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Chapter 6 -9 QUESTIONS 1. Macroscopic screening of urine specimens is used to: A. Provide results as soon as possible B.

Predict the type of urinary casts present C. Increase cost-effectiveness of urinalysis D. Decrease the need for polarized microscopy 2. Variations in the microscopic analysis of urine include all of the following except: A. Preparation of the urine sediment B. Amount of sediment analyzed C. Method of reporting D. Identification of formed elements 3. All of the following can cause false-negative microscopic results except: A. Braking the centrifuge B. Failing to mix the specimen C. Dilute alkaline urine D. Using midstream clean-catch specimens 4. The two factors that determine relative centrifugal force are: A. Radius of rotor head and rpm B. Radius of rotor head and time of centrifugation C. Diameter of rotor head and rpm D. RPM and time of centrifugation 5. When using the glass slide and coverslip method, which of the following might be missed if the coverslip is overflowed? A. Casts B. RBCs C. WBCs D. Bacteria 6. Initial screening of the urine sediment is performed using an objective power of: A. 4_ B. 10_ C. 40_ D. 100_ 7. Which of the following should be used to reduce light intensity in bright-field microscopy? A. Centering screws B. Aperture diaphragm C. Rheostat D. Condenser aperture diaphragm 8. Which of the following are reported as number per LPF? A. RBCs B. WBCs C. Crystals

D. Casts 9. The Sternheimer-Malbin stain is added to urine sediments to do all of the following except: A. Increase visibility of sediment constituents B. Change the constituents refractive index C. Decrease precipitation of crystals D. Delineate constituent structures 10. Nuclear detail can be enhanced by: A. Prussian blue B. Toluidine blue C. Acetic acid D. Both B and C 11. Which of the following lipids is/are stained by Sudan III? A. Cholesterol B. Neutral fats C. Triglycerides D. Both B and C 12. Which of the following lipids is/are capable of polarizing light? A. Cholesterol B. Neutral fats C. Triglycerides D. Both A and B 13. The purpose of the Hansel stain is to identify: A. Neutrophils B. Renal tubular cells C. Eosinophils D. Monocytes 14. Crenated RBCs are seen in urine that is: A. Hyposthenuric B. Hypersthenuric C. Highly acidic D. Highly alkaline 15. Differentiation among RBCs, yeast, and oil droplets may be accomplished by all of the following except: A. Observation of budding in yeast cells B. Increased refractility of oil droplets C. Lysis of yeast cells by acetic acid D. Lysis of RBCs by acetic acid 16. The finding of dysmorphic RBCs is indicative of: A. Glomerular bleeding B. Renal calculi C. Traumatic injury D. Coagulation disorders 17. Leukocytes that stain pale blue with SternheimerMalbin stain and exhibit brownian movement are:

A. Indicative of pyelonephritis B. Basophils C. Mononuclear leukocytes D. Glitter cells 18. Mononuclear leukocytes are sometimes mistaken for: A. Yeast cells B. Squamous epithelial cells C. Pollen grains D. Renal tubular cells 19. When pyuria is detected in a sediment, the slide should be carefully checked for the presence of: A. RBCs B. Bacteria C. Hyaline casts D. Mucus 20. Transitional epithelial cells are sloughed from the: A. Collecting duct B. Vagina C. Bladder D. Proximal convoluted tubule 21. The largest cells in the urine sediment are: A. Squamous epithlial cells B. Urothelial epithelial cells C. Cuboidal epithelial cells D. Columnar epithelial cells 22. A clinically significant squamous epithelial cell is the: A. Cuboidal cell B. Clue cell C. Caudate cell D. Columnar cell 23. Forms of transitional epithelial cells include all of the following except: A. Spherical B. Caudate C. Convoluted D. Polyhedral 24. Increased transitional cells are indicative of: A. Catheterization B. Malignancy C. Pyelonephritis D. Both A and B 25. A primary characteristic used to identify renal tubular epithelial cells is: A. Elongated structure B. Centrally located nucleus C. Spherical appearance D. Eccentrically located nucleus

