PRE-BOARD EXAMINATION IN CLINICAL MICROSCOPY (PART 2)

1. In what sequence does urine formation occur?

A. Proximal convoluted tubule, loop of Henle, distal convoluted tubule, collecting tubule
B. Glomerulus, Bowman’s space, proximal convoluted tubule, loop of Henle, distal convoluted tubule, collecting
duct
C. Bowman’s space, glomerulus, proximal convoluted tubule, loop of Henle, distal convoluted tubule, collecting
duct
D. Glomerulus, proximal convoluted tubule, distal convoluted tubule, loop of Henle, Bowman’s space
2. While performing urinalysis, a technologist notices that the urine has a fruity odor. This patient’s urine most likely
contains:
A. Acetone B. Bilirubin C. Coliform bacilli D. Porphyrin
3. Renal clearance tests are used to evaluate which of the following parameters?
A. Concentrating ability C. Glomerular filtration rate
B. Tubular reabsorption D. Glomerular permeability
4. Which renal function is assessed using specific gravity and osmolality measurements?
A. Tubular excretion ability C. Concentrating ability
B. Glomerular filtration ability D. Tubular secretion ability
5. The color of normal urine is mainly due to the pigment:
A. Bilirubin B. Urobilin C. Urochrome D. Uroerythrin
6. To quantify formed elements such as white blood cells, red blood cells, and casts in a 12-hour urine specimen,
which of the following procedures is used?
A. Guthrie count B. Rothera count C. Addis count D, Folin-Lowry count
7. Which of the following pigments will deposit on urate and uric acid crystals to form a precipitate described as “brick
dust”?
A. Bilirubin B. Urobilin C. Uroerythrin D. Urochrome
8. A white precipitate in normal alkaline urine is most likely caused by:
A. Uric acid crystals C. Amorphous phosphate
B. Radiographic contrast media D. Amorphous urates
9. With which crystal are urinary uric acid crystals often confused?
A. Calcium pyrophosphate C. Calcium oxalate
B. Cystine D. Leucine
10. The method of choice for performing a specific gravity measurement of urine following administration of x-ray
contrast dyes is:
A. Reagent strip B. Refractometer C. Urinometer D. Densitometer
11. Which of the following methods for determining the urine’s specific gravity does NOT detect the presence of urinary
protein or glucose?
A. The urinometer method C. The refractometer method
B. The falling drop method D. The reagents trop method
12. The “double indicator system” employed by commercial reagent strips to determine urine pH uses which two
indicator dyes?
A. Methyl orange and bromphenol blue C. Methyl red and bromthymol blue
B. Phenol red and thymol blue D. Phenolphthalein and litmus
13. Most often, the predominant protein excreted in excess in urine is:
A. Lactoferrin B. Albumin C. -globulin D. Globulin
14. Bence Jones protein is:
A. An abnormal protein associated with UTI
B. An abnormal protein associated with hemolysis
C. An abnormal globulin associated with multiple myeloma
D. A normal serum protein
15. Which of the following aids in the differentiation of hemoglobinuria and hematuria?
A. Urine pH C. Microscopic examination
B. Urine color D. Leukocyte esterase test
16. Myoglobinuria is MOST likely to be noted in urine specimens from patients with which of the following disorders?
A. Hemolytic anemias C. Myocardial infarctions
B. Lower UTI D. Paroxysmal nocturnal hemoglobinuria
17. Ammonium sulfate was added to red urine. The urine had a positive reaction for blood, but no RBCs were seen on
microscopic examination. After centrifugation, the supernatant fluid is red. The abnormal color is caused by:
A. Pyridium B. Hemoglobin C. Porphyrins D. Myoglobin
18. Which statement about hemoglobin and myoglobin is true?
A. They are both heme-containing proteins involved in oxygen transport
B. Their presence is suspected when both the urine and the serum are colored red
C. Their presence in serum is associated with high creatine kinase values
D. They precipitate out of solution when the urine is 80 % saturated with ammonium sulfate
19. A false negative urine reaction when using a dipstick pad for hemoglobin can occur after ingestion of:
A. Vitamin A B. Ascorbic acid C. Vitamin B6 D. Cholesterol
20. Which of the following substances if present in the urine will result in a negative Clinitest?
A. Fructose B. Lactose C. Sucrose D. Galactose
21. The glucose specificity of the “double sequential enzyme reaction” employed on reagent strip tests is due to the use
of:
A. Gluconic acid C. Glucose oxidase-peroxidase
B. Hydrogen peroxide D. Neocuproine
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22. A 17-year-old girl decided to go on a starvation diet. After one week of starving herself, what substance would most
likely be found in her urine?
A. Protein B. Ketones C. Glucose D. Blood
23. Which of the following ketones are NOT detected by the reagent strip or tablet test?
A. Acetone C. B-hydroxybutyrate
B. Acetoacetate D. Acetone and acetoacetate
24. The ketone reagent strip and tablet tests are based on the reactivity of ketones with:
A. Ferric chloride B. Nitroprusside C. Ferric nitrate D. Nitroglycerin
25. Which of the following are characteristic urine findings from a patient with hemolytic jaundice?
A. A positive test for bilirubin and an increased amount of urobilinogen
B. A positive test for bilirubin and a decreased amount of urobilinogen
C. A negative test for bilirubin and an increased amount of urobilinogen
D. A negative test for bilirubin and a decreased amount of urobilinogen
26. Which of the following results are characteristic urine findings from a patient with an obstruction of the bile duct?
A. A positive test for bilirubin and an increased amount of urobilinogen
B. A positive test for bilirubin and a decreased amount of urobilinogen
C. A negative test for bilirubin and an increased amount of urobilinogen
D. A negative test for bilirubin and a decreased amount of urobilinogen
27. The classic Ehrlich’s reaction is based on the reaction of urobilinogen with:
A. Diazotized dichloroaniline C. p-dichlorobenzene diazonium salt
B. p-dimethylaminobenzaldehyde D. p-aminobenzoic acid
28. Red colored-compound produced with the Watson-Schwartz test that is insoluble in chloroform and butanol is:
A. Uroporphyrin C. Urobilinogen
B. Porphobilinogen D. Protoporphyrin
29. Nitrite in urine specimen suggests the presence of:
A. White blood cells C. Bacteria
B. Ammonia D. Urea
30. Which of the following blood cells will NOT be detected by the leukocyte esterase pad because it lacks esterases?
A. Eosinophils B. Lymphocytes C. Monocytes D. Neutrophils
31. Which of the following reagent strip tests can be affected by ascorbic acid, resulting in falsely low or false negative
results?
1. Blood 2. Bilirubin 3. Glucose 4. Nitrite
A. 1, 2 and 3 are correct C. 4 is correct
B. 1 and 3 are correct D. All are correct
32. Which of the following dyes are used in Sternheimer-Malbin stain?
A. Hematoxylin and eosin C. Methylene blue and eosin
B. Crystal violet and eosin D. Crystal violet and safranin
33. The microscopic identification of hemosiderin is enhanced when the urine sediment is stained with:
A. Gram stain B. Hansel stain C. Sudan stain D. Prussian blue stain
34. When a laboratorian performs the microscopic examination of urine sediment, which of the following are
enumerated using the low-power magnification?
