UA BF CHEM exam with correct answers 2024

Which of the following tests included on a urine chemical reagent strip would never be reported out as negative? - answers-Urobilinogen is reported as normal, not negative. A normal urobilinogen result is approximately 0.2-1.0 Ehr U/dL A voided urine specimen is delivered from the women's clinic to the laboratory six hours after collection. The following results are reported: Clarity: cloudy Nitrite: positive Sp. Gravity: 1.020 pH: 9.0 - answers-These results indicate that the urine may have remained too long at room temperature and bacterial contaminants have affected the nitrite and pH results. Unpreserved urine samples should be refrigerated if they cannot be analyzed within two hours. Which of the following procedures should be followed when performing a manual urine reagent strip test? (choose all that apply) - answers-Compare strip to color chart to check for correlating color and handling strips at the end away from the test area are the two correct answers. It is incorrect to leave the reagent strip bottle cap off until testing is completed as moisture from the air can alter the test pads on the chemical reagent strips. Sulfosalicylic acid is a secondary method that can be used to determine the presence of which one of the following substances in the urine, if color interference prevents the accurate reading of a urine chemical reagent strip? - answers-The SSA reaction is used to detect protein in the urine. It is sometimes used as a secondary method if interfering urine color makes it difficult to read the color reaction on the urine reagent strip Which of the following urine chemical reagent strip tests is based on the Ehrlich-aldehyde reaction? - answers-The urobilinogen urine chemical reagent strip test is based on the Ehrlich-aldehyde reaction. In this test, a pink-red color forms in proportion to the amount of urobilinogen present. What effect may bacterial contamination have on urine pH? - answers-A urine pH above 8.0 may indicate that a specimen has been held unpreserved too long, which allows multiplication of urea-splitting bacteria with resultant increase in pH Which of the following statements is TRUE regarding the reagent strip test procedure? - answers-Urine should be well mixed prior to dipping the reagent strip. Urine should NOT be centrifuged prior to dipping the reagent strip. Not all reagent strip tests can be read immediately after dipping the reagent strip into the urine specimen; the manufacturer's read-times must be followed. Excessive carbohydrate loss that may occur due to vomiting or rapid weight loss may result in the presence of which of following substances not normally contained in the urine? - answers-Normal urine specimens usually yield negative results for the presence of ketones. Low levels of ketones may be detected in the urine during conditions of physiological stress such as fasting, rapid weight loss, frequent strenuous exercise or prolonged vomiting. The presence of ketones in these situations is due to either inadequate intake of carbohydrates or increased loss of carbohydrates. Urine should be at room temperature prior to testing with the reagent strip method. - answers-This statement is true. Urine should be at room temperature prior to testing with the reagent strip method. Urine strip reactivity can increase with increased urine temperature, so the optimum temperature is 22-26o C, or room temperature. A patient who has a primarily vegetarian diet will most likely have an acid urine pH - answers-False The reagent strip method for protein primarily tests for which type of protein? - answers-The urine reagent strip method for protein primarily indicates increased albumin, although other proteins may also produce a positive result if greatly elevated. When the glucose result on a urine specimen from an infant is negative on the urine reagent strip, it can be assumed that the specimen is also negative for other reducing substances such as galactose. - answers-This statement is false. The method used with the urine chemical reagent strip is specific for glucose. A patient suspected of a urinary tract infection has a negative nitrite test, but bacteria are present upon microscopic examination. What may have caused this discrepant result? (Choose ALL correct answers) - answers-When a urine sample shows a negative nitrite test, but bacteria are present upon microscopic examination, the false-negative result could be caused by two possibilities listed in the choices above: The bacteria that is present is not a nitrate-reducer OR the urine was in the bladder for an insufficient amount of time for nitrate to be reduced to nitrite. Which of the following white blood cells would NOT produce a positive leukocytes