26. Following an episode of hemoglobinuria, RTE cells may contain: A. Bilirubin B. Hemosiderin granules C. Porphobilinogen D. Myoglobin 27. The predecessor of the oval fat body is the: A. Histiocyte B. Urothelial cell C. Monocyte D. Renal tubular cell 28. A structure believed to be an oval fat body produced a Maltese cross formation under polarized light but does not stain with Sudan III. The structure: A. Contains cholesterol B. Is not an oval fat body C. Contains neutral fats D. Is contaminated with immersion oil 29. The finding of yeast cells in the urine is commonly associated with: A. Cystitis B. Diabetes mellitus C. Pyelonephritis D. Liver disorders 30. The primary component of urinary mucus is: A. Bence Jones protein B. Microalbumin C. Tamm-horsfall protein D. Orthostatic protein 31. The majority of casts are formed in the: A. Proximal convoluted tubules B. Ascending loop of Henle C. Distal convoluted tubules D. Collecting ducts 32. Cylindroiduria refers to the presence of: A. Cylindrical renal tubular cells B. Mucus resembling casts C. Hyaline and waxy casts D. All types of casts 33. A person submitting a urine specimen following a strenuous exercise routine can normally have all of the following in the sediment except: A. Hyaline casts B. Granular casts C. RBC casts D. WBC casts

34. Prior to identifying an RBC cast, all of the following

should be observed except: A. Free-floating RBCs B. Intact RBCs in the cast C. Presence of a cast matrix D. A positive reagent strip blood reaction 35. WBC casts are primarily associated with: A. Pyelonephritis B. Cystitis C. Glomerulonephritis D. Viral infections 36. The shape of the RTE cell associated with renal tubular epithelial casts is primarily: A. Elongated B. Cuboidal C. Round D. Columnar 37. When observing RTE casts, the cells are primarily: A. Embedded in a clear matrix B. Embedded in a granular matrix C. Attached to the surface of a matrix D. Stained by components of the urine filtrate 38. The presence of fatty casts is associated with: A. Nephrotic syndrome B. Crush injuries C. Diabetes mellitus D. All of the above 39. Nonpathogenic granular casts contain: A. Cellular lysosomes B. Degenerated cells C. Protein aggregates D. Gram-positive cocci 40. All of the following are true about waxy casts except they: A. Represent extreme urine stasis B. May have a brittle consistency C. Require staining to be visualized D. Contain degenerated granules 41. The observation of broad casts represents: A. Destruction of tubular walls B. Dehydraton and high fever C. Formation in the collecting ducts D. Both A and C 42. All of the following contribute to the formation of urinary crystals except: A. Protein concentration B. ph C. Solute concentration D. Temperature

43. The most valuable initial aid for the identification of crystals in a urine specimen is: A. ph B. Solubility C. Staining D. Polarized microscopy 44. Crystals associated with severe liver disease include all of the following except: A. Bilirubin B. Leucine C. Cystine D. Tyrosine 45. All of the following crystals routinely polarize except: A. Uric acid B. Cholesterol C. Radiographic dye D. Cystine 46. Differentiation between casts and fibers can usually be made using: A. Solubility characteristics B. Patient history C. Polarized light D. Fluorescent light 47. Match the following crystals seen in acidic urine with their description/identifying characteristics: ____Amorphous urates 1. Envelopes ____Uric acid 2. Thin needles ____Calcium oxalate 3. Yellow-brown, monhydrate whetstone ____Calcium oxalate 4. Pink sediment Dehydrate 5. Ovoid

48. Match the following crystals seen in alkaline urine with their description/identifying characteristics: ____Triple phosphate 1. Yellow granules ____Amorphous phosphate 2. Thin prisms ____Calcium phosphate 3. Coffin lids ____Ammonium biurate 4. Dumbbell shape ____Calcium carbonate 5. White precipitate 6. Thorny apple

Chapter 6 1. C 2. D 3. D 4. C 5. A

6. B 7. C 8. D 9. C 10. D 11. D 12. A 13. C 14. B 15. C 16. A 17. D 18. D 19. B 20. C 21. A 22. B 23. C 24. D 25. D 26. B 27. D 28. A 29. B 30. C 31. C 32. D 33. D 34. B 35. A 36. C 37. C 38. D 39. A 40. C 41. D 42. A 43. A 44. C 45. D 46. C 47. 4, 3, 5, 1 48. 3, 5, 2, 6, 4 49. 4, 8, 7, 6, 1, 5, 3 50. 3, 5, 2, 1, 7, 4

