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WorksheetsAUBF PREFINAL EXAM
Total questions: 101
Worksheet time: 1hrs 21mins
Cerebrospinal fluid (CSF) is formed by ultrafiltration of plasma through the
Choroid plexus
Sagittal sinus
Anterior cerebral lymphatics
Arachnoid membrane
Which statement regarding CSF is true?
Normal values for mononuclear cells are higher for infants than adults
Absolute neutrophilia is not significant if the total WBC count is less than 25/μL
The first aliquot of CSF should be sent to the microbiology laboratory
Neutrophils compose the majority of WBCs in normal CSF
When collecting CSF, a difference between opening and closing fluid pressure greater than 100 mm H2O indicates:
Low CSF volume
Subarachnoid hemorrhage
Meningitis
Hydrocephalus
Which of the following findings is consistent with a subarachnoid hemorrhage rather than a traumatic tap?
Clearing of the fluid as it is aspirated
A clear supernatant after centrifugation
Xanthochromia
Presence of a clot in the sample
The term used to denote a high WBC count in the CSF is:
Empyema
Neutrophilia
Pleocytosis
Hyperglycorrhachia
SITUATION: What is the most likely cause of the following CSF results?
SF glucose 20 mg/dL; CSF protein 200 mg/dL;
CSF lactate 50 mg/dL (reference range 5–25 mg/dL)
Viral meningitis
Viral encephalitis
Cryptococcal meningitis
Acute bacterial meningitis
Which of the following conditions is most often associated with normal CSF glucose and protein?
Multiple sclerosis
Malignancy
Subarachnoid hemorrhage
Viral meningitis
The diagnosis of multiple sclerosis is often based upon which finding?
The presence of elevated protein and low glucose
A decreased IgG index
The presence of oligoclonal bands by electrophoresis
An increased level of CSF β microglobulin
Which of the following results is consistent with fungal meningitis
Normal CSF glucose
Pleocytosis of mixed cellularity
Normal CSF protein
High CSF lactate
In what suspected condition should a wet prep performed in CSF using a warm slide be examined
Cryptococcal meningitis
Amoebic meningoencephalitis
Mycobacterium tuberculosis infection
Neurosyphilis
Which of the following CSF test results is most commonly increased in patients with multiple sclerosis?
Glutamine
Lactate
IgG index
Ammonia
Which of the following is an inappropriate procedure for performing routine CSF analysis?
A differential is done only if the total WBC count is greater than 10/μL
A differential should be done on a stained CSF concentration
A minimum of 30 WBCs should be differentiated
A Wright’s-stained slide should be examined rather than a chamber differential
Which cell is present in the CSF in greater numbers in newborns than in older children or adults?
Eosinophils
Lymphocytes
Monocytes
Neutrophils
Neutrophilic pleocytosis is usually associated with all of the following except:
Cerebral infarction
Malignancy
Myelography
Neurosyphilis
Which statement about CSF protein is true?
An abnormal serum protein electrophoretic pattern does not affect the CSF pattern
The upper reference limit for CSF total protein in newborns is one-half adult levels
CSF IgG is increased in panencephalitis, malignancy, and neurosyphilis
Antibodies to Treponema pallidum disappear after successful antibiotic therapy
Which of the following statements regarding routine microbiological examination of CSF is true?
A Gram stain is performed on the CSF prior to concentration
The Gram stain is positive in fewer than 40% of cases of acute bacterial meningitis
India ink and acid fast stains are indicated if neutrophilic pleocytosis is present
All CSF specimens should be cultured using sheep blood agar, chocolate agar, and supplemented broth
Which organism is the most frequent cause of bacterial meningitis in neonates?
Neisseria meningitidis
Group B Streptococcus
Streptococcus pneumoniae
Klebsiella pneumoniae
Following a head injury, which protein will identify the presence of CSF leakage through the nose
Transthyretin
Myelin basic protein
Tau protein
C-reactive protein
Which of the following statements regarding serous fluids is true?
