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Detection of a fruity odor in a fresh urine sample may be indicative of which of the
following:

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Starvation
Yeast infection
Bacterial infection
Diabetes mellitus

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Conditions such as starvation and diabetes mellitus can lead to an increase of ketones
in the urine, giving the urine a "fruity", sweet type of odor.

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Charcot-Leyden crystals in stool may be associated with an immune response and are
thought to be the breakdown products of:

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neutrophils
eosinophils
monocytes
lymphocytes
basophils

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Charcot-Leyden crystals in stool are thought to be created from damaged eosinophil


byproducts. These crystals have a strong association, although they are rare, with
parasitic infections or allergic reactions.

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An increased number of these cells, when found upon microscopic examination of
urine is termed:

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Glycosuria
Hematuria
Uremia
Normal urine

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Hematuria indicates the presence of red blood cells in the urine.

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A patient who has a primarily vegetarian diet will most likely have an acid urine pH.

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True
False

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This statement is false. A patient who has a primarily vegetarian diet will most likely
have an alkaline urine pH. A low-carbohydrate diet as well as the ingestion of citrus
fruits can also lead to a more alkaline urine sample.
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The crystals that are seen in this image are triple phosphate crystals.

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True
False

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These are cholesterol crystals.

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Which of the following conditions produce glycosuria? (Choose ALL correct


answers)

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Diabetes mellitus
Multiple myeloma
Impaired tubular reabsorption/advanced kidney failure
Preeclampsia

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Diabetes mellitus and impaired tubular reabsorption/advanced kidney failure can


cause glycosuria. Glycosuris is defined as the presence of glucose in the urine. It most
commonly results from diabetes mellitus and impaired tubular reabsorption, but may
also occur in pregnancy and in patients taking adrenocorticosteroids.

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A cystine crystal is seen in this image.

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True
False

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This is true; a cystine crystal is depicted in this image. Cystine crystals are present in
acidic urine, are typically colorless, and have a characteristic hexagonal shape (also
described as appearing similar to a benzene ring). These crystals are associated with
cystinuria.

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Parasites which can be found in urinary sediment include all of the following
EXCEPT:

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Enterobius vermicularis
Trichomonas vaginalis
Plasmodium malariae
Schistosoma haematobium

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Plasmodium malariae is the only parasite that is listed that could NOT potentially be
seen in urine sediment. Plasmodium is a blood parasite.
Both Enterobius vermicularis and Trichomonas vaginalis could potentially arrive in
the urine as contaminants from other sources; Enterobius from fecal contamination
and Trichomonas from vaginal secretions. Of the parasites that are listed, only
Schistosoma haematobium is a true urinary tract parasite.

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Many white blood cells (WBCs) are present in this image of urine sediment that is
observed using brightfield microscopy.

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True
False

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This slide shows many red blood cells (RBCs.)

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A urine production of less than 400 mL/day is:

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Consistent with normal renal function and water balance


Termed isosthenuria
Defined as oliguria
Associated with diabetes mellitus
caused by moderate dehydration

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Oliguria is defined as the production of a decreased amount of urine. This can be


defined as a daily urine production of less than 400 mL.
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Which of the following cast(s) might be found in the urine of a healthy individual
after strenuous exercise:

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Epithelial cell casts


Hyaline casts
Granular casts
Waxy casts

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Hyaline and/or granular casts may be seen in healthy individuals for a short time
period after strenuous exercise.

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What type of white blood cell is seen MOST frequently in urine sediment with
infections of the urinary system?

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Eosinophil
Lymphocyte
Monocyte
Neutrophil
Plasma cell

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Neutrophils are typically increased in urinary bacterial infections.

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Match the following urine chemical reagent strip test pads to the disease or disorder
that would most likely cause a positive test result.

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Diabetes mellitus Ketones
Renal calculi Blood
Hepatitis/cirrhosis Bilirubin
Urinary tract infection Nitrites

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Ketones- Diabetes mellitus

Blood- Renal calculi

Bilirubin- Hepatitis/cirrhosis

Nitrites- Urinary tract infection

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Urine should be at room temperature prior to testing with the reagent strip method.