test on the urine reagent strip? - answers-The presence of lymphocytes will not produce a positive leukocytes test since lymphocytes do not contain leukocyte esterase. Detection of leukocyte esterase is the basis of the leukocytes reagent strip test. Granulocytes (neutrophils, eosinophils, and basophils) contain leukocyte esterase and would be detected by the reagent strip test. Match the following urine chemical reagent strip test pads to the disease or disorder that would most likely cause a positive test result. - answers-Ketones- Diabetes mellitus Blood- Renal calculi Bilirubin- Hepatitis/cirrhosis Nitrite- Urinary tract infection What is the identification of this crystal seen in urine with an alkaline pH? - answers-Ammonium biurate crystals commonly occur in the form of "thorny apples," as shown here, or in polyhedral shapes. They are deeply colored from dark yellow to brown. Identify the crystals that are seen in this image. - answers-This image shows leucine crystals. These crystals are round to oval with radiating bands going from a center point out to the periphery, often referred to as a "wagon wheel." Identify the cells that are indicated by the arrow. - answers-The cells depicted in this image are transitional epithelial cells. These cells originate from the renal pelvis, ureters, bladder, and/or urethra and are usually round or polygonal. They are smaller and smoother in outline than squamous cells but larger than a white blood cell (WBC). Common crystals which can be found in acidic urine include: - answers-Calcium oxalate crystals can be found in acidic urine. Amorphous phosphates, triple phosphate, and calcium carbonate are all found in alkaline urine. What is the identification of these crystals seen in urine with an alkaline pH? - answers-The identification of the crystals depicted in this image are triple phosphate crystals. Triple phosphate crystals may be normal but are usually associated with alkaline urine. These colorless crystals have a characteristic "coffin lid" appearance. What are the microscopic elements that are indicated by arrows in this image? - answers-These are bacteria. The presence of white blood cells supports this identification rather than an "artifact" because white blood cells (WBCs) are usually present with bacteria during a urinary tract infection (UTI). The presence of bacteria with the absence of WBCs is usually an indication of an old specimen that wasn't refrigerated or tested within 2 hours after collection. What cells are present in this image of urine sediment that is observed using brightfield microscopy? - answers-This slide shows red blood cells (RBCs). What crystal is captured in the image below? - answers-A cystine crystal is depicted in this image. Cystine crystals are present in acidic urine, are typically colorless, and have a characteristic hexagonal shape (also described as appearing similar to a benzene ring). These crystals are associated with cystinuria. What is the identity of the cells indicated by the arrow in this image? - answers-The cells in this image are squamous epithelial cells. A squamous epithelial cell is a large flattened cell with abundant cytoplasm and a small round central nucleus. These cells are some of the largest cells found in the urine and are not usually pathologic. Squamous epithelial cells originate from the skin or urethra (lower urethra in males). The sediment from a freshly collected urine specimen is examined microscopically. In addition to bacteria, what other finding from the list below would further indicate the presence of a urinary tract infection (UTI)? - answers-The presence of white blood cells, especially in large quantities as in this case, is very indicative of urinary tract infections as the white cells are migrating to the urinary tract to fight the bacterial infection. What are the microscopic elements that are indicated by arrows in this image? - answers-Yeast can appear as single cells or in budding form. The most common yeast found in urine is Candida albicans, which typically demonstrates budding forms. The presence of budding forms helps to distinguish yeast from RBCs when urine sediment is viewed microscopically. What is the element indicated by the arrow in this image? - answers-The image below depicts a granular cast. Granular casts are usually indicative of renal disease. These casts are composed of a protein matrix with degraded cellular material. Which of the following macroscopic findings is most consistent with the microscopic finding of oval fat bodies? - answers-Positive protein is reported with the presence of oval fat bodies. Damage to the glomerular membrane in the nephrotic syndrome allows passage of proteins and lipids from the blood into the urinary