Progress Exam - Clinical Micros

PROGRESS EXAM: CLINICAL
MICROSCOPY
Total points 81/125
LEMAR REVIEW HUB
Email *
minshi12june24@gmail.com
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KEY *
02-07242022
SURNAME, FIRST NAME *
VILLANUEVA, ANGELICA
SCHOOL *
FEU MANILA
LRH SECTION *
SECTION A
SECTION B
SECTION C
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CHECK 4 BOXES: Variables in the Cockroft and Gault formula. * 0/1
Urine ceatinine
Serum creatinine
Age
Race
Gender
Body weight in kilograms
BUN
Albumin
Correct answer
Serum creatinine
Age
ge
Gender
CHECK 6 BOXES: Variables in the MODIFICATION OF DIET IN RENAL *0/1

DISEASE (MDRD) formula.
Urine ceatinine
Serum creatinine
Age
Race
Gender
BUN
Albumin
Correct answer
Serum creatinine
Age
Race
Gender
BUN
Albumin

In the urinalysis laboratory the primary source in the chain of infection *1/1
would be:
Patients
Needlesticks
Specimens
Biohardous wastes
Feedback
In the clinical laboratory, the most direct contact with a source of infection is through
contact with patient specimens, although contact with patients and infected objects also
occurs.
All of the following should be discarded in biohazardous waste *0/1

containers except:
Urine specimen containers
Towels used for decontamination
Disposable lab coats
Blood collection tubes
Correct answer
Co ect a s e
Urine specimen containers
An acceptable disinfectant for blood and body fluid decontamination is: * 1/1
Sodium hydroxide
Antimicrobial soap
Hydrogen peroxide
Sodium hypochlorite
Centrifuging an uncapped specimen may produce a biologic hazard in the *1/1

form of:
Vectors
Sharps contamination
Aerosols
Specimen contamination
The first thing to do when a fire is discovered is to: * 1/1
Rescue person in danger

Activate the alarm system
Close doors to other areas
Extinguish the fire if possible
If a red rash is observed after removing gloves, the employee: * 1/1
May be washing her hands too often
May have developed a latex allergy
Should apply cortisone cream
Should not rub the hands so vigorously
The classification of a fire that can be extinguished with water is: * 1/1
Class A
Class B
Class C
Class D

Employers are required to provide free immunization for: * 1/1
HIV
HTLV-1
HBV
HCV
The current routine infection control policy developed by CDC and *0/1
followed in all health-care settings is:
Universal precautions
Isolation precautions
Blood and body fluid precautions
Standard precations
Correct answer
Standard precations
Feedback
In 1987 the CDC instituted Universal Precautions (UP). Under
UP all patients are considered to be possible carriers of bloodborne
pathogens.
In 1996 the CDC and the Healthcare Infection Control Practices Advisory Committee
(HICPAC) combined the major features of UP and blood safety isolation (BSI) guidelines
and called the new guidelines Standard Precautions.
Which of the following would be least affected in a specimen that has *1/1
remained unpreserved at room temperature for more than 2 hours?
Urobilinogen
Ketones
Protein
Nitrite
Which of the tubules is impermeable to water? * 1/1
Proximal convoluted tubule
Descending loop of Henle
Ascending loop of Henle
Distal convoluted tubule

Decreased production of ADH: (two possible answers) * 1/1
Produces a large volume of urine
Produces high urine volume
Increases ammonia excretion
Affects active transport of sodium
Feedback
Two possible answers:
In diabetes insipidus: deficiency of ADH
High or large urine volume
Decreased urine specific gravity
The largest source of error in creatinine clearance tests is: * 1/1
Secretion of creatinine
Improperly timed urine specimens
Refrigeration of the urine
Time of collecting blood sample

Variables that are included in the MDRD-IDSM estimated creatinine *1/1

clearance calculations include all of the following except:
Serum creatinine
Weight
Age
Gender
A patient with a viscous orange specimen may have been: * 1/1
Treated for urinary tract infection
Taking vitamin B
Eating fresh carrots
Taking antidepressants
Feedback
Phenazopyridine (Pyridium)
Drug commonly administered for urinary tract infections

Orange in alkaline urine, colorless in acid urine. 0/1
Phenazopyridine (Pyridium)
Phenindione
Methyldopa
Metronidazole (Flagyl)
Correct answer
Phenindione
Feedback
PHENINDIONE
Anticoagulant, orange in alkaline urine, colorless in acid urine
The principle of refractive index is to compare: * 0/1
Light velocity in solutions with light velocity in solids
Light velocity in air with light velocity in solutions
Light scattering by air with light scattering by solutions
Light scattering by particles in solution
C t
Correct answer
Light velocity in air with light velocity in solutions
A specimen with a specific gravity of 1.001 would be considered: * 1/1
Hyposthenuric
Not urine
Hypersthenuric
Isosthenuric
Feedback
Specimens measuring lower than 1.002 probably are not urine.
Most random specimens fall between 1.015 and 1.030.
Leaving excess urine on the reagent strip after removing it from the *1/1
specimen will:
Cause run-over between reagent pads
Alter the color of the specimen
Cause reagents to leach from the pads
Not affect the chemical reactions

