Loresca, Kaycee-Clinical Micros

Loresca, Kaycee Gretz V.
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Clinical Microscopy
1. A ribbon-like stool consistency could be indicative of:

A. Cholera
B. Intestinal constriction
C. Dysentery
D. Cystic fibrosis
Answer: B, Intestinal constriction
A. Cholera- The clinical presentation of cholera ranges from an asymptomatic infection to a severe form,
resulting in watery diarrhea known as rice water stools, with a fluid loss of 500 to 1,000 ml/h. The fulminant
form is attributed to the ctx and tcpA genes.
Reference: de la Maza, L. M., Pezzlo, M. T., Bittencourt, C. E., & Peterson E. M. (2020) Color Atlas of Medical
Bacteriology (3rd Ed) page 135. ASM Press, Washington, DC.
B. Intestinal constriction
Based on Table 14-3: Macroscopic stool characteristics, possible caused of ribbon-like stool is intestinal
constriction.
Reference: Strasinger, S. K., & Di, L. M. S. (2014). Urinalysis and Body Fluids(6th Ed) page 259.
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C. Dysentery
Based on Table 14-3: Macroscopic stool characteristics, dysentery patient has blood-streaked mucus.
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D. Cystic fibrosis
2. Which of the following will not be detected by the leukocyte esterase pad?
A. Neutrophils
B. Trichomonas
C. Eosinophils
D. Lymphocytes
Answer: D, Lymphoctes
The LE test detects the presence of esterase in the granulocytic white blood cells (neutrophils, eosinophils,
and basophils) and monocytes, but not lymphocytes. Neutrophils are the leukocytes most frequently associated
with bacterial infections
Reference: Strasinger, S. K., & Di, L. M. S. (2014). Urinalysis and Body Fluids(6th Ed) page 90. Philadelphia: F.A.
Davis Co.
3. All of the following can be found incorporated into a cast matrix, EXCEPT:
A. WBCs
B. Urothelial cells
C. Bacteria
D. Lipids
Answer: B, Urothelial cells
A.WBCs- Any elements present in the tubular filtrate, including cells, bacteria, granules, pigments, and
crystals, may become embedded in or attached to the cast matrix. The types of casts found in the
sediment represent different clinical conditions and will be discussed separately in this section.
B. Urothelial cells- They are usually present in small numbers in normal urine, representing normal
cellular sloughing. Increased numbers of transitional cells seen singly, in pairs, or in clumps (syncytia)
are present following invasive urologic procedures such as catheterization and are of no clinical
significance
C. Bacteria- Any elements present in the tubular filtrate, including cells, bacteria, granules, pigments, and
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Clinical Microscopy
D. Lipids- Any elements present in the tubular filtrate, including cells, bacteria, granules, pigments, and
References: Strasinger, S. K., & Di, L. M. S. (2014). Urinalysis and Body Fluids(6th Ed) page 115. Philadelphia: F.A.
Davis Co.
Strasinger, S. K., & Di, L. M. S. (2014). Urinalysis and Body Fluids(6th Ed) page 122. Philadelphia: F.A.
Davis Co.
4. When using polarizing microscopy, which urinary sediment component does not exhibit “Maltese cross”
formation? (1) Oval fat bodies; (2) Starch granules; (3) Fatty casts; (4) Diaper fiber
A. 3 and 4
B. 1, 2 and 3
C. 4 only
D. 1, 2, 3 and 4
Answer: C, 4 only
Starch crystals frequently have a characteristic "greenish" appearance and a t-shaped notch in the center. Starch
forms a pseudo "Maltese Cross" when polarized. Starch crystals may be frequently seen in the urinary sediment
as a contaminant from powdered gloves or personal hygiene products. Small starch crystals may be confused
with fat droplets as shown in these examples. Note under polarized light, the Maltese Cross formed by the starch
crystal is less symmetrical. Diaper fiber does not show a “Maltese Cross”.
References: Turgeon, M. L., Linné, J. J., & Ringsrud, K. M. (2012). Linne & Ringsrud's clinical laboratory science:
The basics and routine techniques (6th ed.) page 409. Maryland Heights, MO: Elsevier/Mosby.
Strasinger, S. K., & Di, L. M. S. (2014). Urinalysis and Body Fluids(6th Ed) page 108. Philadelphia: F.A.
Davis Co.
5. In Lesch-Nyhan syndrome, the gene that codes for ____ enzyme is absent:
A. Phenylalanine hydroxylase
B. Homogentisic acid oxidase
C. Tyrosine
D. Hypoxanthine guanine phosphoribosyltransferase
Answer: D,Hypoxanthine guanine phosphoribosyltransferase
A. Phenylalanine hydroxylase-PKU is caused by failure to inherit the gene to produce the enzyme
phenylalanine hydroxylase. The gene is inherited as an autosomal recessive trait with no noticeable
characteristics or defects exhibited by heterozygous carriers.
References Strasinger, S. K., & Di, L. M. S. (2014). Urinalysis and Body Fluids(6th Ed) page 166. Philadelphia: F.A.
Davis Co.
B. Homogentisic acid oxidase- Alkaptonuria was one of the six original inborn errors of metabolism described
by Garrod in 1902. The name alkaptonuria was derived from the observation that urine from patients with this
condition darkened after becoming alkaline from standing at room temperature. Therefore, the term “alkali
lover,” or alkaptonuria, was adopted. This metabolic defect is actually the third major defect in the
phenylalanine-tyrosine pathway and occurs from failure to inherit the gene to produce the enzyme
homogentisic acid oxidase.
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C. Tyrosine - Tyrosyluria The accumulation of excess tyrosine in the plasma (tyrosinemia) producing urinary
overflow may be due to several causes and is not well categorized.
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Clinical Microscopy
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D. Hypoxanthine guanine phosphoribosyltrasnferase - A disorder of purine metabolism known as Lesch-