The normal volume of pleural fluid is 30–50 mL
Mesothelial cells, PMNs, lymphocytes, and macrophages may be present in normal fluids
X-ray can detect a 10% increase in the volume of a serous fluid
Normal serous fluids are colorless
The term effusion refers to:
A chest fluid that is purulent
A serous fluid that is chylous
An increased volume of serous fluid
An inflammatory process affecting the appearance of a serous fluid
Which observation is least useful in distinguishing a hemorrhagic serous fluid from a traumatic tap?
Clearing of fluid as it is aspirated
Presence of xanthochromia
The formation of a clot
Diminished RBC count in successive aliquots
Which of the following laboratory results on a serous fluid is most likely to be caused by a traumatic tap?
An RBC count of 8,000/μL
A WBC count of 6,000/μL
A hematocrit of 35%
A neutrophil count of 55%
Which of the following conditions is commonly associated with an exudative effusion?
Congestive heart failure
Malignancy
Nephrotic syndrome
Cirrhosis
Which of the following conditions is associated with a chylous effusion?
Necrosis
Pulmonary infarction or infection
Systemic lupus erythematosus or rheumatoid arthritis
Lymphatic obstruction
Which of the following conditions is most often associated with a pleural fluid glucose below 30 mg/dL?
Diabetes mellitus
Pancreatitis
Rheumatoid Arthritis
Bacterial pneumonia
In which condition is the pleural fluid pH likely to be above 7.3?
Bacterial pneumonia with parapneumonic exudate
Rheumatoid pleuritis
Esophageal rupture
Pneumothorax
Which of the following characteristics is higher for synovial fluid than for the serous fluids
Specific Gravity
Glucose
Total protein
Viscosity
In which type of arthritis is the synovial WBC count likely to be greater than 50,000/μL?
Septic arthritis
Osteoarthritis
RA
Hemorrhagic arthritis
What type of cell is a “ragocyte”?
Cartilage cell seen in inflammatory arthritis
A PMN with inclusions formed by immune complexes
A plasma cell seen in RA
A macrophage containing large inclusions
Which of the following crystals is the cause of gout?
Uric acid or monosodium urate
Calcium pyrophosphate or apatite
Calcium oxalate
Cholesterol
Which crystal causes “pseudogout”?
Oxalic acid
Calcium pyrophosphate
Calcium oxalate
Cholesterol
A synovial fluid sample is examined using a polarizing microscope with a red compensating filter. Crystals are seen that are yellow when the long axis of the crystal is parallel to the slow vibrating light. When the long axis of the crystal is perpendicular to the slow vibrating light, the crystals appear blue. What type of crystal is present?
Calcium oxalate
Calcium pyrophosphate
Uric acid
Uric acid
In which condition is the synovial fluid glucose most likely to be within normal limits?
Septic arthritis
Inflammatory arthritis
Hemorrhagic arthritis
Gout
Which statement about synovial fluid in RA is true
Synovial/serum IgG is usually 1:2 or higher
Total hemolytic complement is elevated
Ninety percent of RA cases test positive for rheumatoid factor in synovial fluid
Demonstration of rheumatoid factor in joint fluid is diagnostic for RA
Which of the following organisms accounts for the majority of septic arthritis cases in young and middle-age adults
H. influenzae
Neisseria gonorrhoeae
Staphylococcus aureus
Borrelia burgdorferi
Which of the following statements about amniotic fluid bilirubin measured by scanning spectrophotometry is true?
The 410-nm peak is due to hemoglobin and the 450-nm peak is due to bilirubin
Baseline correction is not required if a scanning spectrophotometer is used
Chloroform extraction is necessary only when meconium is present
In normal amniotic fluid, bilirubin increases with gestational age
Which test best correlates with the severity of HDN?
Rh antibody titer of the mother
Lecithin/sphingomyelin (L/S) ratio
Amniotic fluid bilirubin
Urinary estradiol
Which is the reference method for determining fetal lung maturity?
Human placental lactogen
L/S ratio
Amniotic fluid bilirubin
Urinary estriol
Which of the following statements regarding the L/S ratio is true?
