MULTIPLE CHOICE QUESTIONS (20 POINTS) • Hemorrhages

Choose the letter of the correct or best answer for each item. 7. Which of the following is the defect involved in
Type II Renal Tubular Acidosis?
1. What is the characterisic color of urine of patients
• Cannot increase ammonia secretion
with porphyrias?
• Cannot reabsorb bicarbonate
• Red – brown
• Cannot exchange Sodium for Potassium and
• Pink to red
Hydrogen
• Port wine red
• Cannot maintain Hydrogen ion gradient
• Bright Red
8. Which of the following renal calculi is seen in
2. Which of the following procedure uses high-
children with an inherited enzyme deficiency
energy shockwaves that breaks renal stones in
disorder and hyperuricemia?
fragments small enough to be passed in urine?
• Adenine stone
• Ultrasound
• Calcium carbonate
• Lithotripsy
• Xanthine stone
• Laser treatment
• Sulfonamides
• Cytoscopy
9. What colorless compound is formed when
3. Which of the following sequences best describe
ascorbic acid is oxidized?
renal calculi formation?
• Sodium Ascorbate
• Supersaturation, aggregation, crystal growth, stone
• Dehydroascorbic acid
formation
• Hydrogen peroxide
• Supersaturation nucleation, crystal growth,
• Water
aggregation
10. Which of the following is characterized by the
• Nucleation, aggregation, crystal growth, stone
wrinkling of the basement membrane creating
formation
crescents that occupy the glomerular space?
• Nucleation, supersaturation, crystal growth,
• Minimal change disease
aggregation
• Focal segmental glomerulosclerosis
4. What condition is characterized by an abnormal
structure of the valve between the urinary bladder • Membranous glomerulonephritis
and ureter? • Rapidly progressive glomerulonephritis
• Vesicoureteral Reflux 11. Which toxic metabolic product is most commonly
associated with the development of cataracts in
• Intrarenal Reflux
newborns?
• Tubulorrhexis
• Galactonate
• Hydronephrosis
• Galactose – 1 – phosphate
5. Which of the following best explains true
hemoglobinuria? • Galactitol
• It is caused by the lysis of intact red blood cells in • Galactose
passed urine. 12. What disorder is associated with production of
urine with a characteristic “mousy” odor?1 point
• Intravascular hemolysis liberates hemoglobin and
passes it all through the glomerulus. • Alkaptonuria
• All haptoglobins are bound and excess free • Isovaleric aminoacidemia
hemoglobin passes through the glomerulus. • Lesch – Nyhan disease
• Failure of the distal convoluted tubule to reabsorb • Phenylketonuria
and catabolize hemoglobin to ferritin. 13. Which type of tyrosinuria is correctly paired with
6. Which of the following accounts to majority of the enzyme deficient in the disorder?
acute renal failure cases? • Type 1a: Tyrosine aminotransferase
• Renal Calculi • Type 1b: Fumarylacetoacetic acid hydrolase
• Glomerular diseases • Type 2: Maleylacetoacetic acid isomerase
• Severe burns • Type 3: phydroxyphenylpyruvate oxidase
14. Which of the following is characterized by 20. A mother diagnosed with a gestational diabetes
increased plasma levels of one or more amino gave birth to an infant with the following clinical
acids that exceeds the renal threshold, thereby manifestations: cataract formation in the left eye,
resulting in their overflow into the urine? increased ALT, increased AST and bilirubin levels
• No threshold aminoaciduria above 2.3 mg/dL. What is the possible disorder of
• Renal amino aciduria the infant?
• Secondary amino aciduria • Maple Syrup Urine Disease
• Overflow aminoaciduria • Hereditary Cystinosis
15. Which of the following results are consistent to a • Galactosemia
patient with UTI caused by nitrate-reducing gram- • Acidemias
negative bacilli?
MODIFIED TRUE OR FALSE (20 POINTS).
• Positive leukocyte esterase only.
21. Alport’s syndrome is characterized by lamellated
• Positive nitrite only.
basement membrane. The damage in Fabry’s
• Both leukocyte esterase and nitrite are positive.
disease is due to glycosphingolipids deposits.
• Both leukocyte esterase and nitrite are negative.
• First statement is TRUE and the second statement is
16. Which of the following diseases is paired with
FALSE.
substances that deposits on their basement
• First statement is FALSE and the second statement
membrane?
is TRUE.
• Minimal change disease: IgG and fibrin
• Both statements are TRUE.
• Membranous glomerulonephritis: IgA and
• Both statements are FALSE.
coagulation proteins
22. Acute interstitial nephritis is characterized by
• Focal Segmental glomerulosclerosis: IgM and C3
leukocyturia in the absence of bacteriuria.
• Berger’s Disease: IgG and fibrin Antibiotic-related acute interstitial nephritis is
17. Which of the following disorders is characterized characterized by the appearance of rashes.
by the excretion of large amounts of
• First statement is TRUE and the second statement is
