Medical Lab Science: Summative Review with Answers #09

MEDICAL LABORATORY SCIENCE SUMMATIVE EXAM REVIEW QUESTIONS #09 + ANSWERS & RATIONALIZATIONS 1. 2. 3. 4. 5. 6. 7. 8. 9. Which of the following is an abnormal crystal described as a hexagonal plate? a. Cystine → colorless hexagonal palte b. Tyrosine c. Leucine d. Cholesterol Positive for the cyanide nitroprusside test: a. Uric acid crystals b. Cystine → (+) red-purple c. Tyrosine d. Leucine Crystals in an amber-colored urine: Crystals appear as clumped needles or granules with the characteristic yellow color. These crystals are characteristic of: a. Acute glomerulonephritis b. Acute pyelonephritis c. Hepatic disorders d. Lipiduria example, nephrotic syndrome Tests to for bilirubin detection: a. Chloroform test b. Esbach’s test c. Heat and acetic acid test d. Sulkowitch test Calculi formation at pH > 7: a. Uric acid, cystine, xanthine b. Calcium oxalate, apatite c. Triple phosphate, calcium phosphate d. All of the above → Calculi formation: Hurler, Hunter, and Sanfilippo syndromes are hereditary disorders affecting metabolism of: a. Porphyrins b. Purines c. Mucopolysaccharides d. Tryptophan Cetyltrimethylammonium bromide (CTAB) test: a. Homogentisic acid, transient blue b. Mucopolysaccharides, blue spot c. Mucopolysaccharides, white turbidity d. PKU, blue-green color Positive result in the metachromatic staining procedure for mucopolysaccharides: a. Black precipitate b. White turbidity c. Blue spot d. Red spot Which of the following conditions is associated with normal urine color but produces red fluorescence when urine is examined with an ultraviolet (Wood’s) lamp? a. Acute intermittent porphyria b. Lead poisoning c. Erythropoietic porphyria d. Porphyria cutanea tarda 10. Elevated compound(s) in congenital erythropoietic porphyria: a. Protoporphyrin b. ALA, porphobilinogen c. ALA, protoporphyrin d. Uropophyrin, coproporphyrin 11. In Sysmex UF-100 urine cell analyzer, the DNA within the cell is stained with: a. Hematoxylin b. Eosin c. Phenathridine d. Carbocyanine → Sysmex UF-100 stains: 12. In Sysmex UF-100 urine cell analyzer, nuclear membranes, mitochondria and negatively charged cell membranes are stained with: a. Hematoxylin b. Eosin c. Phenathridine d. Carbocyanine 13. Which of the following fluids is not an ultrafiltrate of plasma? a. Cerebrospinal fluid (CSF) b. Peritoneal fluid c. Pleural fluid d. Synovial fluid 14. CSF is routinely collected by lumbar puncture between the: a. First, second or third lumbar vertebrae b. First, second or fourth lumbar vertebrae c. Second, third or fourth lumbar vertebrae d. Third, fourth, or fifth lumbar vertebrae 15. CSF is collected from intervertebral space between: a. T4 and T5 b. L2 and L3 c. L3 and L4 d. L4 and L5 16. What department is the CSF tube labeled 3 routinely sent to? a. Hematology b. Chemistry c. Microbiology d. Serology → CSF Collection tubes: 17. The CSF tube that should be kept at room temperature is: a. Tube 1 b. Tube 2 c. Tube 3 d. Tube 4 18. Fourth CSF tube may be drawn for: a. Cell counts b. Chemical tests c. Chemistry and cell counts d. Microbiology or additional serologic tests 1 19. If only a small amount of CSF is obtained, which is the most important procedure to perform first? a. Cell count b. Chemistries c. Immunology d. Microbiology 20. CSF cell count should be performed: a. Immediately b. Within 5 minutes c. Within 30 minutes d. Within 1 hour → Any cell count should be performed immediately, because WBCs (particularly granulocytes) and RBCs begin to lyse within 1 hour, with 40% of the leukocytes disintegrating after 2 hours. 21. The cell count on a CSF specimen should be performed within ___ of collection. a. 30 minutes b. 1 hour c. 2 hours d. 12 hours e. 24 hours 22. A CSF total cell count is diluted with: a. Distilled water b. Normal saline c. Acetic acid d. Methylene blue 23. A CSF WBC count is diluted with: a. Distilled water b. Normal saline c. Acetic acid d. Methylene blue 24. The reference range for CSF protein is: a. 6 to 8 g/dL b. 15 to 45 g/dL c. 6 to 8 mg/dL d. 15 to 45 mg/dL 25. Major protein in CSF: a. Albumin b. Prealbumin c. Transferrin d. IgG → CSF protein ▪ Albumin makes up most of CSF protein. ▪ Second most prevalent : prealbumin ▪ Alpha globulins: haptoglobin and ceruloplasmin ▪ Major beta globulin: transferrin ▪ Gamma globulin: primarily immunoglobulin G (IgG), with only a small amount of immunoglobulin A (IgA → Immunoglobulin M (IgM), fibrinogen, and beta lipoprotein are not found in normal CSF. 26. Second most prevalent protein in CSF: a. Albumin b. Prealbumin → aka Transthyretin c. Transferrin d. IgG 27. Major beta globulin in CSF: a. Albumin b. Prealbumin c. Transferrin d. IgG 28. CSF gamma-globulin is primarily: a. IgA b. IgE c. IgG d. IgM 29. Following a head injury, which protein will identify the presence of CSF leakage through the nose? a. Transthyretin