Nyhan disease that is inherited as a sex-linked recessive result in massive excretion of urinary uric acid crystals.
Failure to inherit the gene to produce the enzyme hypoxanthine guanine phosphoribosyltransferase is
responsible for the accumulation of uric acid throughout the body.
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6. Extinguishers containing dry chemicals are not recommended for fire caused by:
A. Wood and paper
B. Machines and devices
C. Magnesium
D. Organic solvents
Answer: C, Magnesium
A. Wood and paper- Based on Table 1-2, Extinguishers containing dry chemicals are recommended for fire
caused by Wood and paper.
B. Machines and Devices- Based on Table 1-2, Extinguishers containing dry chemicals are recommended for
fire caused by Wood and paper.
C. Magnesium- Based on Table 1-2, Extinguisher for fire caused by combustible metals should contain Sand or
dry powder.
D. Organic Solvents- Based on Table 1-2, Extinguishers containing dry chemicals are recommended for fire
caused by Wood and paper.
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7. Which urinary crystal can assume the greatest variety of forms?

A. Cystine
B. Phosphate
C. Oxalate
D. Uric acid
Answer: B.Phosphate
A. Cystine- Cystine crystals appear as colorless, hexagonal plates and may be thick or thin
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B.Phosphate- Phosphates represent the majority of the crystals seen in alkaline urine and include amorphous
phosphate, triple phosphate, and calcium phosphate .
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C.Oxalate- Calcium oxalate crystals are frequently seen in acidic urine, but they can be found in neutral urine
and even rarely in alkaline urine. The most common form of calcium oxalate crystals is the dihydrate that is
easily recognized as a colorless, octahedral envelope or as two pyramids joined at their bases
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Clinical Microscopy
D. Uric Acid- Uric acid crystals are seen in a variety of shapes, including rhombic, four-sided flat plates
(whetstones), wedges, and rosettes. They usually appear yellow-brown, but may be colorless and have a six-
sided shape, similar to cystine crystals
Reference: Turgeon, M. L., Linné, J. J., & Ringsrud, K. M. (2012). Linne & Ringsrud's clinical laboratory science:
8. Blood flows through the nephron in the following order:

A.
B. Efferent arteriole, glomerulus, peritubular capillaries, vasa recta, afferent arteriole, renal vein
C. Peritubular capillaries, afferent arteriole, glomerulus, vasa recta, efferent arteriole, renal vein
D. Afferent arteriole, glomerulus, peritubular capillaries, renal vein, vasa recta, efferent arteriole
E. Afferent arteriole, glomerulus, efferent arteriole, peritubular capillaries, vasa recta, renal vein
Answer: D. Afferent arteriole, glomerulus, efferent arteriole, peritubular capillaries, vasa recta, renal
vein
Blood enters the capillaries of the nephron through the afferent arteriole. It then flows through the glomerulus
and into the efferent arteriole. Before returning to the renal vein, blood from the efferent arteriole enters the
peritubular capillaries and the vasa recta and flows slowly through the cortex and medulla of the kidney close to
the tubules.
Reference: Strasinger, S. K., & Di, L. M. S. (2014). Urinalysis and Body Fluids(6th Ed) page 40-41. Philadelphia:
F.A. Davis Co.
9. The glomerular filtrate has a specific gravity of:

A. 1.005
B. 1.015
C. 1.010
D. 1.020
Answer: C. 1.010
The specific gravity of the plasma filtrate entering the glomerulus is 1.010. The term isosthenuric is used to
describe urine with a specific gravity of 1.010.
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10. The average total volume of urine produced by a normal adult every 24 hours is about:
A. 750 mL
B. 2000 mL
C. 1200 mL
D. 2400 mL
Answer: C. 1200 mL
In certain conditions, the volume of urine excreted in 24 hours is a valuable aid to clinical diagnosis. In normal
adults with normal fluid intake, the average 24-hour urine volume is 1200 to 1500 mL. It can, however, normally
range from 600 to 1600 mL.
References: Turgeon, M. L., Linné, J. J., & Ringsrud, K. M. (2012). Linne & Ringsrud's clinical laboratory science:
Taking these factors into consideration, although the normal daily urine output is usually 1200 to 1500 mL, a
range of 600 to 2000 mL is considered normal.
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11. Complete cessation of urine flow due to renal calculi or tumors:

