ANALYSIS OF URINE AND OTHER BODY FLUIDS

QUIZ 2
1. A 24-hour urine from a man who had no
evidence of kidney impairment was sent
to the laboratory for hormone
determination. The volume was 600 mL,
but there was some question as to the
completeness of the 24-hour collection.
The next step would be to:
a. Perform the hormone determination,
since 600 mL is a normal 24-hour urine
volume
b. Check the creatinine level; if it is <1g, do
the procedure
c. Report the hormone determination in
mg/dL in case the specimen was
incomplete
d. Check the creatinine level; if it is >1g, do
the procedure

2. A urine specimen collected on an
apparently healthy 25-year-old man
shortly after he finished eating lunch was
cloudy but showed normal results on a
multiple reagent strip analysis. The most
likely cause of the turbidity is:
a. Fat
b. White blood cells
c. Urates
d. Phosphates
3. Which of the following urinary
parameters are measured during the
course of concentration and dilution tests
to assess renal tubular function?
a. Urea, nitrogen and creatinine
b. Osmolality and specific gravity
c. Sodium and chloride

Answer: D
The reader should know the
approximate volume of a daily
void, which is approximately
1,500 mL, but can range from
600-2,000 mL. In order to
determine if 600 is the actual
volume, or some sample was
missed, evaluate the creatinine.
Creatinine is excreted at
approximately 1.2 mg/24 hour. D
is the correct answer because in
A, it could be correct but it’s not
sufficient, since 600 mL is
unusually low. B is incorrect
because the creatinine is too low
and C is incorrect because it does
not answer the question and it
bills the patient.
Answer: D
The correct answer is D since the
patient is healthy, assume the
turbidity is caused by something
nonpathologic. After meals, urine
is more alkaline; this is referred to
as the alkaline tide. Amorphous
phosphates may be found due to
its alkaline pH.
Answer: B
The correct answer is B since the
specific gravity and osmolarity
are both measures of the
concentration of urine.

Alkaline copper sulphate 5. A patient’s urinalysis revealed a positive bilirubin and a decreased urobilinogen level. Glucose oxidase d. From there. and less in converted into urobilinogen. These results are associated with: a. Antibiotics Answer: B The protein pad of the biochemical strip is held at an acid pH by citrate buffer. Vitamin C b. the acid buffer can “run over” to the pH pad and cause a falsely acidic pH. Copper sulphate is the reagent of the reducing substances (Benedict) test. Citrate buffer c. Sodium and osmolality 4. less bilirubin reaches the intestine. Answer: B Biliary obstruction inhibits the normal flow of conjugated bilirubin into the intestine. Glucose oxidase is the reagent on the glucose strip. . Some urobilinogen is reabsorbed into the bloodstream and will be filtered into the urine. If the strip is not blotted. Hemolytic disease b. The technologist should determine if this patient has taken: a. In cases of biliary obstruction. Biliary obstruction c. High blood pressure medicine d. Urinary tract infection 6. Urobilinogen is a product of bacterial reduction of bilirubin in the intestine. Microscopic analysis of a urine specimen yields a moderate amount of red blood cells in spite of a negative result for occult blood using a reagent strip. A diuretic c. Hepatic disease d. Excess urine on the reagent strip can turn a normal pH result into a falsely acidic pH when which of the following reagents runs into the pH pad? a.d. not an acid. Tetrabromphenol blue is a pH indicator. it will be filtered into the urine. and it backs up into the blood. Tetrabromphenol blue b. Answer: A A is the correct answer because the ascorbic acid inhibits the reactions that use peroxidase.

