CLINICAL MICROSCOPY Internship 1: Midterms

MTAP 1: Doc Yerenze Flores Oct 26, 2023

AUBF
PRE ASSESSMENT 7
1. What is the expected pH range of a freshly voided Answer: D.
urine specimen?
A. 3.5-8.0  pH is the hydrogen content of urine and indicates the homeostasis in the body’s Acid base balance.
B. 3.5-9.0
C. 4.0-8.5
D. 4.5-8.0
2. Which of the following may increase in long Answer: D
standing urine specimen?  An  bacteria will lead to an increased conversion of nitrate to nitrite
A. Nitrites  The bacteria will split the urea into ammonia, causing  pH.
B. Bacteria 
C. pH
D. All of the above

3. Which of the following is inappropriate when Answer: D.

collecting urine for routine bacteriologic culture?  The sample may be held at 2-8C for only up to 24 hours
A. The container must be sterile  The collected sample must be plated within 2 hours unless refrigerated
B. The midstream void technique must be used
C. The collected sample must be plated within 2 hours Note:
unless refrigerated  The most sterile technique: Suprapubic aspiration
D. The sample may be held at 2°C–8°C for up to 48  Urine bacteriologic studies: midstream void
hours prior to plating
4. The presence of ketone bodies in urine specimens Answer: B.
may be detected by use of a reagent strip
impregnated with sodium nitroprusside. Reagent Strip test for Ketones: Sodium Nitroprusside
This strip test is sensitive to the presence of: Sodium nitroprusside cannot detect B-hydroxybutyric acid even if it is the most abundant ketone.
A. Acetoacetic acid and beta-hydroxybutyric acid  Acetoacetic acid and acetone are detected
B. Acetoacetic acid and acetone  The test does not measure β-hydroxybutyrate and is only slightly sensitive to acetone when glycine
C. Diacetic acid and beta-hydroxybutyric acid is also present
D. Beta-hydroxybutyric acid and acetone  Both acetone and β-hydroxybutyric acid are produced from acetoacetic acid.
➢ 78% β-hydroxybutyric acid, 20% acetoacetic acid, and 2% acetone

5. SSA grading: Turbidity with granulation, no Answer: C. 2+

flocculation, with a protein range of 100-200 mg/dL Sulfosalicylic Acid Precipitation Test Procedure
A. Trace
B. +1 1. Add 3 mL of 3% SSA reagent to 3 mL of centrifuged urine
C. +2 2. Mix by inversion, and observe for cloudiness.
D. +3 3. Grade the degree of turbidity (see the following table).

6. Hemoglobin in urine can be differentiated from Answer: A.

myoglobin using:
Myoglobin is soluble to 80% ammonium sulfate (+ Blondheim test)
A. 80% ammonium sulfate to precipitate hemoglobin
B. Sodium dithionite to reduce hemoglobin Both hemoglobin and myoglobin will be positive in a dry reagent strip blood test (+ peroxidase activity)
C. o-Dianisidine instead of benzidine as the color
indicator
D. The dry reagent strip blood test

Hemoglobin Myoglobin
Blondheim’s test Precipitated (-) Soluble (+)
Supernatant Clear Red

WILLIAM, GRACE ANN D. 1

CLINICAL MICROSCOPY Internship 1: Midterms
MTAP 1: Doc Yerenze Flores Oct 26, 2023

