BOC Urinalysis - Body fluids - Lab management Questions and Answers

BOC Urinalysis - Body fluids - Lab management Questions and Answers Urine RR: Color - Yellow (light/pale to dark/deep amber) Clarity/turbidity - Clear or cloudy pH - 4.5-8 Specific gravity - 1.005-1.025 Glucose - ≤130 mg/d CSF glucose - 2/3 of glucose Ketones - None Nitrites - Negative Leukocyte esterase - Negative Bilirubin - Negative Urobilirubin - Small amount (0.5-1 mg/dL) Blood - ≤3 RBCs Protein - ≤150 mg/d RBCs - ≤2 RBCs/hpf WBCs - ≤2-5 WBCs/hpf Squamous epithelial cells - ≤15-20 squamous epithelial cells/hpf Casts - 0-5 hyaline casts/lpf Crystals - Occasionally Bacteria - None Yeast - None A 1:10 dilution is made on a CSF sample. Five squares on each side of the hemacytometer are counted for a total of 10 squares and a total of 150 cells are recorded. What is the count per microliter? 1500 #cells counted x dilution / #large squares x 0.1 The oxidation of hemoglobin to methemoglobin in acidic urine after several hours may cause which of the following color to produce? Red to brown porphobilinogen, hematuria, myoglobinuria, etc. White: phosphates, other crystals Yellow: bilirubin, bile pigments Blue-green: Bacterial infections including urinary tract infection (UTI) by Pseudomonas Which acid is most frequently used to precipitate protein for confirmatory urinalysis tests? Sulfosalicylic (SSA) -measure protein concentration with turbidity -detect albumin and globulins and Bence-Jones proteins -acidification of proteins which causes turbidity What effect may bacterial contamination have on urine pH? The bacteria may make the pH more alkaline. -pH 8: held non-preserved too long -allows the multiplication of urea-splitting bacteria A typical Bronchoalveolar lavage differential contains all the cells EXCEPT: Mesothelial cells -lining cells for serous fluids -typical include ciliated lining cells, macrophages, and lymphocytes Which one of the following proteins in cerebrospinal fluid (CSF) is used to monitor the integrity of the blood-brain barrier? Albumin ordinarily it is not found to any great extent in the central nervous system What is generally accepted as the lower threshold value for semen pH from fertile males? 7.2 7.2-8 According to the lower normal reference limit stated by WHO, which of the following sperm concentrations would be considered abnormally low? 5 x 106 spermatozoa/mL RR: 15 - 200 million Which of the following areas of the brain and spinal cord is responsible for producing CSF? Choroid plexuses CSF flows through the subarachnoid space dura mater is part of the meninges CSF is reabsorbed back in the blood capillaries in the arachnoid granulations A patient presents to his family doctor with respiratory issues. He has a history of being a heavy smoker for more than 20 years, so the physician orders a BAL cell count with differential. Which of the following cells would most closely correlate with the patient's medical history? Macrophages with purple/black inclusions heavy smoker for more than 20 years cells contain hemosiderin aka siderophages Macrophages with phagocytized red blood cells - removal in spleen Macrophages with phagocytized bacteria - bacterial infection A patient with suspected intraabdominal malignancy had a paracentesis procedure performed. The fluid was then sent to the laboratory for examination and fluid differential. perinuclear hof seen Plasma cells plasma cell malignancy in the abdominal cavity or stressful conditions A spectrophotometric scan of amniotic fluid may be valuable in the determination of which of the following conditions: HDN Amniotic fluid bilirubin is elevated 450nm Which of the following conditions is most likely when an oligoclonal band is seen in CSF electrophoresis without a corresponding serum peak? Multiple sclerosis gamma region of CSF electrophoresis (+) IgG also: inflammatory conditions, Guillain-Barre syndrome, bacterial meningitis, viral encephalitis, neurosyphilis, and subacute sclerosing panencephalitis Monocytes, Macrophages, Mesothelial cells, or Lymphocytes? Monocytes: large, convoluted nuclei and large cytoplasms, not really in CSF, sometimes in meningitis Macrophages: not seen in CSF, in meningitis, large w/ abundant cytoplasm Mesothelial cells: not in CSF, sometimes hard to differentiate w/ macrophages Lymphocytes: condensed chromatin and scant blue cytoplasm, increased with viral infections or meningitis A dilution commonly used for a routine sperm count is: 1:20 Which of the following answer choices correctly state the use of urine reagent strips for chemical analysis? Use of a well-mixed, uncentrifuged urine sample at room temperature is the technique for urine reagent strips. cells settle to bottom if not mixed well read 60-120 sec reagents leached from pad when sat for long time Which of the following would be the most characteristic finding in synovial fluid in a case of pseudogout? Calcium pyrophosphate crystals endocrine disorder, high levels of calcium, also degenerative arthritis producing cartilage calcification Monosodium urate crystals: gout WBC seen in viral or bacterial infections macrophages in viral infections, but usually normal The lecithin to sphingomyelin ratio (L/S) is used to assess: Fetal lung maturity above 2:1 indicates mature lung development All of the following crystals are found in normal urine, EXCEPT? Leucine maple syrup