CHAPTER 7: AUBF

1. Which statement regarding renal function is true?

A. Glomeruli are far more permeable to H2O and salt compared with 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 and urea
2. Which statement regarding normal salt and H2O handling by the nephron is correct?
A. The thick 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 less than 3.5 mmol/L
C. No substance can be excreted into urine at a rate that exceeds the glomerular filtration
rate(GFR)
D. When tubular function is lost, the specific gravity (SG) 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 to 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. A midday sample is preferred 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 under 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) 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 reaction
D. Isotope dilution–MS
12. A brown or black pigment in urine can be caused by:
A. Gantrisin (pyridium)
B. Phenolsulfonphthalein (PSP)
C. Rifampin
D. Melanin
13. Urine that is dark red or port wine-colored 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 one of the following characteristics would be a reason for performing a microscopic
examination of urinary sediment?
A. High volume
B. Color intensity
C. Turbidity
D. Specimen from a Foley catheter
16. Which of the following is appropriate when collecting a 24-hour urine sample for
metanephrines?
A. Urine in the bladder is voided at the start of the test and added to the collection container B.
At 24 hours, any urine in the bladder is voided and discarded
C. All urine should be collected in a single container that is kept refrigerated
D. Ten milliliters 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 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. Refractometry is the most accurate way to determine dissolved solute concentration
B. Colorimetric SG test results are falsely elevated when a large quantity of glucose is present
C. Colorimetric SG readings are falsely low 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. A high-protein diet promotes 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 on diet
25. The normal daily urine output for an adult is approximately:
A. 0.2 to 0.5 L
B. 0.6 to 1.6 L
C. 2.7 to 3.0 L
D. 3.2 to 3.5 L
26. The SG of the filtrate in the Bowman space is approximately:
A. 1.000 to 1.002
B. 1.004 to 1.006
C. 1.008 to 1.010
D. 1.012 to 1.014
27. A patient with partially compensated respiratory alkalosis would have a urine pH of:
A. 4.5 to 5.5
B. 5.5 to 6.5
C. 6.5 to 7.5
D. 7.5 to 8.5
28. Which of the following is most likely to cause a false-positive result on the 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 intravenous pyelography (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 on 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 on 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 to 85 mg/dL
B. 100 to 115 mg/dL
C. 130 to 145 mg/dL
D. 165 to 180 mg/dL
38. In which of the following conditions is glycosuria most likely?
A. Addison 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 result
C. False-negative reducing test result 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 classic 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 by 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 result 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 to 2 RBCs per high-power field
(RBCs/HPF)
D. Salicylates cause a false-positive reaction
49. A moderately positive result on the blood test and trace protein test are seen on the dry
reagent strip, and 11 to 20 RBCs/HPF are seen in the microscopic examination. 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 examination
C. Negative blood, but 6 to 10 RBCs/HPF
D. Negative blood, but positive protein
51. Which of the following statements regarding the dry reagent strip test for bilirubin is true?
A. A positive test result is seen in prehepatic, hepatic, and posthepatic jaundice
B. The test detects only conjugated bilirubin
C. Standing urine may become falsely positive because of 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, and the highest levels are seen in the early morning
B. High levels accompanied by a positive bilirubin test result 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 on 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 on the hydrolysis of substrate by WBC esterases
C. Several antibiotics may give a false-positive reaction
D. The test is sensitive to 2 to 3 WBCs/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 on 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 substances can be used to calculate eGFR?
A. p-Aminohippuric acid (PAH)
B. Glycine
C. Cysteine
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

7.2
1. Which of the following dyes are used to make 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 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
Body fluids/Correlate clinical and laboratory data/Urinary sediment/2
3. Which description of urinary sediment with the 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 is analyzed
immediately. The SG of the sample is 1.012, and the pH is 6.5. The dry reagent strip blood test
result is a large positive (3+), and the microscopic examination shows 11 to 20 RBCs/HPF. The
leukocyte esterase reaction is a small positive (1+), and the microscopic examination shows 0
to 2 WBCs/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
D. Squamous epithelium line the vagina, urethra, and wall of the urinary bladder
6. Which of the statements regarding examination of unstained urinary 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 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 is likely be found in the urinary sediment?
A. Trichomonas 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. Which statement regarding urinary casts is true?
A. Many hyaline casts may appear in urinary sediment after jogging or exercise
B. The finding of even a single cast indicates renal disease
C. Casts can be seen in significant numbers even when protein tests are negative
D. Hyaline casts will dissolve readily in acid urine
13. Which condition promotes the formation of casts in 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 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
Body fluids/Correlate clinical and laboratory data/Urine sediment/2
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
Body fluids/Apply knowledge of fundamental biological characteristics/Urine casts/2
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 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. 2 RBCs/HPF
B. 1 hyaline cast per low-power field (LPF)
C. 1 renal cell cast per LPF
D. 5 WBCs/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, and 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 urinary 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 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 urine
D. Dehydration
34. Which of the following conditions characterizes chronic glomerulonephritis and helps
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 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 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. CMV infection
C. Systemic lupus erythematosus (SLE)
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. Which of the following is associated with nephrotic syndrome?
A. Hyperlipidemia
B. Uremia
C. Hematuria and pyuria
D. Dehydration
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 on radiography
C. Triple phosphate stones are found principally in the ureters
D. Stones are usually composed of single salts