PARAMETER HEMOGLOBINURIA MYOGLOBINURIA

Urine Color Pink, red, brown Pink, red, brown (at 25 mg/dl)
Blood Reagent Strip Positive Positive
Serum Color Pink to red Pale Yellow
Serum chemistry tests
Haptoglobin Decreased to absent Normal
Myoglobin Normal Increased
Free Hemoglobin Increased Normal
Creatine Kinase Increased (<10x upper limit) Increased (>10x upper limit)
7. Which of the following preserves protein and formed Answer: B. Boric Acid
elements well?  Formalin is used to preserve sediments
A. Formalin  Phenol and toluene is also not used for preservving urine
B. Boric acid
C. Phenol
D. Toluene
8. Which of the following is the major organic Answer: D.
substance found in urine?
Note
A. Sodium
B. Potassium  Major organic substance: Urea
C. Glucose ➢ Waste product of protein metabolism
D. Urea ➢ Glucose excretion will average less than 1 mmol/day
 Major inorganic substance: Sodium/ Chloride
➢ Sodium: 130 mmol/day
➢ Potassium: 70 mmol/day
9. Which of the following statements regarding the Answer: C. The test is dependent upon an adequate dietary nitrate content
test for nitrite in urine is true?
Nitrite test
A. It detects more than 95% of clinically significant
bacteriuria  It only detects 70% of clinically
B. Formation of nitrite is unaffected by the urine pH significant bacteriuria because of
C. The test is dependent upon an adequate dietary the presence of non-nitrate
nitrate content reducing bacteria
D. A positive test differentiates bacteriuria from in vitro ➢ Enterococcus
bacterial contamination ➢ Acitenobacter
➢ Pseudomonas
 Formation of nitrite is affected by acidic urine (false – results)
 The test is dependent upon nitrate rich food
 A positive test does not differentiate bacteriuria from in vitro bacterial contamination
 Dependent upon the activity of bacterial reductase
 Formed by the reduction of diet-derived nitrates
 Sensitivity is limited by the requirements for dietary nitrate and 3-4 hour storage time in the bladder

10. Which statement about the dry reagent strip test Answer: B.
for leukocytes is true?
LE test
A. The test detects only intact white blood cells (WBCs)
B. The reaction is based upon the hydrolysis of substrate  The reaction is based upon the hydrolysis of substrate by WBC esterase
by WBC esterase  The test detects both lysed and intact white blood cells (WBCs)
C. Several antibiotics may give a false-positive reaction  Antibiotices: false (-) reaction
D. The test is sensitive to 2–3 WBCs per HPF  Sensitivity: >10 WBCs/hpf
11. Which of the following tests is a specific measure of Answer: D. Cystatin C
glomerular filtration?
PAH (p-Aminohippuric acid) clearance
A. p-Aminohippuric acid (PAH) clearance
B. Fishberg concentration test  Filtered in glomerulus but also secreted in tubules
C. Mosenthal dilution test
Fishberg concentration test
D. Cystatin C
 Measuring the ability of kidneys to concentrate urine if patient is deprived of water
Mosenthal dilution test
 Ability to dilute urine if patient is given excessive water intake
12. Which statement regarding normal salt and H2O Answer: A.
handling by the nephron is correct?
The ascending limb of the tubule is highly permeable to salt but not H2O
A. The ascending limb of the tubule is highly permeable
to salt but not H2O  All parts of the tubules are permeable to water exc. The Ascending loop of Henle
B. The stimulus for ADH release is low arterial pressure in  Ascending loop is only permeable to salt
the afferent arteriole  Descending loop: highly permeable to water and urea, impermeable to salt
C. The descending limb of the tubule is impermeable to
OTHERS
urea but highly permeable to salt
D. Renin is released in response to high plasma  The stimulus for RENIN release is low arterial pressure in the efferent arteriole
osmolality  ADH stimulus: high plasma osmolality
13. In renal tubular acidosis, the pH of urine is: Answer: B
A. Consistently acid
Renal tubular Acidosis
B. Consistently alkaline
C. Neutral  Blood is acidic
D. Variable, depending upon diet  Inability to reabsorb bicarbonate in the collecting duct and thus excreted to urine= ALKALINE URINE
14. Which statement best describes the clinical utility Answer: A
of tests for microalbuminuria?
Microalbuminuria
A. Testing may detect early renal involvement in
diabetes mellitus  Early sign of diabetic nephropathy
B. Microalbuminuria refers to a specific subfraction of  Testing is not part of urine urinalysis
albumin found only in persons with diabetic  Orthostatic proteinuria indicates no damage to the kidneys and should not result in a (+) test
nephropathy ➢ Only seen in the morning
C. A positive test result indicates the presence of ➢ Microalbuminuria is through out the day
orthostatic albuminuria  Measures urinary albumin (<15 mg/dL)
D. Testing should be part of the routine urinalysis  Recommended for persons at risk for chronic renal disease, especially persons with DM
 DM renal involvement
➢ Early sign of renal involvement:  albumin excretion
➢ Microalbumin: 20-200 ug/ml > 30 mg albumin/gm crea

