MTAP-2- Clinical- Microscopy ( Rationale) PDF

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MTAP 2 CLINICAL MICROSCOPY 1. How many components are there in the chain of infection a. 3 b. 4 c. 5 2. Quality control refers to the materials, procedures and techniques that monitor the ____ of a laboratory test. 1. Accuracy 2. Precision 3. Reliability a. 1 and 2 b. 1 and 3 c. 2 and 3 3. The purpose of quality control materials is to: a. Monitor instrumentation to eliminate downtime b. Ensure the quality of test results obtained c. d. Monitor the technical competence of laboratory staff 4. Centrifuging uncovered specimens, what is the mode of transmission? a. Ingestion c. Direct contact d. None of these 5. When skin contact occurs, the best first aid is to flush the area with large amounts of water for at least __ minutes, then seek medical attention. a. 5 minutes b. 10 minutes d. 20 minutes 6. Used to disinfect clinical microscopy section a. 70% isopropyl alcohol c. Povidone iodine d. Hydrogen peroxide 7. Combustible metals such as magnesium a. Class A b. Class B c. Class C

8. R in RACE: a. Run

b. Recover d. Retrieve

9. All of the following should be discarded in biohazardous waste containers except: a. b. Disposable lab coat c. Towels used for decontamination d. Blood collection tubes 10. a. b. c. d. 11. a. b. c. d.

Discovered albuminuria in 1964 by boiling urine samples? Domenico Cotugno Thomas Bryant Thudichum He introduced the concept of urinalysis as part of doctor’s routine patient examination in 1827: Ivan Folling Hippocrates William Wollaston

12. The clarity of a urine sample should be determined: a. Using glass tubes only, never plastic b. After addition of salicylic acid c. d. After the specimen cools to room temperature 13. The nurse submitted a specimen. It was unlabeled but the specimen was covered with its request form. What will you do? a. Perform urinalysis b. Put label on the specimen base on the request form c. d. Call the patient and verify if the sample is from him/her Table 1–4 Criteria for Urine Specimen Rejection Unlabeled containers Nonmatching labels and requisition forms Contaminated specimens with feces or toilet paper Containers with contaminated exteriors Insufficient volume of urine Improperly transported or preserved specimens Delay between time of collection and receipt in the laboratory

14. Urine specimens should be analyzed as soon as possible after collection. If urine specimens are allowed to stand at room temperature for an excessive amount of time, the urine pH will become alkaline because of bacterial decomposition of A. Protein C. Creatinine D. Ketones Parameter Change Cause Color Modified/ darkened Odor pH Increased Nitrite Bacteria Clarity Glucose Ketones Decreased Bilirubin Urobilinogen Cells and casts

Oxidation or reduction of metabolites Bacterial multiplication or breakdown of urea to ammonia Bacterial breakdown of urea to ammonia/ loss of CO2 Multiplication of nitrate-reducing bacteria Multiplication Bacterial growth and precipitation of amorphous material Glycolysis and bacterial use Volatilization and bacterial metabolism Photooxidation to biliverdin Oxidation to urobilin Disintegration in dilute alkaline urine

15. Which of the following is the major organic substance found in urine? A. Sodium B. Potassium C. Glucose 16. Which term is defined as a urine volume in excess of 2000 mL excreted over a 24-hour period? A. Anuria B. Oliguria D. Hypersthenuria Urine Volume (24-hour)

Average daily output: 1,200-1,500 mL Variations – in urine output Clinical significance: , – in urine output Clinical significance: tumors – Clinical significance: , – – in

,

,

,

,

,

17. Why is the first-voided morning urine specimen the most desirable specimen for routine urinalysis? A. Most dilute specimen of the day and therefore any chemical compounds present will not exceed the detectability limits of the reagent strips B. Least likely to be contaminated with microorganisms because the bladder is sterile environment C. Most likely to contain protein because the patient has been in the orthostatic position during the night