A ratio of 2:1 or greater usually indicates adequate pulmonary surfactant to prevent respiratory distress syndrome (RDS)
A ratio of 1.5:1 indicates fetal lung maturity in pregnancies associated with diabetes mellitus
Sphingomyelin levels increase during the third trimester, causing the L/S ratio to fall slightly during the last 2 weeks of gestation
A phosphatidylglycerol (PG) spot indicates the presence of meconium in the amniotic fluid
Which of the following conditions is most likely to cause a falsely low L/S ratio?
The presence of PG in amniotic fluid
Freezing the specimen for one month at –20°C
Centrifugation at 1,000 × g for 10 minutes
Maternal diabetes mellitus
Which of the following statements accurately describes hCG levels in pregnancy?
Levels of hCG rise throughout pregnancy
In ectopic pregnancy, serum hCG doubling time is below expected levels
Molar pregnancies are associated with lower levels than expected for the time of gestation
hCG returns to nonpregnant levels within 2 days following delivery, stillbirth, or abortion
Which of the following statements regarding pregnancy testing is true?
β Subunits of human chorionic gonadotropin (hCG), thyroid-stimulating hormone (TSH), and follicle-stimulating hormone (FSH) are very similar
Antibodies against the β subunit of hCG cross-react with luteinizing hormone (LH)
A false-positive result may occur in patients with heterophile antibodies
Serum should not be used for pregnancy tests because proteins interfere
Most cases of Down syndrome are the result of:
Nondisjunction of an E chromosome (E trisomy)
Nondisjunction of chromosome 21 (G trisomy)
A 14–21 chromosome translocation
Deletion of the long arm of chromosome 21
Which assay result is often approximately 25% below the expected level in pregnancies associated with Down syndrome?
Serum unconjugated estriol
L/S ratio
Amniotic fluid bilirubin
Urinary chorionic gonadotropin
Which of the following statements about AFP is correct?
Maternal serum may be used to screen for open neural tube defects
Levels above 4 ng/mL are considered positive
Elevated levels in amniotic fluid are specific for spina bifida
AFP levels increase in pregnancies associated with Down syndrome
First-trimester screening for Down syndrome can be performed using which markers?
Alpha fetoprotein and unconjugated estriol
Free β hCG and pregnancy-associated plasma protein A
Intact hCG and dimeric inhibin A
Dimeric inhibin B and α fetoprotein
When performing marker screening tests for Down syndrome, why are results expressed in multiples of the median (MoM) rather than concentration?
Concentration is not normally distributed
MoM normalizes for gestational age
Some tests cannot be reported in mass units
Mean cannot be determined accurately for these analytes
What is the term for sperm when the anterior portion of the headpiece is smaller than normal?
Azoospermia
Microcephaly
Acrosomal deficiency
Necrozoospermia
What is the most common cause of male infertility?
Mumps
Klinefelter’s syndrome
Varicocele
Malignancy
Which of the following values is the lower limit of normal for sperm concentration?
15 million per mL
40 million per mL
60 million per mL
100 million per mL
Which morphological abnormality of sperm is most often associated with varicocele
Tapering of the head
Cytoplasmic droplet below the neckpiece
Lengthened neckpiece
Acrosomal deficiency
Which of the following stains is used to determine sperm viability?
Eosin Y
Hematoxylin
Papanicolaou
Methylene blue
Which of the following semen analysis results is abnormal?
Volume 1.0 mL
Liquefaction 40 minutes at room temperature
pH 7.6
Motility 50% progressive movement
Which of the following sample collection and processing conditions will lead to inaccurate seminal fluid analysis results?
Sample stored at room temperature for 1 hour before testing
Sample collected following coitus
Sample collected without an anticoagulant
Sample collected without use of a condom
When performing a seminal fluid analysis, what is the upper limit of normal for WBCs?
1 × 106/mL
5 × 106/mL
10 × 106/mL
20 × 106/mL
Which carbohydrate measurement is clinically useful when performing a seminal fluid analysis?
Glucose
Galactose
Fructose
Maltose
Which condition is most often associated with gastric ulcers?
