AUBF PRE - Aubf review questions PDF

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AUBF PRE-TEST 11. Which of the following incorrectly defines proficiency testing except? I. Refers to the lab's policies, processes, procedures, and resources needed to achieve quality testing. II. Included in a QA program. III. The overall process of guaranteeing quality patient care. IV. Formally ...

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AUBF PRE-TEST 1 1. Which of the following incorrectly defines proficiency testing except? I. Refers to the lab's policies, processes, procedures, and resources needed to achieve quality testing. II. Included in a QA program. III. The overall process of guaranteeing quality patient care. IV. Formally known as external quality assessment. I and II only I, II, and IV

IV only II and IV

Quality assessment (QA) - overall process of guaranteeing quality patient care and is regulated throughout the total testing system. Quality system - refers to all of the lab's policies, processes, procedures, and resources needed to achieve quality testing. Proficiency testing - Included in a QA program are procedure manuals, internal quality control, external quality control, electronic quality control, calibration or calibration verification, standardization, proficiency testing (PT), more formally known as external quality assessment (EQA), record keeping, equipment maintenance, safety programs, training, education and competency assessment of personnel, and a scheduled and documented review process. Essentially, QA is the continual monitoring of the entire test process from test ordering and specimen collection through reporting and interpreting results. Written policies and documented actions as they relate to the patient, the laboratory, ancillary personnel, and the health-care provider are required. Having written remedial actions mandating the steps to take when any part of the system fails is essential to a QA program. 2. Which of the following statements are true regarding Universal Precaution? ▪ Developed by CDC and HICPAC ▪ TREAT ALL PATIENTS AND THEIR SPECIMEN AS EQUALLY AND POTENTIALLY INFECTIOUS ▪ Does not recommend hand washing after removing gloves unless visual contamination is present. ▪ EVERY PERSON IS POTENTIALLY INFECTIOUS WITH A MICROORGANISM

THAT CAN BE TRANSFERRED TO SOMEONE IN THE HEALTHCARE SETTING. Rationale: Universal precautions (UP) ● ●

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Developed by CDC in 1987. "All patients are considered to be possible carriers of blood-borne pathogen." "TREAT ALL PATIENTS AND THEIR SPECIMENS AS EQUALLY AND POTENTIALLY INFECTIOUS" Wear gloves when collecting or handling blood and body fluids contaminated with blood and wearing face shields when there is danger of blood splashing on mucous membranes. EXCLUDED: Urine and Body fluids NOT VISIBLY contaminated with blood.

Body Substance Isolation (BSI) ● ● ● ●

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Modification of UP. NOT LIMITED to blood-borne pathogens. "Body fluids and moist body substances are potentially infectious." Expanded the concept of personal protective equipment to include plastic aprons and covers for hair and shoes to keep all moist body substances off hair, skin, clothes, and mucous membranes. Wear gloves AT ALL TIMES. DISADVANTAGE: Does not recommend hand washing after removing gloves unless visual contamination is present.

Standard precautions ●

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Developed by CDC and HICPAC (Healthcare Infection Control Practices Advisory Committee) in 1996. Updated recommendations from the CDC. Combines the major features of UP and BSI guidelines (modification and expansion of UP). "EVERY PERSON IS POTENTIALLY INFECTIOUS WITH A MICROORGANISM THAT CAN BE TRANSFERRED TO

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SOMEONE IN THE HEALTHCARE SETTING." Stresses patient contact Standard Precautions are used for all patient care. Steps taken to encompass fighting the spread of airborne pathogens in situations where providers come into contact with any form of body fluid.

3. Type of Extinguisher used for Type E fires ▪ NOTA ▪ Metal X and Sand ▪ Halon Foam ▪ Dry Chemical 4. Which of the following are decreased when the urine is left with no preservative for more than 2 hours prior to testing: I. Odor II. Clarity III. Bilirubin IV. pH V. Nitrites Choices: ▪ III only ▪ I, II, III, IV, V ▪ II and III only ▪ NOTA Rationale: INCREASED in unpreserved urine: PBacON pH, Bacteria, Odor, Nitrite DECREASED in unpreserved urine: Cla KG BUmili ng RTW Clothes Clarity, Ketones, Glucose, Bilirubin, Urobilinogen, RBCs, Trichomonas, WBCs, Casts. DARKENED/MODIFIED: Color Note: PROTEINS - least affected in unpreserved urine 5. Which of the following is inappropriate when collecting urine for routine bacteriologic culture? ▪ The midstream void technique must be used ▪ The collected sample must be plated within 2 hours unless refrigerated ▪ The sample may be held at 2°C–8°C for up to 48 hours prior to plating ▪ The container must be sterile Rationale: Urine specimens should be plated and incubated within 2 hours of collection (some labs use a 1-hour time limit), and within 24 hours if the sample is refrigerated at