homogentisic acid?
FALSE.
• Alkaptonuria
• First statement is FALSE and the second statement
• Indicanuria is TRUE.
• Tyrosinuria • Both statements are TRUE.
• Melanuria • Both statements are FALSE.
18. If the patient has biliary obstruction, which of the 23. Nephropathic cystinosis is characterized by the
following is expected? accumulation of cystine crystals in the distal
• Increased urine urobilinogen convoluted tubules.Due to the involvement of the
• Decreased urine conjugated bilirubin distal convoluted tubules, the patient
• Decreased urine unconjugated bilirubin consistently produces an acidic urine.
• Acholic or pale stool • First statement is TRUE and the second statement is
19. Which of the following is NOT detected by FALSE.
chemical tests for blood? • First statement is FALSE and the second statement
• Hemoglobin is TRUE.
• Heme • Both statements are TRUE.
• Globin • Both statements are FALSE.
• Intact red cells 24. All white blood cells have leukocyte esterases in
their cytoplasm and therefore used to detect their
presence. A positive leukocyte esterase result is
possible even if there are no visible white blood
cell during microscopy.
• First statement is TRUE and the second statement is
FALSE.
• First statement is FALSE and the second statement • First statement is FALSE and the second statement
is TRUE. is TRUE.
• Both statements are TRUE. • Both statements are TRUE.
• Both statements are FALSE. • Both statements are FALSE.
25. Newborn screening must be performed between 30. Argentaffin cells produce serotonin from 5-
24 hours to 72 hours of life. Newborns placed hydroxyindoleacetic acid in the intestines. In
under intensive care can have the test postponed cases of carcinoid tumors, there is an increase in
up to 7 days. 5-hydroxyindoleacetic acid in urine.
• First statement is TRUE and the second statement is • First statement is TRUE and the second statement is
FALSE. FALSE.
• First statement is FALSE and the second statement • First statement is FALSE and the second statement
is TRUE. is TRUE.
• Both statements are TRUE. • Both statements are TRUE.
• Both statements are FALSE. • Both statements are FALSE.
26. Calcium calculi are frequently associated with 31. Incomplete metabolism of the polysaccharide
metabolic calcium and phosphate disorders. portion of glycosaminoglycans cause
Small or large calculi may be passed in the urine, mucopolysaccharide disorders. Accumulation of
subjecting the patient to severe pain and bleeding. mucopolysaccharide in the cornea is observed in
• First statement is TRUE and the second statement is Sanfilippo’s syndrome.
FALSE. • First statement is TRUE and the second statement is
• First statement is FALSE and the second statement FALSE.
is TRUE. • First statement is FALSE and the second statement
• Both statements are TRUE. is TRUE.
• Both statements are FALSE. • Both statements are TRUE.
27. Myoglobinuria refers to increased levels of • Both statements are FALSE.
myoglobin in urine. It readily passes through the 32. Phenylketonuria is characterized by an increase
glomerulus but is more toxic that hemoglobin. in urinary phenylalanine. Phenylalanine is
• First statement is TRUE and the second statement is metabolized by phenylalanine hydroxylase.
FALSE. • First statement is TRUE and the second statement is
• First statement is FALSE and the second statement FALSE.
is TRUE. • First statement is FALSE and the second statement
• Both statements are TRUE. is TRUE.
• Both statements are FALSE. • Both statements are TRUE.
28. The major component of amyloid is fibril protein. • Both statements are FALSE.
Amyloidosis manifests as nephritic syndrome. 33. Urine pH is an important factor in the presence of
• First statement is TRUE and the second statement is urine crystals, and therefore renal stone
FALSE. formation. As the urine pH increases, urine
• First statement is FALSE and the second statement minerals tend precipitate and therefore enhances
is TRUE. stone formation.
• Both statements are TRUE. • First statement is TRUE and the second statement is
• Both statements are FALSE. FALSE.
29. Porphyrias are autosomal recessive disorders • First statement is FALSE and the second statement
that can manifest as cutaneous lesions. These is TRUE.
blistering lesions are the result of toxic free • Both statements are TRUE.
radicals when porphyrins absorb light. • Both statements are FALSE.
• First statement is TRUE and the second statement is 34. A person who frequently urinates will always test
FALSE. positive for nitrite. All urinary tract infections
 caused by bacteria will have increased urinary 39. Renal calculi have an organic matrix that is solely
nitrites. composed of uromodulin. Inorganic components
• First statement is TRUE and the second statement is of the stones give its physical characteristics.