WILLIAM, GRACE ANN D. 2

CLINICAL MICROSCOPY Internship 1: Midterms
MTAP 1: Doc Yerenze Flores Oct 26, 2023

15. The normal renal threshold for glucose is: Answer: D. 165–180 mg/dL
A. 70–85 mg/dL
B. 100–115 mg/dL
C. 130–145 mg/dL
D. 165–180 mg/dL
16. A positive glucose oxidase test and a negative test Answer: True glycosuria
for reducing sugars indicates:
Reducing sugars test
A. True glycosuria
B. False-positive reagent strip test  Only used to test for inborn errors of metabolism
C. False-negative reducing test caused by ascorbate ➢ Especially Galactosuria
D. Galactosuria
17. Alkaptonuria, a rare hereditary disease, is Answer: D. Homogentisic acid
characterized by the urinary excretion of:
ALKAPTONURIA
A. Alkaptone
B. Phenylalanine  Excessive urinary excretion of homogentisic acid
C. 5-Hydroxyindole acetic acid  Deficiency in homogentisic acid oxidase
D. Homogentisic acid  Homogentisic acid
➢ Product of phenylalanine and tyrosine metabolism
 Black color: due to oxidative process
18. Phenylketonuria may be characterized by which of Answer: A. brain damage if untreated
the following statements?
Phenylketonuria
A. It may cause brain damage if untreated.
B. It is caused by the absence of the enzyme,  Absence of enzyme phenylalanine hydroxylase
phenylalanine oxidase.  Phenylpruvic acid excess is seen in urine
C. Phenylpyruvic acid excess appears in the blood.  Phenylalanine excess appears in blood
D. Excess tyrosine accumulates in the blood  There is no tyrosine accumulation but instead a phenylalanine accumulation

19. Which of the following is true about the final Answer: C. Vasopressin controls the collecting duct reabsorption of water.
concentrating of urine in the kidney?
 The distal convoluted tubule, through passive transport, reabsorbs water.
A. The distal convoluted tubule, through active
➢ There is no active transport of water, only passive transport
transport, reabsorbs water.
 Water is reabsorbed under the direct influence of ADH
B. Water is reabsorbed under the direct influence of
 Water reabsorption is influenced by urine filtrate levels of sodium
angiotensin II.
C. Vasopressin controls the collecting duct reabsorption
of water.
D. Water reabsorption is influenced by urine filtrate
levels of potassium.
20. Which parasite is the most frequently recovered in Answer: B. Trichomonas vaginalis
urine samples?
Trichomonas vaginalis
A. Giardia lamblia
B. Trichomonas vaginalis  Protozoan parasite
C. Ascaris lumbricoides  Causes STI Trichomoniasis
D. Strongyloides stercoralis
Note:
 Strongyloides stercoralis or Ascarid lumbricoides in urine
➢ Indicates contamination and not clinically significant
21. Which condition promotes the formation of casts in Answer: C. Reduced filtrate formation
the urine?
CASTS
A. Chronic production of alkaline urine
B. Polyuria  Casts are usually associated with urine stasis
C. Reduced filtrate formation ➢ Low urine SG=  hydration
D. Low urine SG  Promoted by an acid filtrate,  solute concentration, slow movement of filtrate and reduced filtrate
formation
 Appearance of cast is dependent upon location and time spent in the tubule and chemical and
cellular composition of filtrate
22. Which type of casts signals the presence of chronic Answer: C. Waxy casts
renal failure?
 Waxy/Broad casts: Chronic renal failure
A. Blood casts
 Fatty casts: Nephrotic syndorme
B. Fine granular casts
 Blood/RBC casts: Nephritic syndrome
C. Waxy casts
D. Fatty casts
23. Which of the following crystals is considered Answer: C
nonpathological?
Ammonium biurate: nonpathologic
A. Hemosiderin
B. Bilirubin Hemosiderin: intravascular hemolysis
C. Ammonium biurate Bilirubin: liver damage
D. Cholesterol
Cholesterol: hypercholesterolemia, Nephrotic Syndrome
24. At which pH are ammonium biurate crystals Answer: D. Alkaline
usually found in urine?
Ammonium biurate crystals
A. Acid urine only
B. Acid or neutral urine  Nonpathologic
C. Neutral or alkaline urine  Alkaline urine
D. Alkaline urine only  Thorny apple crystals
25. All of the following are common characteristics of Answer: C. Hematuria and pyuria
the nephrotic syndrome except:
 Differentiating factor of nephrotic and nephritic syndorme
A. Hyperlipidemia
➢ Level of proteinuria
B. Hypoalbuminemia
C. Hematuria and pyuria
D. Severe edema

