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403
 •
rev1ew
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quest1ons

INSTRlJCTIONS Each of the questions or incomplete st atements that follow comprises

four suggested responses. Select the best answer or completion statement in each case.

1. Why is the first-voided morning urine A. Urobilinogen

specimen the most desirable specimen for B. Indican
routine urinaJysis? e. Melanin
A. Most dilute specimen of the day and D. Porphyrin
therefore any chemical compounds
present will not exceed the detectability 4 . What is the expected pH range of a freshly
limits of the reagent strips voided urine specimen?
B. Least likely to be contaminated with A. 3.5 and 8.0
microorganisms B. 3.5 and 9.0
C. Most likely to contain protein because e. 4.0 and 8.5
the patient has been in the orthostatic
D. 4.5 and 8.0
position during the night
D. Most concentrated specimen of the day 5. Urine specimens should be analyzed as
and therefore it is more likely that soon as possible after collection. If urine
abnormalities will be detected specimens are allowed to stand at room
temperature for an excessive amount of
2. The physical characteristic of color is time, the urine pH wil1 become alkaline
assessed when a routine minalysis is because ofbacterial decomposition of
performed. What substance is normally A. Protein
found in urine that is principally B. Urea
responsibJe for its yellow coloration? C. Creatinine
A. Bilirubin D. Ketones
B. Melanin
C. Carotene 6. Which term is defined as a urine volume in
D. Urochrome excess of 2000 mL excreted over a 24-hour
period?
3. ln certain malignant disorders, a substance A. Anuria
is found in the urine that turns the urine B. Oliguria
dark brown or black on exposure of the C. Polyuria
urine to air. What is this substance? D. Hypersthenuria
404

7. lsosthenuria is a term applied to a series of
urine specimens that exhibit a
A. Specífic gravity of exactly 1.000
B. Specific gravity less than 1.007
e. Specific gravity greater than 1.020
D. Fixed specific gravity of approximately
1.010
8. A urine specimen that exhibits yellow foam
on being shaken should be suspected of
having an increased concentration of
A. Protein
B. Hemoglobin
e. Bilirubin
D. Nitrite
9. How should controls be run to ensure the
precision and accuracy of the reagent test
ly strips used for the chemical analysis of
urine?
A . Positive controls should be run on a
daily basis and negative controls when
opening a new bottle of test strips
B. Positive and negative controls should be
run when the test strips' expiration date
is passed
e. Positive and negative controls should be
run on a daily basis
D. Positive contrnls should be run on a
daily basis and negative controls on a
weekly basis
10. The colorimetric reagent strip test for pro-
tein is able to detect as little as 5 to 20 mg
of protein per deciliter. What may cause a
false-positive urine protein reading?
111 A. Ammonia concentration is greater than
ur 0.5 g/day
B. Uric acid concentration is greater than
I
0.5 g/day
e. Glucose concentration is greater than
130 mg/day
D. pH i.s greater than 8.0
O UEST IONS: 1-13 • 405
11 . The reagent test strips used for the detection
of protein in urine are most reactive to
A. Albumin
B. Hemoglobin
C. Alpha-globulins
D. Beta-globulins
12. A urine specimen is tested by a reagent strip
test and the sulfosalicylic acid test to deter-
mine whether protein is present. The former
yields a negative p~otein, whereas the latter
rcsults in a rcading of 2 + protcin. This dif-
ference is best explaincd by which of the
following statements?
A. The urine contained an excessive
amount of amorphous urates or phos-
phates that caused the turbidity seen
with the sulfosalicylic acid test
B. The urine pH was greater than 8, ex-
ceeding the buffering capacity of the
reagent strip, thus causing a false-
negative reaction
C. A protein other than albumin must be
present in the urine
D. ~he reading time of the reagent stríp test
was exceeded (the reading being taken
at 2 minutes), causing a false-negative
reaction to be detected
13. Two different methods are used to assess the
presence of glucose in a urine specimen. A
reagent test strip impregnated with glucose
oxidase- peroxidase reagent yields a nega-
tive result, but a positive result is obtained
with Benedict's test. What is thc best
explanation for these results?
A. Benedict's tcst is more sensitive than the
strip method
B. A non-glucose, reducing substance is
present in the urine sample
C. The urine sample has been
contaminated by hypochlorite
D. Thc urine sample has becn
contaminated by peroxide
406 • 7: URINALYS IS AN O BODY FLUIDS

14. Each of the following is included in the false-positive rcsults for the presence of he-
quality assurance program for a urinalysis moglobin when the urine specimen contains
laboratory. Which one represents a A. Ascorbic acid
preanalytical component of testing? B. Tetracycline
A. Setting collection guidelines for 24-hour C. Myoglobin
unnes D. Nitrite
B. Maintenance schedule for microscopes
C. Reporting units to be used for crystals 18. A rcagent test strip imprcgnated with a
D. Rcquiring acceptable results for control diazonium salt such as diazotized
specimens before any patient results are 2,4-dichloroaniline may be used to
reported out determine which analyte?
A. Glucose
15. The presence ofketone bodies in urine B. Ketone
specimens may be dctected by use of a
C. Hemoglobin
reagent strip impregnated with sodium
D. Bilirubin
nitroprusside. This strip test is sensitive to
the presence of
19. Which of the following can affect a
A. Acetoacetíc acid and specimen 's specifüc gravity if it is found
beta-hydroxybutyric acid in a patíent's urine?
B. Acetoacetic acid and acctone A. 50-100 rbc/hpf
C. Diacetic acid and beta-hydroxybutyric B. 5 mmol/L glucose
acid
e. 3 + amorphous phosphates
D. Beta-hydroxybutyric acid and acetone
D. Moderate bacteria
16. A routine urinalysis is performed on a young
20. With infections of the urinary system, whíte
child suffering from diarrhea. The reagent
blood ceJls are frequently seen in the urine
test strip is negative for glucose but positive
sediment. What type of white blood cell is
for ketones. These results may be explained
seen the most frequently in urine sediment?
by which of the following statements?
A. Eosinophil
A. The child has Type l diabetes mellitus
B. Lymphocyte
B. The child is suffering from lactic
acidosis, and the lactic acid has falsely C. Monocyte
reacted with the impregnated reagent D. Neutrophil
arca for ketones
21. Which of the followíng when present in urine
C. The child is suffering from increased
catabolísm of fat because of decreased can be an early predictor of renal damage
intestinal absorption associated with Type 1 diabetes mellitus?
D. The reagent area for ketones was read A. Macroglobulinuria
after the maxímum reading time allowed B. Paucialbuminuria
C. Hypersthenuria
17. The principie ofthe colorimctric reagent D. Myoglobinuria
strip test for hemoglobin is based on the per-
oxidase activity of hemoglobin in catalyzing 22. Thc identification of unstained cellular
the oxidation of a dye with peroxíde to form components and casts in urine sediments
a colored compound. This method may yield provides a practical method for the detec-
 QUESTIONS: 14- 31 • 407

tion and differentiation of formed elements
be-
LlllS in urinary sediment. Which microscopic
technique is used for thi s procedure?
A. Fluorescent microscopy
B. Phase-contrast microscopy
C. Polarized microscopy
D. Bright-field microscopy
23. Which substance found in urinary sediment
is more easily distinguished by use of
polarized microscopy?
A. Lipids
B. Casts
C . Crystals
D. Ketone bodies
A . These will lyse in the presence of l 0%
acetic acid
B. The number shown in this high power
field does not indicate pathology
C. They can be found in male and female
. .
urme spec1mens
D. They can be confused microscopically
with white blood cells
28. Alkaptonuria, a rare hereditary disease, is
characterized by the urinary excretion of
A. Alkaptone
B. Phenylalanine
C. 5-Hydroxyindole acetic acid
D. Homogentisic acid