Neutral pH Answer: B Osmosis occurs through the red blood cell membrane. The reaction is sensitive to any level of albumin Answer: C The reagent strip for microalbuminuria uses a dye binding technique. Specific gravity <1. along with the reaction of microalbuminuria. and release haemoglobin. lyse. the cells absorb water and swell. A reagent strip test for blood has been reported positive. These red blood cells seen in urine with a: a. A patient admitted following an accident involving massive crush injuries Answer: D . The principle of the reagent strip test for microalbuminuria is: a. Large amounts of ketone bodies d.7. Creatinine corrects for over or under body hydration b. >2% glucose concentrations b. The protein error of indicators c. Hematuria b. In dilute urine. The release of hydrogen ions to an indicator 8.007 c. and myoglobin. A first morning specimen may be too concentrated c. Albumin corrects for over or under body hydration d. Hemoglobinuria c. Oliguria d. A microscopic examination of urine sediment reveals ghost cells. 11. This patient’s condition can be called: a. As opposed to the conventional protein error of indicators principle used in routine reagent strips. The reason that an albumin : creatinine ratio can be run on a random specimen is: a. Microscopic examination fails to yield red blood cells. A diazo reaction b. 10. 9. Answer: A Including a reagent strip reaction for creatinine. A dye-binding reaction d. Hemoglobinuria means that there is no red blood cells present indicating the presence of filtered haemoglobin. the dye is highly sensitive and specific for albumin. the amount of creatinine that is excreted at a constant rate can correct for the hydration or dehydration in a patient’s urine. Hemosiderinuria Answer: B The reagent strip test for blood is positive for haemoglobin from lysed red blood cells. filtered hemoglobin from intravascular hemolysis.

0 Protein: 1+ Blood: Large Glucose: negative Ketones: negative Nitrite: negative Leukocytes: negative Bilirubin: negative Urobilinogen: negative Myoglobin is a product of muscle destruction as occurs with crush injuries. resulting in decreased urine flow. The reagent strip reaction for blood is positive with the presence of RBCs. Maltose b. The sugar most likely responsible for these results is: a. but gives a positive reaction with the copper reduction method. Contaminating oxidizing detergents in the container d. Lactose Answer: D B is incorrect because the 2 keys here are that the dipstick glucose is negative and that the woman is pregnant. The presence of myoglobin in the urine specimen 12. and about to deliver. Failure to mix the specimen before centrifuging b.011 pH: 6. Galactose c.has the following urinalysis results: Color: Red Brown Clarity: Clear Specific Gravity: 1. hemoglobin and myoglobin. Both hemoglobin and myoglobin are toxic to the renal tubules. The woman is may be making milk and lactose is the most likely answer. Microscopic findings RTE: 5-10 RT cell casts: 1-2 The discrepancy between the large amount of blood and the absence of RBCs on microscopy is caused by: a. Mistaking RBCs for RTE cells c. Glucose d. A woman in her ninth month of pregnancy has a urine sugar which is negative with the urine reagent strip. 13. favouring cast formation and the sloughing of the damaged cells. A urinalysis is performed on a 2-weekold infant with diarrhea shows a negative Answer: B Children with failure to thrive may .

Casts dissolved due to decrease in urine pH c. A copper reduction tablet test should be performed to check the urine sample for the presence of: a. In this case. A second technologist reported the same results. 14. Since the reagent strip for glucose shows negative reaction. The most probable explanation for the second technologist’s findings is: a.reaction with the glucose oxidase reagent strip. resulting in the casts dissolving. Casts were never present in this specimen 15. Glucose b. Which of the following aids in differentiating a spherical transitional cell from a round renal tubular cell? a. The centrifuge tube was not discarded and the urine sediment was reevaluated microscopically 5 hours after the above results were reported. this signifies that there is multiplication of the bacteria in the specimen that caused an increase in the urine pH during the 5-hour delay. Galactose c. this leaves galactose. Casts dissolved due to increase in urine pH d. only glucose and galactose are reducing substances. A technologist performed a STAT microscopic urinalysis and reported the following: WBC: 10-13 RBC: 2-6 Hyaline casts: 5-7 Bacteria: 1+ Answer: C The result shows 10-13 WBC are present. except 2+ bacteria and no hyaline casts were found. Spherical transitional cell is larger b. Eccentrically-placed nucleus in the Answer: B B is correct since the centrallyplaced nuclei are the characteristic of spherical transitional cells. Bilirubin d. Sediment was not agitated before preparing the microscope slide b. . Eccentrically-placed nucleus in the renal tubular cell c. Ketones have galactosuria.