filtrate. All of the following are abnormal crystals that can be found in urine except: - answers-Triple phosphate crystals are found in normal, alkaline urine. If the crystals are from solutes that are not normally in the urine, they are considered "abnormal." Abnormal crystals may indicate an abnormal metabolic process. These include tyrosine, leucine, and cystine. What crystals are captured below? - answers-These are cholesterol crystals. These crystals look like plates of glass, sometimes with a notch out of one corner (top image). Which statement about diabetes is FALSE? - answers-Diabetes can produce weight loss as a result of the excess buildup and storage of protein. Weight loss from diabetes results from increased utilization of proteins and fats for energy. Diabetes is considered a metabolic disorder that results when insulin concentrations are absent or reduced, or when insulin action is impaired (referred to as insulin resistance). Without cellular uptake of blood glucose for energy, the balance of metabolizing carbohydrates, fats, and proteins for energy is lost. This results in hyperglycemia and the excess use of fats and proteins for energy production. Polydipsia (increased thirst), polyuria (increased volume of urine), and unexplained weight loss are symptoms of diabetes. Polydipsia and polyuria occur as the body tries to lower blood glucose concentrations with increased urinary excretion of glucose. Weight loss results from increased utilization of proteins and fats for energy. Insulin is the main regulatory hormone produced and secreted by the pancreatic beta cells. It stimulates the uptake of glucose and the movement of glucose from the blood to cells for energy production. - answers-True Insulin is the main regulatory hormone produced and secreted by the pancreatic beta cells. It stimulates the uptake of glucose and the movement of glucose from blood to cells for energy production. Insulin also stimulates glycogenesis, inhibits glycogenolysis, and regulates protein synthesis. Which of the following hormones inhibits gluconeogenesis, the formation of glucose from noncarbohydrate sources such as amino acids, glycerol, and fatty acids? - answers-Insulin Gluconeogenesis is the formation of glucose from noncarbohydrates when carbohydrate intake is absent (a fasting state). The hormones cortisol, along with glucagon and epinephrine, all stimulate this metabolic pathway. Insulin, however, inhibits this pathway and is therefore the correct answer. What condition can be described as the occurrence of blood glucose levels that are higher than normal, but not high enough to diagnose diabetes and suggests an individual at an increased risk for developing type 2 diabetes? - answers-Prediabetes usually occurs when blood glucose levels are higher than normal, but not high enough to diagnose diabetes. The condition suggests an individual is at an increased risk for developing type 2 diabetes. Many people with prediabetes develop type 2 diabetes within 10 years. However, modest weight loss and moderate physical activity may often help people with prediabetes delay or even prevent type 2 diabetes. In the US approximately 1 in 3 adults have prediabetes. Which statements are TRUE regarding the testing and diagnosis of gestational diabetes (GDM)? - answers-The testing and diagnosis of GDM is typically accomplished during a woman's first prenatal visit in those individuals with risk factors. In pregnant women not previously known to have diabetes, testing for GDM is usually done at 24-28 weeks of gestation. In addition, women with GDM are typically screened for persistent diabetes at 4-12 weeks postpartum. Moreover, women with a history of GDM should have lifelong screening for the development of diabetes or prediabetes at least every 3 years. A 2013 NIH panel recommended the two-step approach of screening with a 1-hour, 50-g glucose load test (GLT) followed by a 3-h 100-g oral glucose tolerance test (OGTT) for those who screen positive. Which statement relative to the treatment and management of diabetes is FALSE? - answers-A combination of insulin injections and anti-diabetic drugs should not be used together. For type 1 diabetes, and more severe type 2 diabetes, medication may be required to control blood glucose levels. Some patients may require insulin injections, while others may take anti-diabetic drugs such as metformin and sulfonylureas. Others may require a combination of insulin and anti-diabetic drugs. Improvements in blood sugar levels can often result from weight reduction, increase in exercise, and a more balanced diet. Which of the following patients is MOST at risk for hyperosmolar nonketotic coma? - answers-Ordinarily, ketones are negative in a type 2 diabetic patient. Because the