Types of Urine Specimen 1st morning

Ideal specimen for routine UA Most concentrated and most acidic→ preservation of cells and casts, Pregnancy test (hCG)

Fasting/2nd morning

Glucose determination 2nd voided urine after a period of fasting

Occasional/Single/Random

Routine Qualitative Urine Analysis

Timed Specimen Quantitative UA

24 hr

1st voided urine is discarded w/ proper preservative

12 hr

Addis count -first quantitative measurement of formed elements in the urine using hemacytometer

Afternoon (2PM-4PM)

Urobilinogen bec. Of alkaline tide

4 hr

Nitrite determination : 1st morning/4 hr urine

18) It is a proteolytic enzyme produced by the kidney that reacts with angiotensinogen to produce angiotensin to increase blood pressure. a. Aldosterone c. Erythropoeitin d. ADH 19) Antidiuretic hormone regulates the reabsorption of: b. Sodium in the collecting tubules c. Sodium in the distal convoluted tubule d. Water and sodium in the loop of Henle 20) Water reabsorption occurs throughout the nephron except in the a. Cortical collecting tubules b. Proximal convoluted tubules d. Descending limb of the loops of Henle 21) The final concentration of the urine is determined within the: b. Loops of Henle c. Distal convoluted tubules d. Proximal convoluted tubules 22) The glucose renal threshold is 160–180 mg/dL. This represents the: a. Concentration of glucose in the vasa recta b. Maximum rate of glucose reabsorption in the renal tubule d. Plasma level at the commencement of glucose reabsorption in the nephron 23) Aldosterone is involved in the reabsorption of: a. Potassium c. Bicarbonate d. Hydrogen ion

24) Creatinine is a good substance to use for a renal clearance test because it a. Is exogenous b. Is reabsorbed c. Is affected by fluid intake.

25) Serum osmolality remains relatively constant, whereas the urine osmolality ranges from: a. One-third to one-half that of serum b. One-third to equal that of serum d. Three to five times that of serum 26. The physical characteristic of color is assessed when a routine urinalysis is performed. What substance is normally found in urine that is principally responsible for its yellow coloration? a. Bilirubin b. Melanin c. Carotene

27. In certain malignant disorders, what substance is found in the urine that turns the urine dark brown or black on exposure of the urine to air? a. Urobilinogen b. Indican d. Porphyrin COLOR OF URINE 1. Normal – varies from almost colorless, straw or light yellow to dark yellow, yellow-orange, or amber 2. Variations

Colorless/pale yellow – recent fluid consumption, polyuria, DM, DI Amber/ orange – bilirubin, acriflavine, phenazopyridine, nitrofurantoin, phenindione Yellow-green – oxidation of bilirubin to biliverdin Blue/green – Pseudomonas infection, amitriptyline, methocarbamol, clorets, indican, methylene blue Pink/red – intact RBCs, hemoglobin, myoglobin, porphyrins, beets, menstrual contamination Brown/black – methemoglobin, homogentisic acid, melanin, argyrol, methyldopa, levodopa, metronidazole 28. Which method for the determination of urine specific gravity is based on refractive index? b. Hydrometer c. Reagent strip d. Harmonic oscillation densitometry 29. Normal urine SG b. 1.001-1.040 c. 1.020-1.040 d. 1.000-1.035 30. Interferes with SG determination using refractometer a. RBC b. Epithelial cells c. Glucose

31. Calibration using 9% sucrose a. 1.000 b. 1.022 ± 0.001 d. 1.015 ± 0.001

32. What is the odor of urine of patients with Tyrosinemia a. Ammonia-like b. Faint aromatic c. Cabbage

Normal – faint aromatic due to volatile acids; becomes a Variations a. Ammoniacal (freshly voided) – UTI b. Rancid – tyrosinuria c. Maple syrup/ caramel-like – MSUD d. Sulfur odor – cystine disorders e. Fruity/ sweet – diabetes ketoacidosis f. Mercaptan – asparagus, garlic, and eggs

mmoniacal as the specimen stands g. Mousy – PKU h. Sweaty feet – isovaleric acidemia i. Rotting fish – trimethyl aminuria j. Fecaloid – recto-vesicular fistula k. Cabbage/ hops – methionine malabsorption l. Bleach – contamination