Testing a refrigerated specimen that has not warmed to room *0/1

temperature will adversely affect:
Enzymatic reactions
Dye-binding reactions
Sodium nitroprusside reaction
Diazo reactions
Correct answer
Enzymatic reactions
Quality control of reagent strips is performed: * 1/1
Using positive and negative controls
When results are questionable
At least once every 24 hours
All of the above
Feedback
Quality Control: REAGENT STRIP TESTING
1. Test open bottles of reagent strips with known positive and negative controls every 24
1. Test open bottles of reagent strips with known positive and negative controls every 24
hours.
2. Resolve control results that are out of range by further testing.
3. Test reagents used in backup tests with positive and negative controls.
4. Perform positive and negative controls on new reagents and newly opened bottles of
reagent strips.
5. Record all control results and reagent lot numbers.
All of the following are important to protect the integrity of reagent strips *0/1
except:
Removing the desiccant from the bottle
Storing in an opaque bottle
Storing at room temperature
Resealing the bottle after removing a strip
Correct answer
Removing the desiccant from the bottle
A urine specimen with a pH of 9.0: * 1/1
Indicates metabolic acidosis
Should be recollected
May contain calcium oxalate crystals
Is seen after drinking cranberry juice
Feedback
A pH above 8.5 is associated with an improperly preserved specimen and indicates that a
fresh specimen should be obtained to ensure the validity of the analysis.
The principle of the protein error of indicators reaction is that: * 1/1
Protein keeps the pH of the urine constant
Albumin accepts hydrogen ions from the indicator
Indicator accepts hydrogen ions from albumin
Albumin changes the pH of the urine
Testing for microalbuminuria is valuable for early detection of kidney *1/1

disease and monitoring patients with:
Hypertension
Diabetes mellitus
Cardiovascular disease risk
All of the above
Feedback
Microalbuminuria
The development of diabetic nephropathy leading to reduced glomerular filtration and

eventual renal failure is a common occurrence in persons with both type 1 and type 2
diabetes mellitus. Onset of renal complications can first be predicted by detection of
microalbuminuria, and the progression of renal disease can be prevented through better
stabilization of blood glucose levels and control of hypertension. The presence of
microalbuminuria is also associated with an increased
risk of cardiovascular disease.
The primary reason for performing a Clinitest is to: * 1/1
Check for high ascorbic acid levels
Confirm a positive reagent strip glucose
Check for newborn galactosuria
Confirm a negative glucose reading
A speckled pattern on the blood pad of the reagent strip indicates: * 1/1
Hematuria
Hemoglobinuria
Myoglobinuria
All of the above

An elevated urine bilirubin with a normal urobilinogen is indicative of: * 0/1
Cirrhosis
Hemolytic disease
Hepatitis
Biliary obstruction
Correct answer
Biliary obstruction
A positive nitrite test and a negative leukocyte esterase test is an *1/1

indication of a:
Dilute random specimen
Specimen with lysed leukocytes
Vaginal yeast infection
Specimen older than 2 hours
Feedback
Possible bacterial contamination

Initial screening of the urine sediment is performed using an objective *1/1

power of:
4x
10x
40x
100x
Feedback
LPO:10x
Crenated RBCs are seen in urine that is: * 1/1
Hyposthenuric
Hypersthenuric
Highly acidic
Highly alkaline

Differentiation among RBCs, yeast, and oil droplets maybe accomplished *1/1
by all of the following except:
Observation of budding in yeast cells
Increased refractility of oil droplets
Lysis of yeast cells by acetic acid
Lysis of RBCs by acetic acid
When pyuria is detected in a urine sediment, the slide should be carefully *1/1
checked for the presence of:
RBCs
Bacteria
Hyaline casts
Mucus
Feedback
An increase in urinary WBCs is called pyuria and indicates the presence of an infection or
inflammation in the genitourinary system.
The largest cells in the urine sediment are: * 1/1
Squamous epithelial cells
Urothelial epithelial cells
Cuboidal epithelial cells
Columnar epithelial cells
Following an episode of hemoglobinuria, RTE cells may contain: * 1/1
Bilirubin
Hemosiderin granules
Porphobilinogen
Myoglobin
Feedback
Following episodes of hemoglobinuria (transfusion reactions, paroxysmal nocturnal

hemoglobinuria, etc.), the RTE cells may contain the characteristic yellow-brown
hemosiderin granules. The granules may also be seen free-floating in the urine sediment.
Confirmation of the presence of hemosiderin is performed by staining the urine sediment

with Prussian blue.
A structure believed to be an oval fat body produced a Maltese cross *0/1

formation under polarized light but does not stain with Sudan III. The
structure:
Contains cholesterol
Is not an oval fat body
Contains neutral fats
Is contaminated with immersion oil
Correct answer
Contains cholesterol
The finding of yeast cells in the urine is commonly associated with: * 1/1
Cystitis
Diabetes mellitus
Pyelonephritis
Liver disorders
Feedback
Yeast cells, primarily Candida albicans, are seen in the urine of diabetic patients,
immunocompromised patients, and women with vaginal moniliasis. The acidic, glucose-
containing urine of patients with diabetes provides an ideal medium for the growth of
yeast.
All of the following contribute to urinary crystals formation except: * 1/1
Protein concentration
pH
Solute concentration
Temperature
Feedback
Crystals are formed by the precipitation of urine solutes, including inorganic salts, organic
compounds, and medications (iatrogenic compounds). Precipitation is subject to changes
in temperature, solute concentration, and pH, which affect solubility.
Casts and fibers can usually be differentiated using: * 1/1
Solubility characteristics
Patient history
Polarized light
Fluorescent light
Feedback
Examination under polarized light can frequently differentiate between fibers and casts.
Fibers often polarize, whereas casts, other than fatty casts, do not polarize.
Three-dimensional images: * 0/1
Bright-field microscope
Phase contrast microcope
Interference contrast microscope
Fluorescent microscope
Correct answer
Interference contrast microscope
Feedback
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.
Anti-neutrophilic cytoplasmic antibody is diagnostic for: * 0/1
IgA nephropathy
Wegener granulomatosis
Henoch-Schönlein purpura
Goodpasture syndrome
Correct answer
Wegener granulomatosis
The only protein produced by the kidney is: * 1/1
Albumin
Uromodulin
Uroprotein
Globulin
The presence of renal tubular epithelial cells and casts is an indication of: * 1/1
Acute interstitial nephritis
Chronic glomerulonephritis
Minimal change disease
Acute tubular necrosis

Urinalysis on a patient with severe back pain being evaluated for renal *1/1
calculi would be most beneficial if it showed:
Heavy proteinuria
Low specific gravity
Uric acid crystals
Microscopic hematuria
Feedback
Urine specimens from patients suspected of passing or being in the process of passing
renal calculi are frequently received in the laboratory. The presence of microscopic
hematuria resulting from irritation to the tissues by the moving calculus is the primary
urinalysis finding.