elderly often have reduced renal excretion and impaired cardiac function, a type 2 elderly diabetic is at risk for developing a hyperosmolar nonketotic coma. Which of the following describe type 2 diabetes? - answers-Selections 1,2 and 4 are correct: Type 2 diabetes was previously referred to as non-insulin-dependent diabetes or adult-onset diabetes. Most, but not all, type 2 diabetes are obese. Insulin resistance is probably the primary dysfunction in type 2 diabetes. The hyperglycemia can result from insulin resistance, insulin deficiency, or a defect in insulin secretion.Selection 3 is incorrect: Instead, type 2 diabetes accounts for approximatley 90% of all diabetes. The 2022 American Diabetes Association (ADA) updated guidelines include which of the following recommendations for prediabetes and diabetes screening in asymptomatic adults? - answers-Selections 2, 3 and 4 are correct. The 2022 ADA guidelines recommendations for screening for prediabetes and diabetes in asymptomatic adults indicate that if test results are normal, testing should be repeated at a minimum of 3-year intervals.. Also, patients with prediabetes (A1C ≥5.7% or impaired glucose tolerance or impaired fasting glucose) should be tested yearly and women who were diagnosed with GDM should have lifelong testing at least every 3 years. Selection 1 is incorrect: The ADA now recommends that adults who do not have diabetes symptoms should be screened for prediabetes and type 2 diabetes starting at age 35. According to the 2022 ADA guidelines, a Hb A1C result ≥ 6.5% can be used to diagnose diabetes. - answers-True The ADA's latest guidelines (2022) indicate that one of the criteria for screening to help diagnose diabetes is a Hb A1C level of ≥ 6.5%. Moreover, the ADA indicates that the glycemic target for nonpregnant adults with diabetes is 7.0% and lowering A1C below or around 7.0% has been shown to reduce microvascular complications and macrovascular disease. Therefore, a Hb A1C level that is 7.0% indicates glycemic control for most adults with diabetes. Which of the following statements best describe Hb A1C? - answers-Hb A1C is the nonenzymatic addition of a glucose molecule to Hb A. After a rearrangement, the addition is irreversible. The concentration of Hb A1C relates to the individual's average glucose concentration over two to three months. Which of the following is a disadvantage of using the Hb A1C test over blood glucose measurement for diabetes screening? - answers-Conditions that shorten RBC survival (eg, hemolytic anemia, homozygous sickle cell trait, pregnancy, or recent significant blood loss) will reduce exposure of the RBCs to glucose, thereby lowering the Hb A1C test value. Other disadvantages of utilization of Hb A1C over blood glucose measurement include: Cost per test is higher than blood glucose. Specimens with 10% fetal hemoglobin (HbF) may have a falsely decreased Hb A1C test result. If onset of diabetes is rapid, blood glucose levels will more correctly reflect glycemia than Hb A1C levels. Advantages of utilization of Hb A1C over blood glucose measurement include: Fasting is not required Greater specimen stability Less fluctuations in day-to-day levels caused by stress and illness Which statement best describes ketones and their involvement in ketoacidosis? - answers-Increased ketones can result in a metabolic acidosis referred to as ketosis, ketoacidosis or diabetic acidosis. Type 1 diabetic patients are especially at risk for ketoacidosis. Ketones are produced when glucose is not available to supply the body's cells with energy. This can occur when insulin levels are insufficient or lacking. To make energy, the body then begins breaking down fat into acetyl CoA. The acetyl CoA produced is converted to acetone, acetoacetate, and beta-hydroxybutyrate. These are acids that when dissolved in body fluids in excess, lower the blood pH. One of the ADA's options for the diagnosis of diabetes is the use of a 2 hour plasma glucose (PG) ≥ 200 mg/dL during 75 g oral glucose tolerance test (OGTT). - answers-True Of the 4 options for screening and diagnosing diabetes, one option is the use of the 2-hour plasma glucose (during 75 g OGTT) with plasma glucose result of ≥ 200 mg/dL. A patient has a fasting plasma glucose (FPG) performed at an outpatient laboratory. He has fasted as instructed. The result of the FPG is 135 mg/dL. What does this result indicate and what, if any, further action is recommended by the ADA? - answers-This is considered an elevated plasma glucose level, however in the absence of unequivocal hyperglycemia, the patient needs further testing. The ADA considers a FPG of ≥ 126 mg/dL as elevated. However, in the absence of unequivocal hyperglycemia, the results should be confirmed using repeat