18. Minimal change disease .66 mmol/L) Serum urea nitrogen: 20 mg/dL (7. A 4-year-old girl develops edema following a recent immunization. making these cells the most prominent in cast formation. Acute poststreptococcal glomerulonephritis b.8 g/dL (18 g/L) Serum cholesterol: 450 mg/dL (11. Cystitis is an infection of the bladder. Epithelial cell casts are most indicative of: a. granular & fatty casts Answer: B Minimal change disease is seen primarily in children. often following allergic reactions or immunizations. Nephrotic syndrome c. decreased serum albumin. and WBCs. Round renal tubular cell is larger 16. Glomerulonephritis b. WBC casts would indicate the location of the source of inflammation or infection. A. and D is incorrect since each has its own cast feature in each of the listed disorders such as RBC. Therefore. RBCs d.spherical transitional cell d. elevated serum lipids. Pyelonephritis Answer: C C is correct because tubular necrosis means that there is damage to the renal tubules that causes sloughing of the cells lining the tubules. WBCs b. and normal BUN. Tubular necrosis d.14 mmol/L) Urinalysis: Protein 4+. B. fat. The urine microscopic constituents that best differentiate between cystitis and pyelonephritis are: a. The laboratory results include markedly elevated urine protein. Laboratory studies reveal: Serum albumin: 1. WBC casts Answer: D Pyelonephritis is an inflammation/infection of the renal tubules. fatty casts. hyaline. These findings are most compatible with: a. Bacteria c. 17.

There were 5. Pleural effusion transudate d. The large WBCs contribute more to turbidity than the smaller bacteria. Glucose d. with 75% PMNs. and will form a string of 4-6 cm when expressed from the syringe. Therefore A is the only correct choice.000 WBC/µL. A serum sample was collected immediately afterward. analysis of seminal fluid should also include: a. morphology b. Sperm should be motile. morphology. Motility. In addition to the sperm count in a fertility study. Time of liquefaction. When the serum LD ratio is over 6. 20. This is . Time of liquefaction. Pleural effusion exudate b. Which of the following describes this fluid? a. estimation of motility. White blood cells b. Protein c. If the fluid forms small drops. 21. The LD fluid to serum ratio was 0. Time of liquefaction. qualitative test for hemoglobin and motility Answer: A It is not necessary to test alkaline phosphatase. Bacteria and WBCs are solids that make the CSF turbid. An increase in this fluid is called pleural effusion. surrounding the lungs is called pleural fluid. A turbid cerebrospinal fluid is most commonly caused by increased: a. Pericardial effusion transudate Answer: A The thorax is the chest.000/microliter. Fluid from the chest.c. Associated with inflammation d. acid phosphatase or hemoglobin for fertility. the viscosity is decreased. Pericardial effusion exudate c. the fluid is an exudate. test for acid phosphatise. have normal morphology and have normal viscosity. A fluid sample was collected by thoracentesis. The synovial fluid easily forms small drops from the aspirating syringe. This viscosity is: a. Diabetes mellitus 19. Increased c.9. Associated with hypothyroidism Answer: C A normal synovial fluid is viscous.0 or the WBC is over 1. qualitative test for hemoglobin d. Bacterial organisms Answer: A B and C are incorrect since these two are dissolved substances that do not contribute to turbidity. 22. Acute pyelonephritis d. Normal b. test for alkaline phosphatise c.

Hydrocephalus c. LD values of >200 IU d. MSU are yellow c. Exudates are inflammatory or infectious effusions with high LD. . has the opposite color results. and WBC. protein. MSU are blue b. Multiple sclerosis Answer: D Transudates are thin. Spina bifida b. which is true? a. The presence of oligoclonal bands in the CSD but not in the serum is associated with: a. but do not cause an increased gamma protein. watery effusions with low LD. Answer: D The synthesis of IgG in the central nervous system is associated with some multiple sclerosis. This difference is due to the molecular stacking within the crystals. hence inflammation is the correct answer. 23.associated with arthritis. Corticosteroids are yellow 25. Reye syndrome d. Protein values of >4 g/dL b. This other conditions are also CNS disorders. CPPD are blue d.020 c. Monosodium urate (MSU) and calcium pyrophosphate dehydrate (CPPD) crystals can be distinguished by using a red compensator in a polarizing microscope. When the crystal is aligned with the slow vibration of the compensator. Specific gravity values of >1. but the color Is blue when the crystal is perpendicular to the compensator. Relatively low cell counts 24. Pleural transudates differ from pleural exudates in that transudates have: a. CPPD. low protein. and low cell counts. Answer: B MSU produces a yellow color when the crystal is aligned with the compensator.