b. Myelin basic protein c. Tau protein d. C-reactive protein 30. To assess the permeability of the blood/brain barrier in CSF: a. Albumin b. IgG c. Transferrin d. Prealbumin 31. For an accurate evaluation of CSF glucose, a blood glucose test must be run for comparison. The blood glucose should be drawn about ___ spinal tap to allow time for equilibration between the blood and fluid. a. 2 hour after spinal tap b. 2 hours before spinal tap c. 8 hours after spinal tap d. 8 hours before spinal tap 32. CSF test frequently requested for patients with coma of unknown origin: a. Glucose b. Glutamine c. Lactate d. Protein 33. Given the following information, calculate the total CSF cell count, hazy CSF, diluted 1:20; cells counted in 2 WBC squares on each side of the hemocytometer, 28 and 32. a. 1,500/µL b. 3,000/µL c. 3,200/µL d. 30,000/µL → The formula used for calculating manual cell counts using a hemacytometer is: → Solution: (30 x 20) / (2 x 0.1) = 3,000 34. Compute for the WBC count in patient’s CSF. Dilution 1:20, counted in 4 corner squares Given are the number of WBCs in each square: Square 1: 40 Square 2: 43 Square 3: 43 Square 4: 44 a. b. c. d. → 2, 125 WBCs/cu.mm. 4, 250 WBCs/cu.mm. 8, 500 WBCs/cu.mm. 17,000 WBCs/cu.mm. Solution: (170 x 20) / (4 x 0.1) = 8,500 2 35. Eosinophils may be increased in CSF in fungal infections primarily with: a. Candida albicans b. Coccidioides immitis c. Cryptococcus neoformans d. Histoplasma capsulatum 36. An increase in the amount of serous fluid is called a/an: a. Exudate b. Transudate c. Effusion d. Malignancy 37. The most reliable differentiation of transudate and exudate is usually obtained by: a. Rivalta’s test b. Determining the WBC count c. Determining the fluid: blood ratios for protein and LDH d. Determining the pleural fluid: serum cholesterol ratio 38. Which of the following is characteristic of an exudate effusion? a. Leukocyte count >1000/uL b. Clear appearance c. Protein concentration <3.0 g/dL d. Absence of fibrinogen 39. The recommended test for determining whether peritoneal fluid is a transudate or an exudate is the: a. Fluid: serum albumin ratio b. Serum: ascites albumin gradient c. Fluid: serum lactic dehydrogenase ratio d. Absolute neutrophil count → Differentiation between ascitic (peritoneal) 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 transudate of hepatic origin. 40. Black pleural fluid: a. Aspergillus infection b. Chylous effusion c. Hemothorax d. Rupture of amoebic liver abscess e. Note: 41. Brown pleural fluid: a. Aspergillus infection b. Chylous effusion c. Hemothorax d. Rupture of amoebic liver abscess 42. These cells are increased in effusions resulting from pancreatitis: a. Plasma cells b. Lymphocytes c. Mesothelial cells d. Neutrophils 43. Presence of plasma cells but noticeable lack of mesothelial cells in pleural fluid is associated with: a. Autoimmune disorders b. Viral infections c. Malignancy d. Tuberculosis 44. The pleural fluid hematocrit is more than 50% of the whole blood hematocrit: a. Hemorrhagic effusion b. Hemothorax c. Both of these d. None of these → To differentiate between a hemothorax and hemorrhagic exudate, a hematocrit can be run on the fluid. If the blood is from a hemothorax, the fluid hematocrit is more than 50% of the whole blood hematocrit, because the effusion comes from the inpouring of blood from the injury. A chronic membrane disease effusion contains both blood and increased pleural fluid, resulting in a much lower hematocrit. 45. Which of the following best represents a hemothorax? a. Blood HCT: 42 Fluid HCT: 15 b. Blood HCT: 42 Fluid HCT: 10 c. Blood HCT: 30 Fluid HCT: 10 d. Blood HCT: 30 Fluid HCT: 20 46. The glucose level of normal pleural fluid, transudates, and most exudates ___ serum levels. a. Above serum levels b. Below serum levels c. Same as serum levels d. Variable 47. Glucose in peritoneal fluid is decreased below serum levels in: a. Bacterial peritonitis b. Tubercular peritonitis c. Malignancy d. All of these 48. Normal synovial fluid does not clot; however, fluid from a diseased joint may contain fibrinogen and will clot. Therefore, fluid is often collected in a syringe that has been moistened with: a. EDTA b. SPS c. Heparin → specifically sodium heparin d. Sodium fluoride 49. Required tube for synovial fluid glucose analysis: a. Powdered EDTA b. Liquid EDTA c. Sodium heparin d. Sodium fluoride → To prevent falsely decreased values caused by glycolysis, specimens should be analyzed within 1 hour or preserved with sodium fluoride. 3 50. Synovial fluid is typically collected using sterile needle and syringe and then transferred to collection tubes for testing. Which of the following anticoagulants would be appropriate to use for the aliquot sent for manual cell count and crystal evaluation? a. Liquid EDTA b. Sodium polyanethol sulfonate c. Sodium fluoride d. Lithium heparin 4