A. White blood cells C. Red blood cells
B. Casts D. Renal tubular cells
35. The ova of which parasite may be found in the urinary sediment?
A. Trichomonas vaginalis C. Entamoeba histolytica
B. Schistosoma haematobium D. Trichuris trichiura
36. A technologist is having trouble differentiating between red blood cells, oil droplets, and yeast cells on a urine
microscopy. Acetic acid should be added to the sediment to:
A. Lyse the yeast cells C. Dissolve the oil droplets
B. Lyse the red blood cells D. Crenate the red blood cells
37. Glitter cells are a microscopic finding of:
A. Red blood cells in hypertonic urine C. White blood cells in hypertonic urine
B. Red blood cells in hypotonic urine D. White blood cells in hypotonic urine
38. Urine sediment could have which of the following formed elements and still be considered “normal”?
A. 5 to 10 red blood cells C. A few bacteria
B. 0 to 2 hyaline casts D. A few yeast cells
39. Urinary casts are formed in the:
A. Distal tubules and loops of Henle C. Proximal and distal tubules
B. Distal and collecting tubules D. Proximal tubules and loops of Henle
40. Urinary casts are formed with a core matrix of:
A. Albumin C. Bence Jones protein
B. Tamm-Horsfall mucoprotein D. Transferrin
41. Which of the following crystals, when found in the urine sediment, most likely indicates an abnormal metabolic
condition?
A. Calcium oxalate C. Triple phosphate
B. Bilirubin D. Uric acid
42. Oval fat bodies are derived from:
A. Renal tubular epithelium C. Degenerated WBCs
B. Transitional epithelium D. Mucoprotein matrix
43. In a patient with nephrotic syndrome, the microscopic examination of the urine sediment often reveals:
A. Granular casts C. Red blood cell casts
B. Waxy casts D. Leukocyte casts
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44. The most frequently observed cast in urine is:

A. Red cell B. Hyaline C. Waxy D. Fatty

45. When using polarized light microscopy, which urinary sediment component exhibits Maltese cross formation?
A. RBC B. Oval fat bodies C. Yeast D. Parasites
46. Which of the following frequently occurs following a bacterial infection of the skin or throat?
A. Acute glomerulonephritis C. Membranous glomerulonephritis
B. Chronic glomerulonephritis D. Rapidly progressive glomerulonephritis
47. Phenylketonuria is an inherited metabolic disease in which there is deficiency of an enzyme:
A. Phenylalanine oxidase C. Phosphoalanine hydroxylase
B. Phenylalanine hydroxylase D. Phosphoalanine phosphatase
48. Which of the following disorders is characterized by the urinary excretion of large amounts of arginine, cystine,
lysine, and ornithine?
A. Cystinosis B. Cystinuria C. Lysinuria D. Tyrosinuria
49. Which of the following hereditary diseases results in the accumulation and excretion of large amounts of
homogentisic acid?
