renal tubular acidosis.

19. Which of the following changes is not associated with renal tubular acidosis?
*A. Decreased glomerular filtration rate
B. Decreased renal tubular secretion of hydrogen ions
C. Decreased proximal tubular reabsorption of bicarbonate
D. Increased back-diffusion of hydrogen ions in the distal tubules
20. Which of the following disorders is considered a lower urinary tract infection?
*A. Cystitis
B. Glomerulonephritis
C. Pyelitis
D. Pyelonephritis

21. Most urinary tract infections are caused by

A. yeast, such as Candida spp.
*B. gram-negative rods.
C. gram-positive rods.
D. gram-positive cocci.

22. Which of the following formed elements when present in urine sediment is most indicative of an upper urinary tract
infection?
A. Bacteria
*B. Casts
C. Erythrocytes
D. Leukocytes

23. The most common cause of chronic pyelonephritis is

A. cystitis.
B. bacterial sepsis.
C. drug-induced nephropathies.
*D. reflux nephropathies.

24. Eosinophiluria, fever, and skin rash are characteristic clinical features of
A. acute pyelonephritis.
*B. acute interstitial nephritis.
C. acute glomerulonephritis.
D. chronic glomerulonephritis.

25. Cessation of the administration of a drug is the fastest and most effective treatment for
A. acute pyelonephritis.
*B. acute interstitial nephritis.
C. acute glomerulonephritis.
D. chronic glomerulonephritis.

26. Yeast is considered part of the normal flora in each of the following locations except in the
A. gastrointestinal tract.
B. oral cavity.
*C. urinary tract.
D. vagina.

27. Acute renal failure can be caused by all of the following except
A. hemorrhage.
B. acute tubular necrosis.
*C. acute pyelonephritis.
D. urinary tract obstruction.

28. Which of the following statements about chronic renal failure is true?
A. It can be reversed by appropriate treatment regimens.
*B. It eventually progresses to end-stage renal disease.
C. It is monitored by periodic determinations of renal blood flow.
D. Its onset involves a sudden decrease in the glomerular filtration rate.

29. Isosthenuria, significant proteinuria, and numerous casts of all types describes the urinalysis findings from a patient
with
A. acute renal failure.
B. acute tubular necrosis.
*C. chronic renal failure.
D. renal tubular acidosis.
30. Approximately 75% of the renal calculi that form in patients contain
*A. calcium.
B. cystine.
C. oxalate.
D. uric acid.

31. The formation of renal calculi is enhanced by

A. an increase in urine flow.
B. the natural “acid-alkaline tide” of the body.
C. increases in protein in the urine ultrafiltrate.
*D. increases in chemical salts in the urine ultrafiltrate.

32. An overflow mechanism is responsible for the aminoaciduria present in

A. cystinosis.
B. cystinuria.
*C. tyrosinuria.
D. phenylketonuria.

33. Which of the following hereditary diseases results in the accumulation and excretion of large amounts of
homogentisic acid?
*A. Alkaptonuria
B. Melanuria
C. Phenylketonuria
D. Tyrosinuria

34. Which of the following substances oxidizes with exposure to air, causing the urine to turn brown or black?
*A. Melanin
B. Porphyrin
C. Tyrosine
D. Urobilinogen

35. Which of the following diseases is related to tyrosine production or metabolism?

1- Tyrosinuria
2- Melanuria
3- Phenylketonuria
4- Alkaptonuria
A. 1, 2, and 3 are correct.
B. 1 and 3 are correct.
C. 4 is correct.
*D. All are correct.

36. Which of the following diseases can result in severe mental retardation if not detected and treated in the infant?
1- Phenylketonuria
2- Maple syrup urine disease
3- Galactosuria
4- Alkaptonuria
*A. 1, 2, and 3 are correct.
B. 1 and 3 are correct.
C. 4 is correct.
D. All are correct.

37. Which of the following is a characteristic feature of type 2 diabetes mellitus?

A. Daily insulin injections are necessary.
B. Onset of the disease is usually sudden.
C. Strong tendency to develop ketoacidosis.
*D. The disease usually presents after 40 years of age.

38. Which of the following abnormalities is not a clinical feature of an infant with galactosuria?
A. Cataract formation
B. Liver dysfunction
C. Mental retardation
*D. Polyuria
39. Galactose is produced in the normal metabolism of
A. fructose.
B. glucose.
*C. lactose.
D. sucrose.

40. Which of the following features is not a characteristic of diabetes insipidus?

A. Polyuria
B. Polydipsia
*C. Increased production of antidiuretic hormone
D. Urine with a low specific gravity

41. Porphyria is characterized by

A. increased heme degradation.
*B. increased heme formation.
C. decreased globin synthesis.
D. decreased iron catabolism.