2°C–8°C immediately following collection. No additives are permitted when urine is collected for culture. 6. Which of the following statement correctly describes formalin? I. Interferes with leukocyte esterase, protein, and glucose. II. Reducing agent III. Clings to pipettes and testing material IV. Excellent sediment preservative Choices: IV only II and IV NOTA I, II and IV Rationale: Refrigeration - preservative of choice for routine UA & Urine culture (24hrs). Bacteriostatic for 24 hrs. A: DOES NOT INTERFERE with chem. tests D: INC. SG by hydrometer. PRECIPITATES AP and AU. Thymol A: preserves glucose and sediments well D: INTERFERES w/ acid ppt tests (e.g. SSA) for proteins Boric acid - Keeps pH on 6.0. BacterioSTATIC at 18g/L. Used for Culture transport. A: preserves proteins and formed elements well. DOES NOT INTERFERE with routine analyses other than pH D: May PRECIPITATE crystals when used in large amounts. Formalin - Rinse specimen container with formalin to preserve cells casts. A: EXCELLENT sediment preservative. For ADDIS COUNT. D: Reducing agent. INTERFERES w/ chem. tests for GLUCOSE, BLOOD, LEUKOCYTES, & COPPER REDUCTION. Toluene A: DOES NOT INTERFERE with routine tests D: Floats on urine surface; clings to pipettes & testing materials Sodium fluoride - May use sodium benzoate instead of fluoride for reagent strip testing A: prevents GLYCOLYSIS. Good preservative for drug analyses. D: Inhibits reagent strip tests for GLUCOSE, BLOOD, AND LEUKOCYTE. NOTE: BORIC ACID and HCl - preservative used for urinary 5-HIAA. INC. 5-HIAA in urine = Argentaffinoma = INC. SEROTONIN.

7. How many hours should you collect urine for addis count? ▪ 24 hours ▪ 12 hrs ▪ 4 hours ▪ Afternoon 8. Which of the following incorrectly describes drug specimen collection? I. Chain of custody is the process which provides documentation of proper sample identification from the time of collection to the receipt of laboratory results. II. 60 millilitres is the required urine volume. III. Specimen should be rejected if the temperature is unchecked within 4 hours. IV. Blueing agent (dye) is added to the toilet water reservoir to preserve specimen adulteration. Choices: II and IV III only II only II, III, and IV Rationale: ▪ Chain of custody is the process which provides documentation of proper sample identification from the time of collection to the receipt of lab results. ▪ Required urine volume: 30-45mL (60mL bottle capacity) ▪ Temperature within 4 minutes: 32.5-37.7'C ▪ Blueing agent (dye) is added to the toilet water reservoir to prevent specimen adulteration. 9. Which of the following correctly describes the three-glass collection Choices: ▪ A greater number of bacterial colonies on the first cup than the third cup indicates prostatis ▪ Second cup should be 10x the number of bacteria than the first cup to indicate the presence of prostatitis ▪ The second cup is the prostatic massage specimen ▪ A greater number of bacterial colonies on the third cup than the first cup indicates prostatis Rationale: Three glass technique: 1st: 1st morning urine 2nd: midstream clean catch (control)

3rd: prostatic massage specimen N: 1st>3rd bacterial count (+): 3rd>1st bacterial count PPMT: 1st: midtsream (pre-) 2nd: prostatic (post) (+): 2nd (10x) > 1st bacterial count Stamey-Mears Test (4-glass) - STANDARD for assessing inflammation and the presence of bacteria in the lower urinary tract in men presenting with the chronic prostatitis syndrome/chronic pelvic pain syndrome. 1st: initial (VB1) - voided bladder–1 (VB1), which is the first 10 mL of urine and represents the urethral specimen. 2nd: midstream (VB2) - voided bladder–2 (VB2), is collected, which is another 10 mL of urine and represents the bladder specimen. 3rd: Expressed prostatic secretions - fluid collected during prostatic massage. 4th: PPM (VB3) - voided bladder–3 (VB3), consists of the first 10 mL of urine collected after EPS; it contains any EPS trapped in the prostatic urethra. Presence of bacteria in VB1 = Urethral infection Presence of bacteria in VB2 = Urinary bladder infection Presence of bacteria in EPS and VB3 = Prostatic infection (+) Prostatitis if EPS and VB3: >10-20 WBC/HPF 10. A positive benedict's test shall mean: Choices: ▪ Addison’s disease ▪ Hypothyroidism ▪ Blood glucose concentration of >180 mg/dl ▪ Hypopituitarism Ratio: Renal threshold for glucose: 160-180 mg/dL. 11. Water is reabsorbed in all of the following except: ▪ Collecting duct ▪ descending LH ▪ PCT ▪ Ascending LH 12. Given the following data, compute for the creatinine clearance: Urine creatinine = 110 mg/dL Plasma creatinine = 1 mg/dL Urine volume in 24 hrs = 1500mL Patient of average body surface area. Choices:

▪ 114 mL/min ▪ 113 mL/min ▪ 115 mL/min ▪ 112 mL/min Ratio: Normal values Males: 107-139 mL/min Females: 87-107 mL/min GFR estimate of Cockgroft and Gault: =(140-age)(body wt.)/72 x serum creatinine in mg/dL note: results multiplied by 0.85 for female patients variables: Age, Body wt. (kg), Sex 13. Nonpathologic cause/s of urine turbidity: I. Ammonium biurate crystals II. RBCs III. Radiographic contrast media IV. Nonsquamous epithelial cells V. WBCs Choices: I, II and IV I, II, IV, V III only II, III, IV Rationale: Nonpathologic causes of urine turbidity: ▪ Squamous E.C.s, AU (pink sediment), AP and AC (white), vaginal cream, seen, fecal contam., RCM, talcum powder Pathologic causes of urine turbidity: ▪ RBCs, WBCs, Bacteria, Yeasts, non-squamous E.C., abn. crystals, lymph fluid (chyluria), lipids 14. A 45-year-old African man suffering from albinism was subjected for urinalysis. Upon prolonged standing, his urine eventually turned black. What is the most probable cause? ▪ Rifampin ▪ Malignant melanoma ▪ Metronidazole ▪ Buildup of homogentisic acid 15. Swimming pool odor of urine ▪ Methionine malabsorption ▪ Trimethylamenuria ▪ Hawkinsinuria ▪ Semen 16. The urine output to be considered as polyuria in children: ▪ 2.5 to 3.0 mL/kg/day ▪ >2.5L/day ▪ >2000mL/24 hrs ▪ All of the above

Rationale: Polyuria - causes: DM (high SG), DI (low SG), inc. fluid intake, nervousness, diuretics >2000mL/1440min or >2000mL/24 hrs (in adults - Henry's) >2.5L/day (in adults - Strasinger) 2.5 to 3.0 mL/kg/day (in children) 17. Print blurred through urine ▪ Cloudy ▪ Turbid ▪ Milky ▪ Hazy Rationale: Clear - No visible particulates, transparent Hazy - Few particulates, print easily seen through urine Cloudy - Many particulates, print blurred through urine Turbid - Print cannot be seen through urine Milky - May precipitate or be clotted 18. Which of the following are not soluble dilute acetic acid? ▪ Yeasts ▪ Phosphates ▪ Spermatozoa ▪ Carbonates ▪ Bacteria II, IV, V II and IV I to V I, III, V Rationale: INSOLUBLE in dilute acetic acid: WBCs, Bacteria, Yeasts, Spermatozoa SOLUBLE in dilute acetic acid: RBCs, AP, Carbonates SOLUBLE in HEAT: Amorphous urates, Uric acid crystals SOLUBLE in ETHER: Lipids, lymphatic fluid, chyle 19. Automated reagent strip reader principle ▪ Indirect spectroscopy ▪ Flame photometry ▪ Reflectance photometry ▪ Spectrophotometry Rationale: Light reflection from the test pads decreases in proportion to the intensity of color produced by the concentration of the test substance. The darker the color of the reagent pad, the lesser the light reflection.