A. Anuria
B. Polyuria
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Clinical Microscopy
C. Oliguria
D. Dysuria
Answer: Anuria
A. Anuria- complete absence of urine formation. Obstructive renal disease may result from renal or urinary
tract calculi, benign prostatic hypertrophy, chronic urinary tract infection, or urogenital malignancy.
Obstruction causes the hydrostatic pressure in Bowman’s space to increase. This pressure opposes
glomerular filtration. If the hydrostatic pressure in Bowman’s space equals the hydrostatic pressure in the
glomeruli, then filtrate will not be produced, resulting in anuria.
Reference: Turgeon, M. L., Linné, J. J., & Ringsrud, K. M. (2012). Linne & Ringsrud's clinical laboratory
science: The basics and routine techniques (6th ed.) page 372. Maryland Heights, MO: Elsevier/Mosby.
B. Polyuria -consistent elimination of an abnormally large volume of urine, more than 2000 mL/24 hours.
C. Oliguria: excretion of an abnormally small amount of urine, less than 500 mL/24 hours.
D. Dysuria - Painful urination
Reference:Strasinger, S. K., & Di, L. M. S. (2014). Urinalysis and Body Fluids(6th Ed) page 308. Philadelphia:
F.A. Davis Co.
12. A specimen containing 2 g/dL of glucose and 2 g/dL of protein has a specific gravity reading of 1.026 using a
reagent strip. What is the actual specific gravity reading?
A. 1.032
B. 1.018
C. 1.012
D. 1.026
Answer: 1.012
Corrections for glucose and protein must be calculated by subtracting 0.003 for each gram of protein present
and 0.004 for each gram of glucose present. The amount of protein or glucose present can be determined from
the chemical reagent strip tests.
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13. A positive nitrite test and a negative leukocyte esterase test is an indication of a:
A. Urinary tract infection
B. Specimen with lysed leukocytes
C. Specimen older than 2 hours
D. Candidiasis
Answer: Specimen older than 2 hours
A positive nitrite requires infection with a nitrate-reducing organism, dietary nitrate, and incubation of urine in
the bladder. Red blood cells and white blood cells rapidly decomposed in alkaline and hypotonic specimens.
Urine pH becomes alkaline when unpreserved urine specimen left at room temperature due to urea-splitting
bacteria present that produce ammonia, which is responsible for the increase in urine pH.
14. The precursor of the oval fat body is the:

A. Ovalocyte
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Clinical Microscopy
B. Urothelial cell
C. Squamous epithelial cell
D. Renal tubular cell
Answer: D. Renal Tubular Cell
A. Ovalocyte- ovalocytes are oval, or egg shaped, showing varying degrees of elliptical shaping from slightly
oval to almost a cylindrical form
Reference:Turgeon, M. L., Linné, J. J., & Ringsrud, K. M. (2012). Linne & Ringsrud's clinical laboratory
B. Urothelial cell- Transitional epithelial cells stain with a dark-blue nucleus and varying amounts of pale-
blue cytoplasm, which may have occasional inclusions. Some of these cells have tails and are
indistinguishable from the caudate cells of the renal pelvis.
Reference: Strasinger, S. K., & Di, L. M. S. (2014). Urinalysis and Body Fluids(6th Ed) page 114. Philadelphia:
F.A. Davis Co
C. Squamous epithelial cell- Squamous cells are the largest cells found in the urine sediment. They contain
abundant, irregular cytoplasm and a prominent nucleus about the size of an RBC.
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D. Renal tubular cell- RTE cells absorb lipids that are present in the glomerular filtrate. They then appear
highly refractile, and the nucleus may be more difficult to observe. These lipid-containing RTE cells are
called oval fat bodies.
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15. Leukocytes that stain pale blue with Sternheimer-Malbin stain and exhibit Brownian movement are:
A. Indicative of pyelonephritis
B. Basophils
C. Mononuclear leukocytes
D. Glitter cells
Answer: Glitter cells
A. Indicative of Pyelonephritis- The appearance of WBC casts in the urine signifies infection or
inflammation within the nephron. They are most frequently associated with pyelonephritis and are a
primary marker for distinguishing pyelonephritis (upper UTI) from cystitis (lower UTI).
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B. Basophils- The stages are described in terms of the staining reaction of the cytoplasm as it gains in Hb
concentration: basophilic cytoplasm is blue, polychromatophilic cytoplasm shows shades of blue and
gray as Hb increases, and orthochromic cytoplasm is orange-red.
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C. Mononuclear leukocytes- Specimens requiring dilution can be diluted in the manner described
previously, substituting 3% glacial acetic acid to lyse the RBCs. Adding methylene blue to the diluting
fluid stains the WBCs, providing better differentiation between neutrophils and mononuclear cells.
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Clinical Microscopy
D. Glitter cells-Neutrophils exposed to hypotonic urine absorb water and swell. Brownian movement of
the granules within these larger cells produces a sparkling appearance, and they are referred to as
“glitter cells.” When stained with Sternheimer-Malbin stain, these large cells stain light blue as opposed
to the violet color usually seen with neutrophils. Glitter cells are of no pathologic significance.
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16. Which of the following is(are) reported as number per LPF?