urine disease Calcium oxalates are normal w/ varying pH Ammonium biurate and triple phosphate in normal alkaline White blood cell casts are MOST likely to indicate disease of the: Kidney pyelonephritis also could be in glomerulonephritis, interstitial nephritis, and lupus nephritis A clean-catch midstream urine specimen from a 57-year-old woman was sent to the microbiology laboratory for culture. The patient had a history of fever, chills, and flank pain upon examiation. The urine grew out 10,000 cfu/mL of Escherichia coli. Which of the following categories would the patient be classified? Acute, uncomplicated pyelonephritis 10 WBC common UTI Acute, uncomplicated UTI in women: dysuria, urgency, frequency, suprapubic pain, no urinary symptoms prior, 1,000 cfu/mL, 10 WBC A urine specimen, from a premature infant, was sent for culture to the microbiology laboratory and it grew out 30,000 cfu/mL of a coagulase negative staphylococcus. The physician felt that the growth was skin contamination as the urine was collected in a U-Bag that was attached around the infant's genitalia area. The physician sent a second specimen for culture and it was reported as no growth after 48 hours. Which of the following specimens is the most probable specimen type for the second specimen that was sent to the microbiology laboratory for culture? Suprapubic Bladder Aspiration Urine pediatric pts contamination free Straight Catheterized: more invasive, uncontaminated, physiologic conditions Clean-Catch Midstream: least invasive, clean area Indwelling Catheter: long term, hospitalized, oncology, catheter port, bacteriuria Which of the following statements is TRUE for specific gravity measured by the urine chemical reagent strip method? The urine chemical reagent strip method is not affected by the presence of x-ray contrast media in the urine specimen. based on the relationship between ionic concentration and specific gravity specific gravity increases as ionic concentration increases if no solutes SG would be 1.000 (1.000-1.035) high concentration of protein increases the specific gravity readings on the reagent strip alkaline pH (6.5 or higher) would affect the specific gravity result by decreasing the reading refractometer method: light is refracted in proportion to the amount of total solids dissolved in the urine The glucose result on a urine specimen from an infant is negative on the urine chemical reagent strip, what is the next step? It must be followed by the copper reduction test (Clinitest®) to check for other reducing substances. used to check for other reducing substances reagent tablet based on Benedict's copper reduction reaction screening for inborn metabolic problems; galactosemia Acetest®: confirmatory test for ketones Which one of the following statements concerning Tamm-Horsfall protein is FALSE? It is the protein that is predominantly detected by a urine reagent strip test. albumin (highest conc in body) not tamm-horsfall protein in the urine (proteinuria): renal disease glomerular membrane prevents the passage of high molecular weight proteins "protein error of indicators" produced by the tubules acts as a coating and lubricant in the tubules Hyaline casts are formed by this in distal tubule Which protein is represented by the band labeled by the number 4 on the SPE scan? (cathode to anode; 1 to 4) Albumin closest to the anode (+) migrates the fastest cathode to anode: slowest to fastest gamma, beta, alpha 2, alpha 1, albumin Red blood cells (RBCs), White blood cells (WBCs), Yeast cells, or Squamous epithelial cells in urine sediment (using phase-contrast microscopy)? Red blood cells (RBCs): slightly smaller than WBCs, smooth White blood cells (WBCs): rough appearance, contain granules, multilobed nuclei Yeast cells: oval, budding yeast, severe infections Squamous epithelial cells: large, sometimes clumps, irregular-shaped cytoplasm, prominent centrally located nucleus Which of the following descriptions best describes the term absolute value as it would relate to leukocyte differential counts. Relative % of each cell type multiplied by total white count A 41-year-old man is admitted to the hospital complaining of a decreased frequency of urination, a constant bloated feeling, weight gain, and mild edema of the ankles and eyes. Urinalysis results are as follows: Color: pale yellow Clarity: clear pH: 5.0 SG 1.010 Glucose: 2+ Ketones: negative Protein- 3+ Blood: moderate Bilirubin: negative Bacteria: negative Urobilinogen: normal Nitrate: negative **A large amount of white foam was noted. Microscopic Results: RBCs 0-2 WBCs 0-2 Casts: 2-5 hyaline, 0 - 3 fatty casts, 0 - 2 waxy casts Few transitional epithelial cells Few oval fat bodies Nephrotic syndrome damage to the kidneys; basement membrane of the glomerulus abnormal excretion of protein and red blood cells fats present foamy appearance of urine Oval fat bodies Fatty and waxy casts Renal tubular epithelial cells heavy protein Swelling Weight gain from fluid retention Poor appetite High blood pressure decreasing amount of blood in the sequentially collected tubes; tube #1 contains visible red blood cells, but the amount of blood decreases in the other tubes Traumatic tap Normal CSF is clear and colorless subarachnoid hemorrhage, all three tubes would contain blood and consistent Bacterial meningitis would not show decreasing amounts of red blood cel