Cancer of the stomach
H. pylori infection
Zollinger–Ellison (Z–E) syndrome
Pernicious anemia
In which condition is the highest level of serum gastrin usually seen?
Atrophic gastritis
Pernicious anemia
Z–E syndrome
Cancer of the stomach
Which test can identify persons with gastrin-secreting tumors who do not demonstrate a definitively increased plasma gastrin concentration?
Secretin stimulation
Pentagastrin
Cholecystokinin–pancreozymin
Trypsinogen
Which of the following tests would be normal in pancreatic insufficiency?
Secretin stimulation
D-Xylose absorption
Twenty-four-hour fecal fat
β Carotene absorption
Which of the following is commonly associated with occult blood?
Colon cancer
Atrophic gastritis
Pernicious anemia
Pancreatitis
Which test is most sensitive in detecting persons with chronic pancreatitis?
Fecal trypsin
Fecal chymotrypsin
Fecal elastin-1
Plasma lipase
To determine amniotic fluid contamination with maternal urine, which of the following measurements could be used?
Creatinine concentration
Delta absorbance at 410 nm
Albumin/globulin ratio
Lactate dehydrogenase
With the development of fetal lung maturity, which of the following phospholipid concentrations in amniotic fluid significantly and consistently increases?
Sphingomyelin
Phosphatidyl ethanolamine
Phosphatidyl inositol
Phosphatidyl choline
A patient has been diagnosed with an upper gastrointestinal bleed. Which of the following would be characteristic for this condition?
Brown stool with streaks of bright red
Stool with lack of brown color ("clay-colored")
Stool with a much darker brown/black color
Yellow stool with increased mucus
A pleural effusion is found to have 3000 white blood cells per microliter and 5 g/dL total protein. From this it can be determined that the patient's effusion
A transudate
An exudate
Noninflammatory
Hemorrhagic
The estimation of hyaluronic acid concentration by measurement of viscosity is useful in evaluating which type of fluid?
Spinal
Peritoneal
Pleural
Synovial
Which of the following is characteristic of an exudate effusion?
Leukocyte count >1000/uL
Clear appearance
Protein concentration <3.0 g/dL
Absence of fibrinogen
Which methods may be used to quantify protein in both cerebrospinal fluid and urine specimens?
Trichloroacetic acid and bromcresol green
Ponceau S and Coomassie brilliant blue
Bromcresol green and Coomassie brilliant blue
Coomassie brilliant blue and trichloroacetic acid
Which of the following statements applies to the proper collection and handling of CSF?
The second tube collected should be used for chemistry analyses.
The third tube collected should be used for bacteriologic studies
CSF collected in the evening should be refrigerated and assays performed only by day-shift personnel
With low-volume specimens, a culture is performed first, before cell counts are done.
Compared to the fecal occult blood test, which of the following is a disadvantage of performing a DNA-based test to detect colon cancer?
The DNA test is more invasive.
The DNA test is less sensitive.
The DNA test is more expensive.
Additional diet restrictions are needed for the DNA test.
Which of the following may be associated with morphologic examination of spermatozoa?
Evaluation should include assessment of 1000 spermatozoa
A small number of sperm should have normal morphologic characteristics.
Papanicolaou stain may be used
Presence of red or white cells and epithelial cells need not be noted
Which condition is characterized by increased levels of immunoglobulins in the cerebrospinal fluid, originating from within the central nervous system and not from the general blood circulation?
Gout
Erythroblastosis fetalis
Multiple myeloma
Multiple sclerosis
Which of the following would not be a reason to collect a vaginal fluid for analysis?
Vaginitis
Complications of pregnancy resulting in preterm delivery
Forensic testing in a sexual assault
Pregnancy testing
Which of the following organisms might not be detected if the specimen for vaginal secretion analysis had been refrigerated?
Prevotella bivia
Lactobacillus acidophilus
Trichomonas vaginalis
Candida albicans
The appearance of the vaginal discharge in vulvovaginal
candidiasis is described as:
Clear and colorless
Thin, homogeneous white-to-gray discharge
White, curd-like
Yellow-green and frothy
A normal range for a vaginal pH is
3.8 to 4.5
5.0 to 6.0
6.0 to 7.0
7.0 to 7.4
Which of the following tests differentiates budding yeast cells from RBCs?
pH
Saline wet mount
KOH prep
Whiff test
Which of the following constituents is normal in healthy vaginal fluid secretions?