7.3
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 for 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 protein 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
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 MS is suggested by 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 MS?
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-stained slide should be examined, rather than a chamber differential Body
fluids/Apply principles of standard operating procedures/Cerebrospinal fluid/2
15. Which cell is present in 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 (URL) for CSF total protein in newborns is one half the adult level
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. Haemophilus influenzae
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
21. Which of the following statements regarding serous fluids is true?
A. The normal volume of pleural fluid is 30 to 50 mL
B. Mesothelial cells, PMNs, lymphocytes, and macrophages may be present in normal fluids
C. Radiography 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
Body fluids/Correlate laboratory data with physiological processes/Serous fluids/2
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%
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 (RA)
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. Rheumatoid arthritis
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
31. Which of the following characteristics is higher for synovial fluid than for the serous fluids?
A. Specific gravity
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. Rheumatoid arthritis
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 by 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 URLs for synovial fluid?
WBC Count Percentage of PMNs RBC Count
A. 200/μL 25% 2,000/μL
B. 5,000/μL 50% 10,000/μL
C. 10,000/μL 50% 50,000/μL
D. 20,000/μL 5% 500,000/μL

7.4
1. Which of the following statements about amniotic fluid bilirubin measured by scanning
spectrophotometry is true?
A. The 410-nm peak is caused by hemoglobin and the 450-nm peak is caused by bilirubin
B. Baseline correction is not required because a diode array detector 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 hemolytic disease of the fetus and newborn
(HDFN)?
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 (FLM)?
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 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 human chorionic gonadotropin (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 hCG, thyroid-stimulating hormone (TSH), and follicle-stimulating hormone
(FSH) are identical
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 woman was seen by her physician, who suspected a molar
pregnancy. An hCG test was ordered, and hCG levels were found to be low. The sample was
diluted 10-fold and the assay was repeated. The level 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. 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
10. Which of the following statements about alpha fetoprotein (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
11. First-trimester screening for Down syndrome can be performed using which markers?
A. AFP 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 AFP
12. When performing marker screening tests for Down syndrome, why are results
expressed in multiples of the median (MoM), rather than in 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
13. Which test for 21 trisomy is not recommended for women who are carrying twins? A. First
trimester triple marker screening
B. Maternal plasma cell free fetal DNA
C. Chorionic villus sampling
D. Second trimester quad marker screening
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
15. What is the term for spermatozoa in which 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 syndrome
C. Varicocele
D. Malignancy
17. Which of the following values is the lower limit of normal for sperm concentration? A. 15
million per milliliter
B. 40 million per milliliter
C. 60 million per milliliter
D. 100 million per milliliter
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
24. Which condition is most often associated with gastric ulcers?
A. Cancer of the stomach
B. Helicobacter 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 that 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
29. Which of the following is commonly associated with occult blood?
A. Colon cancer
B. Atrophic gastritis
C. Pernicious anemia
D. Pancreatitis
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

7.5
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, instead of the dipstick protein test, and report D. Request
a new specimen
2. Given the following urinalysis results, select the most appropriate course of action:
pH = 8.0 Ketone = Small Protein = Trace Blood = Neg
Glucose = Neg Nitrite = Neg
Microscopic findings:
RBCs = 0–2/HPF Bacteria = Large
WBCs = 20–50/HPF Crystals = Small, CaCO3
A. Call for a new specimen because urine was contaminated in vitro
B. Recheck pH because 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 Blood = Large Leukocytes = Moderate
Protein = 2+ 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
7. A 2 p.m. urinalysis shows trace glucose on the dry reagent strip test. 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 test results 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 result for
blood, but intact RBCs are not seen on microscopic examination. Which 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
13. SITUATION: When examining a urinary sediment under 400× magnification, the medical
laboratory scientist (MLS) noted many RBCs 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 MLS 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 sample 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 because of hemolysis
D. An error was made in the microscopic examination
17. A urine sample has a negative blood reaction and 5 to 10 cells per high-power field that
resemble RBCs. What is the best course of action?
A. Mix a drop of sediment with 1 drop of WBC counting fluid and re-examine
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
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:serum LD ratio
Body fluids/Select test/Pleural fluid/3
21. A CSF sample from an 8-year-old child with a fever of unknown origin was tested for
glucose, total protein, lactate, and IgG index. 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 20,000/ μL
with 90% macrophages. The gross appearance of the fluid was described by the MLS 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 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 gender
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 MLS also noted that 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 morning and afternoon 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
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 milligram of creatinine
C. Request a new 24-hour urine sample
D. Measure the VMA, and report the catecholamine result only if elevated
27. A sperm motility test was performed and 200 sperm were evaluated in each of two
duplicates. The first sample showed progressive movement in 50% and nonprogressive
movement in 35%, and 15% were immotile. The second showed progressive movement in 35%
and nonprogressive movement in 35%, and 30% were immotile. What is the best course of
action?
A. Report the average of the two values for progressive movement
B. Report the higher of the two values
C. Repeat the motility test
D. Call for a new specimen
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 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 RDS. 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 for delivery. 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 because of 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 at sample submission 92°F
B. SG 1.002; creatinine 15 mg/dL,
C. pH 5.8; temperature 94°C
D. SG 1.012; creatinine 25 mg/dL
31. SITUATION: A urine specimen has an SG of 1.025 and is strongly positive for nitrite. All
other dry reagent strip test results are normal, and the microscopic examination was
unremarkable, showing no WBCs or bacteria. The urine sample was submitted as part of a pre-
employment physical examination 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 Body fluids/Apply
knowledge to identify sources of error/Drug testing/3
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
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
34. A CSF cytospin 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
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 × 1010/L (50,000/μL) and the RBC count was 5.5 ×
1010/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