20. Sensitivity of your glucose reagent strip ▪ 160 mg/dL ▪ 120 mg/dL ▪ 140 mg/dL ▪ 100 mg/dL 21. RST positive for Leukocyte esterase, upon microscopy no WBCs were found. What could be the cause? ▪ Lymphocytes ▪ Trichomonas vaginalis ▪ Both ▪ Neither 22. Positive color of Ketone pad ▪ Uniform green/blue ▪ Purple ▪ Blue ▪ Uniform pink Rationale: 30s Glucose - green to brown Bilirubin - tan or pink to violet 40s Ketones - purple 45s S.G. - Blue (1.000) to Yellow (1.030) 60s Blood - Uniform green/blue (Hgb or Mb); Speckled/spotted (intact RBCs) Protein - Blue pH - Orange (5.0) to Blue (9.0) Urobilinogen - Red Nitrite - Uniform pink 120s Leukocyte esterase – Purple 23. Specific gravity calibration of 5% NaCl in Refractometer ▪ 1.034 ▪ 1.015 ▪ 1.000 ▪ 1.022 24. Myoglobin in urine must be at what concentration to produce a red color? ▪ ≥ 30 mg/dL ▪ ≥ 15 mg/dL ▪ ≥ 25 mg/dL ▪ ≥ 20 mg/dL 25. High nitrites ▪ False negative blood ▪ False negative urobilinogen ▪ False negative bilirubin ▪ All of these 26. Which of the following is correct regarding orthostatic proteinuria and clinical proteinuria? ▪ In Clinical proteinuria, urine is positive for proteins in the first morning and 2 hours after prolonged standing. In O.P., proteins

are negative in the first morning urine and is detectable after 2 hours of standing. ▪ In Orthostatic proteinuria, urine is positive for proteins in the first morning and 2 hours after prolonged standing. In C.P., proteins are negative in the first morning urine and is detectable after 2 hours of standing. ▪ In Clinical proteinuria, urine is negative for proteins in the first morning and 2 hours after prolonged standing. In O.P., proteins are negative in the first morning urine and is detectable after 2 hours of standing. ▪ In Orthostatic proteinuria, urine is negative for proteins in the first morning and 2 hours after prolonged standing. In C.P., proteins are positive in the first morning urine and is undetectable after 2 hours of standing. 27. High protein ▪ False increased Sp.G ▪ Both ▪ Neither ▪ False negative leukocyte 28. In Fanconi syndrome: ▪ Blood glucose concentration is increased; urine glucose is increased. ▪ Blood glucose concentration is increased; urine glucose is normal. ▪ Blood glucose concentration is increased; urine glucose is decreased. ▪ Blood glucose concentration is normal; urine glucose is increased. 29. High Specific gravity: I. False positive for protein II. False negative glucose III. False negative blood IV. False negative nitrite Choices: ▪ II and III ▪ I to IV ▪ I only ▪ I, II, III 30. In using the clinitest, to prevent the event of a pass-through phenomenon, how many drops of urine should we use? ▪ 2 gtts ▪ 3 gtts ▪ 4 gtts ▪ 1 gtt Rationale: Pass-through phenomenon happens when there is >2 g/dL sugar present. Blue>Green>Yellow>Brick red>>>>>>Blue or Green-brown.

Due to reoxidation of the CUPROUS oxide formed to CUPRIC oxide and other cupric complexes. 31. Urine pH in patients suffering from renal tubular acidosis ▪ 7.5 ▪ 8.0 ▪ 8.5 ▪ 5.0 32. Which of the following is untrue of ketone bodies? ▪ b-hydroxybutyric acid is not detected in the RST ▪ Neither ▪ Both ▪ b-hydroxybutyric acid is a major ketone Rationale: BHBA - 78%: major ketone, undetected in RST AAA/Diacetic acid - 20%: parent ketone 2% Acetone 33. How much urine sediment shall be used for microscopic examination? ▪ 10 ul ▪ 0.04 ml ▪ 1 ul ▪ 0.02 ml Rationale: 1. 10-15 ml urine; average:12 ml (3/4 of test tube) 2. centrifuge for 5 minutes at 400 RCF 3. Decant urine (0.5 to 1.0 ml remains) 4. Transfer 20 ul (0.02 ml) sediment to glass slide with 22x22mm coverslip 5. Examine microscopically (10LPF; 10HPF under reduced light) 34. Yellow-brown/colorless elongated prisms in the urine: I. By-products of benzoate and toluene II. Are soluble in H2O and ether III. Hippuric acid crystals IV. Are abnormal crystals Choices: ▪ I and III only ▪ I, II, III ▪ I, II, III, IV ▪ II and IV 35. Reported in Rare, Few, Moderate, Many per HPF: I. Trichomonas II. RBCs III. RTE IV. Transitional E.C.

V.