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True
False

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This statement is true. Urine should be at room temperature prior to testing with the
reagent strip method. Urine strip reactivity can increase with increased urine
temperature, so the optimum temperature is 22-26o C, or room temperature.

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Which of the following tests included on a urine chemical reagent strip would never
be reported out as negative?

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Urobilinogen
Bilirubin
Leukocyte esterase
Blood
Nitrite

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Urobilinogen is reported as normal, not negative. A normal urobilinogen result is
approximately:

0.2-1.0 Ehr U/dL

Question
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Identify the urine sediment elements present in this illustration:

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WBC casts
Coarse granular casts
Waxy casts
Fine granular casts

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Fine granular cases may represent degenerated cellular casts. They usually indicate
renal parenchymal disease, or allograft rejection.

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When the glucose result on a urine specimen from an infant is negative on the urine
chemical reagent strip, it can be assumed that the specimen is negative for other
reducing substances such as galactose.

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True
False

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The method used on the urine chemical reagent strip is specific for glucose. An
additional test, such as Clinitest®, should be used to check for other reducing
substances.

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What effect may bacterial contamination have on urine pH?

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The bacteria may make the pH more alkaline.


The bacteria may make the pH more acidic.
The bacteria would not affect urine pH.

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A urine pH above 8.0 may indicate that a specimen has been held non-preserved too
long, which allows multiplication of urea-splitting bacteria with resultant increase in
pH.

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Abnormal crystals that can be found in urine include: (Choose all that apply.)

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Leucine
Tyrosine
Cystine
Triple phosphate

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If the crystals are from solutes that are not normally in the urine, they are considered
"abnormal." Abnormal crystals may indicate an abnormal metabolic process. Some of
these include: Cystine, tyrosine, and leucine.

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Which of the following cells when found upon microscopic examination of the urine
would be most indicative of kidney disease:
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WBCs and bacteria


Tubular epithelial cells
Squamous epithelial cells
RBCs

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Squamous epithelial cells are usually vaginal contaminants.

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A voided urine specimen is delivered from the women's clinic to the laboratory six
hours after collection. The following results are reported:

Color: yellow Protein: negative Bilirubin: negative


Clarity: cloudy Glucose: negative Urobilinogen: 0.2 mg/dL
Sp. Gravity: 1.020 Ketone: negative Nitrite: positive
pH: 9.0 Blood: negative Leukocyte esterase: negative

What might these results indicate?

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The patient has a urinary tract infection.


The urine may have remained too long at room temperature and bacterial
contaminants have affected the nitrite and pH results.
The specimen had a preservative added.
The leukocyte esterase result is wrong.

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These results indicate that the urine may have remained too long at room temperature
and bacterial contaminants have affected the nitrite and pH results. Urine samples
should be analyzed within a few hours, or stored in the refrigerator.

Question Difficulty: Level 4


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Identify the urine sediment elements shown by the arrow:

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Yeast
WBCs
Fat
Starch crystals

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Starch crystals often contaminate normal urine. They appear round to oval, are highly
refractile, with an irregular indentation in the center. They may exhibit the "Maltese
cross" appearance under polarized light.

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If CSF tubes numbered #1, #2 and #3 CANNOT be analyzed within one hour, the
correct procedure for the microbiology sample tube is to:

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discard it
freeze it
leave it at room temperature
incubate in a 56 degree water bath
refrigerate it

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You must leave the tube at room temperature since refrigerating, freezing, or
incubating the specimen at 56 degrees will destroy Neisseria meningitides (if
present). The sample should not be thrown away.

Question Difficulty: Level 6


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What term is used to describe the color in these tubes of cerebrospinal fluid (CSF)?

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Jaundice
Xanthochromia
Icterus

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The term that is used to describe the color in these tubes of CSF is "xanthochromia."
Xanthochromia is an abnormal color, usually yellow, orange, or pink, in the
supernatant of the CSF sample. It may indicate that a subarachnoid hemorrhage
(SAH) has occurred.
Jaundice and icterus both describe a yellowing of the skin, mucous membranes, and
eyes. Blood plasma/serum that is deep yellow is also described as icteric.