False-positive levels of 5-HIAA can be caused by a diet high in: * 1/1
Meat
Carbohydrates
Starch
Bananas
Feedback
Patients must be given explicit dietary instructions before collecting any sample to be
tested for 5-HIAA, because serotonin is a major constituent of foods such as bananas,
pineapples, and tomatoes.
Medications, including phenothiazines and acetanilids, also interfere with results. Patients
should be directed to withhold medications for 72 hours before specimen collection.

Which type of urine sample is needed for a D-xylose absorption test on an *1/1
adult patient?
24-hour urine sample collected with 20 mL of 6N HCl
2-hour timed postprandial urine preserved with boric acid
5-hour timed urine kept under refrigeration
Random urine preserved with formalin
Feedback
The D-xylose absorption test is used to distinguish pancreatic insufficiency from intestinal
malabsorption.
The test requires a blood sample taken 2 hours after oral administration of 25 g of D-
xylose, and a 5-hour timed urine sample.
D-xylose is absorbed without the aid of pancreatic enzymes, and is not metabolized by the
liver. Therefore, deficient absorption (denoted by a plasma level < 25 mg/dL and urine
excretion of < 4g/5hours) points to malabsorption syndrome.

In automated microscopy, Sysmex UF series, the DNA within the cells is *0/1
stained by the orange dye:
Carbocyanine
Phenathridine
Eosin
Bromcresol green
Correct answer
Phenathridine
Feedback
The DNA within the cells is stained by the orange dye, phenathridine; the nuclear
membranes, mitochondria, and negatively charged cell membranes are stained with a
green dye, carbocyanine.

In automated microscopy, Sysmex UF series, the nuclear membranes, *0/1
mitochondria, and negatively charged cell membranes are stained with a
green dye:
Carbocyanine
Phenathridine
Eosin
Bromcresol green
Correct answer
Carbocyanine
Feedback
The DNA within the cells is stained by the orange dye, phenathridine; the nuclear
membranes, mitochondria, and negatively charged cell membranes are stained with a
green dye, carbocyanine.

The UF-100 and UF-50 use laser-based flow cytometry along with: * 1/1
Impedance detection
Imedance detection and forward light scatter
Impedance detection and fluorescence
Impedance detection and forward light scatter
Impedance detection, forward light scatter and fluorescence
Feedback
The UF-100 and UF-50 use laser-based flow cytometry along with impedance detection,
forward light scatter, and fluorescence to identify the individual characteristics and stained
urine sediment particles in a flowing stream.

Graphic display of size distribution of any small sediment particles *1/1
(ranging from 1 to 6 um2) found during the microscopic examination;
helps to decide whether bacteria are present in these small ranges or if
the detected particles are small crystals or amorphous.
Near-infrared reflectance spectroscopy
Reflectance photomtery
Small-particle histogram
Mass gravity meter
Feedback
IRIS SLIDELESS MICROSCOPE
Small particle histograms are graphic display of size distribution of f any small sediment
particles (ranging from 1 to 6 um2) found during the microscopic examination. The
histograms help to decide whether bacteria are present in these small ranges or if the
detected particles are small crystals or amorphous.
The functions of the CSF include all of the following except: * 0/1
Removing metabolic wastes
Producing an ultrafiltrate of plasma
Supplying nutrients to the CNS

Protecting the brain and spinal cord
Correct answer
Producing an ultrafiltrate of plasma
What department is the CSF tube labeled 3 routinely sent to? * 1/1
Hematology
Chemistry
Microbiology
Serology
The presence of xanthochromia can be caused by all of the following *0/1

except:
Immature liver function
RBC degradation
A recent hemorrhage
Elevated CSF protein
Correct answer
A recent hemorrhage

A web-like pellicle in a refrigerated CSF specimen indicates: * 1/1
Tubercular meningitis
Multiple sclerosis
Primary CNS malignancy
Viral meningitis
CSF total cell count is diluted with: * 0/1
Distilled water
Normal saline
Acetic acid
Hypotonic saline
Correct answer
Normal saline
Feedback
Dilutions for total cell counts are made with normal saline, mixed by inversion, and loaded
into the hemocytometer with a Pasteur pipette.
A CSF WBC count is diluted with: * 1/1
Distilled water
Normal saline
Acetic acid
Hypotonic saline
Feedback
Lysis of RBCs must be obtained before performing the WBC count on either diluted or
undiluted specimens. 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.

A total CSF cell count on a clear fluid should be: * 1/1
Reported as normal
Not reported
Diluted with normal saline
Counted undiluted
Feedback
Clear specimens may be counted undiluted, provided no overlapping of cells is seen

during the microscopic examination. When dilutions are required, calibrated automatic
pipettes, not mouth pipetting, are used.
The purpose of adding 30% albumin to CSF before cytocentrifugation is *1/1

to:
Increase the cell yield
Decrease the cellular distortion
Improve cellular staining
Increase cell yield and decrease cellular distortion

Feedback
As little as 0.1 mL of CSF combined with one drop of 30% albumin produces an adequate
cell yield when processed with the cytocentrifuge. Adding albumin increases the cell yield
and decreases the cellular distortion frequently seen on cytocentrifuged specimens.
Neutrophils with pyknotic nuclei may be mistaken for: * 1/1
Lymphocytes
Nucleated RBCs
Malignant cells
Spindle-shaped cells
Feedback
Neutrophils with pyknotic nuclei indicate degenerating cells. They may resemble nucleated
red blood cells (NRBCs) but usually have multiple nuclei.