42. Which of the following statements regarding porphyrin and porphyrin precursors is true?
1- Porphyria can be inherited or induced.
2- Porphyrin precursors are neurotoxins.
3- Porphyrins can be dark red or purple.
4- Porphyrin precursor accumulation causes skin photosensitivity.
*A. 1, 2, and 3 are correct.
B. 1 and 3 are correct.
C. 4 is correct.
D. All are correct.

FECAL ANALYSIS CHAPTER 10

1. Which of the following substances is not a component of normal feces?
A. Bacteria
*B. Blood
C. Electrolytes
D. Water

2. All of the following actions can result in watery or diarrheal stools except
*A. decreased intestinal motility.
B. inhibition of water reabsorption.
C. inadequate time allowed for water reabsorption.
D. an excessive volume of fluid presented for reabsorption.

3. Lactose intolerance caused by the lack of sufficient lactase primarily presents with
A. steatorrhea.
*B. osmotic diarrhea.
C. secretory diarrhea.
D. intestinal hypermotility.

4. Which of the following tests assists most in the differentiation of secretory and osmotic diarrhea?
A. Fecal fat
B. Fecal carbohydrates
C. Fecal occult blood
*D. Fecal osmolality

5. The inability to convert dietary foodstuffs into readily absorbable substances is called intestinal
A. inadequacy.
B. hypermotility.
C. malabsorption
*D. maldigestion.

6. Intestinal motility is stimulated by each of the following except

A. castor oil.
B. dietary fiber.
C. intestinal distention.
*D. sympathetic nerve activity
7. Which of the following conditions is characterized by the excretion of greasy, pale, foul-smelling feces?
*A. Steatorrhea
B. Osmotic diarrhea
C. Secretory diarrhea
D. Intestinal hypermotility

8. The daily amount of fat excreted in the feces is normally less than
A. 0.7 g.
*B. 7.0 g.
C. 70 g.
D. 700 g.

9. Which of the following tests is used to diagnose steatorrhea?

*A. Fecal fat
B. Fecal carbohydrates
C. Fecal occult blood
D. Fecal osmolality

10. Which of the following statements about feces is TRUE?

A. The normal color of feces is primarily due to urobilinogens.
*B. The amount of feces produced in 24 hours correlates poorly with food intake.
C. The normal odor of feces is usually due to metabolic by-products of intestinal protozoa.
D. The consistency of feces is primarily determined by the amount of fluid intake.

11. Fecal specimens may be tested for each of the following except
A. fat.
B. blood.
*C. bilirubin.
D. carbohydrates.

12. Which of the following substances is responsible for the characteristic color of normal feces?
A. Bilirubin
B. Hemoglobin
*C. Urobilins
D. Urobilinogens

13. Which of the following statements about fecal tests is true?

A. A fecal fat determination identifies the cause of steatorrhea.
*B. A fecal leukocyte determination aids in differentiating the cause of diarrhea.
C. A fecal Clinitest identifies the enzyme deficiency that prevents sugar digestion.
D. A fecal blood screen aids in differentiating bacterial from parasitic infestations.

14. Which of the following types of fat readily stain with Sudan III or Oil Red O stain?
1- Fatty acids
2- Cholesterol
3- Soaps (fatty acid salts)
4- Neutral fats (triglycerides)
A. 1, 2, and 3 are correct.
B. 1 and 3 are correct.
*C. 4 is correct.
D. All are correct.

15. Which of the following types of fat require acidification and heat before they stain with Sudan III or Oil Red O stain?
1- Fatty acids
2- Cholesterol
3- Soaps (fatty acid salts)
4- Neutral fats (triglycerides)
A. 1, 2, and 3 are correct.
*B. 1 and 3 are correct.
C. 4 is correct.
D. All are correct.
16. With the two-slide qualitative fecal fat determination, the first slide produces a normal amount of staining fat
present, whereas the second slide, following acid addition and heat, produces an abnormally increased amount of fat.
These results indicate
*A. malabsorption.
B. maldigestion.
C. parasitic infestation.
D. disaccharidase deficiency.

17. Mass screening in adults for fecal occult blood is performed primarily to detect
A. ulcers.
B. hemorrhoids.
*C. colorectal cancer.
D. esophageal varices.

