Urine formation and routine test.

1. Which statement regarding renal function is true?

*A. Glomeruli are far more permeable to H2O and salt than other capillaries
B. The collecting tubule reabsorbs sodium and secretes potassium in response to antidiuretic hormone (ADH)
C. The collecting tubule is permeable to H2O only in the presence of aldosterone
D. The thick ascending limb is highly permeable to H2O and urea

2. Which statement regarding normal salt and H2O handling by the nephron is correct?
*A. The ascending limb of the tubule is highly permeable to salt but not H2O
B. The stimulus for ADH release is low arterial pressure in the afferent arteriole
C. The descending limb of the tubule is impermeable to urea but highly permeable to salt
D. Renin is released in response to high plasma osmolality

3. Which statement concerning renal tubular function is true?

*A. In salt deprivation, the kidneys will conserve sodium at the expense of potassium
B. Potassium is not excreted when serum concentration is below 3.5 mmol/L
C. No substance can be excreted into urine at a rate that exceeds the glomerular filtration rate
D. When tubular function is lost, the specific gravity of urine will be below 1.005

4. Which of the following is inappropriate when collecting urine for routine bacteriologic culture?
A. The container must be sterile
B. The midstream void technique must be used
C. The collected sample must be plated within 2 hours unless refrigerated
*D. The sample may be held at 2°C–8°C for up to 48 hours prior to plating

5. Which statement about sample collection for routine urinalysis is true?

A. Preservative tablets should be used for collecting random urine specimens
B. Containers may be washed and reused if rinsed in deionized H2O
*C. Samples may be stored at room temperature for up to 2 hours
D. First morning voided samples are not acceptable when renal disease is suspected

6. Which urine color is correlated correctly with the pigment-producing substance?

A. Smoky red urine with homogentisic acid
B. Dark amber urine with myoglobin
*C. Deep yellow urine and yellow foam with bilirubin
D. Red-brown urine with biliverdin

7. Which of the following substances will cause urine to produce red fluorescence when examined with an ultraviolet
lamp (360 nm)?
A. Myoglobin
B. Porphobilinogen (PBG)
C. Urobilin
*D. Coproporphyrin

8. Which of the following conditions is associated with normal urine color but produces red fluorescence when urine is
examined with an ultraviolet (Wood’s) lamp?
A. Acute intermittent porphyria
*B. Lead poisoning
C. Erythropoietic porphyria
D. Porphyria cutanea tarda

9. Which statement regarding porphyria is accurate?

A. Porphyria is exclusively inherited
B. All types cause an increase in urinary porphyrins
C. All types are associated with anemia
*D. Serum, urine, and fecal tests may be needed for diagnosis

10. Which is the most common form of porphyria?

A. Erythropoietic porphyria
B. Acute intermittent porphyria
C. Variegate porphyria
*D. Porphyria cutanea tarda

11. Which of the following methods is the least sensitive and specific for measuring PBG in urine?
*A. Watson–Schwartz test
B. LC–MS
C. Ion exchange chromatography–Ehrlich’s reaction
D. Isotope dilution–MS
12. A brown or black pigment in urine can be caused by:
A. Gantrisin (Pyridium)
B. Phenolsulfonphthalein
C. Rifampin
*D. Melanin

13. Urine that is dark red or port wine in color may be caused by:
A. Lead poisoning
*B. Porphyria cutanea tarda
C. Alkaptonuria
D. Hemolytic anemia

14. Which of the following tests is affected least by standing or improperly stored urine?
A. Glucose
*B. Protein
C. pH
D. Bilirubin

15. Which type of urine sample is needed for a D-xylose absorption test on an adult patient?
A. 24-hour urine sample collected with 20 mL of 6 N HCl
B. 2-hour timed postprandial urine preserved with boric acid
C. 5-hour timed urine kept under refrigeration
D. Random urine preserved with formalin

16. Which of the following is inappropriate when collecting a 24-hour urine sample for catecholamines?
A. Urine in the bladder is voided and discarded at the start of the test
B. At 24 hours, any urine in the bladder is voided and added to the collection
C. All urine should be collected in a single container that is kept refrigerated
*D. Ten mL of 1N sodium hydroxide should be added to the container before collection

17. Urine production of less than 400 mL/day is:

A. Consistent with normal renal function and H2O balance
B. Termed isosthenuria
*C. Defined as oliguria
D. Associated with diabetes mellitus

18. Which of the following contributes to SG, but not to osmolality?

*A. Protein
B. Salt
C. Urea
D. Glucose

19. Urine with an SG consistently between 1.002 and 1.003 indicates:

A. Acute glomerulonephritis
B. Renal tubular failure
*C. Diabetes insipidus
D. Addison’s disease

20. In which of the following conditions is the urine SG likely to be below 1.025?
A. Diabetes mellitus
B. Drug overdose
*C. Chronic renal failure
D. Prerenal failure

21. Which statement regarding methods for measuring SG is true?

*A. To correct a urinometer, subtract 0.001 per each 3°C below 15.5°C
B. Colorimetric SG tests are falsely elevated when a large quantity of glucose is present
C. Colorimetric SG readings are falsely elevated when pH is alkaline
D. Refractometry should be performed before the urine is centrifuged

22. What is the principle of the colorimetric reagent strip determination of SG in urine?
*A. Ionic strength alters the pKa of a polyelectrolyte
B. Sodium and other cations are chelated by a ligand that changes color
C. Anions displace a pH indicator from a mordant, making it water soluble
D. Ionized solutes catalyze oxidation of an azo dye
23. Which statement regarding urine pH is true?
A. High-protein diets promote an alkaline urine pH
B. pH tends to decrease as urine is stored
*C. Contamination should be suspected if urine pH is less than 4.5
D. Bacteriuria is most often associated with a low urine pH

24. In renal tubular acidosis, the pH of urine is:

A. Consistently acid
*B. Consistently alkaline
C. Neutral
D. Variable, depending upon diet

25. The normal daily urine output for an adult is approximately:

A. 0.2–0.5 L
*B. 0.6–1.6 L
C. 2.7–3.0 L
D. 3.2–3.5 L

26. The SG of the filtrate in Bowman’s space is approximately:

A. 1.000–1.002
B. 1.004–1.006
*C. 1.008–1.010
D. 1.012–1.014

27. A patient with partially compensated respiratory alkalosis would have a urine pH of:
A. 4.5–5.5
B. 5.5–6.5
C. 6.5–7.5
*D. 7.5–8.5

28. Which of the following is most likely to cause a false-positive dry reagent strip test for urinary protein?
A. Urine of high SG
*B. Highly buffered alkaline urine
C. Bence–Jones protein
D. Salicylates

29. When testing for urinary protein with sulfosalicylic acid (SSA), which condition may produce a false-positive result?
A. Highly buffered alkaline urine
*B. The presence of x-ray contrast media
C. Increased urinary SG
D. The presence of red blood cells (RBCs)

30. A discrepancy between the urine SG determined by measuring refractive index and urine osmolality would be most
likely to occur:
A. After catheterization of the urinary tract
B. In diabetes mellitus
*C. After an intravenous pyelogram (IVP)
D. In uremia