49. Match the following abnormal crystals with their description/identifying characteristics: ____Cystine 1. Bundles following refrigeration ____Tyrosine 2. Highly alkaline pH ____Cholesterol 3. Bright yellow clumps ____Leucine 4. Hexagonal plates ____Ampicillin 5. Flat plates, high specific gravity ____Radiographic 6. Concentric circles, radial dye striations ____Bilirubin 7. Notched corners 8. Fine needles seen in liver disease 50. Match the following types of microscopy with their descriptions: ____Bright-field 1. Indirect light is reflected off the object ____Phase 2. Objects split light into two beams ____Polarized 3. Low refractive index objects may be overlooked ____Dark-field 4. Three-dimensional images ____Fluorescent 5. Forms halo of light around object ____Interference 6. Detects electrons emitted contrast from objects 7. Detects specific wavelengths of light emitted from objects

1. Quality assessment refers to: A. Analysis of testing controls B. Increased productivity C. Precise control results D. Quality of specimens and patient care 2. During laboratory accreditation inspections, procedure manuals are examined for the presence of: A. Critical values B. Procedure references C. Procedures for specimen preservation D. All of the above 3. Urinalysis procedure manuals are reviewed: A. By the supervisor on each shift B. Weekly by the pathologist C. Only when a procedure is changed D. Annually by a designated authority 4. As supervisor of the urinalysis laboratory, you have just adopted a new procedure. You should: A. Put the package insert in the procedure manual B. Put a complete, referenced procedure in the manual C. Notify the microbiology department D. Put a cost analysis study in the procedure manual 5. Indicate whether each of the following would be considered a 1) preanalytical, 2) analytical, or 3) postanalytical factor by placing the appropriate number in the space: _____ Reagent expiration date _____ Rejection of a contaminated specimen _____ Construction of a Levy-Jennings chart _____ Telephoning a positive Clinitest result on a newborn _____ Calibrating the centrifuge _____ Collecting a timed urine specimen 6. Deionized water used for the preparation of reagents should be checked for: A. Calcium content B. Bacterial content C. Filter contamination D. pH, purity, and bacteria 7. Would a control sample that has accidentally become diluted produce a trend or a shift in the Levy-Jennings plot? A. Trend B. Shift

8. A color change that indicates when a patients specimen or reagent is added correctly would be an example of: A. External QC B. Equivalent QC C. Internal QC D. Proficiency testing 9. What steps are taken when the results of reagent strip QC are outside of the stated confidence limits? A. Check the expiration date of the reagent strip B. Run a new control C. Open a new reagent strips container D. All of the above 10. When a new bottle of qc material is opened, what information is placed on the label? A. The supervisors initials B. The lot number C. The date and the laboratory workers initials D. The time the bottle was opened 11. When a control is run, what information is documented? A. The lot number B. Expiration date of the control C. The test results D. All of the above 12. State which of the CLIA categories is assigned to each of the following laboratory tests by placing the appropriate number in front of the test. 1. Waived 2. PPM 3. Moderate complexity 4. High complexity ____A. Reagent strip urinalysis ____B. Urine culture ____C. Complete urinalysis using the Clinitek 500 ____D. Urine microscopic ____E. Urine pregnancy test 13. How often does CLIA 88 require documentation of technical competency? A. Every 6 months B. Once a year C. Twice the first year and then annually D. Twice the first year and then every 5 years 14. Who are the laboratorys customers in CQI? A. Physicians B. Patients family members C. Patients D. All of the above

15. What is the primary goal of TQM? A. Increased laboratory productivity B. Improved patient outcomes C. Reliability of test results D. Precise test results 16. Match the purpose for developing each of the following: 1. Flowcharts 2. Cause-and-effect diagrams 3. Pareto charts 4. Run charts ____A. Determine cyclic and seasonal differences compared to an average ____B. Break down a process into steps ____C. Identify the major contributors to a problem ____D. Determine the cause of a problem 17. True or False: Most medical errors are the fault of individuals, not the system.

Chapter 7 1. D 2. D 3. D 4. B 5. 2, 1, 2, 3, 2, 1 6. D 7. B 8. C 9. D 10. C 11. D 12. 1, 4, 3, 2, 1 13. C 14. D 15. B 16. 4, 1, 3, 2 17. False