A. Melanuria B. Alkaptonuria C. PhenylketonuriaD. Tyrosinuria
50. Which of the following substances oxidizes with exposure to air, causing the urine to turn brown or black?
A. Porphyrin B. Melanin C. Tyrosine D. Urobilinogen
51. A disease that causes large amounts of valine, leucine and isoleucine to be excreted in urine is:
A. Hurler’s syndrome C. Maple syrup urine disease
B. Cystinuria D. Alkaptonuria
52. Increased amounts of 5-hydroxy indoleacetic acid in the urine is indicative of:
A. Platelet disorders C. Malabsorption syndromes
B. Intestinal obstruction D. Argentaffin cell tumors
53. During a lumbar puncture procedure, the first collection tube of CSF removed should be used for:
A. Microbiology studies C. Hematology tests
B. Cytology studies D. Chemistry tests
54. All of the following proteins are normally present in the CSF, EXCEPT:
A. Transferrin B. Albumin C. Prealbumin D. Fibrinogen
55. Pleocytosis is a term used to describe:
A. A pink, orange, or yellow CSF specimen
B. An increased protein content in the CSF owing in cellular lysis
C. Inflammation and sloughing of the cells from the choroids plexus
D. An increased number of cells in the CSF
56. Regarding CSF, all of the following are indications of a traumatic tap, EXCEPT:
A. Clearing of the fluid as it is aspirated C. Xanthochromia
B. A clear supernatant after centrifugationD. Presence of clot in the sample
57. All of the following proteins are normally present in the CSF except:
A. Albumin B. Fibrinogen C. Prealbumin D. Transferrin
58. An unknown fluid can positively identified as being CSF by:
A. Determining the lactate concentration
B. Determining the albumin concentration
C. Determining the presence of oligoclonal banding on electrophoresis
D. Determining the presence of carbohydrate-deficient transferrin on electrophoresis
59. How many leukocytes are normally present in the CSF obtained from an adult?
A. 0-30 cells/uL B. 0-20 cells/uL C. 0-10 cells/uL D. 0-5 cells/uL
60. Which of the following cells may be present in small numbers in normal CSF?
A. Erythrocytes B. Macrophages C. Plasma cells D. Lymphocytes
61. Which of the following cell types predominate in CSF during a classic case of bacterial meningitis?
A. Lymphocytes B. Macrophages C. Monocytes D. Neutrophils
62. Which of the following cell types predominate in CSF during a classic case of viral meningitis?
A. Lymphocytes B. Macrophages C. Monocytes D. Neutrophils
63. A web-like clot or pellicle is formed in the CSF from patients infected with:
A. Neisseria meningitidis C. Mycobacterium tuberculosis
B. Haemophilus influenzae D. Cryptococcus neoformans
64. India ink preparations and microbial antigen tests can aid in the diagnosis of:
A. Bacterial meningitis C. Viral meningitis
B. Tuberculous meningitis D. Fungal meningitis
65. Limulus Lysate test will detect the presence of:
A. Gram-positive bacteria C. Acid-fast organisms
B. Gram-negative bacteria D. All microorganisms
66. Normal CSF lactate levels (below 25 mg/dL) are commonly found in patients with:
A. Bacterial meningitis C. Tuberculous meningitis
B. Fungal meningitis D. Viral meningitis
67. In suspected case of Reye’s syndrome, it is useful to measure:
A. Glucose B. Ammonia C. Lactic acid D. Glutamine
68. Which of the following parameters directly relates to and provides a check of the spermatozoa motility evaluation?
A. The agglutination evaluation C. The morphology assessment
B. The concentration determination D. The viability assessment
69. The concentration of which of the following substances can be used to positively identify a fluid as seminal fluid?
A. Zinc C. Fructose
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B. Citric acid D. Acid phosphatase

70. The most common cause of male infertility is:
A. Mumps B. Varicocele C. Malignancy D. Klinefelter’s syndrome
71. Which of the following is a characteristic of normal synovial fluid?
A. It forms small clots upon standing C. It is slightly turbid
B. It is dark yellow D. It is viscous
72. A synovial fluid has a high cell count and requires dilution to be counted. Which of the following diluents should be
used?