A. RBCs
B. Granular casts
C. T. vaginalis
D. All of these
Answer: D. All of these
Casts (RBC, blood, or granular) are the only elements found in the urinary sediment that are unique to the
kidney. Once detected, casts must be further identified as to composition using high-power magnification. They
are reported as the average number per 10 lpfs.
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17. An acceptable disinfectant for blood and body fluid decontamination is:
A. NaOH
B. H2O2
C. Sodium chloride
D. Sodium hypochlorite
Answer: D. Sodium hypochlorite
The most prevalent chlorine products in the United States are aqueous solutions of 5.25% to 6.15% sodium
hypochlorite, usually called household bleach. A 1:10 to 1:100 dilution of 5.25% to 6.15% sodium
hypochlorite (i.e., household bleach) or an EPA-registered tuberculocidal disinfectant has been
recommended for decontaminating blood spills. For small spills of blood (i.e., drops) on noncritical surfaces,
the area can be disinfected with a 1:100 dilution of 5.25% to 6.15% sodium hypochlorite or an EPA-
registered tuberculocidal disinfectant.
18. Centrifuging an uncapped specimen may produce a biological hazard in the form of:
A. Vectors
B. Sharps contamination
C. Aerosols
D. Specimen contamination
Answer: Aerosols
To prevent biohazardous aerosols, all specimens must be centrifuged in capped tubes. Particular care should
be taken to avoid splashes and aerosols when removing container tops, pouring specimens, and centrifuging
specimens. Specimens must never be centrifuged in uncapped tubes or in uncovered centrifuges.
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19. An employee who accidentally spills acid on his arm should immediately:
A. Hold the arm under running water for 15 mins
B. Neutralize the acid with a base
C. Consult the MSDS
D. Wrap the arm in gauze and go to the ER
Answer: Hold the arm under the running water for 15 mins.
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Clinical Microscopy
Because many injuries may be extreme, and because immediate care is critical with such injuries, all
laboratory personnel must thoroughly understand the application of the proper first-aid procedures. If alkali
or acid burns on the skin or in the mouth; rinse thoroughly with large amounts of running tap water. If the
burns are serious, consult a physician. Then if alkali or acid burns in the eye; wash out eye thoroughly with
running water for a minimum of 15 minutes. Help the victim by holding the eyelid open so water can make
contact with the eye.
Reference: Turgeon, M. L., Linné, J. J., & Ringsrud, K. M. (2016). Linne & Ringsrud's clinical laboratory science: The
basics and routine techniques (7th ed.) page 44. Maryland Heights, MO: Elsevier/Mosby.
20. Initial screening of the urine sediment is performed using an objective power of:
A. 4x
B. 40x
C. 10x
D. 100x
Answer: 10x
Microscopic examination should be performed in a consistent manner and include observation of a minimum
of 10 fields under both low (10×) and high (40×) power. The slide is first examined under low power to
detect casts and to ascertain the general composition of the sediment. When elements such as casts that
require identification are encountered, the setting is changed to high power.
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21. The best single indicator of renal disease is:

A. Glycosuria
B. Proteinuria
C. Polyuria
D. Pyuria
Answer: Proteinuria
In the detection and diagnosis of renal disease, probably the most significant finding involves urinary
protein. The occurrence of protein in the urine is termed proteinuria. Proteinuria is an abnormal condition,
probably the most important pathologic condition found in a routine urinalysis. The causes of proteinuria
are varied and can be grouped into three major categories: prerenal, renal, and postrenal, based on the
origin of the protein. This may may result from the following: (1) glomerular damage, (2) tubular damage, (3)
prerenal disorders or overflow from excessive production of low-molecular-weight proteins such as
hemoglobin, myoglobin, or immunoglobulins, (4) lower urinary tract disorders, or (5) asymptomatic
disorders.
22. Which of the following types of microscope will differentiate MSU and CPPD crystals based on their
birefringence?
A. Fluorescence microscope
B. Nomarski microscope
C. Polarizing microscope
D. Compensated polarizing microscope
Answer: D. Compensated polarizing microscope
A. Fluorescence microscope- Different fluorescent antibody techniques may be used in primary