1. The majority of glomerular disorders are caused by: A. Sudden drops in blood pressure B. Immunologic disorders C. Exposure to toxic substances D. Bacterial infections 2. Dysmorphic RBC casts would be a significant finding with all of the following except: A. Goodpasture syndrome B. Acute glomeruonephritis C. Chronic pyelonephritis D. Henoch-Schnlein purpura 3. Occassional episodes of macroscopic hematuria over periods of 20 or more years are seen with: A. Crescentic glomerulonephritis B. IgA nephropathy C. Nephrotic syndrome D. Wegeners granulomatosis 4. Antiglomerular basement membrane antibody is seen with: A. Wegeners granulomatosis B. IgA nephropathy C. Goodpasture syndrome D. Diabetic nephropathy 5. Antineutrophilic cytoplasmic antibody is diagnostic for: A. IgA nephropathy B. Wegeners granulomatosis C. Henoch-Schnlein purpura D. Goodpasture syndrome 6. Respiratory and renal symptoms are associated with all of the following except: A. IgA nephropathy B. Wegeners granulomatosis C. Henoch-Schnlein purpura D. Goodpasture syndrome 7. Broad and waxy casts are most frequently seen with: A. Membranoproliferative glomerulonephritis B. Membranous glomerulonephritis C. Chronic glomerulonephritis D. Rapidly progressive glomerulonephritis 8. The presence of fatty casts is associated with all of the following except: A. Nephrotic syndrome B. Focal segmental glomerulosclerosis C. Nephrogenic diabetes insipidus D. Minimal change disease 9. High levels of proteinuria are early symptoms of: A. Alport syndrome B. Diabetic nephropathy

C. IgA nephropathy D. Nephrotic syndrome 10. Ischemia frequently produces: A. Acute renal tubular necrosis B. Minimal change disorder C. Acute renal failure D. Both A and C 11. A disorder associated with polyuria and low specific gravity is: A. Renal glucosuria B. Cystitis C. Nephrogenic diabetes insipidus D. Focal segmental glomerulosclerosis 12. An inherited or accquired disorder producing a generalized defect in tubular reabsorption is: A. Alport syndrome B. Acute interstitial nephritis C. Fanconi syndrome D. Renal glucosuria 13. The presence of renal tubular epithelial cells and casts is an indication of: A. Acute interstitial nephritis B. Chronic glomerulonephritis C. Minimal change disease D. Acute tubular necrosis 14. Differentiation between cystitis and pyelonephritis is aided by the presence of: A. WBC casts B. RBC casts C. Bacteria D. Granular casts 15. The presence of WBCs and WBC casts with no bacteria seen is indicative of: A. Chronic pyelonephritis B. Acute tubular necrosis C. Acute interstitial nephritis D. Both B and C 16. End-stage renal disease is characterized by all of the following except: A. Hypersthenuria B. Isosthenuria C. Azotemia D. Electrolyte imbalance 17. Broad and waxy casts are most likely associated with: A. Nephrotic syndrome B. Chronic renal failure C. Focal segmental glomerulosclerosis D. Acute renal failure

18. Postrenal acute renal failure could be caused by: A. Ischemia B. Acute tubular necrosis C. Acute interstitial nephritis D. Malignant tumors 19. The most common composition of renal calculi is: A. Calcium oxalate B. Magnesium ammonium phosphate C. Cystine D. Uric acid 20. Urinalysis on a patient being evaluated for renal calculi would be most beneficial if it showed: A. Heavy proteinuria B. Calcium oxalate crystals C. Macroscopic hematuria D. Microscopic hematuria

Chapter 8 1. B 2. C 3. B 4. C 5. B 6. A 7. C 8. C 9. D 10. D 11. C 12. C 13. D 14. A 15. A 16. A 17. B 18. D 19. A 20. D

CHAPTER 9 All states require newborn screening for PKU for early: A. Modifications of diet B. Administration of antibiotics C. Detection of diabetes D. Initiation of gene therapy 2. All of the following disorders can be detected by newborn screening except: A. Tyrosyluria B. MSUD C. Melanuria D. Galactosemia 3. The best specimen for early newborn screening is a: A. Timed urine specimen B. Blood specimen C. First morining urine specimen D. Fecal specimen 4. Abnormal urine screening tests categorized as an overflow disorder include all of the following except: A. Alkaptonuria B. Galactosemia C. Melanuria D. Cystinuria 5. Which of the following disorders is not associated with the phenylalanine-tyrosine pathway? A. MSUD B. Alkaptonuria C. Albinism D. Tyrosinemia 6. Urine screening tests for PKU utilize: A. Microbial inhibition B. Nitroso-napthol C. Dinitrophenylhydrazine D. Ferric chloride 7. The least serious form of tyrosylemia is: A. Immature liver function B. Type 1 C. Type 2 D. Type 3 8. An overflow disorder of the phenylalanine-tyrosine pathway that could produce a false-positive reaction with the reagent strip test for ketones is: A. Alkaptonuria B. Melanuria C. MSUD D. Tyrosyluria