18. Which of the following dietary substances can cause a false-negative guaiac-based fecal occult blood slide test?
A. Fish
B. Red meat
*C. Ascorbic acid
D. Fruits and vegetables

19. Which of the following actions can cause a falsepositive guaiac-based fecal occult blood slide test?
*A. Rehydration of the specimen on the slide before testing
B. Degradation of hemoglobin to porphyrin
C. Storage of fecal specimens before testing
D. Storage of slides with the specimen already applied

20. Select the true statement about fecal occult blood tests (FOBTs)?
A. Guaiac-based FOBTs are more specific than immunochemical-based FOBTs.
B. Guaiac-based FOBTs are more expensive than immunochemical-based FOBTs.
*C. Dietary restrictions are not required when immunochemical-based FOBTs are used.
D. Hemoglobin from nonhuman sources (e.g., red meat) can cause false-positive results when immunochemical-
based FOBTs are used.

21. Which of the following conditions can result in the excretion of small amounts of occult blood in the feces?
1- Hemorrhoids
2- Bleeding gums
3- Peptic ulcers
4- Intake of iron supplements
A. 1, 2, and 3 are correct.
B. 1 and 3 are correct.
C. 4 is correct.
*D. All are correct.

22. Which of the following statements regarding the test for fetal hemoglobin in feces (the Apt test) is TRUE?
A. Any adult hemoglobin present should resist alkali treatment.
B. The Apt test is used to differentiate various hemoglobinopathies in the newborn.
C. Hemoglobin degraded to hematin usually produces a positive test result.
*D. A pink color following alkali treatment indicates the presence of fetal hemoglobin.

23. Which of the following are clinical manifestations of a disaccharidase deficiency?

1- A positive fecal Clinitest
2- Constipation and gas
3- A fecal pH of 5.0
4- A positive fecal occult blood test
A. 1, 2, and 3 are correct.
*B. 1 and 3 are correct.
C. 4 is correct.
D. All are correct.

24. Which of the following tests can differentiate inadequate carbohydrate metabolism from inadequate carbohydrate
absorption?
A. Fecal Clinitest
*B. Xylose absorption test
C. Oral carbohydrate tolerance tests
D. Carbohydrate thin-layer chromatography
SEMINAL FLUID CHAPTER 11
1. Seminal fluid analysis is routinely performed to evaluate which of the following?
A. Prostate cancer
*B. Postvasectomy status
C. Penile implant status
D. Premature ejaculation

2. Which of the following structures contribute(s) secretions to semen?

1- Epididymis
2- Prostate gland
3- Seminal vesicles
4- Seminiferous tubules
A. 1, 2, and 3 are correct.
B. 1 and 3 are correct.
C. 4 is correct.
*D. All are correct.

3. Which of the following structures performs an endocrine and an exocrine function?

*A. Testes
B. Epididymis
C. Prostate gland
D. Seminal vesicles

4. The primary function of semen is to

A. nourish the spermatozoa.
B. coagulate the ejaculate.
*C. transport the spermatozoa.
D. stimulate sperm maturation.

What is the main function of Interstitial cells of Leydig?

*A. Produces and secretes sperm
B. Site of spermatogenesis
C. Concentrates and stores sperm
D. Secretes fluid rich in zinc
E. Secretes fluid high in fructose
F. Transports sperm to the ejaculatory duct

What is the main function of Seminiferous tubules?

A. Produces and secretes sperm
*B. Site of spermatogenesis
C. Concentrates and stores sperm
D. Secretes fluid rich in zinc
E. Secretes fluid high in fructose
F. Transports sperm to the ejaculatory duct

What is the main function of Epididymis?

A. Produces and secretes sperm
B. Site of spermatogenesis
*C. Concentrates and stores sperm
D. Secretes fluid rich in zinc
E. Secretes fluid high in fructose
F. Transports sperm to the ejaculatory duct

What is the main function of Prostate gland?

A. Produces and secretes sperm
B. Site of spermatogenesis
C. Concentrates and stores sperm
*D. Secretes fluid rich in zinc
E. Secretes fluid high in fructose
F. Transports sperm to the ejaculatory duct
What is the main function of Seminal vesicles?
A. Produces and secretes sperm
B. Site of spermatogenesis
C. Concentrates and stores sperm
D. Secretes fluid rich in zinc
*E. Secretes fluid high in fructose
F. Transports sperm to the ejaculatory duct

6. Which of the following is a requirement when collecting semen specimens?

A. The patient should abstain from sexual inter course for at least 2 days following the collection.
*B. Only complete collections of the entire ejaculate are acceptable for analysis.
C. A single semen specimen is sufficient for the evaluation of male fertility.
D. Semen specimens must be evaluated within 3 hours following collection.

7. Which of the following conditions adversely affects the quality of a semen specimen?
A. The use of Silastic condoms
B. The time of day the collection is obtained
C. The collection of the specimen in a glass container
*D. The storage of the specimen at refrigerator temperatures

8. Which of the following statements regarding semen is true?

A. Semen usually coagulates within 30 minutes after ejaculation.
B. For semen to liquefy before 60 minutes is abnormal.
*C. Following liquefaction, the viscosity of normal semen is similar to that of water.
D. Following liquefaction, the presence of particulate matter is highly indicative of a bacterial infection.