31. Which of the following is likely to result in a false-negative dry reagent strip test for proteinuria?
A. Penicillin
B. Aspirin
C. Amorphous phosphates
*D. Bence–Jones protein

32. Daily loss of protein in urine normally does not exceed:

A. 30 mg
B. 50 mg
C. 100 mg
*D. 150 mg

33. Which of the following is least likely to cause a false-positive result with turbidimetric protein tests?
A. Tolbutamide
B. X-ray contrast media
C. Penicillin or sulfa antibiotics
*D. Ascorbic acid
34. Which statement best describes the clinical utility of tests for microalbuminuria?
*A. Testing may detect early renal involvement in diabetes mellitus
B. Microalbuminuria refers to a specific subfraction of albumin found only in persons with diabetic nephropathy
C. A positive test result indicates the presence of orthostatic albuminuria
D. Testing should be part of the routine urinalysis

35. Dry reagent strip tests for microalbuminuria that compare albumin to creatinine determine the creatinine
concentration based upon which principle?
*A. Formation of a Cu+2-creatinine complex
B. Enzymatic assay using sarcosine oxidase and peroxidase
C. Reaction of creatinine with alkaline sodium picrate
D. Change in pH as creatinine is converted to creatine

36. Which of the following conditions is least likely to be detected by dry reagent strip tests for proteinuria?
A. Orthostatic albuminuria
B. Chronic renal failure
C. Pyelonephritis
*D. Renal tubular proteinuria

37. The normal renal threshold for glucose is:

A. 70–85 mg/dL
B. 100–115 mg/dL
C. 130–145 mg/dL
*D. 165–180 mg/dL

38. In which of the following conditions is glycosuria most likely?

A. Addison’s disease
B. Hypothyroidism
*C. Pregnancy
D. Hypopituitarism

39. In addition to ascorbate, the glucose oxidase reaction may be inhibited by which substance?
*A. Acetoacetic acid (AAA)
B. ε-Aminocaproic acid
C. Creatinine
D. Azopyridium

40. A positive glucose oxidase test and a negative test for reducing sugars indicates:
*A. True glycosuria
B. False-positive reagent strip test
C. False-negative reducing test caused by ascorbate
D. Galactosuria

41. A negative glucose oxidase test and a positive test for reducing sugars in urine indicates:
A. True glycosuria
B. A false-negative glucose oxidase reaction
*C. The presence of a nonglucose reducing sugar such as galactose
D. A trace quantity of glucose

42. In what condition may urinary ketone tests underestimate ketosis?

*A. Acidosis
B. Hemolytic anemia
C. Renal failure
D. Excessive use of vitamin C

43. AAA is detected in urine by reaction with:

*A. Sodium nitroprusside
B. o-Toluidine
C. m-Dinitrobenzene
D. m-Dinitrophenylhydrazine

44. Nondiabetic ketonuria can occur in all of the following except:

A. Pregnancy
*B. Renal failure
C. Starvation
D. Lactate acidosis
45. Which of the following statements regarding the classical nitroprusside reaction for ketones is true?
A. The reaction is most sensitive to acetone
B. Nitroprusside reacts with acetone, AAA, and β-hydroxybutyric acid
*C. It may be falsely positive in phenylketonuria
D. The reaction is recommended for diagnosing ketoacidosis

46. Hemoglobin in urine can be differentiated from myoglobin using:

*A. 80% ammonium sulfate to precipitate hemoglobin
B. Sodium dithionite to reduce hemoglobin
C. o-Dianisidine instead of benzidine as the color indicator
D. The dry reagent strip blood test

47. Which of the following conditions is associated with a negative blood test and an increase in urine urobilinogen?
A. Calculi of the kidney or bladder
B. Malignancy of the kidney or urinary system
C. Crush injury
*D. Extravascular hemolytic anemia

48. Which statement about the dry reagent strip blood test is true?
A. The test is based on the reaction of hemoglobin with peroxidase
*B. Abnormal color may be absent from the urine when the reaction is positive
C. A nonhemolyzed trace is present when there are 1–2 RBCs per high-power field
D. Salicylates cause a false-positive reaction

49. A moderate-positive blood test and trace protein test are seen on the dry reagent strip, and 11–20 red blood cells
per high-power field are seen in the microscopic exam. These results are most likely caused by which of the following?
A. Transfusion reaction
B. Myoglobinuria
C. Intravascular hemolytic anemia
*D. Recent urinary tract catheterization

50. Which of the following results are discrepant?

A. Small amount of blood but negative protein
B. Moderate amount of blood but no RBCs in microscopic exam
*C. Negative blood but 6–10 RBCs/high-power field (HPF)
D. Negative blood, positive protein

51. Which of the following statements regarding the dry reagent strip test for bilirubin is true?
A. A positive test is seen in prehepatic, hepatic, and posthepatic jaundice
*B. The test detects only conjugated bilirubin
C. Standing urine may become falsely positive due to bacterial contamination
D. High levels of ascorbate will cause positive interference

52. Which of the following reagents is used to detect urobilinogen in urine?

A. p-Dinitrobenzene
B. p-Aminosalicylate
*C. p-Dimethylaminobenzaldehyde
D. p-Dichloroaniline

53. Which of the following statements regarding urinary urobilinogen is true?

A. Diurnal variation occurs with highest levels seen in the early morning
B. High levels occurring with a positive bilirubin test indicate obstructive jaundice
*C. Dry reagent strip tests do not detect decreased levels
D. False-positive results may occur if urine is stored for more than 2 hours

54. Which of the following statements regarding the test for nitrite in urine is true?
A. It detects more than 95% of clinically significant bacteriuria
B. Formation of nitrite is unaffected by the urine pH
*C. The test is dependent upon an adequate dietary nitrate content
D. A positive test differentiates bacteriuria from in vitro bacterial contamination

55. Which statement about the dry reagent strip test for leukocytes is true?
A. The test detects only intact white blood cells (WBCs)
*B. The reaction is based upon the hydrolysis of substrate by WBC esterases
C. Several antibiotics may give a false-positive reaction
D. The test is sensitive to 2–3 WBCs per HPF
56. Which of the following statements about creatinine clearance is correct?
A. Dietary restrictions are required during the 24 hours preceding the test
B. Fluid intake must be restricted to below 600 mL in the 6 hours preceding the test
C. Creatinine clearance is mainly determined by renal tubular function
*D. Creatinine clearance is dependent upon lean body mass

57. A male patient’s eGFR is 75 mL/min. This indicates:

A. Normal glomerular filtration rate
B. The patient is uremic and will be hyperkalemic
C. Renal tubular dysfunction
*D. Reduced glomerular filtration without uremia

58. Which of the following tests is a specific measure of glomerular filtration?

A. p-Aminohippuric acid (PAH) clearance
B. Fishberg concentration test
C. Mosenthal dilution test
*D. Cystatin C

59. Which statement regarding urea is true?

*A. Urea is 100% filtered by the glomeruli
B. Blood urea levels are independent of diet
C. Urea is not significantly reabsorbed by the tubules
D. Urea excretion is a specific measure of glomerular function