24. Glitter cell is a term used to describe a 29. Excessive lipid metabolism, as is seen in
specific type of diabetes mellitus, is indicated by the
presence in the urine of
A. Ketone body
A. Hemoglobin
B. Oval fat body
e. Fatty droplet B. Ketone bodies
D. Neutrophil
C. Glucose
D. Protein
25. The final phase of degeneration that
li te granular casts undergo is represented by 30. Metastatic carcinoid tumors arising from
lC which of the following casts? the enterochromaffin cells of the
lS A. Fine gastrointestina] tract are characterized
1t? by increased excretion of urinary
B. Coarse
A. Serotonin
C. Cellular
B. 5-Hydroxytryptophan
D. Waxy
C. Hornogentisic acid
26. What condition is characterized by D. 5-Hydroxyindole acetic acid
increased urinary excretion of protein
·ine during the day while at night there is a 31. Some clinica] conditions are characterized
normal excretion of protein? by unique urinalysis result patterns. Which
A. Pathological proteinuria of the following shows such a relationship?
B. Bence Jones proteinuria A. Nephrotic syndrorne: positive protein
on reagent strip, negative protein with
C. Orthostatic proteinuria
sulfosaJicyJic acid
D. Functional nocturia
B. Intensive dieting; increased ketones,
27. A freshly collected and processed urine spec- negative glucose
imen is examined microscopically. Which of C . Multiple myeloma: positive protein by
the following statements about the major both reagent strip and sulfosaJicylic aéid
formed element in Calor Plate 46 is true? D. Cystitis: positive nitrite and protein
408 • 7: URINALYSIS ANO BODY FLUIDS
32. Nitrite in a urine specimen suggests the
presence of
A. White blood cells
B. Red blood cells
e. Bacteria
D. Yeasts
33. lf a fasting plasma glucose levei of
100 mg/dL is obtained on an individual,
what is the expected fasting cerebrospinal
fluid (CSF) glucose levei in mg/dL?
A. 25
B. 50
e. 65
D. 100
34. A patient with diabetes mellitus complicated
with kidney malfunction is admitted to the
hospital. His chemical urinalysis results show
a glucose levei of 1000 mg/dL, a protein levei
of 2000 rng/dL, a protein determination of
2.04 g/dL by sulfosalicylic acid, anda ketone
levei of 40 mg/dL. The specific gravity is
1.018 with the use of a reagent strip. What is
this patient's co1Tect specific gravity?
A . 1.007
B. 1.008
e. 1.011
D. 1.018
35. To preserve the sensitivity of the reagent
test strips used for the chemical evaluation
of urine, how should the strips be handled?
A. Used within one year after opening
B. Kept in a loosely capped container
e. Protected from excessive heat
D. Stored in a refrigerator
36. Which is true about the formed element
found in Color Plate 47?
A. May be found in normal alkaline urine
B. Always associated with renal pathology
e.Never found at urine pH 7.0
D. Always associated with lung pathology
37. Which formed element is not found in the
high-power field shown in Color Plate 48?
A. White blood cell
B. Mucus
e. Squamous epithelium
D. Sperm
38. Which of the following is true about the
final concentrnting of urine in the kidney?
A. The distal convoluted tubule, through
active transport, reabsorbs water
B. Water is reabsorbed under the direct
influence of angiotensin II
e. Vasopressin controls the collecting duct
reabsorption of water
D. Water reabsorption is influenced by
urine filtra te leveis of potassium
39. If a urine specimen is left standing at room
temperature for severa! hours, which of the
following changes may occur?
A. Multiplication of bacteria
B. An increase in the glucose concentration
e. Production of an acid urine
D. Deterioration of any albumin present 4
40. The diJuting and concentrating ability of the
kidneys may be measured by performing
which of the following urine tests?
A. Sodium
B. Creatinine
e. Volume
D. Specific gravity
41. Positive results on Benedict's test would be
obtained if the mine sample contained
which of the following?
A. Urea
B. Potassium
e. Sucrose
4
D. Ascorbic acid
42. Phenylketonuria may be characterized by
which of the following statements?
 OU ESTIONS: 32- 5 2 • 409