WILLIAM, GRACE ANN D. 3

CLINICAL MICROSCOPY Internship 1: Midterms
MTAP 1: Doc Yerenze Flores Oct 26, 2023

26. This is a form of nephrotic syndrome that children Answer: B. Henoch-Schonlein purpura
can develop:
 Occurs primarily in children following viral respiratory
A. IgA nephropathy
infections;
B. Henoch-Schonlein purpura
 a decrease in platelets disrupts vascular integrity
C. Minimal change disease
 Initial appearance of purpura followed by blood in sputum
D. Acute glomerulonephritis
and stools and eventual renal involvement
 Significant test: Stool occult blood

27. Which of the following abnormal crystals is often Answer: A. Cystine

associated with formation of renal calculi?
Cystine Renal calculi Highly insoluble and form kidney stones
A. Cystine
B. Ampicillin Ampicillin Px being treated with high doses of Long colorless prisms in sheaves
C. Tyrosine ampicillin
D. Leucine
Tyrosine Liver disease or tyroosinosis
Leucine Chronic liver disease
28. Which statement about renal calculi is true? Answer: A
A. Calcium oxalate and calcium phosphate account for
Renal Calculi
about three-fourths of all stones
B. Uric acid stones can be seen by x-ray  Calcium oxalate and calcium phosphate account for about three-fourths of all stones
C. Triple phosphate stones are found principally in the  3/4 of all stones contain calcium
ureters ➢ 3/4 of these contain calcium oxalate
D. Stones are usually comprised of single salts  Stones are comprised of multiple stones
Calcium oxalate Hard, dark, and coarse most common component of urinary
stones
Uric acid Yellow to reddish brown Cannot be seen in X-ray because they are
transparent radiographically
Triple calcium phosphate Light and crumble easily
Struvite Radiodense, Lodge in renal pelvis
29. Which of the following conditions is seen in acute Answer: D. Abnormal urinary sediment
renal failure and helps to differentiate it from prerenal
Pre renal and acute renal failure
failure?
A. Hyperkalemia and uremia  Hyperkalemia and uremia
B. Oliguria and edema  Oliguria and edema
C. Low creatinine clearance  Low creatinine clearance
D. Abnormal urinary sediment
30. Oval fat bodies are often seen in: Answer: B. Nephrotic
A. Chronic glomerulonephritis
B. Nephrotic syndrome
C. Acute tubular nephrosis
D. Renal failure of any cause
31. Choose the correct order of the path of urine Answer: E.
drainage. Choose the best answer.
Renal pyramids → Renal papilla → Renal calyces → Renal pelvis → Ureters → Urinary bladder → Urethra
A. Renal papilla → Renal Pelvis → Renal Calyces →
Ureters → Urinary bladder → Urethra
B. Renal calyces → Renal pyramids → Renal papilla →
Renal pelvis → Urinary bladder → Urethra
C. Renal pyramids → Renal pelvis → Renal papilla →
Ureters → Urinary bladder → Urethra
D. Renal pyramids → Renal papilla → Renal calyces →
Renal pelvis → Urethra → Urinary bladder
E. Renal pyramids → Renal papilla → Renal calyces →
Renal pelvis → Ureters → Urinary bladder → Urethra