60. Given the following data, calculate the creatinine clearance.

Serum creatinine = 1.2 mg/dL; urine creatinine = 100 mg/dL; urine volume = 1.4 L/day; body surface area = 1.80 m2
A. 47 mL/min
*B. 78 mL/min
C. 100 mL/min
D. 116 mL/min

Urine microscopy and diseases

1. Which of the following dyes are used in Sternheimer–Malbin stain?
A. Hematoxylin and eosin
*B. Crystal violet and safranin
C. Methylene blue and eosin
D. Methylene blue and safranin Body fluids/Apply principles of basic laboratory procedures/Staining/1

2. Which of the following statements regarding WBCs in urinary sediment is true?

A. “Glitter cells” seen in the urinary sediment are a sign of renal disease
B. Bacteriuria in the absence of WBCs indicates lower urinary tract infection (UTI)
C. WBCs other than PMNs are not found in urinary sediment
*D. WBC casts indicate that pyuria is of renal, rather than lower urinary, origin

3. Which description of sediment with Sternheimer–Malbin stain is correct?

*A. Transitional epithelium: cytoplasm pale blue, nucleus dark blue
B. Renal epithelium: cytoplasm light blue, nucleus dark purple
C. Glitter cells: cytoplasm dark blue, nucleus dark purple
D. Squamous epithelium: cytoplasm pink, nucleus pale blue

4. SITUATION: A 5-mL urine specimen is submitted for routine urinalysis and analyzed immediately. The SG of the
sample is 1.012 and the pH is 6.5. The dry reagent strip test for blood is a large positive (3+) and the microscopic
examination shows 11–20 RBCs per HPF. The leukocyte esterase reaction is a small positive (1+), and the microscopic
examination shows 0–5 WBCs per HPF. What is the most likely cause of these results?
A. Myoglobin is present in the sample
B. Free hemoglobin is present
*C. Insufficient volume is causing microscopic results to be underestimated
D. Some WBCs have been misidentified as RBCs

5. Which of the following statements regarding epithelial cells in the urinary system is correct?
A. Caudate epithelial cells originate from the upper urethra
*B. Transitional cells originate from the upper urethra, ureters, bladder, or renal pelvis
C. Cells from the proximal renal tubule are usually round in shape
D. Squamous epithelium line the vagina, urethra, and wall of the urinary bladder
6. Which of the statements regarding examination of unstained sediment is true?
A. Renal cells can be differentiated reliably from WBCs
*B. Large numbers of transitional cells are often seen after catheterization
C. Neoplastic cells from the bladder are not found in urinary sediment
D. RBCs are easily differentiated from nonbudding yeast

7. Which of the following statements regarding cells found in urinary sediment is true?
A. Transitional cells resist swelling in hypotonic urine
*B. Renal tubular cells are often polyhedral and have an eccentric round nucleus
C. Trichomonads have an oval shape with a prominent nucleus and a single anterior flagellum
D. Clumps of bacteria are frequently mistaken for blood casts

8. Which of the following statements regarding RBCs in the urinary sediment is true?
A. Yeast cells will lyse in dilute acetic acid but RBCs will not
B. RBCs are often swollen in hypertonic urine
*C. RBCs of glomerular origin often appear dysmorphic
D. Yeast cells will tumble when the cover glass is touched but RBCs will not

9. Renal tubular epithelial cells are shed into the urine in largest numbers in which condition?
A. Malignant renal disease
B. Acute glomerulonephritis
C. Nephrotic syndrome
*D. Cytomegalovirus (CMV) infection of the kidney

10. The ova of which parasite may be found in the urinary sediment?
A. T. vaginalis
B. Entamoeba histolytica
*C. Schistosoma hematobium
D. Trichuris trichiura

11. Oval fat bodies are often seen in:

A. Chronic glomerulonephritis
*B. Nephrotic syndrome
C. Acute tubular nephrosis
D. Renal failure of any cause

12. All of the following statements regarding urinary casts are true except:
A. Many hyaline casts may appear in sediment after jogging or exercise
B. An occasional granular cast may be seen in a normal sediment
*C. Casts can be seen in significant numbers even when protein tests are negative
D. Hyaline casts will dissolve readily in alkaline urine

13. Which condition promotes the formation of casts in the urine?

A. Chronic production of alkaline urine
B. Polyuria
*C. Reduced filtrate formation
D. Low urine SG

14. The mucoprotein that forms the matrix of a hyaline cast is called:
A. Bence–Jones protein
B. β-Microglobulin
*C. Tamm–Horsfall protein
D. Arginine-rich glycoprotein

15. “Pseudocasts” are often caused by:

A. A dirty cover glass or slide
B. Bacterial contamination
*C. Amorphous urates
D. Mucus in the urine

16. Which of the following statements regarding urinary casts is correct?

A. Fine granular casts are more significant than coarse granular casts
B. Cylindruria is always clinically significant
C. The appearance of cylindroids signals the onset of end-stage renal disease
*D. Broad casts are associated with severe renal tubular obstruction
17. A sediment with moderate hematuria and RBC casts most likely results from:
A. Chronic pyelonephritis
B. Nephrotic syndrome
*C. Acute glomerulonephritis
D. Lower urinary tract obstruction

18. Urine sediment characterized by pyuria with bacterial and WBC casts indicates:
A. Nephrotic syndrome
*B. Pyelonephritis
C. Polycystic kidney disease
D. Cystitis

19. Which type of casts signals the presence of chronic renal failure?
A. Blood casts
B. Fine granular casts
*C. Waxy casts
D. Fatty casts

20. SITUATION: Urinalysis of a sample from a patient suspected of having a transfusion reaction reveals small yellow-
brown crystals in the microscopic examination. Dry reagent strip tests are normal with the exception of a positive blood
reaction (moderate) and trace positive protein. The pH of the urine is 6.5. What test should be performed to positively
identify the crystals?
A. Confirmatory test for bilirubin
B. Cyanide–nitroprusside test
C. Polarizing microscopy
*D. Prussian blue stain

21. When examining urinary sediment, which of the following is considered an abnormal finding?
A. 0–2 RBCs per HPF
B. 0–1 hyaline casts per low-power field (LPF)
*C. 0–1 renal cell casts per LPF
D. 2–5 WBCs per HPF

22. SITUATION: A urine sample with a pH of 6.0 produces an abundance of pink sediment after centrifugation that
appears as densely packed yellow- to reddish-brown granules under the microscope. The crystals are so dense that no
other formed elements can be evaluated. What is the best course of action?
A. Request a new urine specimen
*B. Suspend the sediment in prewarmed saline, then repeat centrifugation
C. Acidify a 12-mL aliquot with three drops of glacial acetic acid and heat to 56°C for 5 minutes before centrifuging
D. Add five drops of 1N HCl to the sediment and examine

23. How can hexagonal uric acid crystals be distinguished from cystine crystals?
A. Cystine is insoluble in hydrochloric acid but uric acid is soluble
*B. Cystine gives a positive nitroprusside test after reduction with sodium cyanide
C. Cystine crystals are more highly pigmented
D. Cystine crystals form at neutral or alkaline pH, uric acid forms at neutral to acidic pH

24. The presence of tyrosine and leucine crystals together in a urine sediment usually indicates:
A. Renal failure
*B. Chronic liver disease
C. Hemolytic anemia
D. Hartnup disease

