Urinalysis
After receiving a 24 hour urine for quantitative total protein analysis, the laboratorian must first:
A) subculture the urine for bacteria
B) add the appropriate preservative
C) screen for albumin using a dipstick
D) measure the total volume
A brown-black urine would most likely contain:
A) bile pigment
B) porphyrins
C) melanin
D) blood cells
C)Bile is green. Porphyrins are red. Melanin is black. Blood cells are red or white.
The preparation of a patient for standard glucose tolerance testing should include:
A) a high carbohydrate diet for 3 days
B) a low carbohydrate diet for 3 days
C) fasting for 48 hours prior to testing
D) bed rest for 3 days
A) GTT diet preparation. Glucose tolerance test identifies abnormalities in the way your body handles glucose after a meal.
The reference range for the pH of arterial blood measured at 37C is:
A) 7.28-7.34
B) 7.33-7.37
C) 7.35-7.45
D) 7.45-7.50
C) 7.35-7.45 !!!!
TSH is produced by the:
A) hypothalamus
B) pituitary gland
C) adrenal cortex
D) thyroid
B) TSH is produced by pituitary gland while TRH is produced in the hypothalamus and thyroxine is produced in the thyroid gland.
A) exposed to light
B) adjusted to a neutral pH
C) cooled to room temperature
D) collected in a nonsterile container
A) Urobilinogen is degraded by light.
Acid urine that contains hemoglobin will darken on standing due to the formation of:
A) myoglobin
B) sulfhemoglobin
c) methemoglobin
d) red blood cells
C)Hemoglobin may be converted to methemoglobin in an acid urine. This will cause the sample to darken on standing.
Cerebrospinal fluid for glucose assay should be:
A) refrigerated
B) analyzed immediately
C) heated to 56C
D) stored at room temperature after centrifugation
B) Glycolysis may occur more quickly on glucose in CSF due to presence of bacteria or cells so it should be analyzed immediately.
The expected blood gas results for a patient in chronic renal failure would match the pattern of:
A) metabolic acidosis
B) respiratory acidosis
C) metabolic alkalosis
D) respiratory alkalosis
A) Reduced excretion of acids
BONUS: Can you name another disease correlation??
Which of the following enzymes are used in the diagnosis of acute pancreatitis?
A) amylase (AMS)
B) aspartate aminotransferase (AST)
C) gamma-glutamyl transferase (GGT)
D) lactate dehydrogenase (LD)
A) Amylase and lipase are hydrolases involved in the breakdown of starch and glycogen, and lipid metabolism. Both enzymes are primarily located in the pancreas. Disorders of the pancreas are characterized by elevated levels of the enzymes. 5-NT, GGT, AST and LD are elevated in liver and hepatobiliary diseases.
A patient with uncontrolled diabetes mellitus will most likely have:
A) pale urine with high specific gravity
B) concentrated urine with a high specific gravity
C) pale urine with a low specific gravity
D) dark urine with a high specific gravity
A) The high specific gravity is due to glucose in the urine. Patients with diabetes mellitus have polyuria, so that the volume of urine dilutes the urochrome (color), making the urine pale.
A) Vomiting
B) Anemia
C) Hypoglycemia
D) Biliary Tract Obstruction
A) Vomiting leads to dehydration and utilization of fat for energy. Fat metabolism produces ketones.
Hemoglobin A1c represents:
A) valine substitution for glutamine at the 6th position of the beta chain of hemoglobin
B) ketone formation due to hydrolysis of the alpha and beta C-terminus forming an abnormal hemoglobin
C) glycosylation of valine in the polypeptide N-terminus of normal adult hemoglobin
D) glucose reduction in the presence of oxygen at the N-terminus of the polypeptide chains of hemoglobin
C) The formation of the sugar-hemoglobin linkage indicates the presence of excessive sugar in the bloodstream, often indicative of diabetes. The process by which sugars attach to hemoglobin is called glycation. HbA1c is a measure of the beta-N-1-deoxy fructosyl component of hemoglobin.
A patient is admitted to the ER in a state of metabolic alkalosis. Which of the following would be consistent with this diagnosis?
A) high TCO2, increased HCO3
B) low TCO2, increased HCO3
C) high TCO2, decreased HCO3
D) low TCO2, decreased HCO3
A) Metabolic alkalosis is defined as elevation of the body's pH above 7.45. It involves a primary increase in serum bicarbonate (HCO3-) concentration, due to a loss of H+ from the body or a gain in HCO3.
Increased concentrations of alpha-fetoprotein (AFP) in adults in are most characteristically associated with:
A) hepatocellular carcinoma
B) alcoholic cirrhosis
C) chronic active hepatitis
D) multiple myeloma
A) AFP is an oncofetal glycoprotein marker for hepatocellular carcinoma. Elevated levels of AFP (<200 ug/L) are seen in hepatitis and cirrhosis. In hepatocellular carcinoma, the levels can be greater than 1,000 ug/L.