Question Difficulty: Level 8


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The nitrite portion of the test strip can be used to: (Choose ALL correct answers)

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Monitor antibiotic therapy


Detect a bladder infection in an early stage in pregnant women
Screen individuals with recurrent infections
Detect presence of cystitis

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The nitrite portion of the test strip can be used to monitor antibiotic therapy, detect a
bladder infection in an early stage in pregnant women, screen individuals with
recurrent infections, and detect presence of cystitis.
The test reaction on the urine chemical reagent strip pad for nitrite works by detecting
when nitrite in the urine reacts with para-arsanilic acid to form a diazonium
compound. This diazonium compound in turn couples with 1,2,3,4-
tetrahydrobenzo(h)quinoline-3-ol to produce a pink color.

Question Difficulty: Level 9

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The reagent strip method for protein primarily tests for which type of protein?

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Globulin
Bence-Jones protein
Albumin
Mucoprotein

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The urine reagent strip method for protein primarily indicates increased albumin,
although other proteins may also produce a positive result if greatly elevated.
Question Difficulty: Level 4

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All of the statements below about synovial fluid are true EXCEPT:

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arthrocentesis is performed as a means to evaluate arthritis and other joint


disorders
synovial fluid is present only in movable joints
joint fluid resembles plasma in viscosity
joint fluid has approximately the same glucose as plasma

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Synovial fluid is actually quite viscous and does not have the same consistency as
plasma. The reason for its thicker consistency is to provide cushion and reduce
friction between the articular cartilage of synovial joints during movement.

Question Difficulty: Level 6

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How should the production of a blue or purple color on the test pad of an Ictotest® be
interpreted?

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Positive for bilirubin


Positive for ketones
Negative for bilirubin
Negative for ketones

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The production of a blue or purple color on the test pad of an Ictotest® be interpreted
as positive for bilirubin.

Question Difficulty: Level 4


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What is the glomerular filtration rate for a patient with a serum creatinine of 2 mg/dL,
if the urine creatinine was 124 mg/dL and the urine volume was 2.2 L/24 hrs?

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9.5 mL/min
13.6 mL/min
95 mL/min
136 mL/min
1.36 mL/min

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One method of calculating a glomerular filtration rate is using creatinine and urine
volume to determine creatinine clearance. The equation is as follows:

Creatinine Clearance = (urine creatinine X urine flow rate) / plasma creatinine; where
urine flow rate = volume in mL /24 hours x h/60 min)

In this case = creatinine clearance = 124 X (2200/24 x hour/60) / 2 = 94.7 or 95


ml/min

Question Difficulty: Level 7

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What types of cells are present in this field of a cytocentrifuged CSF sample?

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red cells
lymphocytes
neutrophils
blasts

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There are no blasts seen in this image. The lymphocytes seen here are mature, though
from cytocentrifugation they can appear to have prominent nucleoli similar to blasts.
The chromatin pattern of the nucleus in the lymphs shown is mature and clumped.

Question Difficulty: Level 5

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The microscopic finding illustrated in this image is a hyaline cast.

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True
False

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This is a fiber artifact.

Question Difficulty: Level 3

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True or false? Hyaline casts are present in this slide.


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True
False

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This is true. There are approximately 5 hyaline casts in this image.

Question Difficulty: Level 3

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Excessive carbohydrate loss that may occur due to vomiting, or rapid weight loss may
result in the presence of which of following substances not normally contained in the
urine?

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glucose
bilirubin
ketones
urobilinogen

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Normal urine specimens usually yield negative results for the presence of ketones.
Ketone bodies such as acetoacetic acid, beta-hydroxybutyric acid, and acetone can
cause positive test results on the urine reagent strip pad for ketones. These
intermediate byproducts are associated with the breakdown of fat. Causes: diabetes
mellitus, starvation, vomiting, diarrhea, etc.

Question Difficulty: Level 4

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Sulfosalicylic acid can be used to confirm the result of which of the following tests
included on a urine chemical reagent strip?

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Protein
Glucose
Bilirubin
Urobilinogen

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The SSA reaction is used to detect protein in the urine. Unlike the protein test on the
urine chemical reagent strip, the SSA reaction will detect albumin and globulins, and
Bence-Jones proteins. This principle is based on the acidification of proteins which
causes turbidity and can be measured based on protein concentration present.