25. Which of the following crystals is considered nonpathological?

A. Hemosiderin
B. Bilirubin
*C. Ammonium biurate
D. Cholesterol

26. At which pH are ammonium biurate crystals usually found in urine?

A. Acid urine only
B. Acid or neutral urine
C. Neutral or alkaline urine
*D. Alkaline urine only
27. Which of the following crystals is seen commonly in alkaline and neutral urine?
A. Calcium oxalate
B. Uric acid
*C. Magnesium ammonium phosphate
D. Cholesterol

28. Which crystal appears in urine as a long, thin hexagonal plate, and is linked to ingestion of large amounts of benzoic
acid?
A. Cystine
*B. Hippuric acid
C. Oxalic acid
D. Uric acid

29. Small yellow needles are seen in the sediment of a urine sample with a pH of 6.0. Which of the following crystals can
be ruled out?
A. Sulfa crystals
B. Bilirubin crystals
C. Uric acid crystals
*D. Cholesterol crystals

30. Oval fat bodies are derived from:

*A. Renal tubular epithelium
B. Transitional epithelium
C. Degenerated WBCs
D. Mucoprotein matrix

31. Oval fat bodies are often associated with:

*A. Lipoid nephrosis
B. Acute glomerulonephritis
C. Aminoaciduria
D. Pyelonephritis

32. Urine of constant SG ranging from 1.008 to 1.010 most likely indicates:
A. Addison’s disease
*B. Renal tubular failure
C. Prerenal failure
D. Diabetes insipidus

33. Which of the following characterizes prerenal failure, and helps to differentiate it from acute renal failure caused by
renal disease?
*A. BUN:creatinine ratio of 20:1 or higher
B. Urine:plasma osmolal ratio less than 2:1
C. Excess loss of sodium in the urine
D. Dehydration

34. Which of the following conditions characterizes chronic glomerulonephritis and helps to differentiate it from acute
glomerulonephritis?
A. Hematuria
*B. Polyuria
C. Hypertension
D. Azotemia

35. Which of the following conditions is seen in acute renal failure and helps to differentiate it from prerenal failure?
A. Hyperkalemia and uremia
B. Oliguria and edema
C. Low creatinine clearance
*D. Abnormal urinary sediment

36. Which of the following conditions characterizes acute renal failure and helps to differentiate it from chronic renal
failure?
*A. Hyperkalemia
B. Hematuria
C. Cylindruria
D. Proteinuria
37. The serum concentration of which analyte is likely to be decreased in untreated cases of acute renal failure?
A. Hydrogen ions
B. Inorganic phosphorus
*C. Calcium
D. Uric acid

38. Which of the following conditions is associated with the greatest proteinuria?
A. Acute glomerulonephritis
B. Chronic glomerulonephritis
*C. Nephrotic syndrome
D. Acute pyelonephritis

39. Which of the following conditions is often a cause of glomerulonephritis?

A. Hypertension
B. Cytomegalovirus infection
*C. Systemic lupus erythematosus
D. Heavy metal poisoning

40. Acute pyelonephritis is commonly caused by:

*A. Bacterial infection of medullary interstitium
B. Circulatory failure
C. Renal calculi
D. Antigen–antibody reactions within the glomeruli

41. All of the following are common characteristics of the nephrotic syndrome except:
A. Hyperlipidemia
B. Hypoalbuminemia
*C. Hematuria and pyuria
D. Severe edema

42. Which of the following conditions is a characteristic finding in patients with obstructive renal disease?
A. Polyuria
*B. Azotemia
C. Dehydration
D. Alkalosis

43. Whewellite and weddellite kidney stones are composed of:

A. Magnesium ammonium phosphate
*B. Calcium oxalate
C. Calcium phosphate
D. Calcium carbonate

44. Which of the following abnormal crystals is often associated with formation of renal calculi?
*A. Cystine
B. Ampicillin
C. Tyrosine
D. Leucine

45. Which statement about renal calculi is true?

*A. Calcium oxalate and calcium phosphate account for about three-fourths of all stones
B. Uric acid stones can be seen by x-ray
C. Triple phosphate stones are found principally in the ureters
D. Stones are usually comprised of single salts

CEREBROSPINAL FLUID
1. Cerebrospinal fluid (CSF) is formed by ultrafiltration of plasma through the:
*A. Choroid plexus
B. Sagittal sinus
C. Anterior cerebral lymphatics
D. Arachnoid membrane

2. Which statement regarding CSF is true?

*A. Normal values for mononuclear cells are higher for infants than adults
B. Absolute neutrophilia is not significant if the total WBC count is less than 25/μL
C. The first aliquot of CSF should be sent to the microbiology laboratory
D. Neutrophils compose the majority of WBCs in normal CSF
3. When collecting CSF, a difference between opening and closing fluid pressure greater than 100 mm H2O indicates:
*A. Low CSF volume
B. Subarachnoid hemorrhage
C. Meningitis
D. Hydrocephalus

4. Which of the following findings is consistent with a subarachnoid hemorrhage rather than a traumatic tap?
A. Clearing of the fluid as it is aspirated
B. A clear supernatant after centrifugation
*C. Xanthochromia
D. Presence of a clot in the sample

5. The term used to denote a high WBC count in the CSF is:
A. Empyema
B. Neutrophilia
*C. Pleocytosis
D. Hyperglycorrhachia

6. Which of the following adult CSF specimen values in the following able are consistent with bacterial meningitis

A. Andy’s specimen
B. Peter’s specimen
*C. Katie’s specimen
D. Lewis’ specimen

7. Given the following data, determine the corrected CSF WBC count.
RBCs in CSF: 6,000/uL
RBCs in Peripheral blood: 4.0 x 10^6/uL

WBC in CSF: 150/uL

WBCs in Peripheral blood: 5.0 x 10^3/uL
A. 8 WBC/μL
*B. 142 WBC/μL
C. 120 WBC/μL
D. 145 WBC/μL

8. SITUATION: What is the most likely cause of the following CSF results?
CSF glucose 20 mg/dL;
CSF protein 200 mg/dL;
CSF lactate 50 mg/dL (reference range 5–25 mg/dL)
A. Viral meningitis
B. Viral encephalitis
C. Cryptococcal meningitis
*D. Acute bacterial meningitis

9. Which of the following conditions is most often associated with normal CSF glucose and protein?
A. Multiple sclerosis
B. Malignancy
C. Subarachnoid hemorrhage
*D. Viral meningitis

10. The diagnosis of multiple sclerosis is often based upon which finding?
A. The presence of elevated protein and low glucose
B. A decreased IgG index
*C. The presence of oligoclonal bands by electrophoresis
D. An increased level of CSF β microglobulin

11. Which of the following results is consistent with fungal meningitis?

A. Normal CSF glucose
*B. Pleocytosis of mixed cellularity
C. Normal CSF protein
D. High CSF lactate
12. In what suspected condition should a wet prep using a warm slide be examined?
A. Cryptococcal meningitis
*B. Amoebic meningoencephalitis
C. Mycobacterium tuberculosis infection
D. Neurosyphilis

13. Which of the following CSF test results is most commonly increased in patients with multiple sclerosis?
A. Glutamine
B. Lactate
*C. IgG index
D. Ammonia