identification of microorganisms or in the final identification of bacteria such as group A streptococci,
replacing older serologic methods.
B. Nomarski microscope-
C. Polarizing microscope- Polarizing microscopy is often used in geology for particle analysis and in forensic
medicine clinically. With the polarizing microscope, the optical properties of an object can be determined.
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Clinical Microscopy
D. Compensated polarizing microscope- CPPD crystals usually appear rhomboid-shaped or square but may
appear as short rods. They are usually located within vacuoles of the neutrophils. MSU crystals lyse
phagosome membranes and therefore do not appear in vacuoles. To avoid misidentification of CPPD
crystals, the classic rhomboid shape should be observed and confirmed with red compensated polarized
microscopy. Both MSU and CPPD crystals have the ability to polarize light. However, MSU is more highly
birefringent and appears brighter against the dark background.
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23. Reaction time for C-stix reagent strip for ascorbic acid:
A. 10 seconds
B. 45 seconds
C. 30 seconds
D. 60seconds
Answer: A.10 seconds
The ascorbic acid testing area of C-Stix reagent strips is impregnated with phosphomolybdates buffered in
an acid medium. The phosphomolybdates are reduced by ascorbic acid to molybdenum blue, and this test
detects 5 mg/dL of ascorbic acid in urine after 10 seconds.
Reference: McPherson, R. A., Pincus, M. R., & Henry, J. B. (2007). Henry's Clinical Diagnosis and Management by
Laboratory Methods (23rd Ed) page 458. Philadelphia: Saunders Elsevier.
24. Failure to mix a specimen prior to inserting the reagent strip will primarily affect the:
A. Blood reading
B. Nitrite reading
C. Glucose reading
D. pH reading
Answer: A. Blood reading
Formed elements such as red and white blood cells sink to the bottom of the specimen and will be
undetected in an unmixed specimen.
Reference: Strasinger, S. K., & Di, L. M. S. (2014). Urinalysis and Body Fluids(6th Ed) page 72. Philadelphia: F.A. Davis
Co
25. Not true about myoglobinuria: (1) Clear, red urine and pale yellow plasma; (2) Associated with rhabdomyolysis;
(3) Precipitated by ammonium sulfate; (4) Not precipitated by ammonium sulfate
A. 4 only
B. 1, 2 and 4
C. 3 only
D. 1, 2 and 3
Answer: C. 3 only
Myoglobin, a heme-containing protein found in muscle tissue, not only reacts positively with the reagent
strip test for blood but also produces a clear red-brown urine. It should be suspected in patients with
conditions associated with muscle destruction (rhabdomyolysis).
A precipitation test was used to screen for the presence of myoglobin; 2.8 g of ammonium sulfate are added
to 5 mL of centrifuged urine. After mixing and allowing the specimen to sit for 5 minutes, the urine is filtered
or centrifuged, and the supernatant is tested for a reaction for blood with a reagent strip. The principle of
this screening test is based on the fact that the larger hemoglobin molecules are precipitated by the
ammonium sulfate, and myoglobin remains in the supernatant.
Reference : Strasinger, S. K., & Di, L. M. S. (2014). Urinalysis and Body Fluids (6th Ed) page 84-85. Philadelphia: F.A.
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26. Human chorionic gonadotropin (hCG) peaks during what period of normal pregnancy?
A. 3 months
B. 7 months
C. 5 months
D. 9 months
Answer: A. 3 months
In a normal pregnancy, detectable amounts of about 25 mIU/mL β-hCG are secreted 2 to 3 days (48- 72
hours) after implantation, or approximately 8 to 10 days after conception or fertilization. Peak levels are
reached approximately 2 to 3 months after the last menstrual period. Levels rise rapidly after conception.
27. Performing bronchoalveolar lavage (BAL) is important in the diagnosis of ______ in immunocompromised
patients:
A. Primary atypical pneumonia
B. Pneumocystis jiroveci pneumonia
C. Tuberculosis
D. Paragonimiasis
Answer: Pneumocystis jiroveci pneumonia
A. Primary atypical pneumonia- The optimal test for diagnosis of infection caused by M. pneumoniae is nucleic
acid amplification. Both single assays and multiplex PCR assays, which detect several respiratory pathogens, are
commercially available. The best specimen is a nasopharyngeal swab, but bronchoalveolar lavage fluid and lung
tissue may be acceptable depending on the assay.
B. Pneumocystis jirovevi pneumonia- Pneumocystis jirovecii (carinii), most recently classified as a fungus but
formerly as a parasite, is best recovered by bronchoalveolar lavage or induced sputum in immunocompromised
patients. Open lung biopsy sample was the specimen of choice before the AIDS epidemic. Gomori methenamine
silver stain is used to identify the organism; it stains the cyst form but not the trophozoites.
Bronchoalveolar lavage is becoming an important diagnostic test for P. carinii in immunocompromised patients.
With P. carinii, characteristic amorphous material is seen microscopically under low power and organisms are
visible under high power.
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C. Tuberculosis- Acid-fast bacilli may be seen in urine sediment, but because the urethral flora may contain
nonpathogenic acid-fast organisms, the presence of tuberculosis in urine must be substantiated by culture
and/or polymerase chain reaction methods.
Reference:McPherson, R. A., Pincus, M. R., & Henry, J. B. (2007). Henry's Clinical Diagnosis and Management by
D. Paragonimiasis- Diagnosis is made by the finding of typical eggs in stool, sputum, or, occasionally, tissues.
Eggs of the different Paragonimus species cannot be readily differentiated, and specific identification may be
inferred from the area of origin. Operculate, unembryonated eggs measure 80 to 120 µm by 45 to 70 µm and
have a moderately thick, yellow-brown shell
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28. Renal calculi that are described as very hard, often of a dark color, and typically have a rough surface?
A. Calcium oxalate
B. Phosphate
C. Uric acid
D. Cystine
Answer: A. Calcium oxalate
A. Calcium oxalate- Approximately 75% of the renal calculi are composed of calcium oxalate or calcium
phosphate
Reference: Strasinger, S. K., & Di, L. M. S. (2014). Urinalysis and Body Fluids(6th Ed) page157. Philadelphia:
F.A. Davis Co
B. Phosphate- phosphate crystals are not frequently encountered. They may appear as colorless, flat
rectangular plates or thin prisms often in rosette formations.
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C. Uric Acid- Uric acid crystals have a variety of shapes and colors. Typically, they are yellow or reddish
brown, similar to the chemically related amorphous urates (Fig. 13-22, B). The typical shape is the
whetstone. Other shapes include rhombic plates or prisms, somewhat oval forms with pointed ends
(“lemon shaped”), and barrel-shaped forms. Wedges, rosettes, irregular plates, and laminated forms are
also seen
The basics and routine techniques (7th ed.) page 429. Maryland Heights, MO: Elsevier/Mosby
D. Cystine- Cystine crystals appear as colorless, hexagonal plates and may be thick or thin (Figs. 6–91 and 6–
92). Disintegrating forms may be seen in the presence of ammonia. They may be difficult to differentiate
from colorless uric acid crystals.
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29. True about Rivalta’s test:

A. Identify an unknown body fluid as synovial fluid
B. Positive in transudates
C. Positive in exudates
D. Identify fetal hemoglobin from stool or vomitus
Answer: Positive in exudates
30. Which of the following matches regarding specimen collection is/are incorrect? (1) Arthrocentesis – synovial
fluid; (2) Amniocentesis – amniotic fluid; (3) Thoracentesis – Ascitic fluid; (4) Pericardiocentesis – Pleural fluid
A. 1 and 2
B. 1 and 3
C. 3 and 4
D. 2 and 4
Answer: C, 3 and 4
Thoracentesis is a surgical puncture into the thoracic cavity to collect pleural fluid. While, pericardiocentesis is a
surgical puncture into the pericardial cavity to obtain pericardial fluid.
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31. The primary chemical constituents of normal urine are:

A. Protein, sodium and water
B. Urea, water and protein
C. Urea, chloride and water
D. Urea, bilirubin and glucose
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Answer: C. Urea, chloride and water
In general, urine consists of urea and other organic and inorganic chemicals dissolved in water. . Urea, a
metabolic waste product produced in the liver from the breakdown of protein and amino acids, accounts for
nearly half of the total dissolved solids in urine. The major inorganic solid dissolved in urine is chloride, followed
by sodium and potassium.
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Protein should not be present in normal urine because presence of protein can indicate an early renal disease. In
the detection and diagnosis of renal disease, probably the most significant finding involves urinary protein.
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However, the appearance of bilirubin in the urine can provide an early indication of liver disease. It is often
detected long before the patient exhibits jaundice.
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32. This provides a three-dimensional image showing very fine structural details by splitting the light ray so that the
beams pass through different area of the specimen
A. Interference contrast
B. Polarizing microscope
C. Fluorescent microscope
D. Electron microscope
Answer: A. Interference contrast
Interference-contrast microscopy provides a three-dimensional image showing very fine structural detail by
splitting the light ray so that the beams pass through different areas of the specimen.
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The use of polarized light aids in the identification of crystals and lipids. Both substances have the ability to
rotate the path of the unidirectional polarized light beam to produce characteristic colors in crystals and Maltese
cross formation in lipids.
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Fluorescence microscopy is a rapidly expanding technique used in the medical field today. It is used to detect
bacteria and viruses within cells and tissues through a technique called immunofluorescence.
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Electron microscopy is a type of microscope that uses accelerated electrons as a source of illumination.
33. A negative urine pregnancy test performed on a random specimen may need to be repeated using a:
A. Clean-catch specimen
B. Fasting specimen
C. First morning specimen
D. 24-hour specimen
Answer: C. First morning-specimen
A. As an alternative to the catheterized specimen, the midstream clean-catch specimen provides a safer, less
traumatic method for obtaining urine for bacterial culture and routine urinalysis. It provides a specimen that is
less contaminated by epithelial cells and bacteria.
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Clinical Microscopy
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B. The fasting state is defined as having no food or liquid other than water for 8 to 12 hours before blood
collection. Fasting specimens are not necessary for most laboratory determinations. Blood from fasting patients
is usually drawn in the morning before breakfast.
C. The first morning specimen is a concentrated specimen, thereby assuring detection of chemicals and formed
elements that may not be present in a dilute random specimen. Although it may require the patient to make an
additional trip to the laboratory, this is the ideal screening specimen. It is also essential for preventing false-
negative pregnancy tests. Also, the first morning urine specimen is required because it contains the highest
concentration of hormone.
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D. The most common tests requiring the 24-hour urine specimen include those measuring creatinine, urine urea
nitrogen, glucose, sodium, potassium, and substances such as catecholamines and 17-hydroxysteroids that are
affected by diurnal variations.
34. “Isosthenuria” is a term applied to a series of urine specimens from the same patient that exhibit a:
A. SG of exactly 1.000
B. SG of less than 1.005
C. SG of greater than 1.025
D. Fixed SG of approximately 1.010
Answer: D. Fixed SG of approximately 1.010
Isosthenuric is pertaining to urine specific gravity the same as the 1.010 of the glomerular filtrate.
Reference: Strasinger, S. K., & Di, L. M. S. (2014). Urinalysis and Body Fluids (6th Ed) page 310. Philadelphia: F.A.
Davis Co
35. A clinically significant epithelial cell is the:

A. RTE cell
B. Caudate cell
C. Clue cell
D. A and C
Answer: A. RTE cell
RTE cells are the most clinically significant of the epithelial cells. The presence of increased amounts is
indicative of necrosis of the renal tubules, with the possibility of affecting overall renal function.
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A variation of the squamous epithelial cell is the clue cell, which does have pathologic significance. Clue cells are
indicative of vaginal infection by the bacterium Gardnerella vaginalis. They appear as squamous epithelial cells
covered with the Gardnerella coccobacillus.
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36. When using the glass slide and coverslip method, which of the following might be missed if the coverslip is
overflowed?
A. Crystals
B. Casts
C. WBCs
D. RTE cells
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Clinical Microscopy
Answer: B. Casts
The volume of sediment placed on the microscope slide should be consistent for each specimen. When using the
conventional glass-slide method, the recommended volume is 20 µ L (0.02 mL) covered by a 22 × 22 mm glass
cover slip. Allowing the specimen to flow outside of the cover slip may result in the loss of heavier elements such
as casts.
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37. The finding of dysmorphic RBCs is indicative of:

A. Renal lithiasis
B. Glomerulonephritis
C. Rhabdomyolysis
D. Hemophilia A
Answer: B. Glomerulonephritis
A. Approximately 75% of the renal calculi are composed of calcium oxalate or calcium phosphate. Magnesium
ammonium phosphate (struvite), uric acid, and cystine are the other primary calculi constituents.
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B. RBCs that vary in size, have cellular protrusions, or are fragmented are termed dysmorphic and have been
associated primarily with glomerular bleeding. The presence of RBCs in the urine is associated with damage to
the glomerular membrane or vascular injury within the genitourinary tract.
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C. In myoglobinuria, the presence of myoglobin rather than hemoglobin should be suspected in patients with
conditions associated with muscle destruction (rhabdomyolysis).
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D. The term hemophilia A, the classic form of the disorder, is adopted to designate the hereditary disease caused
by a deficiency in the factor VIII:C subunit. Patients with severe hemophilia A have a history of bleeding into
joints and intramuscular hemorrhage.
The basics and routine techniques (7th ed.) page 363 . Maryland Heights, MO: Elsevier/Mosby.
38. The primary component of urinary mucus is:

A. Tamm-Horsfall protein
B. Uromodulin
C. Goblet cells
D. A and B
Answer: D. A and B
Immunologic analysis has shown that uromodulin is a major constituent of mucus. Uromodulin is a glycoprotein
excreted by the RTE cells of the distal convoluted tubules and upper collecting ducts. Tamm-Horsfall protein
(uromodulin) produced by the renal tubular epithelial cells; and proteins from prostatic, seminal, and vaginal
secretions. Uromodulin is a more recent name for Tamm-Horsfall protein. Uromodulin is routinely produced in
the distal convoluted tubule
References: Strasinger, S. K., & Di, L. M. S. (2014). Urinalysis and Body Fluids (6th Ed) page 75. Philadelphia: F.A.
Davis Co
Strasinger, S. K., & Di, L. M. S. (2014). Urinalysis and Body Fluids (6th Ed) page 120. Philadelphia: F.A.
Davis Co
39. What is the normal value for urinary eosinophils?