A. lt may cause brain damage if untreated A. Sphingomyelin

? B. It is caused by the absence of the
enzyme, phenylalanine oxidase
e. Phenylpyruvic acid excess appears ín
the blood
D. Excess tyrosine accumulates in the
blood
? 43. What condition is suggested by the number
of the formed element that predominates in
the low-power field of Color Plate 49?
A. Glomerulonephritis
B. Improperly collected specimen
.ct e. Pyelonephritis
D. Nephrotic syndrome
44. Xanthochromia of cerebrospinal flui d
(CSF) samples may be dueto increased
n leveis of which of the following?
LC A. Chloride
B. Protein
e. Glucose
lOn
D. Magnesium
45. All the following would be characterized
by an increased number of the urinary
:he component in Colar Plate 50 except
A. Acute glomerulonephritis
B. Renal calculi
e. Menstrual contamination
D. Nephrotic syndrome
46. To determine amniotic fluid contamination
with maternal urine, which of the following
1e measurements could be used?
A. Creatinine concentration
B. Lecithin/sphingornyelin ratio
e. Albumin/globulin ratio
D. Lactate dehydrogenase
47. With the development of fetal Jung maturity,
.which of the following phospholipid
concentrations ín arnniotic fluid
significantly and consistently increases?
B. Phosphatidyl ethanolamine
e. Phosphatidyl inositol
D. Phosphatidyl choline
48. Which ofthe following amniotic fluid
measurements is used as an indicator of
fetal maturity?
A. Phosphatidyl glycerol
B. Phosphatidyl inositol
e. Alpha1-fetoprotein
D. Delta absorbance at 450 nm
49. Contamination of amniotic fluid with even
small amounts of maternal or fetal blood
could significantly interfere in the measure-
ment of which of the following?
A. Net absorbance at 450 nm
B. Creatinine
e. AIpha 1- fetoprotein
D. Urea nitrogen
50. Patients with diabetes insípidus tend to
produce urine in volume
with specific gravity.
A. Increased, decreased
B. lncreased, increased
e. Decreased, decreased
D. Decreased, increased
51. The estimation of hyaluronic acid concen-
tration by measurement of viscosity is
useful in evaluating which type of fluid?
A. Cerebrospinal
B. Peritoneal
e. Pleural
D. Synovial
52. Which of the following is characteristic of
an exudate effusion?
A. Leukocyte count greater than 1000/ µL
B . Clear appearance
e. Protein concentration less than 3.0 g/dL
D. Absence of fibrinogen
410 • 7: U R INALYS ISAN D BODY FLUIDS
53. Ali thc following systems may be used to
determine the specific gravity of urine
except
A. Refractometer
B. Osmometer
C. TS meter
D. Polyelectrolytes
54. Which methods may be used to quantify
protein in both cerebrospinal fluid and urine
specimens?
A. Sulfosalicylic acid and bromcresol
green
B. Ponceau S and Coomassie brilliant blue
C. Bromcresol green and Coomassie
brilliant blue
D. Coomassie brilliant blue and
sulfosalicylic acid
55. Which of the following characteristics is
true of the urinary components in Color
Plate 51?
A . Consist entirely ofTamm-Horsfall protein
B. Presence always indicates a disease
process
C. Can be observed with polarized
m1croscopy
D. Appear yellowish in brightfield
microscopy
56. A characteristic of substances normally
found dissolved in the urine is that they
are all
A. Water soluble
B. Inorganic
C. Organic
D. Waste products
57. Which oft,he following statements applies to
the proper collection and handling of CSF?
A. The second tube collected should be
used for chemistry analyses
B. The third tube collected should be used
for bacteriologic studies
C. CSF collected in the evening should be
refrigerated and assays performed only
by day-shift personnel
D. With low-volume specimens, a culture
is performed first, before cell counts are
done
58. Ali the following characteristics are true for
the urinary components in Color Plate 52
except
A. Appear morphologically as octahedrals
resembl ing envelopes
B. Appear as dumbbell or oval forms
C. Appear only in an acid urine
D. Occur in a normal urine
59. Which assay is commonly performed on
pleural, pericardial, and peritoneal fluids?
A. Total protein
B. Specific gravity
C. Osmolality
D. Calcium
60. Which urinalysis reagent strip test will
never be reported out as "negative"?
A. Protein
B. Urobilinogen
C. Bilirubin
D. Nitrite
61. The following urinalysis results were ob-
tained on a 40-year-old white male whose
skin appeared yellowish during the clinical
examination. Color and clarity- dark
brown, clear; protein-negative; glucose-
negative; blood---negative; ketones--nega-
tive; bilirubin-moderate;
urobilinogcn- 0.2 rng/dL. These results are
clinically significant in which of the follow-
ing conditions?
A. Bile duct obstruction
B. Cirrhosis
C. Hepatitis
D. Hemolytic anemia
 OUESTIONS: 53-67 • 411

be 62. Which of the following pertains to the 66. The following urinalysis biochemical
lly performance of a sperm count? results were obtained from a 4-month-old
A. Performed by means of a direct infant who experienced vomiting and
observation on a glass slide diarrhea after milk ingestion and failed to
re
B. Requires dilution of the seminal fluid gain weight. pH- 6; protein- negative;
are
specimen glucose- ncgative; kctone-·-ncgati ve;
bilirubin-negative; Clinitest-2 + These
C. Performed on a sample prior to
results are clinica11y significant in which of
for complete liquefaction
2 the following disorders?
D. Manual sperm counts yield precise data
A. Diabetes mellitus
ais B. Ketosis
63. Which of the following may be associated
with morphologic examination of C. Starvation
spermatozoa? D. Galactosemia
A. Evaluation should include assessment of
67. Which of the following ís a true statement?
1000 spermatozoa
A. Renal tubular cells originate from the
B. A small number of spcrm should have
renal pelvis
normal morphologic characteristics
.? B. Red blood cells in acid urine (pH 4.5)
C. Papanicolaou stain may be used
will usually be crenated because of the
D. Presence of red or white cells and
acidity
epithelial cells need not be noted
C. Bacteria introduced into a urine
specimen at the time of the collection
64. Which condition is characterízed by will have no immediate effect on the
increased leveis of immunoglobulins in levei of nitrite in the specimen
the cerebrospinal fluid, originating from
D. Pilocarpine iontophoresis is the method
within the central nervous system and not
of choice for the collection of
from the general blood circulation?
pericardial fluid
A. Gout
B. Erythroblastosis fetalis
C. Multiple myeloma
D. Multiple sclerosis

e 65. Which of the following statements pertains

:ai to screening methods used to determine
pregnancy?
A. Immunoassays will use reagent anti-CG
;a- to react with patient CG
B. One-step pregnancy tests require the use
u-e ofboth anti-a-CG and anti-[3-CG as
)\V-
reagents
C. Internai controls provided within the kit
will assess if the patient's specimen was
collected correctly
D. Externai quality control is not needed
with these methods
 fiÍ_answers
rationales
1.
-·
D. The first-voided morning urine specimen is the
rnost desirable for chemical and microscopic
analysis because it is the most concentrated speci-
men of the day. Protein and nitrite testing are bet-
ter performed on a concentrated specimen, as are
the specific gravity determination and the exami-
nation of urinary sediment. However, because of
the Jack of food and fluid intake during the night,
glucose metabolism may be better assessed on the
basis of a postprandial specimen.
2.
D. Urochrorne, a yellow-brown pigment derived from
urobilin, is principally responsible for the yellow
coloration of normal urine. Urocbrome is excreted
at a constant rate, showing no diurna) variation.
Therefore the color of normal urine, which may
range from straw to deep amber, is dependent on
the concentrating ability of the kidney and the vol-
ume of urine excreted.
3.
C. Melanin, a substance derived from tyrosine, is re-
sponsible for the pigmentation of the eyes, skin,
and hair. ln some malignancies, known as mela-
nomas, the tumor or mole takes on a darkly pig-
mented appearance because of the melanin present.
ln cases of metastatic melanoma, me lanogen,
which is a colorless precursor of melanin, is ex-
creted in the urine. If the urine is allowed to stand
at room temperature for 24 hours, the melanogen
is oxidized to melanin, imparting a dark brown or
black coloration to the specimen. Qualitative
screening tests for the detection of melanin in
412
urine utilize ferric chloride or sodium nitroprns-
side as the oxidation reagent systems.
4.
D. pH is a representative symbol for the hydrogen ion
concentration. The kidney plays an important role in
the maintenance of the acid-base balance of body
tluids by either excreting or retaining hydrogen ions.
A normally functioning kidney will excrete urine D
with a pH between 4 .5 and 8.0, depending on the
overall acid-base needs of the body.
5.
B. At room temperature the amount of bacteria pres-
ent in a urine sample will increase. The bacteria
are capable of metabolizing the urinary urea to
ammonia. The ammonia formed through this
process will cause an alkalinization of the urine.
6.
C. On the average, a normal adult excretes
1200-1500 mL of urine daily. Polyuria is a term
used to describe the excretion of a urine volume in
excess of 2000 mL/day. ln oliguria, the daily urine
excretion is less than 500 mL, and in anuria the
urine formation is completely suppressed . Hyper-
sthenuria refors to urines of any volume contain-
ing increased leveis of dissolved solute.
7.
D. Isosthenuria is a term applied to a series of urine
specimens that exhibit a fixed specific gravity ofap-
proximately 1.010. ln isosthenuria there is little, if
any, variation of the specific gravity between urine
specimens. This condition is abnormal and denotes