14. Which of the following is an inappropriate procedure for performing routine CSF analysis?
*A. A differential is done only if the total WBC count is greater than 10/μL
B. A differential should be done on a stained CSF concentrate
C. A minimum of 30 WBCs should be differentiated
D. A Wright’s-stained slide should be examined rather than a chamber differential

15. Which cell is present in the CSF in greater numbers in newborns than in older children or adults?
A. Eosinophils
B. Lymphocytes
*C. Monocytes
D. Neutrophils

16. Neutrophilic pleocytosis is usually associated with all of the following except:
A. Cerebral infarction
B. Malignancy
C. Myelography
*D. Neurosyphilis

17. Which statement about CSF protein is true?

A. An abnormal serum protein electrophoretic pattern does not affect the CSF pattern
B. The upper reference limit for CSF total protein in newborns is one-half adult levels
*C. CSF IgG is increased in panencephalitis, malignancy, and neurosyphilis
D. Antibodies to Treponema pallidum disappear after successful antibiotic therapy

18. Which of the following statements regarding routine microbiological examination of CSF is true?
A. A Gram stain is performed on the CSF prior to concentration
B. The Gram stain is positive in fewer than 40% of cases of acute bacterial meningitis
C. India ink and acid fast stains are indicated if neutrophilic pleocytosis is present
*D. All CSF specimens should be cultured using sheep blood agar, chocolate agar, and supplemented broth

19. Which organism is the most frequent cause of bacterial meningitis in neonates?
A. Neisseria meningitidis
*B. Group B Streptococcus
C. Streptococcus pneumoniae
D. Klebsiella pneumoniae

20. Following a head injury, which protein will identify the presence of CSF leakage through the nose?
A. Transthyretin
B. Myelin basic protein
*C. Tau protein
D. C-reactive protein

SEROUS FLUID
21. Which of the following statements regarding serous fluids is true?
A. The normal volume of pleural fluid is 30–50 mL
*B. Mesothelial cells, PMNs, lymphocytes, and macrophages may be present in normal fluids
C. X-ray can detect a 10% increase in the volume of a serous fluid
D. Normal serous fluids are colorless

22. The term effusion refers to:

A. A chest fluid that is purulent
B. A serous fluid that is chylous
*C. An increased volume of serous fluid
D. An inflammatory process affecting the appearance of a serous fluid
23. Which of the following laboratory results is characteristic of a transudative fluid?
A. SG = 1.018
B. Total protein = 3.2 g/dL
*C. LD fluid/serum ratio = 0.25
D. Total protein fluid/serum ratio = 0.65

24. Which observation is least useful in distinguishing a hemorrhagic serous fluid from a traumatic tap?
A. Clearing of fluid as it is aspirated
B. Presence of xanthochromia
*C. The formation of a clot
D. Diminished RBC count in successive aliquots

25. Which of the following laboratory results on a serous fluid is most likely to be caused by a traumatic tap?
*A. An RBC count of 8,000/μL
B. A WBC count of 6,000/μL
C. A hematocrit of 35%
D. A neutrophil count of 55%

PLEURAL FLUID
26. Which of the following conditions is commonly associated with an exudative effusion?
A. Congestive heart failure
*B. Malignancy
C. Nephrotic syndrome
D. Cirrhosis

27. Which of the following conditions is associated with a chylous effusion?

A. Necrosis
B. Pulmonary infarction or infection
C. Systemic lupus erythematosus or rheumatoid arthritis
*D. Lymphatic obstruction

28. Which of the following conditions is most often associated with a pleural fluid glucose below 30 mg/dL?
A. Diabetes mellitus
B. Pancreatitis
*C. RA
D. Bacterial pneumonia

29. In which condition is the pleural fluid pH likely to be above 7.3?

A. Bacterial pneumonia with parapneumonic exudate
B. Rheumatoid pleuritis
C. Esophageal rupture
*D. Pneumothorax

PERITONEAL FLUID
30. Which of the following hematology values best frames the upper reference limits for peritoneal fluid?

*A. Andy’s specimen

B. Peter’s specimen
C. Katie’s specimen
D. Lewis’ specimen

SYNOVIAL FLUID
31. Which of the following characteristics is higher for synovial fluid than for the serous fluids?
A. SG
B. Glucose
C. Total protein
*D. Viscosity
32. In which type of arthritis is the synovial WBC count likely to be greater than 50,000/μL?
*A. Septic arthritis
B. Osteoarthritis
C. RA
D. Hemorrhagic arthritis

33. What type of cell is a “ragocyte”?

A. Cartilage cell seen in inflammatory arthritis
*B. A PMN with inclusions formed by immune complexes
C. A plasma cell seen in RA
D. A macrophage containing large inclusions

34. Which of the following crystals is the cause of gout?

*A. Uric acid or monosodium urate
B. Calcium pyrophosphate or apatite
C. Calcium oxalate
D. Cholesterol

35. Which crystal causes “pseudogout”?

A. Oxalic acid
*B. Calcium pyrophosphate
C. Calcium oxalate
D. Cholesterol

36. A synovial fluid sample is examined using a polarizing microscope with a red compensating filter. Crystals are seen
that are yellow when the long axis of the crystal is parallel to the slow vibrating light. When the long axis of the crystal is
perpendicular to the slow vibrating light, the crystals appear blue. What type of crystal is present?
A. Calcium oxalate
B. Calcium pyrophosphate
*C. Uric acid
D. Cholesterol

37. In which condition is the synovial fluid glucose most likely to be within normal limits?
A. Septic arthritis
B. Inflammatory arthritis
*C. Hemorrhagic arthritis
D. Gout

38. Which statement about synovial fluid in RA is true?

*A. Synovial/serum IgG is usually 1:2 or higher
B. Total hemolytic complement is elevated
C. Ninety percent of RA cases test positive for rheumatoid factor in synovial fluid
D. Demonstration of rheumatoid factor in joint fluid is diagnostic for RA

39. Which of the following organisms accounts for the majority of septic arthritis cases in young and middle-age adults?
A. H. influenzae
*B. Neisseria gonorrhoeae
C. Staphylococcus aureus
D. Borrelia burgdorferi

40. Which of the following hematology values best frames the upper reference limits for synovial fluid?

*A. Andy’s specimen

B. Peter’s specimen
C. Katie’s specimen
D. Lewis’ specimen
AMNIOTIC FLUID
1. Which of the following statements about amniotic fluid bilirubin measured by scanning spectrophotometry is true?
*A. The 410-nm peak is due to hemoglobin and the 450-nm peak is due to bilirubin
B. Baseline correction is not required if a scanning spectrophotometer is used
C. Chloroform extraction is necessary only when meconium is present
D. In normal amniotic fluid, bilirubin increases with gestational age

2. Which test best correlates with the severity of HDN?

A. Rh antibody titer of the mother
B. Lecithin/sphingomyelin (L/S) ratio
*C. Amniotic fluid bilirubin
D. Urinary estradiol