FALSE. • First statement is TRUE and the second statement is
• First statement is FALSE and the second statement FALSE.
is TRUE. • First statement is FALSE and the second statement
• Both statements are TRUE. is TRUE.
• Both statements are FALSE. • Both statements are TRUE.
35. Oliguria is observed during the recovery phase of • Both statements are FALSE.
acute tubular necrosis. During this phase, excess 40. Normally, trace amounts of bilirubin are present
amounts of sodium and potassium accumulates in urine. A positive test for bilirubin implies a
in the body. significant increase in bilirubin.
• First statement is TRUE and the second statement is • First statement is TRUE and the second statement is
FALSE. FALSE.
• First statement is FALSE and the second statement • First statement is FALSE and the second statement
is TRUE. is TRUE.
• Both statements are TRUE. • Both statements are TRUE.
• Both statements are FALSE. • Both statements are FALSE.
36. Metabolic disorders are commonly inherited in an
MORSE TYPE (40 POINTS)
autosomal recessive manner. It manifests as an
Select all possible answers for each question by ticking
enzyme deficiency resulting to the accumulation
the box beside each answer.
of a metabolite.
• First statement is TRUE and the second statement is 41&42 Which of the following can distinguish
FALSE. hemoglobinuria from myoglobinuria?
• First statement is FALSE and the second statement 2 points
is TRUE.
• Blood reagent strip
• Both statements are TRUE.
• Urine Color
• Both statements are FALSE.
• Plasma creatine kinase
37. Ascorbic acid is a water-soluble substance that
acts as an enzyme cofactor in metabolic 43&44 Which of the following amino acids is/are present
processes. It is a strong reducing substance that in the urine of patients with cystine stones?
is synthesized by the liver and excreted in urine. 2 points
• First statement is TRUE and the second statement is
FALSE. • Arginine
• First statement is FALSE and the second statement • Lysine
is TRUE. • isoleucine
• Both statements are TRUE. 45&46 Select all renal diseases that are associated with
• Both statements are FALSE. the presence of casts in urine.
38. Less than 0.4 mg/dL of porphobilinogen is 2 points
normally excreted in urine. Porphobilinogens
undergo reversible oxidation and form • Acute glomerulonephritis
porphyrins. • Acute pyelonephritis
• First statement is TRUE and the second statement is • Renal tubular acidosis
FALSE.
47&48 Which of the following can result to
• First statement is FALSE and the second statement hemoglobinuria?
is TRUE. 2 points
• Both statements are TRUE.
• Both statements are FALSE. • Crush injury
 • Transfusion reaction 2 points
• Seizure
• Sticking to a vegetarian diet.
49&50 Urine from patients with phenylketonuria will react • Intake of citrus fruits.
with: • Drinking plenty of water.
2 points
63&64 Which of the following is associated with disorders
• Ferric chloride of the phenylalanine-tyrosine pathway?
• Dinitrophenylhydrazine 2 points
• Silver nitroprusside
• Malignant melanoma
51&52 Which of the following mucopolysaccharide • Deficiency of the enzyme fumarylacetoacetate
disorders is associated with mental retardation and hydrolase
skeletal abnormality? • Albinism
2 points
65&66 Select all clinical features of nephrotic syndrome.
• Hurler 2 points
• Hunter
• Hematuria
• Sanfilippo’s
• Proteinuria
53&54 Which among the following is/are renal stone • Lipiduria
inhibitor/s?
67&68 Select all possible causes of toxic acute tubular
2 points
necrosis.
• Tamm-Horsfall protein 2 points
• Complement proteins
• Severe burns
• Heparan sulfate
• Vehicular accident
55&56 Select all parameters to which ascorbic acid • Rhabdomyolysis
interferes by reacting with the product of the first reaction.
69&70 Select all diseases that manifest with nephritic
2 points
syndrome.
• Blood 2 points
• Glucose
• Membranous Glomerulonephritis
• Nitrite
• Minimal Change Disease
57&58 Which of the following specimens can be used for • Rapidly Progressive glomerulonephritis
porphyrin testing?
71&72 Which of the following metabolic disorders can be
2 points
characterized basing on urine color?
• Blood 2 points
• Urine
• Alkaptonuria
• Feces
• Melanuria
59&60 Elevated levels of 5-HIAA in urine are associated • Indicanuria
with:
73&74 Which of the following is seen in sickle cell disease?
2 points
2 points
• Carcinoid tumors
• Increased urine urobilinogen
• Platelet abnormalities
• Negative urine bilirubin reagent pad
• Diet high in bananas and tomatoes
• Positive urine bilirubin reagent pad
61&62 Which among the following “home remedies” can
help prevent the formation of renal stones?
75&76 Which of the following amino acid disorders is Bilirubin: Negative
associated with neurological abnormality? Urobilinogen: Normal
2 points