Lactobacilli
Basal cells
Trichomonas vaginalis
Pseudohyphae
Vaginal specimens collected for a saline wet prep should be:
Refrigerated to preserve motility
Prepared as soon as possible
Mailed to a reference laboratory
Preserved with potassium hydroxide
A positive amine (Whiff) test is observed in which of the following syndromes?
Bacterial vaginosis
Vulvovaginal candidiasis
Atrophic vaginitis
Desquamative inflammatory vaginitis
All of the following are diagnostic of bacterial vaginosis except:
Vaginal pH of 3.8
Presence of clue cells
Positive amine (Whiff) test
Thin, homogeneous white-to-gray vaginal discharge
Which of the following organisms produces lactic acid and hydrogen peroxide to maintain an acid vaginal environment?
Gardnerella vaginalis
Mobiluncus spp.
Lactobacilli spp.
β -Hemolytic streptococci
All of the following are diagnostic of vulvovaginal candidiasis except:
Large numbers of WBCs
Presence of clue cells
Positive KOH test
Vaginal pH of 4.0
All of the following are diagnostic of trichomoniasis except
Vaginal pH of 6.0
Positive amine test
Positive KOH test
Motile trichomonads present
The bacteria associated with desquamative inflammatory vaginitis is:
β -Hemolytic streptococci
Trichomonas vaginalis
Gardnerella vaginalis
Mycoplasma hominis
The protein present in vaginal secretions that can identify patients who are at risk for preterm delivery is:
Human chorionic gonadotropin
Estrogen
PAMG-1
Fetal fibronectin
Collection of sweat for analysis is performed using what method?
Pilocarpine Iontophoresis
Paracentsis
Thoracentesis
Sweat induction
A chloride t value >60 mmol/L from sweat analysis is indicative
Cystic Fibrosis
Down Syndrome
Zollinger Ellison Syndrome
Pernicious Anemia
Which of the following is not a composition of of gastric fluid?
Hydrochloric Acid
Mucus
Digestive Enzyme
Electrolytes
Hormones
This enzyme is produced by the G-cells that stimulate parietal cells to produce HCl.
Pepsin
Gastrin
Pepsinogen
Amylase
This is characterized by increased gastrin level leading to gastric acid hypersecretion
Cystic Fibrosis
Down Syndrome
Zollinger Ellison Syndrome
Pernicious Anemia
This is characterized by increased gastrin level leading to gastric acid hypersecretion
Cystic Fibrosis
Down Syndrome
Zollinger Ellison Syndrome
Pernicious Anemia
This gastric stimulant is the most preferred and is administered intramuscularly or IV.
Insulin
Gastrin
Pentagastrin
Pepsin
This term refers to decreased free Hydrochloric Acid
Euchlorhydria
Achlorhydria
Hypochlorhydria
Hyperchlorhydria
Achylia
This term means absence of all acids in the stomach
Euchlorhydria
Achlorhydria
Hypochlorhydria
Hyperchlorhydria
Achylia
Which of the following serves a marker for acceptance of sputum specimen
>25 epithelial cells
Plasma
Electrolytes
Mucin
Anchovy red sputum indicates
Infection with P. aeroginusa
Early lobar pnuemonia
Tuberculosis infection
Bonchiectasis
These are fragments of necrotic pulmonary tissues seen in Pulmonary TB or Pulmonary gangrene.
Bronchial cast
Cheesy masses
Dittrich’s Plug
Pneumolith
Curschmann’s spiral
These are calcified fragments of tuberculous tissue or calcified foreign matter
Bronchial cast
Cheesy masses
Dittrich’s Plug
Pneumolith
Curschmann’s spiral
These represents eosinophil degradation, associated with bronchial asthma
Bronchial cast
Cheesy masses
Dittrich’s Plug
Pneumolith
Charcott Leyden crystals