32. True about the Renin-Angiotensin-Aldosterone- Answer:

System
 Lungs: Angiotensin I is converted to Angiotensin 2
A. Renin converts Angiotensinogen to Angiotensin I in the
 Angiotensin II
lungs
➢ Triggers release of ADH and aldosterone
B. Angiotensin II triggers the release of ADH and
➢ Dilates the afferent arteriole and constiricts the efferent arteriole
aldosterone
 Renin is released by juxtaglomerular cells in macula densa
C. Angiotensin II acts to dilate the efferent arteriole and
 Angiotensinogen is released by liver
constrict the afferent arteriole
 Renin is released by kidneys
D. Renin is released by the extraglomerular mesangial
cells

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CLINICAL MICROSCOPY Internship 1: Midterms
MTAP 1: Doc Yerenze Flores Oct 26, 2023

33. Which of the following is not a function of Answer: C. Distal tubule: potassium reabsorption
Angiotensin II?
In the distal tubule, sodium is reabsorbed and not potassium
A. Vasoconstriction
B. Proximal tubule: sodium reabsorption
C. Distal tubule: potassium reabsorption
D. Collecting duct: water reabsorption

34. Decreased production of ADH: Answer: B

A. Produces low urine volume
ADH aka arginine-vasopressin hormone
B. Produces high urine volume
C. Increases ammonia excretion  ADH = DIURESIS = increased and dilute urine & concentrated blood
D. Affects active transport of sodium
 Usually seen in Diabetes insipidus
Central Diabetes insipidus Nephrogenic Diabetes insipidus
Pituitary gland dysfunction Resistance to ADH
 ADH Normal ADH
35. Part of the nephron most susceptible to ischemia. Answer: A.
A. Renal medulla
Renal medulla
B. Renal cortex
C. Renal pyramids  Lesser blood supply and thus prone to ischemia
D. Renal columns
36. Correct process of Stone formation. Answer: C. Supersaturation → Nucleation →Crystal growth → Aggregation
A. Supersaturation → Crystal growth → Nucleation →
Aggregation
B. Supersaturation → Nucleation → Aggregation →
Crystal growth
C. Supersaturation → Nucleation →Crystal growth →
Aggregation
D. Supersaturation → Aggregation → Nucleation →
Crystal growth

37. A male pediatric patient presents with mental Answer: B.

retardation, hyperuricemia and self-mutilating
Lesch-Nyhan disease
tendencies:
A. Hurler syndrome  Self mutilation
B. Lesch-Nyhan disease  Hyperuricemia
C. Melituria  Mental retardation
D. Sanfilippo syndrome  Defective HGPRT enzyme = no salvage of uric acid
➢ Uric acid is not converted to amino acids= accumulation

38. A 34-year-old female submitted a dark yellow Answer: A

urine which was tested and resulted to a positive
 Bilirubin in urine: conjugated
bilirubin in the reagent strip. What
➢ Unconjugated urine is never found in urine because they are not water soluble
can be presumed about this bilirubin in the urine?
 Urobilinogen: Bilirubin tha has passed through the small intestine
A. The bilirubin is conjugated
B. It has passed through the small intestine
C. It is attached to protein
D. The bilirubin is unconjugated

39. In computing the estimated GFR using the Answer: B. Urine Creatinine
Cockroft and Gault method, the following parameters
are used, except:
A. Age
B. Urine creatinine
C. Serum creatinine
D. Weight
E. None of the above

WILLIAM, GRACE ANN D. 5

CLINICAL MICROSCOPY Internship 1: Midterms
MTAP 1: Doc Yerenze Flores Oct 26, 2023