33) Which of the following is not a source of erroneous results when reagent strips are used? a. Testing a refrigerated urine specimen b. Timing using a clock without a second hand c. Allowing excess urine to remain on the reagent strip

34. Which principle is used in the determination of specific gravity by reagent strip methods? The pKa of a polyelectrolyte is altered by the urine’s ionic strength. b. Cations are chelated by a color-changing ligand. c. Ions catalyze the oxidation of a chromogen. d. Solutes release H ions to change the pKa.

35. Which of the following methods used to determine the specific gravity of urine does not detect the presence of urine protein or glucose? a. Total solids (TS) meter b. Refractometry d. Urinometry 36. Which of the following substances if present in the urine results in a negative Clinitest? a. Fructose b. Lactose c. Galactose

37. Normally, daily urine protein excretion does not exceed b. 500 mg/day c. 1.5 g/day d. 2.5 g/day 38. Which of the following proteins originates in the urinary tract? a. Albumin b. Bence Jones protein c. β2-Microglobulin

39. Which of the following statements about Bence Jones protein is correct? a. The protein consists of κ and λ light chains b. The protein is found in the urine of patients with multiple sclerosis c. It precipitates when urine is heated to 100° C and redissolves to 60° C d. The protein produce positive reagent strip protein test and a negative SSA 40. A false-positive protein may be produced by: a. Albumin b. c. Ascorbic acid d. Run-over effect 41. Percentage of SSA reagent in SSA Test a. 1 b. 2 d. 4 42. Purple colors are observed in the positive reactions for: a. Blood and glucose b. Bilirubin and urobilinogen d. Protein and nitrite 43. The ketone most detectable by all reagent strips is: b. Beta-hydroxybutyric acid c. Acetone d. Phenylketone

44. Which of the following aids in the differentiation of hemoglobinuria and hematuria? a. Urine pH b. Urine color c. Leukocyte esterase test

45. A Watson-Schwartz test is performed on a urine specimen. The following results are seen: chloroform tube —red color in the bottom layer; butanol tube: red color in the top layer. These results indicate the presence of: b. Porphobilinogen c. Urobilinogen and other Ehrlich’s reactive substances d. Porphobilinogen and other Ehrlich’s reactive substances 46. Indican is: a. Soluble in chloroform, insoluble in butanol b. c. Soluble in both chloroform and butanol d. Insoluble in both chloroform and butanol 47. a.

Rapid screening test for urinary porphobilinogen: Watson-Schwartz test

c. d.

Blondheim’s test APT test

48. A result of 4.5 Ehrlich unit urobilinogen is equivalent to: a. 0.45 mg/dL c. 45 mg/dL d. 450 mg/dL 49. Which of the following blood cells will not be detected by the leukocyte esterase pad because it lacks esterases? a. Eosinophils c. Monocytes d. Neutrophils 50. Microscopic examination of a urine sediment revealed an average of 2 to 5 white blood cells per high-power field, whereas the leukocyte esterase test by reagent strip was negative. Which of the following statements best accounts for this discrepancy? a. The urine is contaminated with vaginal fluid b. Many white blood cells are lysed, and their esterase has been inactivated c. Ascorbic acid is interfering with the reaction on the reagent strip

51. Which of the following tests does not have a negative reading on reagent strip color charts? a. Blood b. Glucose c. Ketone

52. Which of the following substances or actions can produce false-positive nitrite results? a. Ascorbic acid b. Strong reducing agents c. Vaginal contamination

53. All of the following are correct match, except: a. Ketone – sodium nitroprusside b. Leukocyte – indoxyl carbonic acid ester c. Protein – tetrabromphenol blue – 54. Testing specimens that contain high levels of ascorbate may affect the reading of all of these EXCEPT: a. Bilirubin b. Glucose c. Nitrite

55. C-stix reagent strip for ascorbic acid: b. c. d.

20 seconds 30 seconds 45 seconds

56. a.