9. Which of the following statements regarding the manual evaluation of sperm motility is not true?
A. Sperm motility most often is graded subjectively.
B. Sperm motility is affected adversely by temperature.
C. Sperm motility assesses speed and forward progression.
*D. Sperm motility should be evaluated initially and at 2 hours after collection.

10. Which of the following statements regarding sperm concentration is true?

A. Sperm concentration within a single individual is usually constant.
B. Sperm concentration depends solely on the period of abstinence.
*C. In a normal ejaculate, sperm concentration ranges from 20 to 250 million per milliliter.
D. For fertility purposes, sperm concentration is more important than sperm motility.

11. Which of the following statements regarding sperm morphology is true?

A. Sperm morphology is usually evaluated using a peroxidase stain.
*B. Stained smears of fresh semen can be used to evaluate sperm morphology.
C. Sperm morphology is evaluated using 400× (high-power) magnification.
D. Normal semen contains at least 80% sperm with normal morphology.

12. Which of the following parameters directly relates to and provides a check of the sperm motility evaluation?
A. Agglutination evaluation
B. Concentration determination
C. Morphology assessment
*D. Vitality assessment

13. Microscopically, immature spermatogenic cells are often difficult to distinguish from
A. bacteria.
B. erythrocytes.
*C. leukocytes.
D. epithelial cells.

14. A semen pH greater than 7.8 is associated with

A. premature ejaculation.
B. obstruction of the vas deferens.
C. abnormal seminal vesicle function.
*D. infection of the male reproductive tract.
15. Fructose in semen assists in the evaluation of which of the following?
1- The secretory function of the seminal vesicles
2- The functional integrity of the epididymis
3- The functional integrity of the vas deferens
4- The secretory function of the prostate gland
A. 1, 2, and 3 are correct.
*B. 1 and 3 are correct.
C. 4 is correct.
D. All are correct.

16. Which of the following substances can be used to evaluate the secretory function of the prostate gland?
A. Carnitine
B. Fructose
C. pH
*D. Zinc

17. The concentration of which of the following substances can be used to positively identify a fluid as seminal fluid?
*A. Acid phosphatase
B. Citric acid
C. Fructose
D. Zinc

AMNIOTIC FLUID CHAPTER 12

1. Which of the following is not a function of the amniotic fluid surrounding a developing fetus?
A. Amniotic fluid provides protection of the fetus.
B. Amniotic fluid enables fetal movement.
*C. Amniotic fluid is a medium for oxygen exchange.
D. Amniotic fluid is a source of water and solute exchange.

2. Amniocentesis is usually performed at 15 to 18 weeks’ gestation to determine which of the following conditions?
A. Fetal distress
B. Fetal maturity
*C. Genetic disorders
D. Infections in the amniotic fluid

3. Through which of the following mechanism(s) does solute and water exchange occur between the fetus and the
amniotic fluid?
1-Fetal swallowing of the amniotic fluid
2- Transudation across the fetal skin
3- Fetal urination into the amniotic fluid
4- Respiration of amniotic fluid into the fetal pulmonary system
A. 1, 2, and 3 are correct.
B. 1 and 3 are correct.
C. 4 is correct.
*D. All are correct.

4. Select the term used to describe a decreased volume of amniotic fluid present in the amniotic sac.
A. Anhydramnios
B. Hydramnios
*C. Oligohydramnios
D. Polyhydramnios

5. Amniotic fluid specimens are immediately protected from light to preserve which of the following substances?
*A. Bilirubin
B. Fetal cells
C. Meconium
D. Phospholipids

6. Which of the following substances, when present in amniotic fluid, is affected adversely by refrigeration?
A. Bilirubin
*B. Fetal cells
C. Protein
D. Phospholipids
7. When processing amniotic fluid, high centrifugation speeds are used to clear the fluid of turbidity for
*A. bilirubin analysis.
B. culturing of fetal cells.
C. meconium detection.
D. phospholipid analysis.

8. Analysis for which of the following substances can aid in the differentiation of amniotic fluid from urine?
1- Urea
2- Glucose
3- Creatinine
4- Protein
A. 1, 2, and 3 are correct.
B. 1 and 3 are correct.
C. 4 is correct.
*D. All are correct.

9. Which of the following statements about amniotic fluid is true?

A. Amniotic fluid is normally clear and colorless.
*B. Normally amniotic fluid contains fetal hair, cells, and vernix.
C. Amniotic fluid and urine can be differentiated by a physical examination of the fluid.
D. When contaminated with meconium, amniotic fluid takes on a yellow or amber coloration.