Macrophages appear in the CSF after: * 1/1
Hemorrhage
Repeated spinal taps
Diagnostic procedures
All of the above
Feedback
The purpose of macrophages in the CSF is to remove cellular debris and foreign objects
such as RBCs. Macrophages appear within 2 to 4 hours after RBCs enter the CSF and are
frequently seen following repeated taps. They tend to have more cytoplasm than
monocytes in the peripheral blood (PB). The finding of increased macrophages indicates a
previous hemorrhage.
Nucleated RBCs are seen in the CSF as a result of: * 1/1
Elevated blood RBCs
Treatment of anemia
Severe hemorrhage
Bone marrow contamination

Feedback
NRBCs are seen as a result of bone marrow contamination during the spinal tap. This is
found in approximately 1% of specimens. Capillary structures and endothelial cells may be
seen following a traumatic tap.
Myeloblasts are seen in the CSF: * 0/1
In bacterial infections
In conjunction with CNS malignancy
After cerebral hemorrhage
As a complication of acute leukemia
Correct answer
As a complication of acute leukemia
The reference range for CSF protein is: * 1/1
6 to 8 g/dL
15 to 45 g/dL
6 to 8 mg/dL
15 to 45 mg/dL
Feedback
Reference values for total CSF protein are usually listed as 15 to 45 mg/dL but are
Reference values for total CSF protein are usually listed as 15 to 45 mg/dL, but are
somewhat method dependent, and higher values are found in infants and people over age
40.
This value is reported in milligrams per deciliter and not grams per deciliter, as are plasma
protein concentrations.
Elevated CSF protein values can be caused by all of the following except: * 0/1
Meningitis
Multiple sclerosis
Fluid leakage
CNS malignancy
Correct answer
Fluid leakage
The integrity of the blood–brain barrier is measured using the: * 1/1
CSF/serum albumin index
CSF/serum globulin ratio
CSF albumin index
CSF IgG index
Feedback
ALBUMIN INDEX
A i d l l th 9 t i t t bl d b i b i Th i d i
An index value less than 9 represents an intact blood– brain barrier. The index increases
relative to the amount of damage to the barrier.
Measurement of which of the following can be replaced by CSF *1/1

glutamine analysis in children with Reye syndrome?
Ammonia
Lactate
Glucose
Alpha-ketoglutarate
Feedback
Reye syndrome
Acute encephalopathy and liver infiltration seen in children following viral infections

Determining CSF ________ provides an indirect test for the presence of *1/1
excess ammonia in the CSF.
Alpha-ketoglutarate
Glucose
Glutamine
Lactate
Feedback
Determining CSF glutamine provides an indirect test for the presence of excess ammonia
in the CSF.
The normal concentration of glutamine in the CSF is 8 to 18 mg/dL.

Before performing a Gram stain on CSF, the specimen must be: * 0/1
Filtered
Warmed to 37C
Centrifuged
Mixed
Correct answer
Centrifuged
Feedback
The Gram stain is routinely performed on CSF from all suspected cases of meningitis,
although its value lies in detecting bacterial and fungal organisms. All smears and cultures
should be performed on concentrated specimens because often only a few organisms are
present at the onset of the disease. The CSF should be centrifuged at 1500 g for 15
minutes, and slides and cultures should be prepared from the sediment. Use of the
cytocentrifuge provides a highly concentrated specimen for Gram stains.
Particular attention should be paid to the Gram stain for the CLASSIC *1/1
STARBURST PATTERN produced by:
Hemophilus influenzae
Neisseria meninigitidis
Cryptococcus neoformans
Coccidioides immitis
Maturation of spermatozoa takes place in the: * 1/1
Sertoli cells
Seminiferous tubules
Epidiymis
Seminal vesicles
Enzymes for the coagulation and liquefaction of semen are produced by *1/1
the:
Seminal vesicles
Bulbourethral glands
Ductus deferens
Prostate gland

If the first portion of a semen specimen is not collected, the semen *1/1
analysis will have which of the following?
Decreased pH
Increased viscosity
Decreased sperm count
Decreased sperm motility
Feedback
When a part of the first portion of the ejaculate is missing, the sperm count will be
decreased, the pH falsely increased, and the specimen will not liquefy.
When part of the last portion of ejaculate is missing, the semen volume is decreased, the
sperm count is falsely increased, the pH is falsely decreased, and the specimen will not
clot.

A semen specimen delivered to the laboratory in a condom has a normal *1/1
sperm count and markedly decreased sperm motility. This indicates:
Decreased fructose
Antispermicide in the condom
Increased semen viscosity
Increased semen alkalinity
Feedback
Specimens should be collected by masturbation. If this is not possible, only nonlubricant-

containing rubber or polyurethane condoms should be used.
Ordinary condoms are not acceptable because they contain spermicides.

Liquefaction of a semen specimen should take place within: * 1/1
1 hour
2 hours
3 hours
4 hours
Feedback
A fresh semen specimen is clotted and should liquefy within 30 to 60 minutes after
collection; therefore, recording the time of collection is essential for evaluating semen
liquefaction.
Failure of liquefaction to occur within 60 minutes may be caused by a deficiency in

prostatic enzymes and should be reported.