Sensitivity of Bilirubin reagent strip 0.2 to 0.4 mg/dL

c. d.

0.5 to 1.0 mg/dL 1.0 to 1.5 mg/dL

57. When semi-automated urine chemistry analyzers are used, the color that develops on the reaction pads is measured by: a. Spectrophotometry b. Fluorescence photometry d. Comparing with a color chart Regent strip test 1.

Principle

Reagents

Color reaction

M: Poly(methylvinyl ether) maleic anhydride, BTB C: Ethyleneglycol-bis (aminoethylether), BTB Methyl red; bromthymol blue

F(+): High concentration of protein F(–): Highly alkaline urine Runover from adjacent pads Old specimens

2.

3. P

4.

M: Tetrabromphenol blue C: Tetrachlorophenol tetrabromosulfonphthalein

M: Glucose oxidase, peroxidase, KI C: Glucose oxidase, peroxidase, TMB

Sources of interference

g

F(+): Highly buffered alkaline urine, pigmented specimens, chlorhexidine, phenazopyridine, QACs (detergents), antiseptics, loss of buffer, high SG F(–):Proteins other than albumin, high salt concentration, microalbuminuria F(+): Oxidizing agents, detergents n F(–): Ascorbic acid, ketones, high SG, low temperatures, improperly n preserved specimens

M: Sodium nitroprusside C: Sodium nitroprusside and glycine

5.

( )

M:Diisopropylbenzene dihydroperoxide TMB C: 2,5-dimethyl 2,5dihydroperoxyhexane TMB

6.

M: 2,4-dichloroaniline diazonium salt C:2,6-dichlorobenzene

7.

diazoniumtetrafluoroborate

8.

M: paradiethylaminobenzaldehyde C: 4-methoxybenzene diazonium tetrafluoroborate

9.

M: p-arsanilic acid, tetrahydrobenzoquinolinol C: sulfanilamide, 3hydroxy1,2,3,4- tetrahydro- 7,8benzoquinoline M:Derivatized pyerole amino acid ester, diazonium salt C: Indoxylcarbonic acid ester, diazonium salt

10.

or

F(+): Phthalein dyes, highly pigmented red urine, levodopa, medications containing SH group F(–): Improperly preserved specimens F(+): Strong oxidizing agents, bacterial peroxidases, menstrual contamination F(–): High SG, crenated cells, formalin, captopril, nitrite, ascorbic acid, unmixed specimen F(+): Highly pigmented urine, indican, phenazopyridine, metabolites of Lodine F(–): Specimen exposure to light, ascorbic acid >25 mg/dL, high concentration of nitrite F(+): PBG, indican, procaine, paminosalicylic acid, sulfonamides, methyldopa, chlorpromazine, pigmented urine F(–): Old specimens, formalin, high concentration of nitrite F(+): Old specimen, highly pigmented urine F(–):Nonreductase-containing bacteria, lack of urinary nitrate, insufficient contact time between bacteria and nitrate, bacteria converting nitrite to nitrogen, antibiotics, ascorbic acid, high SG F(+): Strong oxidizing agents, formalin, highly pigmented urine, nitrofurantoin F(–): protein, glucose, oxalic acid, ascorbic acid, gentamicin, cephalosporins, tetracyclines

58. Broad casts are defined as those with a diameter two to six times that of normal casts. They indicate tubular dilation and/or stasis in the distal collecting duct. Which types of casts may occur in broad forms? 1. Hyaline 2. Cellular 3. Granular 4. Waxy a. 1 and 3 b. 2 and 4 c. 1, 2 and 3 59.