lhe presence of severe renal damage in which both
the diluting ability and the concentrating ability of
the kidneys have been severely affected.
---··----· ------··------··-·---- -----------· ·--~-------·-------
8.
e. Normal urine does not foam on being shaken.
However, urine containing bilirubin will exhibit
yellow foaming when the specimen is shaken. ln
fact, the foam test was actually the first test for
bilirubin, prior to the development of the chemical
tests. If the shaken specimen shows a white foam,
increased urine protein can be suspected.
9.
C. For guality control of reagent test strips, it is rec-
ommended that both positive and negative controls
be used daily. It is necessary that any deterioration
1rus-
of the strips be detected in order to avoid false-
positive or false-negative results. The use of posi-
tive and negative contrais will act as a check on
the reagents, on the technique employed, and on
11on the interpretive ability of the person or instrument
lein performing the test.
1ody
ons. 10.
nne D. The principle of the reagent strip method for the de-
the tection of protein in urine is based on a color change
in an indicator system, such as tetrabromophenol
blue, that is buffered to pH 3. The buffering capacity
of the strip is sufficient provided that the urine pH
1res- does not exceed 8.0. Within the normal urine pH
:ena range of 4 .5- 8.0, a change in color in the reagent
:l to stiip is an ind ication of the presence of protein in the
this urine. With a urine pH greater than 8, the buffering
capacity of the strip may be exceeded, and a false-
positive color change in the impregnated area will
reflect the pH of the urine rather than the presence
etes ofprotein.
erm
e in 11.
rine A. ln healthy individuais the amount of protein ex-
the creted in the urine should not exceed 150 mg/24 hr.
per- When protein is present in the urine, the colori-
ain- metric reagent test strips change color, indicating a
semiquantification of the amount of protein pres-
ent. Serum proteins are classified as being albu-
min or globulin in nature, and the type of protein
ri ne excreted in the urine is dependent on the disorder
·ap- present. Although the strip test is a rapid screening
e, if method for the detection of urinary protein, it
rine must be noted that this method is more sensitive to
:>tes the presence of albumin in the specimen than to
ANSWERS & RATIONALES: 1- 15 • 413
the presence of g lobulin, Bence fones protein, or
mucoprotein.
12.
-------·--·--·-·--···----~·---··--·-·-----··---·--------·--··-· ----
e. When globulin, mucoprotein, or Bence Jones pro-
tein is present in a urine specimen, the reagent
strip test may give a negative result because the
strip is more sensitive to the presence of albumin
than to the presence of other proteins in urine.
However, the sulfosalicylic acid (SSA) test is able
to detect not only alhumin but also globulin, mu-
coprotein, and Bence Jones protein in a specimen.
Therefore, it can be seen that a negative reagent
strip test result for protein but a positive sulfosali-
cylic acid test result is possible when the protein
present is some protein other than albumin. For
this reason the sulfosalicylic acid test is frequently
run as a confirmatory procedure in testing for uri-
nary protein.
13.
B. The test strip impregnated with glucose oxidase-
peroxidase reagent is specific for glucose. Bene-
dict's test, however, is responsive to both glucose
anda variety of non-glucose, reducing substances.
Therefore a negative strip test result with a posi-
tive Benedict's test result is possible when a non-
glucose, reducing substance is present in the urine
specimen. It should be noted that contamination of
a urine specimen with hypochlorite or peroxide
would actually cause a positive reactio n with the
glucose oxidase-peroxidase method, and a nega-
tive/decreased result with Benedict's test.
14.
--------------------
A. Preanalytical components of laboratory testing in-
clude ali variables that can affect the integrity or
acceptability of the patient specimen prior to
analysis, such as correct collection teclmique. An-
alytical factors affect the actual a nalysis of the
specimen (temperature, condition of equipment,
timing, presence of interfering substances). Post-
analytical factors affect the final handling of the
results generated (reporting units, criticai values,
acceptability of quality control).
15.
B. Under normal metabolic conditions, the body me-
tabolizes fat to carbon dioxide and water. With in-
adequate carbohydrate intake, as with dieting and
starvation, or with inadequate carbohydrate me-
tabolism, as with diabetes mellitus, the re is an in-
414 • 7: URINALYSIS ANO BODY FLUJOS
creased utilization of fat. Because of this increased
fat metabolism, the body is unable to completely
degrade the fat, resulting in a buildup of interme-
diary products known as ketone bodies. Ketone
bodies is a collective term used to denote the pres-
ence of acetoacetic acic~ beta-hydroxybutyric acid,
and acetone. Reagent test strips impregnated
with sodium nitroprusside are able to detect the
presence of acetoacetic acid and acetone in urine
specímens. Although beta-hydroxybutyric acid ac-
counts for approximately 78% of the total ketones,
it is not detected by the sodium nitroprusside test.
16.
C. Although a positive result on a urine test for ke-
tones is most commonly associated with increased
urinary glucose leveis, as in diabetes mellitus,
other conditions may cause the urine ketone test to
show positive results while the urine glucose test
shows negative results. In young children, a nega-
tive glucose reaction accompanied by a positive
ketone reaction is sometimes seen. Ketones in the
urine rnay be seen when a child is suffering from
an acute febrile disease or toxic condition that is
accompanied by vomiting or diarrhea. ln these
cases, bccause of either decreased foód intake or
decreased intestinal absorption, fat catabolism is
increased to such an extent that the intermediary
products, known as ketone bodies, are formed and
excreted in the urine.
17.
C. The colorimetric reagent strip test for the detection
of hemoglobin in urine utilizes a butfered test
zone impregnated with a dye and organic perox-
ide. The peroxidase activity of hemoglobin cat-
alyzes the oxidation of the dye with peroxide to
form a colored compound. Like hemoglobin, myo-
globin also has a peroxidase activity and when
present in a urine specimen, myoglobin will react,
yielding false-positive results. ln the presence of
large amounts of ascorbic acid, antibiotics contain-
ing ascorbic acid as a preservative, formaldehyde,
or nitrite, the urine reaction may be inhibited,
causing false-negative results.
18.
D. Bilirubin is a compound that is formed as a result
of hemoglobin breakdown. The majority of biliru-
bin in the blood is bound to albumin and is known
as unconjugated bilirubin. Since unconjugated
bilirubin is not water soluble, it may not be ex-
creted in the urine. The rernainder of the bilirubin
in the blood has been processed by the liver. ln the
tiver, the bilirubin is conjugated with glucuronic
acid or sulfuric acid. This conjugated bilirubin is
water soluble, and it is this portion that is excreted
in increased amounts in the urine in some hepatic
and obstrnctive biliary tract diseases. The presence
of conjugated bilirubin in a urine specimen may be
detected by use of the reagent test strips. The test
strips are impregnated with a diazonium salt, such
as diazotized 2,4-dichloroaniline, which forrns a
purplish azobilirubin compound with bilirubin.
19.
B. . Only dissolved solutes affect specific gravity.
Cells, mucus, crystals, or any other formed ele-
ments will have no eftect, regardless of concentra-
tion. 1f the reagent strip method is used, it should
be noted that only dissolved ions will affect spe-
cific gravity resu]ts. In such instances as diabetes
mellitus, with urine glucose leveis over 2 g/dL,
there may be a discrepancy between specific grav-
ity readings taken with a reagent strip method ver-
sus that using a refractometer.
20.
D. The majority of renal and urinary tract diseases
are characterized by an increased number of neu-
trophilic leukocytes in the urine. To identify cor-
rectly any white blood cells present in a urine
specirnen, it is necessary to examine the specimen
as soon as possible after collection. This is neces-
sary since leukocytes tend to lyse easily when ex-
posed to either hypotonic or alkaline urine.
21.
B. The ability of the glomerulus to prevent filtration
of protein is one of the first renal properties af-
fected in the renal complications of Type l dia-
betes mellitus. As microcirculation in the nephron
is compromised, increasing amounts of albumin
will be found in the urine. These leveis will ini-
tially be less than the sensitivity levei of the
reagent strips usually used fo r urinalysis (5-
1O mg/dL). Special strips with a protein sensitivity
of 2 mg/dL or less must be used to detect and fol-
low these urine prote in changes in at-risk patient
populations.
22.
B. To better diagnose renal and urinary tract diseases,
it is necessary to examine urinary sediment care-
 ANSWERS & RATIO NALES: 16- 30 • 415