Proteolytic enzymes may be added to semen specimens to: * 1/1
Increase the viscosity
Dilute the specimen
Decrease the viscosity
Neutralize the specimen
Feedback
Analysis of the specimen cannot begin until liquefaction (normal is within 30 to 60

minutes) has occurred.
If after 2 hours the specimen has not liquified, an equal volume of physiologic Dulbecco’s
phosphate-buffered saline or proteolytic enzymes such as alpha-chymotrypsin or
bromelain may be added to induce liquefaction and allow the rest of the analysis to be
performed.

The primary reason to dilute a semen specimen before performing a *1/1
sperm concentration is to:
Immobilize the sperm
Facilitate chamber count
Decrease the viscosity
Stain the sperm
Feedback
The most commonly used dilution is 1:20 prepared using a mechanical (positive-
displacement) pipette.
Dilution of the semen is essential because it immobilizes the sperm before counting.
The traditional diluting fluid contains sodium bicarbonate and formalin, which immobilize
and preserve the cells; however, good results can also be achieved using saline and
distilled water.

For determination of sperm concentration, both sides of the Neubauer *0/1
hemocytometer are loaded and allowed to settle for 3 to 5 minutes; then
they are counted, and the counts should agree within ___%.
Agree within 5%
Agree within 10%
Agree within 20%
Agree within 30%
Correct answer
Agree within 10%
Feedback
Using the Neubauer hemocytometer, sperm are usually counted in the four corner and
center squares of the large center square, similar to a manual RBC count.
Both sides of the hemocytometer are loaded and allowed to settle for 3 to 5 minutes; then
they are counted, and the counts should agree within 10%. An average of the two counts is
used in the calculation. If the counts do not agree, both the dilution and the counts are
repeated.
The purpose of the acrosomal cap is to: * 1/1
Penetrate the ovum

Protect the the nucleus
Create energy for tail movement
Protect the neckpiece
The sperm part containing a mitochondrial sheath is the: * 0/1
Head
Neckpiece
Midpiece
Tail
Correct answers
Head
Midpiece
Feedback
The midpiece is the thickest part of the tail because it is surrounded by a mitochondrial
sheath that produces the energy required by the tail for motility.

All of the following are associated with sperm motility except the: * 1/1
Head
Neckpiece
Midpiece
Tail
Feedback
Abnormalities in head morphology are associated with poor ovum penetration, whereas
neckpiece, midpiece, and tail abnormalities affect motility.

Additional parameters measured by Kruger’s strict morphology include all *0/1
of the following except:
Vitality
Presence of vacuoles
Acrosome size
Tail length
Correct answer
Vitality
Feedback
Additional parameters in evaluating sperm morphology include measuring head, neck, and
tail size; measuring acrosome size; and evaluating for the presence of vacuoles. Inclusion
of these parameters is referred to as Kruger’s strict criteria.
Strict criteria evaluation requires the use of a stage micrometer or morphometry. At

present, evaluation of sperm morphology using strict criteria is not routinely performed in
the clinical laboratory but is recommended by the WHO. Strict criteria evaluation is an
integral part of assisted reproduction evaluations.

Round cells that are of concern and may be included in sperm counts and *0/1
morphology analysis are:
Leukocytes
Spermatids
RBCs
Leukocytes and spermatids
Correct answer
Leukocytes and spermatids
Feedback
Differentiation and enumeration of round cells (immature sperm and leukocytes) can also
be made during the morphology examination.
Peroxidase-positive granulocytes are the predominant form of leukocyte in semen and can
be further differentiated from spermatogenic cells and lymphocytes using a peroxidase
stain.

Following an abnormal sperm motility test with a normal sperm count, *0/1
what additional test might be ordered?
Fructose level
Zinc level
Mixed agglutination reaction
Eosin-nigrosin stain
Correct answer
Eosin-nigrosin stain
Feedback
Decreased sperm vitality may be suspected when a specimen has a normal sperm
concentration with markedly decreased motility. Sperm vitality should be assessed within
1 hour of ejaculation. Vitality is evaluated by mixing the specimen with an eosin-nigrosin
stain, preparing a smear, and counting the number of dead cells in 100 sperm using a
brightfield or phase-contrast microscope.
Living cells are not infiltrated by the dye and remain bluish white, whereas dead cells stain
red against the purple background. Normal vitality requires 50% or more living cells and
should correspond to the previously evaluated motility.

Follow-up testing for a low sperm concentration would include testing *0/1
for:
Antisperm antibodies
Seminal fluid fructose
Sperm vitality
Prostatic acid phosphatase
Correct answer
Seminal fluid fructose
Feedback
Low sperm concentration may be caused by lack of the support medium produced in the
seminal vesicles, which can be indicated by a low to absent fructose level in the semen.

Measurement of alpha-glucosidase is performed to detect a disorder of *0/1
the:
Seminiferous tubules
Epididymis
Prostate gland
Bulbourethral glands
Correct answer
Epididymis
Feedback
decreased neutral alpha-glucosidase, glycerophosphocholine, and L-carnitine suggest a

disorder of the epididymis.

A specimen delivered to the laboratory with a request for prostatic acid *1/1
phosphatase and glycoprotein p30 was collected to determine:
Prostatic infection
Presence of antisperm antibodies
A possible rape
Successful vasectomy
Feedback
On certain occasions, the laboratory may be called on to determine whether semen is

actually present in a specimen. A primary example is in cases of alleged rape.
Microscopically examining the specimen for the presence of sperm
may be possible, with the best results being obtained by enhancing the specimen with
xylene and examining under phase microscopy.
Seminal fluid contains a high concentration of prostatic acid phosphatase, so detecting

this enzyme can aid in determining the presence of semen in a specimen.
A more specific method is the detection of seminal glycoprotein p30
(prostatic specific antigen [PSA]), which is present even in the absence of sperm.
Further information can often be obtained by performing ABO blood grouping and DNA
analysis on the specimen.