3. Which is the reference method for determining fetal lung maturity?

A. Human placental lactogen
*B. L/S ratio
C. Amniotic fluid bilirubin
D. Urinary estriol

4. Which of the following statements regarding the L/S ratio is true?

*A. A ratio of 2:1 or greater usually indicates adequate pulmonary surfactant to prevent respiratory distress
syndrome (RDS)
B. A ratio of 1.5:1 indicates fetal lung maturity in pregnancies associated with diabetes mellitus
C. Sphingomyelin levels increase during the third trimester, causing the L/S ratio to fall slightly during the last 2
weeks of gestation
D. A phosphatidylglycerol (PG) spot indicates the presence of meconium in the amniotic fluid

5. Which of the following conditions is most likely to cause a falsely low L/S ratio?
A. The presence of PG in amniotic fluid
B. Freezing the specimen for one month at –20°C
*C. Centrifugation at 1,000 × g for 10 minutes
D. Maternal diabetes mellitus

6. Which of the following statements accurately describes hCG levels in pregnancy?

A. Levels of hCG rise throughout pregnancy
*B. In ectopic pregnancy, serum hCG doubling time is below expected levels
C. Molar pregnancies are associated with lower levels than expected for the time of gestation
D. hCG returns to nonpregnant levels within 2 days following delivery, stillbirth, or abortion

7. Which of the following statements regarding pregnancy testing is true?

A. β Subunits of human chorionic gonadotropin (hCG), thyroid-stimulating hormone (TSH), and follicle-stimulating
hormone (FSH) are very similar
B. Antibodies against the β subunit of hCG cross-react with luteinizing hormone (LH)
*C. A false-positive result may occur in patients with heterophile antibodies
D. Serum should not be used for pregnancy tests because proteins interfere

8. SITUATION: A pregnant female was seen by her physician who suspected a molar pregnancy. An hCG test was ordered
and found to be low. The sample was diluted 10-fold and the assay was repeated. The result was found to be grossly
elevated. What best explains this situation?
A. The wrong specimen was diluted
B. A pipeting error was made in the first analysis
*C. Antigen excess caused a falsely low result in the undiluted sample
D. An inhibitor of the antigen–antibody reaction was present in the sample

9. Most cases of Down syndrome are the result of:

A. Nondisjunction of an E chromosome (E trisomy)
*B. Nondisjunction of chromosome 21 (G trisomy)
C. A 14–21 chromosome translocation
D. Deletion of the long arm of chromosome 21

10. Which assay result is often approximately 25% below the expected level in pregnancies associated with Down
syndrome?
*A. Serum unconjugated estriol
B. L/S ratio
C. Amniotic fluid bilirubin
D. Urinary chorionic gonadotropin
11. Which of the following statements about AFP is correct?
*A. Maternal serum may be used to screen for open neural tube defects
B. Levels above 4 ng/mL are considered positive
C. Elevated levels in amniotic fluid are specific for spina bifida
D. AFP levels increase in pregnancies associated with Down syndrome

12. First-trimester screening for Down syndrome can be performed using which markers?
A. Alpha fetoprotein and unconjugated estriol
*B. Free β hCG and pregnancy-associated plasma protein A
C. Intact hCG and dimeric inhibin A
D. Dimeric inhibin B and α fetoprotein

13. When performing marker screening tests for Down syndrome, why are results expressed in multiples of the median
(MoM) rather than concentration?
A. Concentration is not normally distributed
*B. MoM normalizes for gestational age
C. Some tests cannot be reported in mass units
D. Mean cannot be determined accurately for these analytes

14. Which statement regarding the fetal fibronectin test is true?

A. A positive test is correlated with a low probability of delivery within 14 days
*B. The test should not be performed before week 24 or after the end of week 34
C. The test is performed on amniotic fluid
D. The test is used to identify amniotic fluid after rupture of the fetal membranes

SEMINAL FLUID
15. What is the term for sperm when the anterior portion of the headpiece is smaller than normal?
A. Azoospermia
B. Microcephaly
*C. Acrosomal deficiency
D. Necrozoospermia

16. What is the most common cause of male infertility?

A. Mumps
B. Klinefelter’s syndrome
*C. Varicocele
D. Malignancy

17. Which of the following values is the lower limit of normal for sperm concentration?
*A. 15 million per mL
B. 40 million per mL
C. 60 million per mL
D. 100 million per mL

18. Which morphological abnormality of sperm is most often associated with varicocele?
*A. Tapering of the head
B. Cytoplasmic droplet below the neckpiece
C. Lengthened neckpiece
D. Acrosomal deficiency

19. Which of the following stains is used to determine sperm viability?

*A. Eosin Y
B. Hematoxylin
C. Papanicolaou
D. Methylene blue

20. Which of the following semen analysis results is abnormal?

*A. Volume 1.0 mL
B. Liquefaction 40 minutes at room temperature
C. pH 7.6
D. Motility 50% progressive movement

21. Which of the following sample collection and processing conditions will lead to inaccurate seminal fluid analysis
results?
A. Sample stored at room temperature for 1 hour before testing
*B. Sample collected following coitus
C. Sample collected without an anticoagulant
D. Sample collected without use of a condom
22. When performing a seminal fluid analysis, what is the upper limit of normal for WBCs?
*A. 1 × 106/mL
B. 5 × 106/mL
C. 10 × 106/mL
D. 20 × 106/mL

23. Which carbohydrate measurement is clinically useful when performing a seminal fluid analysis?
A. Glucose
B. Galactose
*C. Fructose
D. Maltose

GASTRIC FLUID
24. Which condition is most often associated with gastric ulcers?
A. Cancer of the stomach
*B. H. pylori infection
C. Zollinger–Ellison (Z–E) syndrome
D. Pernicious anemia

25. In which condition is the highest level of serum gastrin usually seen?
A. Atrophic gastritis
B. Pernicious anemia
*C. Z–E syndrome
D. Cancer of the stomach

26. In determining free HCl, the gastric fluid is titrated to pH ___.

A. 6.5
B. 4.5
*C. 3.5
D. 2.0

27. Which test can identify persons with gastrin secreting tumors who do not demonstrate a definitively increased
plasma gastrin concentration?
*A. Secretin stimulation
B. Pentagastrin
C. Cholecystokinin–pancreozymin
D. Trypsinogen

28. Which of the following tests would be normal in pancreatic insufficiency?

A. Secretin stimulation
*B. D-Xylose absorption
C. Twenty-four-hour fecal fat
D. β Carotene absorption

30. Which test is most sensitive in detecting persons with chronic pancreatitis?
A. Fecal trypsin
B. Fecal chymotrypsin
*C. Fecal elastin-1
D. Plasma lipase

FECAL
29. Which of the following is commonly associated with occult blood?
*A. Colon cancer
B. Atrophic gastritis
C. Pernicious anemia
D. Pancreatitis

CASE
1. Given the following dry reagent strip urinalysis results, select the most appropriate course of action: pH = 8.0
Protein = 1+
Glucose = Neg
Blood = Neg
Ketone = Neg
Nitrite = Neg
Bilirubin = Neg
A. Report the results, assuming acceptable quality control
B. Check pH with a pH meter before reporting
*C. Perform a turbidimetric protein test and report instead of the dipstick protein
D. Request a new specimen