bin fully by the most appropriate microscopic method healthy, anti except for the excessive protein excre-
the available. Formed elements in the urine, such as tion, they show no other signs of renal disease.
,nic cells and casts, are more easily differentiated by
1 is the use of phase-contrast microscopy. This is espe- 27.
:ted cially true for the identification of the more C. The yeasts, as seen in Calor Plate 46, can resemble
Hic translucent elements such as the hyaline casts. red blood cells. They can be differentiated by in-
nce Phase microscopy tends to enhance the outline of troducing a drop of 10% acetic acid under the
· be the formed elements, allowing them to stand out cover slip: red cells will lyse and yeasts will not.
test and be more easily distinguished. They can be found in urine from either sex as evi-
uch dence of a nonbacterial type of urinary tract infoc-
sa 23. tion. ln a fresh urine, the number of yeasts shown
A. Fatty materiais in urinary sediment may be identi- would suggest palhology rather than contamina-
fied by means of staining techniques using Sudan tion.
III and oil red O or by means of polarized mi-
·ity. croscopy. Polarized microscopy is especially use- 28.
!le- ful when the composition of fatty casts, fatty D. Alkaptonuria is a rare hereditary disease that is
tra- droplets, or oval fat bodies is primarily choles- characterized by excessive urinary excretion of
•Uld terol. When cholesterol molecules are exposed to homogentisic acid. This acid, the product of
:pe- polarized microscopy, the effect is such that a phenylalanine and tyrosine metabolism, accumu-
!tes Maltese cross fonnation becomes visible, simpli- lates in urine because of a deficiency in the en-
dL, fying the identification process. zyme homogentisic acid oxidase, which nonnally
·av- catalyzes the oxidation of homogentisic acid to
ter- 24. maleyl acetoacetic acid. Urine containing ho-
D. When neutrophils are exposed to hypotonic urine, mogentisic acid tums black on standing because of
their physical appearance becomes altered. Under an oxidative process; thus the screening test for
hypotonic conditions, the neutrophils tend to swell alkaptonuria consists of the detection of a black
ises and the cytoplasmic granules contained within the coloration in urine that is left standing at room
1eu- cells exhibit Brownian movement. This Brownian temperature for 24 hours.
;or- movement of the granules causes the neutrophilic
rine contents to refract in such a way that the cells ap- 29.
nen pear to glitter- thus, the name glitter cells. B. Diabetes mellitus is rnarked by an underutilization
;es- of blood glucose by the cells of the body as a re-
ex- 25. sult of inadequate glucose uptake by the cells.
D. Waxy casts represent the final phase of granular Since glucose metabolism is depressed, the ceUs
cast degeneration. As the fine granules of thc must revert to lipid catabolism for energy produc-
granular casts lyse, highly refractive, smooth, tion. Such an increased use of Jipid results in in-
tion blunt-ended waxy casts are formed. When waxy complete lipid metabolism, so that intermediary
af- casts are found in the urine sedimcnt, the implica- products are formed. These intermediary products,
dia- tion is that there is nephron obstruction caused by known as ketone bodies, accumulate in the blood
tron tubular inflammation and degeneration. and are excreted in the urine.
min
ini- 26. 30.
the C. Orthostatic protcinuria, also referred to as postural D. The intestinal enterochromaffin cells, sornetimes
(5- proteinuria, is characterized by an increased excre- called tbe argentaffin cells, produce a substance
vity tion of protein during the day when a patient is in known as serotonin from the amino acid trypto-
fol- an erect position. When the patient lies down, the phan. ln cases of metastatic carcinoid tumors,
ient proteinuria disappears; urine tested for protein excessive amounts of serotonin are produced. Ser-
during this time period will show a negative reac- otonin may then undergo oxidative deamination to
tion. This condition, in which urinary protein is form the metabolite 5-hydroxyindole acetic acid
found during the day but not at night as a function (5-HlAA), which is excreted in the urine. lt is the
ses, of the patient's body position, occurs in 3-5% of quantification of 5-HIAA that is diagnostically
are- young adults. These young adults appear to be significant as it reflects serotonin production.
416 • 7 : URINALYSIS ANO BODY FLUIDS
31. ------·------·--------··--··----------·
--·-
B. Because of increased lipid metabolism in long-
term, intensive dieting, ketone body formation
will increase. Blood glucose leveis in such patients
will be normal or decreased. ln nephrotic syn-
drome, the large amounts of albumin excreted will
be detectable by both reagent strip and SSA meth-
ods. ln multiple myeloma, however, the increased
globulin light chains (Bence Jones proteins) ex-
creted will only be detectable by SSA since the
reagent strip is more sensitive to albumin. Cystitis
is a lower urinary tract infection afTecting the blad-
der but not the kidney itself. This will not have in-
creased protein, while an upper urinary tract
infection will.
32.
C. Bacteria of the Enterobacter, Citrobacter, Es-
cherichia, Proleus, Klebsieíla, and Pseudomonas
species produce enzymes that catalyze the reduc-
tion of nitrate, a substance normally found in
urine, to nitrite. Reagent test strips have been de-
veloped that are able to detect nitrite in urine.
Therefore, a positive nitrite test result is an indi-
rect indication of the presence of bacteria in the
. .
unne spec1men.
33.
C. Cerebrospinal fluid (CSF) is a clear, colorless liq-
uid that may be described as a modified ultrafil-
trate of blood. Both active transport and passive
diffusion are involved in the passage of glucose
from the blood into the CSF. Normally, fasting
CSF glucose leveis range between 50 and 80 mg/dL,
representing approximately 60-70% of the blood
glucose levei. ln hyperglycemia with plasma glu-
cose leveis of 300 mg/dL, the active transport
mechanism reaches a point of maximum response,
so that CSF glucose leveis reílect approximately
30% of the plasma glucose levei. Decreased CSF
glucose leveis are associated with hypoglycemia, a
faulty active transport mechanism, and excess uti-
lization of glucose by microorganisms, red or
white blood cells, or the central nervous system.
34.
D. Reagent strip methods for specific g ravity are sen-
sitive to the presence of ions in the specimen. As
such, they will not be affected by unionized
solutes such as glucose and protein. Measurement
of the ionized components of urine represents a
truer estimate of the concentrating ability of the
kidneys.
35.
C. To avoid loss of sensitivity, it is necessary that the
reagent test strips for chemical analysis of urine be
stored in a coo!, dry place and protected from both
rnoisture and excessive heat. Because of moisture
buildup, the strips should not be stored in a re-
frigerator. Impregnated reagent areas should be
checked for discoloration and the strip not used
if any discoloration is observed. To protect the
strips, it is necessary that the cap be kept on the
· container tightly at all times and removed only
long enough to remove the needed strips. To pre-
vent contamination, the impregnated reagent areas
should not be touched with the fingers or placed
on a countertop.
36.
A. Normal alkaline (or neutral) urine may contain
tripie phosphate crystals, as seen in Color Plate
4 7. These crystals can be identified by the charac-
teristic "coffin lid" appearance. They usually do
not indicate any pathology.
37.
D. Refer to Calor Plate 48. White blood cells are
12- 15 microns in diameter with a granular cyto-
plasm. Mucus strands can be seen here as translu-
cent, long, thin filaments. Squamous epithelial
cells are 40-50 microns in diameter, with a large
cytoplasm/nucleus ratio. They can at times have
their cell membrane folded over. Not present in
this field are sperm, which have a 4- 6-micron-
diameter head attached to a long ílagellum.
38.
C. The distal convoluted tubule and collecting duct
provide water reabsorption through the action of
antidiuretic horrnone (vasopressin). The reni n-
angiotensin-aldosterone system is responsible for
sodium reabsorption by the distal and collecting
tubules. Decreased plasma volume Jeads to pres-
sure alterations detected by receptors located in
the kidney's juxtaglomerular apparatus and the
right atrium of the heart. These changes trigger the
production of renin and antidiuretic hormone, re-
spectively.
 ANSWERS & RATIONALES. 3 1-45 • 417