testing. (Diagnosis requires two abnormal results on same sample or in separate sample) A 70-year-old type 2 diabetic patient is comatose and in the emergency department. STAT blood glucose and serum ketones are ordered. Blood glucose is 650 mg/dL Serum ketones are negative What is the best conclusion? - answers-The patient may have hyperosmolar nonketotic coma and should be further evaluated. The blood glucose value is critical and with negative ketones is consistent with type 2 diabetes. The elderly type 2 diabetic is at risk for a hyperosmolar nonketotic coma. The patient becomes dehydrated due to increased urine excretion to lower the blood glucose. If reduced renal or cardiac function is also present, glucose excretion is impaired and blood glucose concentrations can become extremely high. Ketones are not produced in excess; thus, the patient remains nonketotic. Insufficient hydration, elevated blood glucose, and decreased renal excretion of waste products result in an increased osmolality and total concentration of all plasma components A measurement of urine glucose would not be useful at this point. A physician is evaluating a 45-year-old obese male for diabetes and orders a plasma glucose at time of evaluation and a Hb A1C one week later. The patient has a family history of diabetes and currently exhibits symptoms of diabetes. What would be the best course of action if these are the blood glucose results? Casual blood glucose: 208 mg/dL Hb A1C one week later: 7.2% - answers-A casual blood glucose ≥ 200 mg/dL on a patient with symptoms and an A1C≥ 6.5% meet diagnostic criteria for diabetes. A Hb A1C result for a diabetic patient is 6.0%. What conclusion can be made regarding this patient's carbohydrate management? - answers-The results demonstrate compliance with diet and medication. The Hb A1C result is 7.0%, indicating glycemic control for most adults with diabetes. Gestational diabetes is diagnosed with the same testing and criteria used for the diagnosis of diabetes for a nonpregnant adult. - answers-False There are different screening tests for gestational diabetes and an oral glucose tolerance test (OGTT) is used to confirm diagnosis. An NIH panel recommended the two-step approach of screening with a 1 hour, 50 g glucose load test (GLT), followed by a 3 hour, 100 g OGTT for those who screen positive. Six months ago, a 55-year-old female had a fasting plasma glucose (FPG) greater than 200 mg/dL on two occasions. She was diagnosed as having type 2 diabetes and treatment was started. Along with routine FPG, which of the following tests would most likely be used to monitor glycemic control? - answers-FPG is performed to monitor diabetes, often weekly or even daily. The ADA also recommends that a Hb A1Cbe tested at least two times each year in patients who are meeting treatment targets and have stable glycemic control. In recent years, the American Diabetes Association (ADA) recommended reporting which of these values to correlate with Hb A1C as a further indicator of glycemic control? - answers-In 2008, the ADA recommended calculating and reporting the estimated average glucose (eAG) with Hb A1C measurement results. eAG is a glucose concentration level calculated from a patient's Hb A1C result. The eAG is essentially a health tool to help clinicians set glucose level targets in patients, especially useful in cases where the patient is not entirely compliant and where patients don't check their blood glucose frequently enough to keep proper track through self-monitoring of blood glucose. The ADA introduced the term to help translate the A1C results into numbers that are closer to every day readings on glucose meters. Whole blood glucose values are ____________ plasma glucose values. - answers-Whole blood glucose values are lower than plasma glucose values. For this reason, point-of-care whole blood glucose meters are programmed to correct the value before presenting the result; therefore, the whole blood glucose meter result correlates to serum or plasma results. Atherosclerosis is a hardening of an artery specifically due to which of the following? - answers-Atherosclerosis is a hardening of an artery specifically due to the buildup of plaque. The risk to patients with significant atherosclerosis is that eventually a narrowing of the artery (stenosis) can cause a reduction in oxygen delivery to tissues and plaque rupture can lead to an acute coronary event. Which assay is performed to diagnose congestive heart failure (CHF)? - answers-BNP is elevated in CHF patients. Cardiac troponins are measured to diagnose an AMI and homocysteine, hs-CRP, and ischemia modified albumin are markers of risk for cardiac disease. Select the true statement regarding lipids and heart disease. - answers-It