10. Which of the following is not a test to evaluate the surfactants present in the fetal pulmonary system?
*A. ΔA 450
B. Lecithin/sphingomyelin ratio
C. Phosphatidylglycerol detection
D. Foam stability index

11. Which of the following test results would indicate fetal lung immaturity?
1- A lecithin/sphingomyelin ratio of less than 2.0
2- A lecithin/sphingomyelin ratio of more than 2.0
3- A lecithin/sphingomyelin ratio of more than 2.0, with phosphatidylglycerol absent
4- A lecithin/sphingomyelin ratio of less than 2.0, with phosphatidylglycerol present
A. 1, 2, and 3 are correct.
*B. 1 and 3 are correct.
C. 4 is correct.
D. All are correct.

12. Which of the following conditions can cause erythroblastosis fetalis?

A. Immaturity of the fetal liver
B. Decreased amounts of amniotic fluid
C. Inadequate fetal pulmonary surfactants
*D. Maternal immunization by fetal antigens

13. A ΔA450 value that falls into zone III indicates that the fetus is experiencing
A. no hemolysis.
B. mild hemolysis.
C. moderate hemolysis.
*D. severe hemolysis.

CEREBROSPINAL FLUID CHAPTER 13

1. Cerebrospinal fluid (CSF) is produced primarily from
*A. secretions by the choroid plexus.
B. diffusion from plasma into the central nervous system.
C. ultrafiltration of plasma in the ventricles of the brain.
D. excretions from ependymal cells lining the brain and spinal cord.

2. Cerebrospinal fluid is found between the

A. arachnoid and dura mater.
*B. arachnoid and pia mater.
C. pia mater and dura mater.
D. pia mater and choroid plexus.
3. Which of the following statements regarding CSF is true?
*A. Cerebrospinal fluid is constantly produced.
B. Cerebrospinal fluid is reabsorbed into the blood at the choroid plexus.
C. Cerebrospinal fluid is essentially composed of diluted plasma.
D. Cerebrospinal fluid circulates through the brain and spinal cord because of active and passive diffusion
processes.

4. Which of the following substances does not normally pass through the blood-brain barrier?
A. PO2
B. Albumin
C. Glucose
*D. Fibrinogen

5. During a lumbar puncture procedure, the first collection tube of CSF removed should be used for
*A. chemistry tests.
B. cytologic studies.
C. hematologic tests.
D. microbiological studies.

6. Which of the following is not an analytical concern when the processing and testing of CSF are delayed?
A. The viability of microorganisms
*B. The lability of the immunoglobulins
C. The lysis of leukocytes and erythrocytes
D. Alterations in the chemical composition

7. Pleocytosis is a term used to describe

*A. an increased number of cells in the CSF.
B. a pink, orange, or yellow CSF specimen.
C. an increased protein content in the CSF caused by cellular lysis.
D. inflammation and sloughing of cells from the choroid plexus.

8. All of the following can cause xanthochromia in CSF except

A. high concentrations of protein.
B. high concentrations of bilirubin.
*C. increased numbers of leukocytes.
D. erythrocytes from a traumatic tap.

9. In CSF, which of the following findings indicates a traumatic puncture?

A. The presence of erythrophagocytic cells in the CSF
B. Hemosiderin granules within macrophages in the CSF sediment
*C. An uneven distribution of blood in the CSF collection tubes
D. A xanthochromic supernatant following CSF centrifugation

10. How many leukocytes are normally present in the CSF obtained from an adult?
*A. 0 to 5 cells/mL
B. 0 to 10 cells/mL
C. 0 to 20 cells/mL
D. 0 to 30 cells/mL

11. Which of the following cells can be present in small numbers in normal CSF?
A. Erythrocytes
*B. Lymphocytes
C. Macrophages
D. Plasma cells

12. Which of the following cell types predominate in CSF during a classic case of bacterial meningitis?
A. Lymphocytes
B. Macrophages
C. Monocytes
*D. Neutrophils

13. Which of the following cell types predominate in CSF during a classic case of viral meningitis?
*A. Lymphocytes
B. Macrophages
C. Monocytes
D. Neutrophils
14. When choroid plexus cells and ependymal cells are present in CSF, they
A. are often clinically significant.
B. represent the demyelination of nerve tissue.
*C. can closely resemble clusters of malignant cells.
D. indicate breakdown of the blood-brain barrier.

15. All of the following proteins are normally present in the CSF except
A. albumin.
*B. fibrinogen.
C. transthyretin.
D. transferrin.