1ts a 39. 42.

· tbe A. Only freshly voided urine specimens should be
used for urinalysis testing. If the specimen cannot
be examined within 1 hour after collection, it
should be refrigerated to help preserve the in-
t the tegrity of the specimen. When urine is left stand-
e be ing at room temperature for an excessive period,
both multiplication of bacteria will occur. The bac-
1ture teria are capable of converting urea in the urine
1 re- to ammonia, causing the urine to become more
i be alkaline. Loss of carbon dioxide from the speci-
JSed men will also contribute to the alkalinization
the of the urine. Constituents such as glucose, biliru-
the bin, and urobilinogen will a lso be lost from the
only specimen.
pre-
reas
40.
lCed
D. Both the specific gravity and the osmola lity deter-
minations have been used as a measure of the di-
luting and concentrating ability of the kidneys.
Both tests are based on the measurement of the
1tain proportion of dissolved solids to total volume of
>late urine. The specific gravity, although a somewhat
1rac- easier procedure to perform, is not as exact a
r do measurement as the osmolality. The specific grav-
ity is dependent not only on tbe quantity of solute
present but also on the type of solute present.
Therefore, if large molecules such as protein or
are glucose are present in excess, a disproportionate
yto- specific gravity reading may be obtained. With an
1slu- osmolality determination, such interference would
elial be avoided because the osmolality is dependent
arge only on the number of dissolved particles present
Jave in the urine specimen.
1t in
ron-
41.
D. Benedict's test is a copper reduction method
for the detection of glucose and other reducing
substances in urine. ln this test, alkaline copper
duct sulfate is reduced to cuprous oxide by any reduc-
n of ing substance present in urine. The drawback of
nm- this procedure is that it is nonspecific for glu-
: for cose. Nonglucose reducing substances such as
:ting ascorbic acid, creatinine, and uric acid or other
.res- reducing sugars, such as galactose and lactose,
d in can also cause a positive reaction. Therefore,
the when used alone, Benedict's test can only detect
r the the presence of reducing substances in urine but
, re- cannot itself identify the exact reducing sub-
stance present.
A. Phenylketonuria is inherited as an autosomal re-
cessive trail thal manifests itself in the homozy-
gous form. The basis for the disease lies in the fact
tbat the enzyme phenylalanine hydroxylase, which
is needed for lhe conversion of phenylalanine to
tyrosine, is absent. Because of this enzyme defi-
ciency, phenylalanine leveis rise in the blood with
increased amounts of phenylpyruvic acid and
other derivatives being excreted in the urine. If the
disease is detected at an early stage, me ntal retar-
dation may be avoided by restricting lhe dietary
intake of phenylalanine.
43.
B. Color Plate 49 demonstrates significantly in-
creased numbers of squamous epithelial cells in
the field. This usually suggests the sample has not
been collected by the preferred method of "clean
midstream catch." Such proper collection would
have flushed out these cells, found at the externai
meatus and final one-third of the urethra. Cells
characteristically found in cases of g lomeru-
lonephritis are red blood cells. ln pyelonephritis,
white blood cells would predominate, while cases
of nephrotic syndrome will show oval fat bodies
and red blood cells.
44.
B. A variety of substances in CSF specimens have
been associated with a xanthochromic appearance.
Among those substances are oxyhemoglobin,
carotenoids, bilirubin, and protein. The appear-
ance of the specimen by itsclf is not usually spe-
cific for a particular disease state, bul it may
provide useful information in comparison with
other findings. Glucose, magnesium, and chloride
do not contribute to the color of the specimen.
45.
D. Refer to Color Plate 50. Erythrocytes or red blood
cells (RDCs) occur in small numbers (0-2/HPF) in
a normal urine. Using bright-field microscopy, un-
stained RBCs appear as colorless discs with an av-
erage size of 7 µm in diameter. lncreased or large
numbers of RBCs are commonly seen with acute
glomerulonephritis, renal calculi, acute infections,
and menstrual contamination. The nephrotic syn-
drome is characterized by heavy proteinuria, oval
418 • 7: URINALYSIS AND BODY FLUIDS
fat bodies, renal tubular epithelial cells, casts, and
waxy and fatty casts.
46.
A. Because there rnay be technical problems associ-
ated with amniocentesis, contamination with ma-
ternal urine should be considered in evaluating
specimens submitted for amniotic fluid analysis.
Urinary concentrations of creatinine and urea ni-
trogen are anywhere from 1O to 50 times the am-
niotic fluid concentrations, and an increased
concentration of either in the amniotic fluid would
be sensitive indicators of urinary contamination.
Measurements of albumin, total protein, or lactate
dehydrogenase would be of little use for this pur-
pose because their relative concentrations in urine
and amniotic fluid are not predictably ditferent.
47.
D. The alveolar concentrations of the various phos-
pholipids (surfactants) change during fetal lung
development, and because these changes are re-
flected directly in the amniotic fluid, a number of
investigations have shown that analysis of the tluid
can provide good predictive information for the
development of respiratory distress syndrome in
the newborn. The concentrations of sphingomyelin
and phosphatidyl inositol increase until about 32
to 34 weeks of gestation and then decline. Con-
versely, lecithin (phosphatidyl choline) and phos-
phatidyl glycerol concentrations increase rapidly
after 32 to 34 weeks of gestation, and their con-
centrations relative to those of the other phospho-
1ipids are useful in assessing the development of
fetal Jung maturity.
48.
A. Measurements on amniotic fluid that are used for
determining fetal maturity can usually be related
to the maturity of a particular organ. For exarnple,
the levei of creatinine appears to be related to the
maturity of the fetal kidney. The lecithin/ sphin-
gomyelin ratio, phosphatidyl glycerol leveis, and
the foam stability index have been shown to corre-
late well with the development of fetal lung matu-
rity. Only those tests that measure fetal Jung
development will be useful in predicting the respi-
ratory distress syndrome. The net absorbance at
450 nm measurement is nota measure of fetal ma-
turity but is useful in monitoring the course of the
isoimmunization syndrome.
49.
A. Th;···~P~~t;op·h-~to~;t;i~-~~th~;a--r;:-detecti~~
the isoirnmunization syndrome, applied to amni-
otic fluid, is based on the determination of bilini-
bin concentration by measuring the net change in
absorbance at 450 nm. Hemoglobin absorbs
strongly at approximately 41 O nm and therefore
can interfere in the net absorbance at 450 nm
measurement. The presence of meconium in anmi-
otic tluid is in itself an indication of fetal distress
and it can interfere in the spectrophotometric'
measurement because of its absorbance at approx-
imately 410 nm. Creatinine and protein do not
have strong absorbance bands in this spectral re-
gion and are generally not a problem.
50.
A. Diabetes insipidus is caused by a deficiency in an-
tidiuretic hormone. Such deficiencies will result in
the kidney's inability to reabsorb water at the distal
and collecting tubules. This atfects only water re-
absorption and not the reabsorption of other uri-
nary solutes. Excreted solute amounts will be the
sarne, but the water volume into which they are
excreted wi ll be larger. This results in higb urine
volumes and low final solute concentrations. The
low solute will .lead to Jow specific gravities in
these patients' specimens.
51.
D. Synovial fluid is a form of plasma ultrafiltrate
with added hyaluronic acid. Decreased viscosity
and poor mucin clot formation are indications of
the decreased hyaluronate concentration of syn-
ovial fluid. Either of these findings is usually an
indication of inflammation. Since the viscosity of
synovial fluid is normally very high, it can be esti-
mated by the length of string formed when the
fluid drops from a syringe. The term mucin in the
mucin clot test is a misnomer, since mucin is not
present in synovial fluid.
52.
A. Effusions result from an imbalance of the flow of
body fluids. Effusions are classified as exudates or
transudates on the basis of certain characteristics.
Exudates are generally formed in response to in-
flammation or infection with concomitant capil-
lary wall damage. Exudates are characterized by
protein leveis greater than 3.0 g/dL, leukocyte
counts greater than 1000/µL, and the presence of a
 ANSWERS & RATIONALES: 46- 60 • 419