2. Given the following urinalysis results, select the most appropriate course of action:
pH = 8.0
Protein = Trace
Glucose = Neg
Ketone = Small
Blood = Neg
Nitrite = Neg
Microscopic findings:
RBCs = 0–2/HPF
WBCs = 20–50/HPF
Bacteria = Large
Crystals = Small, CaCO3
A. Call for a new specimen because urine was contaminated in vitro
B. Recheck pH because calcium carbonate (CaCO3) does not occur at alkaline pH
*C. No indication of error is present; results indicate a UTI
D. Report all results except bacteria because the nitrite test was negative

3. SITUATION: A 6-mL pediatric urine sample is processed for routine urinalysis in the usual manner. The sediment is
prepared by centrifuging all of the urine remaining after performing the biochemical tests. The following results are
obtained:
SG = 1.015
Protein = 2+
Blood = Large
RBCs: 5–10/HPF
WBCs: 5–10/HPF
Select the most appropriate course of action.
A. Report these results; blood and protein correlate with microscopic results
*B. Report biochemical results only; request a new sample for the microscopic examination
C. Request a new sample and report as quantity not sufficient (QNS)
D. Recentrifuge the supernatant and repeat the microscopic examination

4. Given the following urinalysis results, select the most appropriate course of action:
pH = 6.5
Protein = Neg
Glucose = Neg
Ketone = Trace
Blood = Neg Bilirubin = Neg
Microscopic findings:
Mucus = Small
Ammonium urate = Large
*A. Recheck urine pH
B. Report these results, assuming acceptable quality control
C. Repeat the dry reagent strip tests to confirm the ketone result
D. Request a new sample and repeat the urinalysis

5. Given the following urinalysis results, select the most appropriate course of action:
pH = 6.0
Protein = Neg Glucose = Neg
Ketone = Neg
Blood = Neg Bilirubin = Neg
Other findings:
Color: Amber
Transparency: Clear
Microscopic: Bilirubin granules = Small
*A. Perform a tablet test for bilirubin before reporting
B. Request a new sample
C. Recheck the pH
D. Perform a test for urinary urobilinogen

6. A biochemical profile gives the following results:

Creatinine = 1.4 mg/dL
BUN = 35 mg/dL
K = 5.5 mmol/L
All other results are normal and all tests are in control. Urine from the patient has an osmolality of 975 mOsm/kg. Select
the most appropriate course of action.
A. Check for hemolysis
B. Repeat the BUN and report only if normal
C. Repeat the serum creatinine and report only if elevated
*D. Report these results

7. A 2 p.m. urinalysis has a trace glucose by the dry reagent strip test. A fasting blood glucose drawn 8 hours earlier is
100 mg/dL. No other results are abnormal. Select the most appropriate course
of action.
*A. Repeat the urine glucose and report if positive
B. Perform a test for reducing sugars and report the result
C. Perform a quantitative urine glucose; report as trace if greater than 100 mg/dL
D. Request a new urine specimen

8. Following a transfusion reaction, urine from a patient gives positive tests for blood and protein. The SG is 1.015. No
RBCs or WBCs are seen in the microscopic examination. These results:
A. Indicate renal injury induced by transfusion reaction
B. Support the finding of an extravascular transfusion reaction
*C. Support the finding of an intravascular transfusion reaction
D. Rule out a transfusion reaction caused by RBC incompatibility

9. A urine sample taken after a suspected transfusion reaction has a positive test for blood, but intact
RBCs are not seen on microscopic examination. Which one test result would rule out an intravascular hemolytic
transfusion reaction?
A. Negative urine urobilinogen
B. Serum unconjugated bilirubin below 1.0 mg/dL
C. Serum potassium below 6.0 mmol/L
*D. Normal plasma haptoglobin

10. Given the following urinalysis results, select the most appropriate course of action:
pH = 5.0
Protein = Neg
Glucose = 1,000 mg/dL
Blood = Neg
Bilirubin = Neg
Ketone = Moderate
SSA protein = 1+
A. Report the SSA protein result instead of the dry reagent strip result
*B. Call for a list of medications administered to the patient
C. Perform a quantitative urinary albumin
D. Perform a test for microalbuminuria

11. Urinalysis results from a 35-year-old woman are:

SG = 1.015
pH = 7.5
Protein = Trace
Glucose = Small
Ketone = Neg
Blood = Neg Leukocytes = Moderate Microscopic findings:
RBCs: 5–10/HPF
WBCs: 25–50/HPF
Select the most appropriate course of action.
*A. Recheck the blood reaction; if negative, look for budding yeast
B. Repeat the WBC count
C. Report all results except blood
D. Request a list of medications

12. A routine urinalysis gives the following results:

pH =6.5
Protein = Neg
Blood = Neg
Glucose= Trace
Ketone = Neg
Microscopic findings:
Blood casts: 5–10/LFP
Mucus: Small
Crystals: Large, Amorphous
These results are most likely explained by:
A. False-negative blood reaction
B. False-negative protein reaction
*C. Pseudocasts of urate mistaken for true casts
D. Mucus mistaken for casts
13. SITUATION: When examining a urinary sediment under 400× magnification, the technologist noted many red blood
cells to have cytoplasmic blebs and an irregular distribution of the hemoglobin. This phenomenon is most often caused
by:
A. Intravascular hemolytic anemia
*B. Glomerular disease
C. Hypotonic or alkaline urine
D. Severe dehydration

14. SITUATION: A urine specimen is dark orange and turns brown after storage in the refrigerator overnight. The
technologist requests a new specimen. The second specimen is bright orange and is tested immediately. Which test
result would differ between the two specimens?
A. Ketone
B. Leukocyte esterase
*C. Urobilinogen
D. Nitrite

15. A patient’s random urine consistently contains a trace of protein but no casts, cells, or other biochemical
abnormality. The first voided morning sample is consistently negative for protein. These findings can be explained by:
A. Normal diurnal variation in protein loss
B. Early glomerulonephritis
*C. Orthostatic or postural albuminuria
D. Microalbuminuria

16. A urine sample with a pH of 8.0 and a specific gravity of 1.005 had a small positive blood reaction, but is negative for
protein and no RBCs are present in the microscopic examination of urinary sediment. What best explains these findings?
A. High pH and low SG caused a false-positive blood reaction
B. The blood reaction and protein reaction are discrepant
*C. Hemoglobin is present without intact RBCs due to hemolysis
D. An error was made in the microscopic examination

17. A urine sample has a negative blood reaction and 5–10 cells per high-power field that resemble red blood cells.
What is the best course of action?
*A. Mix a drop of sediment with 1 drop of WBC counting fluid and reexamine
B. Report the results without further testing
C. Repeat the blood test and if negative report the results
D. If the leukocyte esterase test is positive, report the cells as WBCs

18. A toluidine blue chamber count on CSF gives the following values:
WBCs in CSF: 10 x 10^6/L
WBCs in Peripheral Blood: 5 x 10^9/L
RBCs in CSF: 1,000 x 10^6/L
RBCs in Peripheral Blood: 5 x 10^12/L
After correcting the WBC count in CSF, the technologist should next:
A. Report the WBC count as 9 × 106/L without additional testing
B. Report the WBC count and number of PMNs identified by the chamber count
C. Perform a differential on a direct smear of the CSF
D. Concentrate CSF using a cytocentrifuge and perform a differential

19. A blood-tainted pleural fluid is submitted for culture. Which test result would be most conclusive in classifying the
fluid as an exudate?