16. Which of the following events does not result in an increased CSF total protein?
A. A traumatic puncture procedure
B. Alterations in the blood-brain barrier
*C. Trauma to the central nervous system, resulting in fluid loss
D. Decreased reabsorption of CSF into the peripheral blood

17. Which of the following proteins in the CSF is used to monitor the integrity of the blood-brain barrier?
*A. Albumin
B. Transthyretin
C. Transferrin
D. Immunoglobulin G

18. An immunoglobulin G index greater than 0.70 indicates

*A. intrathecal synthesis of immunoglobulin G.
B. a compromised blood-brain barrier.
C. active demyelination of neural proteins.
D. increased transport of immunoglobulin G from plasma into the CSF.

19. An unknown fluid can be positively identified as CSF by determining the

A. lactate concentration.
B. albumin concentration.
C. presence of oligoclonal banding on electrophoresis.
*D. presence of carbohydrate-deficient transferrin on electrophoresis.

20. Which of the following statements about oligoclonal bands is false?

A. In the CSF, these bands indicate increased intrathecal concentrations of immunoglobulin G.
*B. The bands usually correlate with the stage of disease and can be used to predict disease progression.
C. The bands are often present in the CSF and serum of individuals with a lymphoproliferative disease.
D. The bands are often present in the CSF but not in the serum of individuals with multiple sclerosis.

21. Which of the following statements about CSF glucose is false?

*A. Increased CSF glucose values are diagnostically significant.
B. Glucose enters the CSF by active transport and simple diffusion.
C. Decreased CSF glucose values reflect a defective blood-brain barrier and increased glycolysis.
D. CSF glucose values reflect the plasma glucose concentration 30 to 90 minutes preceding collection.

22. Normal CSF lactate levels (less than 25 mg/dL) are commonly found in patients with
A. bacterial meningitis.
B. fungal meningitis.
C. tuberculous meningitis.
*D. viral meningitis.

23. 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

24. India ink preparations and microbial antigen tests on CSF can aid in the diagnosis of
A. bacterial meningitis.
*B. fungal meningitis.
C. tuberculous meningitis.
D. viral meningitis.
SYNOVIAL FLUID CHAPTER 14
1. Which of the following tasks is a function of synovial fluid?
1- Providing lubrication for a joint
2- Assisting in the structural support of a joint
3- Transporting nutrients to articular cartilage
4- Synthesizing hyaluronate and degradative enzymes
A. 1, 2, and 3 are correct.
*B. 1 and 3 are correct.
C. 4 is correct.
D. All are correct.

2. Which of the following statements is a characteristic of normal synovial fluid?

*A. Synovial fluid is viscous.
B. Synovial fluid is slightly turbid.
C. Synovial fluid is dark yellow.
D. Synovial fluid forms small clots on standing.

3. Which of the following components is not normally present in synovial fluid?

*A. Fibrinogen
B. Neutrophils
C. Protein
D. Uric acid

4. Which of the following substances will not increase the turbidity of synovial fluid?
A. Fat
B. Crystals
*C. Hyaluronate
D. WBCs

5. Abnormally decreased viscosity in synovial fluid results from

A. mucin degradation by leukocytic lysosomes.
B. overproduction of synovial fluid by synoviocytes.
C. autoimmune response of synoviocytes in joint disease.
*D. depolymerization of hyaluronate by neutrophilic enzymes.

6. A synovial fluid specimen is received in the laboratory 2 hours after collection. Which of the following changes to the
fluid will most likely have taken place?
A. The specimen will have clotted.
B. The uric acid concentration will have decreased.
*C. Crystals may have precipitated or dissolved.
D. The lactate concentration will have decreased because of anaerobic glycolysis.

7. Which of the following anticoagulants does not have the potential to precipitate out in crystalline form when used for
synovial fluid specimens?
A. Sodium citrate
*B. Sodium heparin
C. Lithium heparin
D. Potassium oxalate

8. A synovial fluid specimen has a high cell count and requires dilution to be counted. Which of the following diluents
should be used?
*A. Normal saline
B. Dilute acetic acid (2%)
C. Dilute methanol (1%)
D. Phosphate buffer solution (0.050 mol/L)

9. Which of the following results from synovial fluid analysis indicates a joint disease process?
A. A few synoviocytes present in the fluid
B. A WBC count lower than 200 cells/mL
C. An RBC count lower than 2000 cells/mL
*D. A differential count showing greater than 25% neutrophils
10. Differentiation of synovial fluid crystals, based on their birefringence, is achieved using
A. transmission electron microscopy.
B. phase-contrast microscopy.
C. direct polarizing microscopy.
*D. compensated polarizing microscopy.