- sufficient amount of fibrinogen to cause clotting.

ln contrast, transudates are characterized by pro-
56. -·- - -----·- ·- - - - - - -··--·--· -
A.:-r~·· l;·~ · :r~;~~-d i;·~~:i~~, a solute must be water solu-
1n of tein leveis less than 3.0 g/dL, leukocyte counts ble. Solutes can be inorganic (e.g., sodium) or
mni- less than 300/ µ,L, and the absence of fibrinogen. organic (e.g., urea). Excreted waste products,
iliru- Transudates are generally formed as the result of meaning end products of metabolism, are creati-
~e in nonínflammatory processes, including alterations nine, urea, and uric acid. Some excreted solutes,
>orbs in plasma oncotic pressure, pleural capillary hy- however, are not present as waste but as overload,
~fore
drostatic pressure, or intrapleural pressure. such as glucose or sodium.
1nm
mni-
:ress, 53. 57.
tetric B. A clinically useful test for assessing the concen- D. Cerebrospinal fluid (CSF) must be collected in
)fOX- trating and diluting ability of the kidneys is the de- sterile tubes. The first tube is generally used for
1 not termination of urine specific gravity. The specific chemistry and serology studies, the second tube is
11 re- gravity is a measure of the proportion of dissolved employed for bacteriologic examination, and the
solids in a given volume of solvent. The TS meter third tube is used for cell counts. Tubes used for
is a specific type of refractometer that utilizes the chemistry and bacteriologic studies should be cen-
close correlation of a solution's refractive índex trifuged before use. CSF should remain uncen-
with its solute concentration to determine the spc- t1ifuged for cell counts. Low-volume specimens
n an-
1lt in cific gravity of urine. The refractive índex is the need to be cultured first (to ensure sterility) before
ratio of the velocity of light in air to the velocity of any other test is performed. Since the analyses of
iistal
:r re- light in a solution, this being comparable to the CSF should be performed immediately, it is ciiti-
. uri- number of dissolved particles in that solution. cal that personnel on ali shifts be able to perform
e the Polyelectrolytes are incorporated into urinalysis the necessary testing.
{ are
reagent strips. A dye also present in the strips will
Llfme
change color because of a pKa change in the poly- 58.
The electrolytes. The pKa varies with the ionic con- C. Calcium oxalate crystals, as seen in Color Plate
es m centration of the urine. The color obtained is 52, are commonly encountered in normal acidic
compared with a set of standard colors, each color urine but may be observed in neutral urine and
correlating with a different specific gravity con- rarely in an alkaline urine. Using bright-field mi-
centration. croscopy, calcium oxalate crystals appear as small,
colorless octahedrals or envelopelike forms, and
ltrate
54. they may also be observed in dumbbell or ovoid
osity
D. Trichloroacetic acid and sulfosalicylic acid are forms. These crystals are soluble in dilute hy-
ílS of
turbidimetric methods used to quantify small drochloric acid.
syn-
ly an amounts of protein, less than 100 mg/dL, ir~ cere-
ty of brospinal fluid (CSF) and urine . spec_nnens. 59.
esti- Coomassie brilliant blue is a colonmetnc dye A. When pleural, pericardial, and peritoneal fluids with
1 the
binding method in which protein complexes wi~h unknown abnormalities are examined, the following
n the the dye, forming a soluble blue comp_l~x: Th1s assays are generally performed: total protein, red and
s not method also exhibits the necessary sens1ttV1ty for white blood cell counts, differential count, Gram
detecting small quantities of protein. stain, culture, and cytologic evaluation. ln addition
to these tests, determination of values for any of the
following may also be warranted, depending on the
55.
IW Of A. As seen in Color Plate 51, hyaline casts are t~e particular case involved: glucose, amylase, lactate
dehydrogenase, pH, ammonia, creatinine, and alka-
.es or most commonly observed cast, and they cons1st
_
. f: t · A reterence line phosphatase. The general appearance of the
stics. completely of Tamm-Hors a 11 pro e111·
. . h . -ts per low-power specimen should always be noted.
o in- unne may contam 0-2 ya1me cas .
. . t anslucent usmg
:apil- fJeld. Hyalme casts appear r
they have a re- 60.
:d by bright-field microscopy because .
. Ph e contrast m1- B. The sensitivity of a method is the lowest conceu-
)Cyte fractive índex similar to unne. as b ·tt ·r
. 1· e the casts e e . tration of the analyte that will result in a detectable
! ofa croscopy may be used to v1sua 1z
420 • 7 ; URINALYSIS ANO BODY FLUIDS
reaction signal. The protein, bilirubin, and nitrite
readout color scales each have a color associated
with analyte concentrations Jess than the method's
sensitivity, called "negative." Urobilinogen's read-
out color scale begins with its lowest reportable
value, but there is no pad associated with concen-
trations less than this.
61.
A. ln the hepatic phase of bilirubin metabolism,
bilirubin is conjugated with glucuronic acid to
forro water-soluble conjugated bilirubin. The con-