A. Dilute acetic acid C. Dilute methanol
B. Normal saline D. Phosphate buffer solution
73. Normal joint fluid is viscous because of a high concentration of:
A. -globulin B. Hyaluronate C. Mucin D. Neutrophils
74. Differentiation of synovial fluid crystals, based on their birefringence, is achieved using:
A. Transmission electron microscopy C. Direct polarizing microscopy
B. Compensated polarizing microscopy D. Phase contrast microscopy
75. Which of the following crystals is characteristically seen in patients with gout?
A. Cholesterol crystals
B. Monosodium urate monohydrate crystals
C. Hydroxyapatite crystals
D. Calcium pyrophosphate dihydrate crystals
76. Which crystal causes “pseudogout”?
A. Oxalic acid C. Calcium oxalate
B. Calcium pyrophosphate D. Cholesterol
77. Neutrophils that contain a precipitated rheumatoid factor in their cytoplasm:
A. LE cells B. Reiter cells C. Ragocytes D. Macrophages
78. What is the preferred stimulant of gastric acidity for routine analysis?
A. Histalog B. Histamine C. Insulin D. Pentagastrin
79. A gastric stimulant to determine a successful vagotomy procedure is:
A. Insulin B. Pepsin C. Histamine D. Pentagastrin
80. Serum gastrin levels would be greatest in:
A. Atrophic gastritis C. Pernicious anemia
B. Zollinger-Ellison syndrome D. Cancer of the stomach
81. A condition in which the patient shows no response to gastric stimulation is:
A. Pernicious anemia C. Ulcers
B. Zollinger-Ellison syndrome D. Diabetes
82. Select the term used to describe a decreased volume of amniotic fluid present in the amniotic sac:
A. Ahydramnios C. Hydramnios
B. Oligohydramnios D. Polyhydramnios
83. Amniotic fluid is immediately protected from light to preserve which of the following substances?
A. Phospholipids B. Fetal cells C. Meconium D. Bilirubin
84. Which of the following causes erythroblastosis fetalis?
A. Immaturity of the fetal liver C. Inadequate fetal surfactants
B. Decreased amount of amniotic fluid D. Maternal immunization by fetal antigens
85. The best available guide in the assessment of gestational age is the amniotic determination of:
A. Bilirubin C. Creatinine
B. Uric acid D. Protein
86. Which of the following amniotic fluid measurements is increased in neural tube disorder?
A. Lecithin/sphingomyelin ratio C. Acetylcholinesterase activity
B. Bilirubin D. Phospatidylinositol
87. Which of the following terms is another name for peritoneal fluid?
A. Synovial B. Ascitic C. Pelvic D. Abdominal
88. Thoracentesis refers specifically to the removal of fluid from the:
A. Abdominal cavity C. Peritoneal cavity
B. Pleural cavity D. Pericardial cavity
89. A pleural or peritoneal fluid amylase level 2 times higher than the serum amylase level may be found in effusions
resulting from:
A. Hepatic cirrhhosis C. Rheumatoid arthritis
B. Pancreatitis D. Lymphatic obstruction
90. Bronchoalveolar lavage is useful in the detection of:
A. Tuberculosis C. Malignant melanoma
B. Pneumocystis carinii D. Klebsiella pneumoniae
91. The most abundant cell seen in a BAL is:
A. Neutrophil C. Macrophage
B. Bronchial epithelial cell D. Lymphocyte
92. Which of the following tests is required in order to diagnose steatorrhea?
A. Fecal fat C. Fecal occult blood
B. Fecal carbohydrates D. fecal osmolality
93. Which of the following is responsible for the characteristic color of normal feces?
A. Urobilin B. Hemoglobin C. Bilirubin D. Urobilinogen
94. Mass screening for occult blood in the feces is primarily performed to detect:
A. Colorectal cancer C. Ulcer
B. Hemorrhoids D. Malabsorption
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95. Which of the following dietary substances can cause a false negative fecal occult blood slide test?
A. Ascorbic acid B. Fish C. Red meat D. Fruits and vegetables

96. In the Apt test, maternal hemoglobin will produce a:

A. Pink solution
B. Yellow-brown precipitate after standing for 2 minutes
C. Yellow-brown supernatant after standing for 2 minutes
D. Red-brown supernatant after standing for 2 minutes
97. Due to variability in bowel habits, the most representative timed fecal sample is:
A. 2-day collection C. 4-day collection
B. 3-day collection D. 5-day collection
98. Which of the following is the indicator of choice in fecal occult blood slide tests?
A. Guaiac B. Benzidine C. Orthotoluidine D. Tetramethylbenzidine
99. Yellowish or gray caseous bodies with the size of a pinhead, found in sputum:
A. Cheesy masses C. Broncholiths
B. Bronchial casts D. Dittrich plugs
100. Eosinophils and Curschmann’s spirals may be found in which of the following conditions:
A. Bronchiectasis C. Pneumonia
B. Chronic bronchitis D. Bronchial asthma

END OF THE EXAM