Following a negative postvasectomy wet preparation, the specimen *0/1
should be:
Centrifuged and reexamined
Stained and reexamined
Reported as no sperm seen
Detect presence of male antibodies
Correct answer
Centrifuged and reexamined
Feedback
A negative wet preparation is followed by specimen centrifugation for 10 minutes and

examination of the sediment.

Normal synovial fluid resembles: * 1/1
Egg white
Normal serum
Dilute urine
Lipemic serum
Feedback
The word “synovial” comes from the Latin word for egg, ovum.
Normal viscous synovial fluid resembles egg white.

When diluting a synovial fluid WBC count, all of the following are *0/1
acceptable except:
Acetic acid
Isotonic saline
Hypotonic saline
Saline with saponin
Correct answer
Acetic acid
Feedback
Traditional WBC diluting fluid cannot be used because it contains acetic acid that causes
the formation of mucin clots.
Normal saline can be used as a diluent. If it is necessary to lyse the RBCs, hypotonic saline
(0.3%) or saline that contains saponin is a suitable diluent.
Methylene blue added to the normal saline stains the WBC nuclei, permitting separation of
the RBCs and WBCs during counts performed on mixed specimens.

Synovial fluid crystals associated with inflammation in dialysis patients *1/1
are:
Calcium pyrophosphate dihydrate
Calcium oxalate
Corticosteroid
Monosodium urate
Feedback
Calcium oxalate crystals in renal dialysis patients.

Synovial fluid for crystal examination should be examined as a/an: * 1/1
Wet preparation
Wright's stain
Gram stain
Acid-fast stain
Feedback
Fluid is examined as an unstained wet preparation. One drop of fluid is placed on a

precleaned glass slide and cover slipped. The slide can be initially examined under low
and high power using a regular light microscope.
Crystals may be observed in Wright’s-stained smears; however, this should not replace the
wet prep examination and the use of polarized and red-compensated polarized light for
identification.

The most frequently performed chemical test on synovial fluid is: * 0/1
Total protein
Uric acid
Calcium
Glucose
Correct answer
Glucose
Feedback
The most frequently requested test is the glucose determination, because markedly
decreased glucose values indicate inflammatory (group II) or septic (group III) disorders.
An increase in the amount of serous fluid is called a/an: * 0/1
Exudate
Transudate
Effusion
Malignancy
C t
Correct answer
Effusion
Fluid:serum protein and lactic dehydrogenase ratios are performed on *1/1

serous fluids:
When malignancy is suspected
To classify transudates and exudates
To determine the type of serous fluid
When a traumatic tap has occurred
Feedback
Traditionally, a variety of laboratory tests have been used to differentiate between

transudates and exudates, including appearance, total protein, lactic dehydrogenase, cell
counts, and spontaneous clotting.
However, the most reliable differentiation is usually obtained by determining the fluid:
blood ratios for protein and lactic dehydrogenase
A differential observation of pleural fluid associated with tuberculosis is: * 1/1
Increased neutrophils
Decreased lymphocytes
Decreased mesothelial cells
Increased mesothelial cells

A pleural fluid pH of 6.0 indicates: * 0/1
Esophageal rupture
Mesothelioma
Malignancy
Rheumatoid effusion
Correct answer
Esophageal rupture
Feedback
A pH value as low as 6.0 indicates an esophageal rupture that is allowing the influx of
gastric fluid.
Pleural fluid pH lower than 7.2 may indicate the need for chest-tube drainage, in addition
to administration of antibiotics in cases of pneumonia.
In cases of acidosis, the pleural fluid pH should be compared with the blood pH. Pleural
fluid pH at least 0.30 degrees lower than the blood pH is considered significant.

Plasma cells seen in pleural fluid indicate: * 0/1
Bacterial endocarditis
Primary malignancy
Metastatic lung malignancy
Tuberculosis infection
Correct answer
Tuberculosis infection
The recommended test for determining whether peritoneal fluid is a *0/1

transudate or an exudate is the:
Fluid:serum albumin ratio
Serum ascites albumin gradient
Fluid:serum lactic dehydrogenase ratio
Absolute neutrophil count
Correct answer
Serum ascites albumin gradient
Feedback
Feedback
Differentiation between ascitic fluid transudates and exudates is more difficult than for
pleural and pericardial effusions. The serum-ascites albumin gradient (SAAG) is
recommended over the fluid:serum total protein and LD ratios to detect transudates of
hepatic origin.
Differentiation between bacterial peritonitis and cirrhosis is done by *1/1

performing a/an:
WBC count
Differential
Absolute neutrophil count
Absolute lymphocyte count
Feedback
Normal PERITONEAL FLUID WBC counts are less than 350 cells/μL, and the count
increases with bacterial peritonitis and cirrhosis.
To distinguish between those two conditions, an absolute neutrophil count should be

performed. An absolute neutrophil count >250 cells/μL or >50% of the total WBC count
indicates infection.