11. The microscopic examination of synovial fluid for crystals can be difficult because
1- numerous artifacts are also birefringent.
2- few crystals may be present.
3- free-floating crystals can become enmeshed or hidden in fibrin.
4- different crystals can closely resemble each other morphologically.
A. 1, 2, and 3 are correct.
B. 1 and 3 are correct.
C. 4 is correct.
*D. All are correct.

12. Which of the following crystals characteristically occurs in patients with gout?
A. Cholesterol crystals
B. Hydroxyapatite crystals
*C. Monosodium urate crystals
D. Calcium pyrophosphate dihydrate crystals

13. In synovial fluid, which of the following crystals is not birefringent?

A. Cholesterol crystals
*B. Hydroxyapatite crystals
C. Monosodium urate crystals
D. Calcium pyrophosphate dihydrate crystals

14. Assuming that a patient is fasting, which of the following analytes is normally present in the synovial fluid in
essentially the same concentration as in the blood plasma?
1- Glucose
2- Lactate
3- Uric acid
4- Protein
A. 1, 2, and 3 are correct.
*B. 1 and 3 are correct.
C. 4 is correct.
D. All are correct.

15. Which of the following findings provides a definitive diagnosis of a specific joint condition?
*A. Staphylococcal bacteria identified by Gram stain
B. Corticosteroid crystals identified during the microscopic examination
C. A plasma–synovial fluid glucose difference exceeding 20 mg/dL
D. Greater than 25 WBCs/μL observed during the microscopic examination

16. Analysis of a synovial fluid specimen reveals the following:

Cloudy, yellow-green fluid of low viscosity
Total leukocyte count of 98,000 cells/μL
Plasma–synovial fluid glucose difference of 47 mg/dL
Based on the information provided and Table 14-2, this specimen most likely would be classified as
A. noninflammatory.
B. inflammatory.
*C. septic.
D. hemorrhagic.

17. An analysis of a synovial fluid specimen reveals the following:

Yellow fluid of high viscosity
Total leukocyte count of 300 cells/μL
Plasma–synovial fluid glucose difference of 17 mg/dL
Based on the information provided and Table 14-2, this specimen would most likely be classified as
*A. noninflammatory.
B. inflammatory.
C. septic.
D. hemorrhagic.
SEROUS FLUID CHAPTER 15
1. Which of the following statements about serous fluid–filled body cavities is true?
1- A parietal membrane is attached firmly to the body cavity wall.
2- Serous fluid acts as a lubricant between opposing membranes.
3- A serous membrane is composed of a single layer of flat mesothelial cells.
4- The visceral and parietal membranes of an organ are actually a single continuous membrane.
A. 1, 2, and 3 are correct.
B. 1 and 3 are correct.
C. 4 is correct.
*D. All are correct.

2. Which of the following mechanisms is responsible for the formation of serous fluid in body cavities?
*A. Ultrafiltration of circulating blood plasma
B. Selective absorption of fluid from the lymphatic system
C. Diuresis of solutes and water across a concentration gradient
D. Active secretion by mesothelial cells that line the serous membranes

3. Which of the following conditions enhances the formation of serous fluid in a body cavity?
A. Increased lymphatic absorption
*B. Increased capillary permeability
C. Increased plasma oncotic pressure
D. Decreased capillary hydrostatic pressure

4. The pathologic accumulation of fluid in a body cavity is called

A. an abscess.
*B. an effusion.
C. pleocytosis.
D. paracentesis.

5. Paracentesis and serous fluid testing are performed to

1- remove serous fluids that may be compressing a vital organ.
2- determine the pathologic cause of an effusion.
3- identify an effusion as a transudate or an exudate.
4- prevent volume depletion caused by the accumulation of fluid in body cavities.
*A. 1, 2, and 3 are correct.
B. 1 and 3 are correct.
C. 4 is correct.
D. All are correct.

6. Thoracentesis refers specifically to the removal of fluid from the

A. abdominal cavity.
B. pericardial cavity.
C. peritoneal cavity.
*D. pleural cavity.

7. Which of the following parameters best identifies a fluid as a transudate or an exudate?

A. Color and clarity
B. Leukocyte and differential counts
C. Total protein and specific gravity measurements
*D. Total protein ratio and lactate dehydrogenase ratio

8. Chylous and pseudochylous effusions are differentiated by their

A. physical examinations.
B. cholesterol concentrations.
*C. triglyceride concentrations.
D. leukocyte and differential counts.

9. Which of the following conditions is most often associated with the formation of a transudate?
A. Pancreatitis
B. Surgical procedures
*C. Congestive heart failure
D. Metastatic neoplasm
Which type of serous effusion is related to nephrotic syndrome?
*A. Transudate
B. Exudate

Which type of serous effusion is related to trauma?

A. Transudate
*B. Exudate

Which type of serous effusion is related to hepatic cirrhosis?