• Phenylketonuria
81. If Ictotest is performed using the patient’s sample
• Galactosemia
and the result is positive, what would be the possible
• Tyrosinemia
explanation?
77&78 Select all glomerular diseases where leukocytic 1 point
infiltration can be observed.
• Ictotest is more specific in detecting unconjugated
2 points
bilirubin in urine.
• Crescentic glomerulonephritis • The reagent strip method cannot detect
• Post-Streptococcal Acute glomerulonephritis unconjugated bilirubin in urine.
• Membranoproliferative Glomerulonephritis • Ictotest is generally more sensitive than the reagent
strip method.
• Ictotest should be repeated and must be consistent
79&80 Select all characteristics of Type III renal tubular with reagent strip method.
acidosis
2 points 82 & 83 Select all tests/parameters with abnormal or
discrepant findings
• Increased ammonia secretion
• Increased bicarbonate reabsorption in PCT • Physical Examination
• Impaired sodium-potassium exchange mechanism • Specific gravity
• pH
• Protein
CASE ANALYSIS (20 POINTS). Study the cases carefully • Urobilinogen
and answer the questions provided.
• Bilirubin

A 43-year-old male patient reports fatigue and nausea CASE ANALYSIS

during his annual check-up. The attending physician A 23-year-old immunocompromised female patient
noted a yellowish discoloration in the sclera of his eyes. complained of dysuria and a mild fever. The physician
Urinalysis results are as follows. The patient urine is suspects urinary tract infection and requested for
dark yellow, cloudy and has a characteristic yellow foam. routine urinalysis. Upon physical examination, her urine
appears yellow and slightly cloudy. Notable reagent
strip results are as follows:
Physical Examination:
Color: Dark Yellow
Clarity: Cloudy SG=1.015
Other remarks: Yellow foam pH=6.5
Protein= 1+
Chemical examination: Leukocyte esterase= Positive
SG: 1.020 Nitrite=Negative.
pH: 6.5
84. During microscopy, numerous oval budding cells
Blood: Negative
were observed. What do these results imply?
Protein: 2+
1 point
LE: Negative
Nitrite: Negative • There is an inflammation in the kidneys or along the
Glucose: Negative urinary tract.
Ketones: Negative • It suggests urinary tract infection caused by
bacteria.
 • It suggests urinary tract infection caused by a Negative Protein reagent pad
fungal organism. Urine color
• The results are inconsistent and testing must be Dysmorphic red blood cells
repeated. RBC casts

CASE ANALYSIS
A 22 – year – old female clinical laboratory student
CASE ANALYSIS performs urinalysis on her own urine as part of a
A 45-year-old female patient with systemic lupus laboratory class. Significant results include:
erythematosus is transferred to a university hospital
because of significant deterioration of renal function.
Routine urinalysis results from a fresh sample are as Physical Examination:
follows: Color: Yellow
Clarity: Slightly cloudy

Physical Examination: Chemical examination:

Color: Brown SG: 1.015
Clarity: Cloudy pH: 7.5
Protein: 1+
Chemical examination: LE: Positive
SG: 1.010 Nitrite: Positive
pH: 7.0
Blood: 4+ Microscopic Examination:
Protein: 3+ RBC/hpf: 25 – 50, dysmorphic cells seen
LE: Negative WBC/hpf: 25 – 40
Nitrite: Negative Epithelial cells: few squamous epithelial cells
Glucose: Negative Bacteria: Moderate
Ketones: Negative
Bilirubin: Negative 88&89 Select tests that supports your answer
Urobilinogen: Normal 2 points

• Urine Color
Microscopic Examination:
• Specific gravity
RBC/hpf: 25 – 50, dysmorphic cells seen
• Urine Leukocyte Esterase and Nitrite
WBC/hpf: 5 – 10
Casts/lpf: 0 – 2 RBC cast; 5 – 10 granular; 0 – 2 hyaline • White Blood cells and Epithelial Cells
Epithelial cells: few transitional cells/hpf • White Blood cells and Bacteria
Crystals/hpf: few calcium oxalate 90. What do these findings suggest?
85. Which of the following is the possible renal disease 1 point
of the patient based on the provided urinalysis results? • Upper urinary tract infection
1 point • Lower urinary tract infection
Nephrotic Syndrome • Acute glomerulonephritis
Acute Interstitial nephritis • Nephrolithiasis
Acute pyelonephritis
Acute Glomerulonephritis

86&87 Select all results that would suggest bleeding in

the nephrons
2 points

Negative Blood reagent pad

 CASE ANALYSIS • Acute glomerulonephritis
A 33-year-old male patient arrived in the emergency • Urinary tract infection
room complaining of severe pain from his right flank and • Renal Calculi
groin area. He is also concerned with his frequent urge
to urinate but releasing minimal or no urine in the CASE ANALYSIS. Type you answers in upper case
bathroom. Symptoms got worse when he was self- format.
medicating a cold with over-the-counter drugs and Simon Peter was admitted to the emergency room due
increasing his intake of the new brand of multivitamins to abdominal pain, nausea, increasing fever,
for almost 2 weeks. constipation, muscle weakness and excessive vomiting.
Basing on his ultrasound result, his appendix is
ruptured. Surgery was immediately performed. After the
Physical Examination: operation, the doctor noticed that Simon developed
Color: Pink neuropsychiatric problems and had episodes of seizure.
Clarity: Slightly Cloudy Later in the evening, the nurse noticed a purple
coloration on the urinary catheter bag.
Chemical examination:
SG: 1.030 (Refractometer: 1.035) 94. What substance is most likely causing the distinct
pH: 5.5 urine color PORPHYRINS
Blood: Negative 95. What test can detect its presence in urine?
Protein: 1+ (SSA: 1+Nit) PORPHYRIN TEST
LE: Negative 96. State one clinical finding that supports the diagnosis
Nitrite: Positive of the patient, aside from what was mentioned
Glucose: Negative HYPERTENSION
Ketones: Negative 97. What is most probable diagnosis for Simon Peter
Bilirubin: Negative PORYPHYRIN DISORDER
Urobilinogen: Normal
CASE ANALYSIS. Write your answers in upper case
Microscopic Examination: format.
RBC/hpf: 10 – 25 A 2-month-old baby boy was observed by his parents to
WBC/hpf: 5 – 10 have slowed development in cognitive and motor skills.
Casts/lpf: 0 – 2 hyaline They also observed the occasional appearance of a
Epithelial cells: Few transitional cells/hpf substance resembling orange sand in the child’s
Crystals/hpf: Many calcium oxalate diapers.

91&92 Which of the among the results would support 98. What is the most probable condition manifested by the
your answer? 2-month-old baby boy? PURINE DISORDER
2 points 99. What microscopic element serves as a marker for the
identification of this disease? PRESENCE OF URIC ACID
• Positive nitrite test with negative leukocyte esterase CRYSTALS
• High specific gravity in both methods of testing 100. Name the enzyme that is deficient in this disorder
• Low urinary pH and presence of proteins HYPOXANTHINE GUANINE
• Presence of white blood cells and Negative PHOSPHORIBOSYLTRANSFERASE
leukocyte esterase
• Presence of Calcium oxalate crystals and red blood
cells

93. Which of the following conditions does the patient

likely have?
1 point

• Drug-induced acute interstitial nephritis.