Ascitic fluid TRANSUDATE: * 0/1
Bacterial peritonitis
Cirrhosis
Intestinal perforation, ruptured appendix
Malignancy
Correct answer
Cirrhosis
Feedback
Hepatic disorders such as cirrhosis are frequent causes of ascitic transudates.
Bacterial infections (peritonitis)—often as a result of intestinal perforation or a ruptured

appendix—and malignancy are the most frequent causes of exudative fluids.
Detection of the CA 125 tumor marker in peritoneal fluid indicates: * 1/1
Colon cancer
Ovarian cancer
Gastric malignancy
Prostate cancer
Prostate cancer
What is the primary cause of the normal increase in amniotic fluid as a *0/1
pregnancy progresses?
Fetal cell metabolism
Fetal swallowing
Fetal urine
Transfer of water across the placenta
Correct answer
Fetal urine

How are specimens for FLM testing delivered to and stored in the *1/1
laboratory?
Delivered on ice and refrigerated
Immediately centrifuged
Kept at room temperature
Delivered in a vacuum tube
Feedback
Fluid for fetal lung maturity (FLM) tests should be placed in ice for delivery o the
laboratory and kept refrigerated.
Specimens for bilirubin testing must be immediately protected from light. This can be
accomplished by placing the specimens in amber-colored tubes, wrapping the collection
tube in foil, or by use of a black
plastic cover for the specimen container.
Specimens for cytogenetic studies or microbial studies must be processed aseptically and
maintained at room temperature or body temperature (37°C incubation) prior to analysis to
prolong the life of the cells needed for analysis.

Why are amniotic specimens for cytogenetic analysis incubated at 37°C *1/1
prior to analysis?
To detect the presence of meconium
To differentiate amniotic fluid from urine
To prevent photo-oxidation of bilirubin to biliverdin
To prolong fetal cell viability and integrity
Feedback
Specimens for cytogenetic studies or microbial studies must be processed aseptically and
maintained at room temperature or body temperature (37°C incubation) prior to analysis to
prolong the life of the cells needed for analysis.

Plotting the amniotic fluid OD on a Liley graph represents the severity of *0/1
hemolytic disease of the newborn. A value that is plotted in zone II
indicates what condition of the fetus?
No hemolysis
Mildly affected fetus
Moderately affected fetus that requires close monitoring
Severely affected fetus that requires intervention
Correct answer
Moderately affected fetus that requires close monitoring
Feedback
Notice that the Liley graph plots the A450 against gestational age and is divided into three
zones that represent the extent of hemolytic severity.
Values falling in zone I indicate no more than a mildly affected fetus; those in zone II
indicate moderate hemolysis and require careful monitoring anticipating an early delivery
or exchange transfusion upon delivery, whereas a value in zone III indicates severe
hemolysis and suggests a severely affected fetus.
Intervention through induction of labor or intrauterine exchange transfusion must be

considered when a D A450 is plotted in zone III.

When severe HDN is present, which of the following tests on the amniotic *0/1
fluid would the physician NOT ORDER to determine whether the fetal
lungs are mature enough to withstand a premature delivery?
AFP levels
Foam stability index
Lecithin/sphingomyelin ratio
Phosphatidyl glycerol detection
Correct answer
AFP levels
Feedback
Increased levels of alpha-fetoprotein (AFP) in both the maternal circulation and the
amniotic fluid can be indicative of fetal neural tube defects, such as anencephaly and
spina bifida.

Amniocentesis may be indicated at 15 to 18 weeks’ gestation for the *0/1
following conditions to determine early treatment or intervention: CHECK
FOUR (4) BOXES
Family history of chromosome abnormalities, such as trisomy 21 (Down

syndrome)
Earlier pregnancy or child with birth defect
Fetal lung maturity
HDN caused by Rh blood type incompatibility
Elevated maternal serum alpha-fetoprotein
Abnormal triple marker screening test
Correct answer
Family history of chromosome abnormalities, such as trisomy 21 (Down syndrome)

Amniocentesis is indicated later in the pregnancy (20 to 42 weeks) to *0/1
evaluate: CHECK TWO (2) BOXES
Family history of chromosome abnormalities, such as trisomy 21 (Down syndrome)
Fetal lung maturity
Correct answer
Fetal lung maturity

When performing an L/S ratio by thin-layer chromatography, a mature *1/1
fetal lung will show:
Sphingomyelin twice as concentrated as lecithin
No sphingomyelin
Lecithin twice as concentrated as sphingomyelin
Equal concentrations of lecithin and sphingomyelin
Feedback
The L/S ratio will rise to 2.0 or higher as the lecithin production increases to prevent
alveolar collapse.

A rapid immunologic test for FLM that does not require performance of *0/1
thin-layer chromatography is:
AFP levels
Amniotic acetylcholinesterase
Aminostat-FLM
Bilirubin scan
Correct answer
Aminostat-FLM
Feedback
AMNIOSTAT FLM: IMMUNOLOGIC AGGLUTINATION TEST FOR PHOSPHATIDYLGLYCEROL

The presence of phosphatidyl glycerol in amniotic fluid fetal lung maturity *0/1
tests must be confirmed when:
Hemolytic disease of the newborn is present
The mother has maternal diabetes
Amniotic fluid is contaminated by hemoglobin
Neural tube disorder is suspected
Correct answers
The mother has maternal diabetes
Amniotic fluid is contaminated by hemoglobin
Feedback
The presence of another lung surface lipid, phosphatidyl glycerol (PG), is also essential for
adequate lung maturity and can be detected after 35 weeks’ gestation.
The production of PG normally parallels that of lecithin, but its production is delayed in
cases of maternal diabetes.
In this circumstance, respiratory distress occurs in the presence of an L/S ratio of 2.0.
Therefore, a thin-layer chromatography lung profile must include lecithin, sphingomyelin,
and PG to provide an accurate measurement of FLM.

OD 650 nm: * 1/1
Bilirubin
Lamellar bodies
Lecithin
Oxyhemoglobin
Feedback
The presence of lamellar bodies increases the OD of the amniotic fluid. Specimens are
centrifuged at 2000 g for 10 minutes and examined using a wavelength of 650 nm.