jugated biJirubin passes into the bile duct and on
to the intestinal tract. ln the intestine, it is reduced
by intestinal bacteria to form urobilinogen. Bile
duct obstruction is characterized by an obstruction
of the t1ow of conjugated bilirubin into the intes-
tinal tract to complete its metabolism. The conju-
gated bilirubin, which is water soluble, will be
excreted by the kidney. Since bilirubin is not en-
tering the intestines, the normal production of uro-
bil inogen is decreased. Therefore, the urine
biochemical test will indicate a positive reagent
strip test for bilirubin, positive Ictotest, and "nor-
mal" (0.2 mg/dL) urobilinogen (since ~here is no
reagent strip pad for "negative" urobilinogen).
62.
B. Sperm counts are performed after complete lique-
faction with the use of a diluted samp le to charge
the hemacytometer. The seminal fluid is diluted
1:20 by means of a calibrated micropipet. The
diluent may be isotonic saline. The number of
sperm counted in 2 mm2 multiplied by 100,000
represents the quantity of sperm per milliliter.
Since these counts tend to be imprecise, it is rec-
ommended that both the dilution and the count be
performed in duplicate and the results averaged.
63.
C. The morphologic characteristics of spennatozoa are
best evaluated by means of smears stained with
.Papanicolaou stain. Other stains used include
Kernechtrot, Giemsa, basic fuchsin, crystal violet,
and hematoxylin. When oil immersion is used, a
minimum of 200 spermatozoa should be evaluated
for morphologic characteristics. Although sources
differ as to the exact number, it is generally estab-
lished that at least 60% of the spenn should have
normal morphologic features. When this micro-
scopic analysis is performcd, the presence of eryth-
rocytes, leukocytes, epithelial ceHs, and micro-
organisms should be indicated.
64.
O. f mmunoglobulins (lgG) are normally present at
less than 1 mg/dL in the CSF. Increased CSF lgG
can result from increased CSF production (e.g.,
multiple sclerosis) or from increased transport
from the blood plasma (compromised blood-brain
barrier). Neither gout, erythoblastosis feta li s (iso-
immunization syndrome), nor multiple myeloma
produces increased CSF IgG leveis.
65.
A. Many simplified yet immunologically sophisti-
cated methods exist currently for determining
pregnancy. Ali are based on the reaction between
patient chorionic gonadotropin (CG) and anti-CG.
Most kits will use an antibody recognizing one
subunit of CG (alpha or beta), while other kits
may use both anti-a-CG and anti-jj-CG. Internai
controls in these kits will only check if the pro-
cedural steps were performed correctly. They can-
not detect problems with any pre-analytical
variables, like specimen handling or appropriate-
ness. ln addition, internai quality control cannot
be used to assess the kit's accuracy in distinguish-
ing "positive" from "negative" specimens. Only
the use of externai quality contrai specimens can
accomplish this.
66.
O. Galactosemia, an inborn error of metabolism, is
characterized by the inability to metabolize ga lac-
tose, a monosaccharide that is contained in milk as
a constituent of the disaccharide, lactose. Thus
galactose appears in elevated leveis in the blood
and urine. The condition may result in liver dis-
ease, mental retardation, and cataract formation if
not treated or controlled. ln the biochemical analy-
sis of the urine, the conflicting results for the two
glucose tests may be explained as follows. The
glucose oxidase reagent strip test is specific
for glucose, therefore, the glucose will be nega-
tive. The clinitest, a modification of the Benedict's
test procedure, detects most reducing su bstances.
Since galactose is present in the urine and is a re-
ducing substance, the clinitest is positive.
67.
C. Renal tubular cells ongmate from the renal
medulla or cortex. Red blood cell crenation is a
 ANSWERS & RATIONALES: 61-67 • 421

tcro- phenomenon reflecting increased solute concen- REFERENCES

tration (hyperosmolality), and is not caused by
urine pH. Red cells will, however, lyse at high al-
kalíne pH. The nitrite reaction requires (a) a suffi-
1t at cient dietary source of nitrate, (b) sufficient
lgG numbers of bacteria present in the urine, (e) suffi-
e.g., cient incubation time (> 4 hours). Bacteria intro-
•port duced at collection, even in sufficient number. will
'rain not have had sufficient incubation time to convert
(iso- urine nitrate to nitrite. Pilocarpine iontophoresis is
oma the collection method for sweat.
Brunzel, N. A. (1994). Fundamentais of Urine and
Body Fluid Analysis. Philadelphia: W B. Saunders.
Lehman, C. A. ( 1998). Saunders Manual of Clínica/
Laboratory Science. Philadelphia: W B. Saunders.
Ringsrud, K. M., and Linné, J. J. (1995). Urinalysis
and Body Fluids- A Colar Text and Atlas. St.
Louis: Mosby-Year Book.
Strasinger, S. K., and DiLorenzo, M. S. (2001).
Urina~i,,ú'I and Body Fluids, 4th ed. Philadelphia:
E A. Davis Co.
Wallach, J. (1996). lnterpretation of Diagnostic Tests,
6th ed. New York: Little, Brown and Co.

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