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Clinical Microscopy
A. >10%
B. >1%
C. <1%
D. <10%
Answer: C. <1%
Eosinophils are not normally seen in the urine; therefore, the finding of more than 1% eosinophils is considered
significant. For example, the presence of urinary eosinophils is primarily associated with drug-induced
interstitial nephritis. Also, small numbers of eosinophils may be seen with urinary tract infection (UTI) and renal
transplant rejection.
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40. Which of the following cell types is responsible for the secretion of hydrochloric acid in the stomach?
A. Parietal cells
B. G cells
C. Chief cells
D. All of these
Answer: A.Parietal cells
In cephalic phase of gastric secretion, anticipation of food (i.e., hunger response) has four effects on the stomach.
First, gastrin is secreted into the blood by specialized G cells in the pyloric gland and stomach and by the delta
cells of the pancreas. Then, gastrin induces secretion of hydrochloric acid by parietal cells of the gastric glands in
the proximal body and fundus, and secretion of pepsin by the chief cells. Then, vagal excitation lowers the
threshold of parietal cells to gastrin stimulation. Finally, gastric peristalsis and emptying of stomach is promoted.
Reference: Hubbard, J.D. (2010). A Concise Review of Clinical Laboratory Science (2nd Ed) page 354. Philadelphia:
Lippincott Williams & Wilkins
41. A sweat chloride of 70 mEq/L is indicative of:

A. Multiple sclerosis
B. Cystic fibrosis
C. Excessive sweating
D. Biliary obstruction
Answer: B. Cystic fibrosis
A diagnosis of multiple sclerosis is usually confirmed by demonstration of oligoclonal banding in the CSF, which
is not present in the serum and particularly when accompanied by an increased IgG index.
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The Chloride content of sweat is useful in diagnosing cystic fibrosis, a disease of the exocrine glands. Affected
infants usually have concentrations of sweat Cl– greater than 60mmol/L; affected adults have concentrations
greater than 70mmol/L (reference values average about 40mol/L).
42. The presence of white blood cells and bacteria and the absence of casts may be an indication of:
A. Acute interstitial nephritis
B. Cystitis
C. Acute pyelonephritis
D. Acute tubular necrosis
Answer: B. Cystitis
A. Acute interstitial nephritis

In acute interstitial nephritis, urinalysis results include hematuria, possibly macroscopic, mild to moderate
proteinuria, numerous WBCs, and WBC casts without bacteria.
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Clinical Microscopy
B. Cystitis
In cystitis, urinalysis reveals the presence of numerous WBCs and bacteria, often accompanied by mild
proteinuria and hematuria and an increased pH
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C. Acute pyelonephritis
In acute pyelonephritis, Urinalysis results are similar to those seen in cystitis, including numerous
leukocytes and bacteria with mild proteinuria and hematuria. The additional finding of WBC casts,
signifying infection within the tubules, is of primary diagnostic value for both acute and chronic
pyelonephritis. Sediments also should be carefully observed for the presence of bacterial casts.
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D. Acute tubular necrosis

In acute tubular necrosis, urinalysis findings include mild proteinuria, microscopic hematuria, and, most
noticeably, the presence of RTE cells and RTE cell casts containing tubular fragments consisting of three or
more cells.
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43. They serve as nurse cells for the developing sperm cells:
A. Sertoli cells
B. Round cells
C. Spermatids
D. Cytotrophoblast cells
Answer: A. Sertoli cells
The Sertoli cell, which is a nurse cell in intimate contact with all sperm cells and which regulates many aspects of
spermatogenesis.
Reference: White, B.A, Harrisson, J.R. & Mehlmann, L.M. (2019). Endocrine and Reproductive Physiology page
188. Missouri: Elsevier, Inc.
Specialized Sertoli cells provide support and nutrients for the germ cells as they undergo mitosis and meiosis
(spermatogenesis).
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44. Broad and waxy casts are most likely associated with:
A. Nephrotic syndrome
B. Acute renal failure
C. End-stage renal disease
D. Focal segmental glomerulosclerosis
Answer: End-stage renal disease
The progression to end-stage renal disease is characterized by a marked decrease in the glomerular filtration
rate (less than 25 mL/min); steadily rising serum BUN and creatinine values (azotemia); electrolyte imbalance;
lack of renal concentrating ability producing an isosthenuric urine; proteinuria; renal glycosuria; and an
abundance of granular, waxy, and broad casts, often referred to as a telescoped urine sediment.
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45. Casts are formed primarily in which portion of the kidney?