A lamellar body count of 50,000 correlates with: * 0/1
Absent phosphatidyl glycerol and L/S ratio of 1.0
L/S ratio of 1.5 and absent phosphatidyl glycerol
OD at 650 nm of 1.010 and an L/S ratio of 1.1
Correct answer
Feedback
The number of lamellar bodies present in the amniotic fluid correlates with the amount of
phospholipid present in the fetal lungs.
The presence of lamellar bodies increases the OD of the amniotic fluid. Specimens are
centrifuged at 2000 g for 10 minutes and examined using a wavelength of 650 nm, which
rules out interference from hemoglobin but not other contaminants, such as meconium.
An OD of 0.150 has been shown to correlate well with an L/S ratio of greater than or equal
to 2.0 and the presence of phosphatidyl glycerol.
A consensus protocol for noncentrifuged samples considers LBCs greater than 50,000/uL
an indication of FLM and values below 15,000/uL as immature.

The normal composition of feces includes all of the following except: * 1/1
Bacteria
Blood
Electrolytes
Water
Feedback
The normal fecal specimen contains bacteria, cellulose, undigested foodstuffs, GI

secretions, bile pigments, cells from the intestinal walls, electrolytes, and water.
The normal brown color of the feces is produced by: * 1/1
Cellulose
Pancreatic enzymes
Undigested foodstuffs
Urobilin

Stool specimens that appear ribbon-like are indicative of which *1/1
condition?
Bile duct obstruction
Colitis
Intestinal constriction
Malignancy
What is the fecal test that requires a 3-day specimen? * 1/1
Fecal occult blood
APT test
Elastase 1
Quantitative fecal fat testing
Feedback
Quantitative fecal analysis requires the collection of at least a 3-day specimen. The patient
must maintain a regulated intake of fat (100 g/d) before and during the collection period.
What is the significance of an APT test that remains pink after addition of *1/1
sodium hydroxide?
Fecal fat is present
Fetal hemoglobin is present
Fecal trypsin is present
Vitamin C is present
Feedback
In the presence of alkali-resistant fetal hemoglobin, the solution remains pink (HbF),
whereas denaturation of the maternal hemoglobin (HbA) produces a yellow-brown
supernatant after standing for 2 minutes.
A patient whose stool exhibits increased fats, undigested muscle fibers, *1/1
and the inability to digest gelatin may have:
Bacterial dysentery
A duodenal ulcer
Cystic fibrosis
Lactose intolerance
A stool specimen collected from an infant with diarrhea has a pH of 5.0. *1/1
This result correlates with a:
Positive APT test
Negative trypsin test
Positive Clinitest
Negative occult blood test
Feedback
Normal stool pH is between 7 and 8; however, increased use of carbohydrates by intestinal

bacterial fermentation increases the lactic acid level and lowers the pH to below 5.5 in
cases of carbohydrate disorders.
What is the recommended number of samples that should be tested to *1/1

confirm a negative occult blood result?
One random specimen
Two samples taken from different parts of three stools
Three samples taken from the outermost portion of the stool
Three samples taken from different parts of two stools

Feedback
Two samples from three different stools should be tested before a negative result is
confirmed.
A positive amine (Whiff) test is observed in which of the following *1/1

syndromes?
Bacterial vaginosis
Vulvovaginal candidiasis
Atrophic vaginitis
Desquamative inflammatory vaginitis
Feedback
Amine (Whiff) Test
1. Apply one drop of the saline vaginal fluid suspension to the surface of a clean glass
slide.
2. Add one drop of 10% KOH directly to the vaginal sample.
3. Holding the slide in one hand, gently fan above the surface of the slide with the other
hand and assess for the presence of a fishy amine odor.
4. Report as positive or negative.
Positive: The presence of a fishy odor after adding KOH.
Negative: The absence of a fishy odor after adding KOH.

The presence of fetal fibronectin in vaginal secretions between 24 and 34 *0/1
weeks’ gestation is associated with preterm delivery.
Bacterial vaginosis
Candidiasis
Desquamative inflmmatory vaginitis
Preterm delivery
Correct answer
Preterm delivery
Feedback
The presence of fetal fibronectin in vaginal secretions between 24 and 34 weeks’

gestation is associated with preterm delivery.
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PROGRESS EXAM: CLINICAL

LEMAR REVIEW HUB

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SURNAME, FIRST NAME *

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CHECK 4 BOXES: Variables in the Cockroft and Gault formula. * 0/1

Body weight in kilograms

Body weight in kilograms

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CHECK 6 BOXES: Variables in the MODIFICATION OF DIET IN RENAL *0/1

Body weight in kilograms

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All of the following should be discarded in biohazardous waste *0/1

Urine specimen containers

Towels used for decontamination

Disposable lab coats

Blood collection tubes

Urine specimen containers

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Centrifuging an uncapped specimen may produce a biologic hazard in the *1/1

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The first thing to do when a fire is discovered is to: * 1/1

Rescue person in danger

Close doors to other areas

Extinguish the fire if possible

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If a red rash is observed after removing gloves, the employee: * 1/1

May be washing her hands too often

May have developed a latex allergy

Should apply cortisone cream

Should not rub the hands so vigorously

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Blood and body fluid precautions

In 1987 the CDC instituted Universal Precautions (UP). Under

UP all patients are considered to be possible carriers of bloodborne

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Which of the tubules is impermeable to water? * 1/1

Proximal convoluted tubule

Descending loop of Henle

Ascending loop of Henle

Distal convoluted tubule

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Produces a large volume of urine

Produces high urine volume

Increases ammonia excretion

Affects active transport of sodium

Two possible answers:

In diabetes insipidus: deficiency of ADH

High or large urine volume

Decreased urine specific gravity

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The largest source of error in creatinine clearance tests is: * 1/1

Improperly timed urine specimens

Refrigeration of the urine

Time of collecting blood sample

Variables that are included in the MDRD-IDSM estimated creatinine *1/1