9. An overflow disorder that could produce a falsepositive reaction with clinitest is: A. Cystinuria B. Alkaptonuria C. Indicanuria D. Porphyrinuria 10. A urine that turns black after sitting by the sink for several hours could be indicative of: A. Alkaptonuria B. MSUD C. Melanuria D. Both A and C 11. Ketonuria in a newborn is an indication of: A. MSUD B. Isovaleric acidemia C. Methylmalonic acidemia D. All of the above 12. Urine from a newborn with MSUD will have a significant: A. Pale color B. Yellow precipitate C. Milky appearance D. Sweet odor 13. A substance that reacts with p-nitroaniline is: A. Isovaleric acid B. Propionic acid C. Methylmalonic acid D. Indican 14. Which of the following has a significant odor? A. Isovaleric acidemia B. Propionic acidemia C. Methylmalonic acidemia D. Indicanuria 15. Hartnup disease is a disorder associated with the metabolism of: A. Organic acids B. Tryptophan C. Cystine D. Phenylalanine 16. 5-HIAA is a degradation product of: A. Heme B. Indole C. Serotonin D. Melanin

17. Elevated urinary levels of 5-HIAA are associated with: A. Carcinoid tumors B. Hartnup disease C. Cystinuria D. Platelet disorders 18. False-positive levels of 5-HIAA can be caused by a diet high in: A. Meat B. Carbohydrates C. Starch D. Bananas 19. Place the appropriate letter in front of the following statements. A. Cystinuria B. Cystinosis ____IEM ____Inherited disorder of renal tubules ____Fanconi syndrome ____Cystine deposits in the cornea ____Early renal calculi formation 20. Urine from patients with cystine disorders will react with: A. Dinitrophenylhydrazine B. Sodium cyanide C. Ehrlich reagent D. 1-Nitroso-napthol 21. Blue diaper syndrome is associated with: A. Lesch-Nyhan syndrome B. Phenylketonuria C. Cystinuria D. Hartnup disease 22. Homocystinuria is caused by failure to metabolize: A. Lysine B. Methionine C. Arginine D. Cystine 23. Early detection is most valuable for correction of: A. Homocystinuria B. Cystinuria C. Indicanuria D. Porphyrinuria 24. The Ehrlich reaction will only detect the presence of: A. Aminolevulinic acid B. Porphobilinogen C. Coproporphyrin D. Protoporphyrin

25. Acetylacetone is added to the urine prior to performing the Ehrlich test when checking for: A. Aminolevulinic acid B. Porphobilinogen C. Uroporphyrin D. Coproporphyrin 26. The classic urine color associated with porphyria is: A. Dark yellow B. Indigo blue C. Pink D. Port wine 27. Which of the following specimens can be used for porphyrin testing? A. Urine B. Blood C. Feces D. All of the above 28. The two stages of heme formation affected by lead poisoning are: A. Porphobilinogen and uroporphyrin B. Aminolevulinic acid and porphobilinogen C. Coproporphyrin and protoporphyrin D. Aminolevulinic acid and protoporphyrin 29. Hurler, Hunter, and Sanfilippo syndromes are hereditary disorders affecting metabolism of: A. Porphyrins B. Purines C. Mucopolysaccharides D. Tryptophan 30. Many uric acid crystals in a pediatric urine specimen may indicate: A. Hurler syndrome B. Lesch-Nyhan disease C. Melituria D. Sanfilippo syndrome 31. Deficiency of the GALT enzyme will produce a: A. Positive Clinitest B. Glycosuria C. Galactosemia D. Both A and C 32. Match the metabolic urine disorders with their classic urine abonormalities. ____PKU A. Sulfur odor ____Indicanuria B. Sweaty feet odor ____Cystinuria C. Orange sand in diaper ____Homogentisic acid D. Mousy odor ____Lesch-Nyhan disease E. Black color F. Blue color

Chapter 9 1. A 2. C 3. B 4. D 5. A 6. D 7. A 8. B 9. B 10. D 11. D 12. D 13. C 14. A 15. B 16. C 17. A 18. D 19. B, A, B, B, A 20. B 21. D 22. B 23. A 24. B 25. A 26. D 27. D 28. D 29. C 30. B 31. D 32. D, F, A, E, C