40. A first morning specimen would be requested to Answer: D.

confirm which of the following? Orthostatic proteinuria
A. Diabetes insipidus
B. Fanconi’s syndrome  Only the first morning specimen should be positive for protein
C. Urinary tract infection
D. Orthostatic proteinuria
41. A 22-year-old female had her urinalysis and blood Answer: Renal disease
chem done with the following results: what could be DM FBS cutoff: >124 mg/dL
the reason for this?
UA: glucose +++, (-) nitrite, (-) LE, few bacteria Non hyperglycemic glucosuria: renal dxe
FBS: 92mg/dL
A. Hormonal disorders
B. Gestational diabetes
C. Diabetes mellitus
D. Renal disease
42. In what area of the glomerulus are casts formed? Answer: A. Distal tubules and collecting ducts\
A. Distal tubules and collecting ducts Distal tubules and collecting ducts
B. Distal tubules and loops of Henle
C. Proximal and distal tubules  Where uromodulin is secreted and casts are formed
D. Proximal tubules and loops of Henle
43. What will happen if you are not able to collect the Answer: C.
last specimen of a timed urine? 24 HOUR URINE COLLECTION
A. Cause falsely increased results
B. Affect the preservation of glucose  First void discarded
C. Cause falsely decreased results  Last void included
D. Adversely affect reagent strip results
44. Which of the following is the principle of the Answer: A
reagent strip test for pH? pH reagent strip test: double indicator reaction
A. A double indicator reaction
B. The protein error of indicators protein reagent strip test: protein error of indicators
C. The diazo reaction  Protein accepts hydrogen ions from an indicator dye
D. A dye-binding reaction
Glucose reagent strip test: double sequential enzyme reaction
Blood reagent strip test: Pseudoperoxidase activity of hemoglobin
45. Which of the following best describes the chemical Answer: C. Protein accepts hydrogen ions from an indicator dye
principle of the protein reagent strip?
Protein error of indicators
A. Protein reacts with an immunocomplex on the pad
B. Protein causes a pH change on the reagent strip pad  Principle:
C. Protein accepts hydrogen ions from an indicator dye ➢ color change in an indicator system, buffered to pH 3
D. Protein causes protons to be released from a  Buffering capacity of the strip is sufficient provided that the urine pH does not exceed 8.0
polyelectrolyte  pH > 8.0: buffering capacity of strip may be exceeded
➢ false positive color change in the impregnated area reflecting the pH of the urine rather than
the presence of protein
46. Which of the following is the principle of the Answer: A. A double sequential enzyme reaction
reagent strip test for glucose?
A. A double sequential enzyme reaction
B. Copper reduction
C. The peroxidase activity of glucose
D. Buffered reactions of mixed enzyme indicators
47. Reagent strip reactions for blood are based on Answer: A. Pseudoperoxidase activity of hemoglobin
which of the following?
A. Pseudoperoxidase activity of hemoglobin
B. Oxidation of hemoglobin peroxidase
C. Reaction of hemoglobin with bromothymol blue
D. Reduction of a chromogen by hemoglobin
48. How can pyelonephritis be differentiated with Answer: C. Presence of White blood cell casts
cystitis using urinalysis results?
A. Presence of Eosinophils
B. Presence of Hyaline casts
C. Presence of White blood cell casts
D. Presence of Bacteriuria
49. What is the container capacity for drug testing? Answer: A. 60 Ml
A. 60mL
Drug testing
B. 30-45mL
C. 10-15mL  container capacity: 60 ml
D. 50mL  Urine required: 30-45 ml
Routine urinalysis
 Container capacity: 50 ml
 Urine required: 10-15 mL
50. Which of the following conditions characterizes Answer: A. Hyperkalemia
more of an acute renal failure and would differentiate
Acute renal failure
it from chronic renal failure?
A. Hyperkalemia • Reduced glomerular filtration coupled with  tubular secretion= hyperkalemia
B. Hematuria
Chronic renal failure
C. Cylindruria
D. Proteinuria • Collecting tubules will prevent salt and water reabsorption= hypokalemia even if there is
reduced glomerular filtration
• Characterized by interminent heavy hematuria and proteinuria
• Casts: broad and waxy casts

WILLIAM, GRACE ANN D. 6