Broad and waxy casts are most likely associated with: a. Acute glomerulonephritis b. Acute interstitial nephritis c. Acute pyelonephritis

60. All of the following statements are true regarding amorphous urates, except: a. Urine sediment may appear pink-orange to reddish brown on macroscopic examination; this appearance has been referred to as brick dust b. It will convert to uric acid crystals with acidification with acetic acid c. It will dissolve with heat (60° C)

61. All of the following statements are true regarding amorphous phosphates, except: a. They have a granular appearance microscopically b. They tend to be colorless and will produce a fine or lacy white precipitate macroscopically c. It will dissolve in acids such as dilute hydrochloric and nitric acids and vary in solubility in acetic acid

62. Cholesterol crystals are associated with disorders producing lipiduria such as the nephrotic syndrome. It is soluble in: a. Acetone b. Ammonia c. Acetone

63. Leucine crystals are, occurring as yellow, oily-appearing spheres with radial and concentric striations. Leucine may be precipitated with tyrosine crystals if alcohol is added to the urine. b. Both statements are incorrect c. First statement correct, second incorrect d. First statement incorrect, second correct 64. Method of reporting for normal urinary crystals: a. Presence or absence b. Rare, few, moderate, many per LPF d. Average number per HPF 65. Method of reporting for cystine crystals: a. Presence or absence b. Rare, few, moderate, many per LPF c. Rare, few, moderate, many per HPF

66. Method of reporting for transitional epithelial (urothelial) cells: a. Presence or absence b. Rare, few, moderate, many per LPF d. Average number per HPF 67. Crystals may appear as colorless, flat rectangular plates or thin prisms often in rosette formations: : b. Calcium oxalate c. Triple phosphate d. Uric acid 68. Apatite: a. Magnesium ammonium phosphate STRUVITE c. Monohydrate calcium oxalate WHEWELLITE d. Dihydrate calcium oxalate WEDDELITE

69. Positive for the cyanide-nitroprusside reaction: POSITIVE RESULT IS RED-PURPLE a. Calcium oxalate b. Uric acid c. Sulfonamides Red blood cells White blood cells Renal tubular ECs Transitional ECs Biconcave, anucleate discs, Granular, larger than RBCs, Vary in size and shape; with Spherical, polyhedral, and 7 µm in diameter ~12 µm in diameter eccentric nucleus caudate; with central nucleus Abnormal morphology glomerulonephritis, indicates malignancy or f= renal calculi, malignancy viral infection B n: hepatitis ( following H n: and hemolytic conditions Oval invasive urologic procedures e.g. catheterization fat bodies: lipiduria, g

ATN

Squamous ECs Abundant, irregular cytoplasm and a prominent central nucleus about the size of an RBC

Bacteria Gram – rods of family Enterobacteriaceae, and cocci esp. and

Yeast cells Small, refractile oval structures; most common

– indicates ( with coccobacilli)

= covered when h

– inhabits the urinary bladder; ova have a characteristic terminal spine

y

and a p

Parasites –most common; may resemble a WBC, transitional, or RTE cell; causes nonspecific urethritis

e and

Casts Hyaline cast

Red blood cell cast

White blood cell cast appearance,

; ; prototype

RTE cell cast Consists of

a

of all casts Indicates Seen with other pathological and casts in cases of AGN, damage to the capillary CGN, APN, and CHF structure of the nephrons

Seen in ( and b (

Granular cast Waxy cast Broad cast Matrix contains coarse or High RI; fine granules from the ( disintegration of cellular and and casts, filtered proteins, or ;homogenous, dark lysosomes secreted by RTE , Indicates fin dest

Crystals

) and

n, associated with exposure to

) Fatty cast ;

and

; matrix may contain few or many s, and es may be attached to the matrix Seen in in conjunction with o...