****TRICKY WORDING**** Beware of questions like this
A) tetrabromphenol blue
B) citrate buffer
C) glucose oxidase
D) alkaline copper sulfate
B) The protein pad of the biochemical strip is held at an acid pH by citrate buffer. If the strip is not blotted, the acid buffer can "run over" to the pH pad and cause a falsely acidic pH. Tetrabromphenol blue is a pH indicator, not an acid. Glucose oxidase is the reagent on the glucose strip. Copper sulfate is the reagent of the reducing substances (Benedict) test.
A positive result for a bilirubin on a reagent test strip should be followed up by:
A) notifying the physician
B) requesting a new specimen
C) performing an Ictotest
D) performing a urobilinogen
C) The bilirubin dipstick pad can show a false-positive from a colored urine. All positives should be confirmed with an Ictotest.
A patient with hemolytic anemia will:
A) show a decrease in glycated Hgb value
B) show an increase in glycated Hgb value
C) show little or no change in glycated Hgb value
D) demonstrate an elevated HgbA1
A) Glycated hemoglobin directly related to life of RBC. Conditions such as acute and chronic blood loss, hemolytic anemia, end-stage renal disease and splenomegaly can all cause falsely lowered A1c results. This is primarily due to the associated chronic anemia with decreased red cell survival.
A blood gas sample was sent to the lab on ice; and a bubble was present in the syringe. The blood had been exposed to room air for 2 hours. The following change in blood gas will occur:
A) CO2 content increased/pCO2 decreased
B) CO2 content and pO2 increased/pH increased
C) CO2 content and pCO2 decreased/pH decreased
D) pO2 increased/HCO3 decreased
D) When air is introduced into the sample pO2 increases if patient O2 is <150 mmHg, pO2 decreases if patient O2 is >150 mmHg,pH increases, and pCO2 decreases. HCO3 refers to the total amount of CO2 that is transported in the blood.
Estrogen and progesterone receptor assays are useful in identifying patients who are likely to benefit from endocrine therapy to treat which of the following?
A) Ovarian Cancer
B) Breast Cancer
C) Endometriosis
D) Amenorrhea
B) About 55-60% of patients whose breast tumors demonstrate estrogen receptors (ER) respond well to endocrine therapy. Ovarian cancer can be monitored with CA-125 tumor marker while FSH and LH are often used to monitor the menstrual cycle.
A urine specimen is analyzed for glucose by a glucose oxidase reagent test strip and a copper reduction test. If both results are positive, which of the following interpretations is correct?
A) galactose is present
B) glucose is present
c) lactose is not present
d) sucrose is not present
B) A positive glucose oxidase is specific for glucose. Glucose will also cause copper reduction. (A positive Clinitest)
Routine screening of urine samples for glycosuria is performed primarily to detect:
A) glucose
B) galactose
C) bilirubin
D) ketones
A) The 2 sugars in these distractor answers are glucose and galactose. Galactosuria is a relatively rare genetic condition. The glucose biochemical strip is specific for glucose and will not detect galactose. Glucose is found in diabetes mellitus as well as other diseases.
What is the best method to diagnose lactase deficiency?
A) H2 breath test
B) plasma aldolase level
C) LDH level
D) D-xylose test
A) Diagnosis of lactase deficiency. The hydrogen breath test is a simple and noninvasive way to diagnose common gastrointestinal conditions, including lactose intolerance and SIBO (small intestine bacterial overgrowth) The breath test evaluates your digestion of particular sugars by measuring the gas you exhale, usually hydrogen and methane.
Respiratory acidosis is described as an:
A) increase in CO2 content and pCO2 with a decreased pH
B) decrease in CO2 content with an increased pH
C) increase in CO2 content with an increased pH
D) decrease in CO2 content and pCO2 with a decreased pH
A) Decreased pH, Increased pCO2
Respiratory acidosis is a condition that occurs when the lungs cannot remove all of the carbon dioxide the body produces. This causes body fluids, especially the blood, to become too acidic
Increased total serum LD activity is:
A) sensitive and specific to acute myocardial infarction
B) specific to acute hepatic disease such as viral hepatitis
C) sensitive to pancreatic obstruction but not pancreatitis
D) sensitive but not specific to neoplastic disease
D) Total LD arises from many tissues, including cardiac, red blood cells, lymphocytes, lung, spleen, pancreas, liver and skeletal muscles. It is nonspecific; however, individual isoenzyme patterns are most specific to certain disorders. It is sensitive, and when monitored over time can be used as a general tumor marker for carcinomas, ALL, and other neoplasia.