*A. Transudate
B. Exudate

Which type of serous effusion is related to malignancies?

A. Transudate
*B. Exudate

11. Which of the following laboratory findings on an effusion does not indicate a specific diagnosis?
A. LE cells found during the microscopic examination
*B. A serous fluid glucose concentration less than 60 mg/dL
C. Microorganisms identified by Gram or acid-fast stain
D. Malignant cells identified during the microscopic or cytologic examination

12. An abnormally low fluid pH value is useful when evaluating conditions associated with
*A. pleural effusions.
B. pleural and pericardial effusions.
C. pericardial and peritoneal effusions.
D. pleural, pericardial, and peritoneal effusions.

13. A pleural or peritoneal fluid amylase level two times higher than the serum amylase level can be found in effusions
resulting from
*A. pancreatitis.
B. hepatic cirrhosis.
C. rheumatoid arthritis.
D. lymphatic obstruction.

14. A glucose concentration difference greater than 30 mg/dL between the serum and an effusion is
associated with
A. pancreatitis.
B. hepatic cirrhosis.
*C. rheumatoid arthritis.
D. lymphatic obstruction.

15. Which of the following actions can adversely affect the chances of obtaining a positive stain or culture when
performing microbiological 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

CHAPTER 16 VAGINAL SECRETIONS

1. Which of the following devices should be used to collect a sample of vaginal secretions?
A. Cervical brush on a teflon shaft
B. Cotton-tipped swab on a wooden shaft
*C. Polyester-tipped swab on a plastic shaft
D. Wool-tipped swab on a wooden shaft

2. Which of the following organisms is adversely affected if a vaginal secretions specimen is refrigerated?
A. Chlamydia trachomatis
B. Candida albicans
C. Gardnerella vaginalis
*D. Trichomonas vaginalis
3. Which range of pH values is associated with secretions from a healthy vagina?
*A. 3.8 to 4.5
B. 4.5 to 5.8
C. 5.8 to 6.5
D. 7.0 to 7.4

4. Which of the following elements is considered abnormal when present in vaginal secretions?
A. Bacteria
*B. Pseudohyphae
C. Yeast
D. White blood cells

5. Which of the following organisms and substances is responsible for the normal pH of the vagina?
A. Gardnerella vaginalis and its metabolic by-product succinic acid
*B. Lactobacilli spp. and their metabolic by-product lactic acid
C. Mobiluncus spp. and their metabolic by-product acetic acid
D. Prevotella spp. and their metabolic by-product phenylacetic acid

6. Which of the following statements best describes a clue cell?

A. Degenerating squamous epithelial cells with distinctive keratohyalin granulation
B. Budding yeast (e.g., blastoconidia) with small coccobacilli adhering to their surfaces
*C. Squamous epithelial cells with numerous bacteria adhering to their outer cell membranes
D. White blood cells with numerous bacteria completely covering them such that they appear as
floating spherical orbs of bacteria

7. Which of the following vaginal secretion results correlate with health?

A. pH 3.9; white blood cells, 3+
*B. pH 4.2; white blood cells, 1+
C. pH 4.8; white blood cells, rare
D. pH 5.5; white blood cells, 2+

8. Which of the following statements best describes the microbial flora of a healthy vagina?
*A. Large gram-positive rods predominate.
B. Large gram-positive cocci predominate.
C. Small gram-negative rods predominate.
D. Small gram-variable coccobacilli predominate.

9. Which of the following tests is most helpful in differentiating red blood cells from yeast in vaginal secretions?
A. pH
B. Amine test
C. Wet mount examination
*D. KOH preparation and examination

10. Which of the following vaginal secretion findings is most diagnostic for bacterial vaginosis?
A. pH 5.0
*B. Clue cells
C. Pseudohyphae
D. Parabasal cells

11. Which of the following substances is responsible for the foul, fishy odor obtained when the “whiff” test is performed
on vaginal secretions?
A. Lactic acid
B. Polyamine
*C. Trimethylamine
D. Hydrogen peroxide

12. Select the condition that correlates best with the following vaginal secretion results:
pH: 5.9 Amine test: positive
KOH examination: negative
Wet mount examination: bacteria: mixed bacterial flora
WBC: 4+
A. Normal, indicating a healthy vagina
B. Bacterial vaginosis
C. Candidiasis
*D. Trichomoniasis
13. Select the condition that correlates best with the following vaginal secretion results:
pH: 4.6 Amine test: negative
KOH examination: negative
Wet mount examination: bacteria: large rods
predominate
WBC: 1+
*A. Normal, indicating a healthy vagina
B. Bacterial vaginosis
C. Candidiasis
D. Trichomoniasis