Question Difficulty: Level 4

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Identify the urine sediment element indicated by the arrow in the illustration:

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Mucus thread
Cylindroid
Hyaline cast
Waxy cast

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Hyaline casts generally appear as colorless, homogeneous, and transparent with


rounded ends. They can also be seen as a result of dehydration, after diuretic therapy,
in renal disease, and transiently as a result of exercise.

Question Difficulty: Level 4

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The constituents that are indicated by the arrows in this image of a stained urine
sediment are:

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Red blood cells


Yeast
Renal epithelial cells
Leukocytes

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These are yeast. They can be distinguished from red blood cell by observing budding
of the yeast.

Renal epithelial cells and white blood cells have nuclei. These cells do not have
nuclei. Leukocytes are also present in this field.

Question Difficulty: Level 3

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Substances found in urinary sediment that are more easily distinguished by use of
polarized microscope are:

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WBC
RBC
Casts
Lipids
Crystals

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Lipids tend to form a "maltese cross" pattern when viewed in polarized light, which
helps to differentiate them from other urine microscopic components.

Question Difficulty: Level 7

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Which of the following tests would be useful in the assessment of glomerular
filtration:

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24 hour urine protein


Creatinine clearance
PSP test
Urea clearance

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Creatinine clearance tests are utilized to estimate the glomerular function of the
kidney. The creatitine clearance calculation is defined as the volume of plasma that is
cleared of creatinine by the kidney per unit of time and uses the following formula:

creatinine clearance = Urine creatinine conc x Volume / Plamsa creatinine conc

Creatinine clearance measurements have a recommended specimen requirement = 24-


hour urine collection.

Question Difficulty: Level 3

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Match urine color with substance that might have been responsible:

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White Phosphates
Yellow Bilirubin
Clear to straw Normal
Pale red Red blood cells

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Pale red- presence of red blood cells

Yellow- presence of bilirubin

White- presence of phosphates


Clear/straw- Normal

Question Difficulty: Level 3

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Which of the following statements are TRUE regarding the reagent strip test
procedure? (Choose ALL of the correct answers)

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Urine should be centrifuged prior to dipping the reagent strip.


Urine should be well mixed prior to dipping the reagent strip.
When visually reading the reagent strip, all results can be read immediately after
dipping the strip in the urine specimen.
Prolonged immersion may wash out test reagents.

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True Statements:

Urine should be well mixed prior to dipping the reagent strip. Prolonged immersion
may wash out test reagents.

False Statements:

Urine should be centrifuged prior to dipping the reagent strip. When visually reading
the reagent strip, all results can be read immediately after dipping the strip in the urine
specimen.

Question Difficulty: Level 5

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A patient suspected of a urinary tract infection has a negative nitrite test, but bacteria
are present upon microscopic examination. What may have caused this discrepant
result? (Choose ALL correct answers)
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The bacteria present are not nitrate-reducers.


The urine specimen may have been tested too soon after collection.
The urine was not held in the bladder for a sufficient amount of time for nitrate
to be reduced to nitrite.
The urine was in the bladder for more than 4 hours.

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When a urine sample shows a negative nitrite test, but bacteria are present upon
microscopic examination, the false-negative result could be caused by two
possibilities listed in the choices above:

The bacteria that is present is not a nitrate-reducer OR the urine was in the bladder for
an insufficient amount of time for nitrate to be reduced to nitrite.

Question Difficulty: Level 5

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Which of the following tests confirms the presence of Bence-Jones proteinuria:

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Protein electrophoresis
Sulfosalicylic acid precipitation
Cryoprecipitation
Immunoelectrophoresis

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Immunoelectrophoresis is used to detect the presence of Bence-Jones proteins.


Immunoelectrophoresis is used to help detect, diagnose, and monitor the course and
treatment of conditions associated with abnormal proteins (such as Bence-Jones),
including Multiple Myeloma, Waldenstrom's macroglobulinemia, and a few other
related diseases.
Question Difficulty: Level 6

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Which of the following would best describe what you might observe after a traumatic
CSF tap:

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All tubes pale yellow


All tubes clear
All tubes contain equal amounts of blood
Significantly more RBCs found in tube #1 vs. tube #3

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A traumatic tap would result in the introduction of more blood in the initial collection
tube (#1), than in subsequent tubes (#2 and #3).

Question Difficulty: Level 3