A. Proximal convoluted tubule
B. Glomerulus
C. Collecting duct
D. A and C
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Clinical Microscopy
Answer: C. Collecting Duct
Casts are the only elements found in the urinary sediment that are unique to the kidney. They are formed within
the lumens of the distal convoluted tubules and collecting ducts, providing a microscopic view of conditions
within the nephron.
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46. A parasite associated with a positive leukocyte esterase is:

A. Enterobius vermicularis
B. Trichomonas vaginalis
C. Schistosoma haematobium
D. Candida albicans
Answer: B. Trichomonas vaginalis
A positive LE test result is most frequently accompanied by the presence of bacteria, may or may not produce a
positive nitrite reaction. Infections caused by Trichomonas, Chlamydia, yeast, and inflammation of renal tissues
(i.e., interstitial nephritis) produce leukocyturia without bacteriuria. Esterases also are present in Trichomonas
and histiocytes.
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47. Which of the following amino acid(s) is (are) not affected in cystinuria? (1) Arginine (2) Leucine; (3) Ornithine;
(4) Cystine
A. 2 only
B. 1, 2, 3 and 4
C. 1, 3 and 4
D. None of these
Answer: A. 2 only
As the name implies, cystinuria is marked by elevated amounts of the amino acid cystine in the urine. The
demonstration that not only cystine but also lysine, arginine, and ornithine are not reabsorbed has ruled out the
possibility of an error in metabolism even though the condition is inherited.
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48. What is the positive color in Micral test?

A. Yellow
B. Red
C. White
D. Purple
Answer: B. Red
In micral test, reagent strips contain a gold-labeled antihuman albumin antibody-enzyme conjugate. Albumin in
the urine binds to the antibody. The conjugated enzyme reacts with the substrate, producing colors ranging from
white to red. Results range from 0 to 10 mg/dL.
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49. Incorrect statement regarding renal tubular acidosis: (1) Urine pH is acidic; (2) Blood pH is alkaline (3) Inability
to secrete hydrogen ions; (4). Metabolic acidosis
A. 1 and 2
B. 3 and 4
C. 2, 3 and 4
D. 1, 2, 3 and 4
E.
Answer: A. 1 and 2
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Clinical Microscopy
In classic renal tubular acidosis, glomerular filtration is normal, but the distal tubular ability to form ammonia
and exchange hydrogen ions for cations is defective. Systemic acidosis results. The urine is relatively alkaline,
and the pH cannot be lowered below 6 to 6.5, even with administration of an acid-loading substance.
50. Not true about glomerulus: (1) Nonselective filter of plasma substances with a MW of <70kDa; (2) Albumin is
normally filtered because it has a MW of 66kDa; (3) Positively-charged; (4). Concentration tests are used to
evaluate glomerular filtration
A. 1, 2 and 3
B. 1 and 4
C. 2, 3 and 4
D. 1 only
Answer: C. 2,3 and 4
The glomerular capillaries are covered by the inner layer of Bowman’s capsule, forming a semipermeable
membrane that allows passage of all substances with molecular weights less than about 70,000 Daltons. The
normal glomerular membrane allows the passage of proteins with molecular weights of 50,000 to 60,000 D or
less. Albumin has a molecular weight of about 67,000 D. This is a fairly small molecule, and some albumin is
normally filtered through the glomerulus. Creatinine clearance test is used to evaluate glomerular filtration.
Because creatinine is normally found at a relatively constant level in the blood, it provides the laboratory with
an endogenous procedure for evaluating glomerular function.
References: Strasinger, S. K., & Di, L. M. S. (2014). Urinalysis and Body Fluids (6th Ed) page 47. Philadelphia: F.A.
Davis Co
Turgeon, M. L., Linné, J. J., & Ringsrud, K. M. (2016). Linne & Ringsrud's clinical laboratory science:
The basics and routine techniques (7th ed.) page 388-389 . Maryland Heights, MO: Elsevier/Mosby.

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1. A ribbon-like stool consistency could be indicative of:

Answer: B, Intestinal constriction

Answer: B, Urothelial cells

Answer: D,Hypoxanthine guanine phosphoribosyltransferase

D. Hypoxanthine guanine phosphoribosyltrasnferase - A disorder of purine metabolism known as Lesch-

7. Which urinary crystal can assume the greatest variety of forms?

8. Blood flows through the nephron in the following order:

9. The glomerular filtrate has a specific gravity of:

11. Complete cessation of urine flow due to renal calculi or tumors:

D. Dysuria - Painful urination

Answer: Specimen older than 2 hours

14. The precursor of the oval fat body is the:

Answer: D. Renal Tubular Cell

Answer: Glitter cells

16. Which of the following is(are) reported as number per LPF?

Answer: D. All of these

Answer: D. Sodium hypochlorite

21. The best single indicator of renal disease is:

Answer: D. Compensated polarizing microscope

A. Fluorescence microscope- Different fluorescent antibody techniques may be used in primary

Answer: A.10 seconds

Answer: A. Blood reading

Answer: Pneumocystis jiroveci pneumonia

Answer: A. Calcium oxalate

29. True about Rivalta’s test:

Answer: Positive in exudates

31. The primary chemical constituents of normal urine are:

Answer: C. Urea, chloride and water

Answer: A. Interference contrast

Answer: C. First morning-specimen

Answer: D. Fixed SG of approximately 1.010

35. A clinically significant epithelial cell is the:

Answer: A. RTE cell

37. The finding of dysmorphic RBCs is indicative of:

38. The primary component of urinary mucus is:

39. What is the normal value for urinary eosinophils?

Answer: A.Parietal cells

41. A sweat chloride of 70 mEq/L is indicative of:

Answer: B. Cystic fibrosis

A. Acute interstitial nephritis

D. Acute tubular necrosis

Answer: A. Sertoli cells

Answer: End-stage renal disease

45. Casts are formed primarily in which portion of the kidney?

Answer: C. Collecting Duct

46. A parasite associated with a positive leukocyte esterase is:

Answer: B. Trichomonas vaginalis

48. What is the positive color in Micral test?

Answer: C. 2,3 and 4

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