*A. Andy’s specimen

B. Peter’s specimen
C. Katie’s specimen
D. Lewis’ specimen

20. A pleural fluid submitted to the laboratory is milky in appearance. Which test would be most useful in differentiating
between a chylous and pseudochylous effusion?
*A. Fluid to serum triglyceride ratio
B. Fluid WBC count
C. Fluid total protein
D. Fluid to serum LD ratio
21. A cerebrospinal fluid sample from an 8-year-old child with a fever of unknown origin was tested for glucose, total
protein, lactate, and IgG index. The glucose was 180 mg/dL but all other results were within the reference range. The
CSF WBC count was 9 × 106/L and the RBC count was 10 × 106/L. The differential showed 50% lymphocytes, 35%
monocytes, 10% macrophages, 3% neutrophils, and 2% neuroectodermal cells. What is the most likely cause of these
results?
A. Aseptic meningitis
B. Traumatic tap
C. Subarachnoid hemorrhage
*D. Hyperglycemia

22. A WBC count and differential performed on ascites fluid gave a WBC count of 20,000μL with 90% macrophages. The
gross appearance of the fluid was described by the technologist as “thick and bloody.” It was noted on the report that
several clusters of these cells were observed and that the majority of the cells contained many vacuoles resembling
paper-punch holes. What do the observations above suggest?
*A. Malignant mesothelial cells were counted as macrophages
B. Adenocarcinoma from a metastatic site
C. Lymphoma infiltrating the peritoneal cavity
D. Nodular sclerosing type Hodgkin’s disease

23. Given the following data for creatinine clearance, select the most appropriate course of action.
Volume = 2.8 L/day;
surface area = 1.73 m2;
urine creatinine = 100 mg/dL;
serum creatinine = 1.2 mg/dL
A. Report a creatinine clearance of 162 mL/min
B. Repeat the urine creatinine; results point to a dilution error
*C. Request a new 24-hour urine sample
D. Request the patient’s age and sex

24. An elevated amylase is obtained on a stat serum collected at 8 p.m. An amylase performed at 8 a.m. that morning
was within normal limits. The technologist also noted that a urine amylase was measured at 6 p.m. Select the most
appropriate course of action.
A. Repeat the stat amylase; report only if within normal limits
B. Repeat both the a.m. and p.m. serum amylase and report only if they agree
C. Request a new specimen; do not report results of the stat sample
*D. Review the amylase result on the 6 p.m. urine sample; if elevated, report the stat amylase

25. Results of a fetal lung maturity (FLM) study from a patient with diabetes mellitus are as follows:
L/S ratio = 2.0;
Phosphatidyl glycerol = Pos;
Creatinine = 2.5 mg/dL
Given these results, the technologist should:
*A. Report the result and recommend repeating the L/S ratio in 24 hours
B. Perform scanning spectrophotometry on the fluid to determine if blood is present
C. Repeat the L/S ratio after 4 hours and report those results
D. Report results as invalid

26. A 24-hour urine sample from an adult submitted for catecholamines gives a result of 140 μg/day (upper reference
limit 150 μg/day). The 24-hour urine creatinine level is 0.6 g/day. Select the best course of action.
A. Check the urine pH to verify that it is less than 2.0
B. Report the result in μg catecholamines per mg creatinine
*C. Request a new 24-hour urine sample
D. Measure the VMA and report the catecholamine result only if elevated

27. A 5-hour urinary D-xylose test on a 7-year-old boy who was given 0.5 g of D-xylose per pound is 15%. The 2-hour
timed blood D-xylose is 15 mg/dL (lower reference limit 30 mg/dL). Select the most appropriate action.
A. Request that a β carotene absorption test be performed
B. Repeat the urinary result because it is borderline
C. Request a retest using a 25-g dose of D-xylose
*D. Request a retest using only a 1-hour timed blood sample

28. A quantitative serum hCG is ordered on a male patient. The technologist should:
*A. Perform the test and report the result
B. Request that the order be cancelled
C. Perform the test and report the result if negative
D. Perform the test and report the result only if greater than 25 IU/L
29. SITUATION: A lamellar body count (LBC) was performed on an amniotic fluid sample that was slightly pink in color
within 1 hour of specimen collection. The sample was stored at 4°C prior to analysis. The result was 25,000/μL, classified
as intermediate risk of respiratory distress syndrome. The physician waited 24 hours and collected a new sample that
was counted within 2 hours of collection on the same instrument. The LCB count of the new sample was 14,000/ μL and
the patient was reclassified as high risk. Which statement best explains these results?
A. Loss of lamellar bodies occurred in the second sample because of storage
*B. Blood caused a falsely elevated result for the first sample
C. The fetal status changed in 24 hours owing to respiratory illness
D. The difference in counts is the result of day-to-day physiological and instrument variance

30. When testing for drugs of abuse in urine, which of the following test results indicate dilution and would be cause for
rejecting the sample?
A. Temperature upon sample submission 92°F
*B. Specific gravity 1.002; Creatinine 15 mg/dL,
C. pH 5.8; temperature 94°C
D. Specific gravity 1.012, creatinine 25 mg/dL

31. SITUATION: A urine specimen has a specific gravity of 1.025 and is strongly positive for nitrite. All other dry reagent
strip test results are normal, and the microscopic exam was unremarkable, showing no WBCs or bacteria. The urine
sample was submitted as part of a preemployment physical exam that also includes drug testing.
Which most likely caused these results?
A. A viral infection of the kidney
B. A urinary tract infection in an immunosuppressed person
*C. An adulterated urine specimen
D. Error in reading the nitrite pad caused by poor reflectometer calibration

32. A CSF sample submitted for cell counts has a visible clot. What is the best course of action?
A. Count RBCs and WBCs manually after diluting the fluid with normal saline
B. Tease the cells out of the clot before counting, then dilute with WBC counting fluid
*C. Request a new sample
D. Perform a WBC count without correction

34. A CSF CytoPrep smear shows many smudge cells and macrophages with torn cell membranes. What most likely
caused this problem?
*A. Failure to add albumin to the cytospin cup
B. Failure to collect the CSF in EDTA
C. Centrifuge speed too low
D. Improper alignment

33. Total hemolytic complement and glucose are ordered on a synovial fluid sample that is too viscous to pipet. What is
the best course of action?
A. Dilute the sample in saline
*B. Add 1 mg/mL hyaluronidase to the sample and incubate at room temperature for 30 minutes
C. Warm the sample to 65°C for 10 minutes
D. Request a new specimen

35. An automated electronic blood cell counter was used to count RBCs and WBCs in a turbid pleural fluid sample. The
WBC count was 5 × 10^10/L (50,000/μL) and the RBC count was 5.5 × 10^10/L (55,000/ μL). What is the significance of
the RBC count?
*A. The RBC count is not significant and should be reported as 5,000/μL
B. The RBC count should be reported as determined by the analyzer
C. A manual RBC count should be performed
D. A manual RBC and WBC count should be performed and reported instead