Normal crystals Choices: ▪ I and III only ▪ I, III, IV, V ▪ II, IV, V ▪ I, IV, V 36. Yellowish to brownish red & moderately hard calculi ▪ Calcium sulfate ▪ Uric acid and Urate ▪ Calcium oxalate ▪ Cystine 37. Major constituent of renal calculi ▪ Cystine ▪ Calcium oxalate ▪ Uric acid and Urate ▪ Phosphate 38. A dehydrated 45-year-old male patient came into the lab. His doctor ordered a routine urinalysis and urine C/S to rule out pyelonephritis. Physical examination shows tenderness in the right hypochondriac region. Upon macroscopic examination, the specimen was turbid and has a dark yellow color. Microscopic examination showed flat crystals with notched edges 20 per LPF. Reagent strip test showed: Glu - Neg Bili - Neg Ketones - Neg Sp. Gravity - 1.045 Bld - Neg pH - 5.4 Pro - Neg Uro - Normal Nit - Neg LE – Neg Identify the urinary crystal. ▪ Cholesterol ▪ Radiographic dye ▪ Sulfonamide ▪ Uric acid 39. Reported in average per 10 HPF I. RBC II. Oval fat bodies III. WBC IV. RTE Choices: ▪ I, II, III, IV ▪ I, II, and IV ▪ I and III only ▪ I, II, and III only 40. Stain used to differentiate WBCs and RTE cells

▪ Toluidine blue ▪ Hansel stain ▪ Oil Red O ▪ Gram stain (identifies bacterial casts) 41. True about urothelium: I. Syncytia is seen in catheterization II. Centrally located nucleus III. Derived from the linings of the lower portion of the urethra IV. Eccentrically located nucleus Choices: ▪ I and II only ▪ I and IV only ▪ III only ▪ IV only 42. Under histopathologic examination of the glomerulus, a characteristic "tram-track" appearance has been noted ▪ IgA nephropathy ▪ Henoch Schoenlein purpura ▪ Membranoproliferative glomerulonephritis ▪ Wegeners granulomatosis 43. Disruption of electrical charges that produce the tightly fitting podocyte barrier resulting in massive loss of proteins and lipids ▪ Nephrotic syndrome ▪ Minimal change disease ▪ Berger’s disease ▪ Fanconi syndrome 44. Which of the following diseases is characterized by antibodies binding to segmenters in vascular walls. ▪ Goodpasture Syndrome ▪ Membranous glomerulonephritis ▪ RPG ▪ Wegeners granulomatosis 45. Genetic disorder chaarcterized by thinning of the glomerular basement mebrane ▪ Diabetic nephropathy ▪ Alport syndrome ▪ Minimal change disease ▪ FSGS 46. Which of the following utilizes a bacterial inhibition test as a screening test ▪ Alkaptonuria ▪ Phenylketonuria ▪ Melanuria ▪ Tyrosyluria 47. Orange diaper syndrome ▪ Lesch-Nyhan disease ▪ Alkaptonuria ▪ Hartnups disease ▪ Serratia marcescens

48. Most common IEM in the Philippines ▪ HH syndrome ▪ Cystinuria ▪ Lesch-Nyhan disease ▪ MSUD 49. Positive result for the Mucopolysaccharide Paper Test ▪ White turbidity ▪ Green color ▪ Blue color ▪ Black color 50. CTAB test is a screening for ▪ 5-HIAA ▪ Cystinuria ▪ Mucopolysaccharides ▪ Aminoacidurias

AUBF POST-TEST 1 1. Which description regarding epithelial cells in the urinary system is correct? ▪ Transitional cells originate from the upper urethra, ureters, bladder, or renal pelvis ▪ Squamous epithelium line the vagina, urethra, and wall of the urinary bladder ▪ Cells from the proximal renal tubule are usually round in shape ▪ Caudate epithelial cells originate from the upper urethra 2. All of the following are common characteristics of the nephrotic syndrome except: ▪ Severe edema ▪ Hypoalbuminemia ▪ Hyperlipidemia ▪ Hematuria and pyuria 3. The fluid leaving the glomerulus has specific gravity of: ▪ 1.020 ▪ 1.010 ▪ 1.015 ▪ 1.025 4. A negative blood test and an increase in urine urobilinogen is correlated with: ▪ Calculi of the kidney or bladder ▪ Crush injury ▪ Extravascular hemolytic anemia ▪ Malignancy of the kidney or urinary system 5. A moderate-positive blood test and trace protein test are seen on the dry reagent strip, and 11–20 red blood cells per high-power field are seen in the microscopic exam. These results are most likely caused by which of the following? ▪ Intravascular hemolytic anemia ▪ Recent urinary tract catheterization ▪ Transfusion reaction ▪ Myoglobinuria 6. A long, thin hexagonal plate, and is linked to inges...