is now known that atherosclerosis formation is primarily an inflammatory process but lipids do play a role in the process. Increased blood levels of LDL-C indicates a greater risk for atherosclerosis. An increased level of HDL-C is not associated with an increased risk for cardiovascular disease. In fact, the HDL lipoprotein plays a role in reducing lipid levels in the blood." A characteristic of a good cardiac biomarker is that it is normally present in a HIGH concentration in the peripheral blood. - answers-False A biomarker that is a good indicator of cardiac damage is normally in low concentrations in peripheral blood. Which two of the following biomarkers are not specific to cardiac muscle and may be elevated in patients with injury to muscle other than cardiac muscle? - answers-Myoglobin and CK-MB are present in skeletal muscle and can be elevated in injury to these cells. Other causes of increased myoglobin and CK-MB levels include: Severe injury to skeletal muscle Strenuous exercise Extremely difficult breathing (increased use of chest muscles) Kidneys failure Chronic muscle disease Alcohol abuse Troponin T and I tests are much more specific to cardiac muscle than myoglobin and CK-MB assays. Which cardiac protein is part of the myocyte contraction mechanism? - answers-Both cTnI and cTnT are components of the regulation of myocyte contraction. Which statement is TRUE concerning C-reactive protein (CRP)? - answers-CRP and hs-CRP assays are measuring the same protein. A patient with a high CRP will also have a high hs-CRP. Therefore, patients with high CRP cannot be assessed for cardiovascular risk using the hs-CRP assay. hs-CRP is still used to assess risk, despite its limitations. Mrs. Jones, a diabetic, is admitted to the hospital on November 25th. It appears that she has had an AMI but did not feel the severe chest pain because of diabetic neuropathy. She has not felt well since November 20th and her physician believes she possibly had an AMI on November 20th.Assuming that the infarct was uncomplicated, which of the following cardiac biomarkers would most likely still be elevated and would assist in an AMI diagnosis? - answers-Cardiac troponin, either cTnI or cTnT, remains elevated after an AMI for 10-14 days. Myoglobin returns to normal range in 24-36 hours and CK-MB is back to normal range in 48-72 hours. A 32-year-old teacher is seeing her internist for her yearly physical. Because of a family history of heart disease, she is concerned about her risk for cardiac disease. She is not a smoker nor hypertensive, and is not overweight. She is physically active and maintains a good diet and nutrition. Her physician ordered a lipid panel and hs-CRP to evaluate her cardiac disease risk. - answers-Cholesterol 189 mg/dL 200 mg/dL Triglyceride 140 mg/dL 150 mg/dL LDL- cholesterol 98 mg/dL 100 mg/dL (optimal) HDL-cholesterol 60 mg/dL≥ 59 mg/dL (optimal) hs-CRP 0.9 mg/dL 1 mg/L (low risk) The individual would be at low risk for cardiac disease. She does not have any risk factors, her lipid levels are in the recommended ranges, and her hs-CRP is in low risk range. Which of the following organs synthesizes and secretes b-type natriuretic peptide (BNP)? - answers-BNP is secreted by the heart and acts as an indicator of the heart's relative functionality. A higher BNP level signifies worsening symptoms of heart failure, as the left ventrical myocardium releases BNP in response to ventricular wall stress or tension, which occur in chronic heart failure. Infarction - answers-An area of tissue death that occurs due to lack of oxygen. Angina - answers-Chest pain caused by inadequate supply of oxygen to heart myocardium. Congestive heart failure - answers-A left ventricular dysfunction resulting from aging, hypertension, atherosclerosis or muscle damage from an AMI or repeated AMIs. Ischemia - answers-An inadequate blood supply that decreases availability of oxygen What is the function of BNP? - answers-BNP promotes diuresis in order to decrease intravascular volume and lower blood pressure. It is a marker of volume overload. The minimum acceptable sweat yield for a valid sweat test using 2x2 inch gauze is 75 mg. What is the minimum acceptable sweat yield for a valid test collected in 30 minutes using the Macroduct® coil method? - answers-The minimum acceptable sweat yield in 30 minutes collection using Macroduct® coil is 15 µL. Approximately 47% of individuals with cystic fibrosis are homozygous for the F508del mutation of cystic fibrosis transmembrane conductance regulator (CFTR). How does this mutation affect CFTR? - answers-The F508del mutation results in a block in processing. This mutation is associated with a lack of amino acid, phenylalanine (Phe or F), at position 508 ( F508del). The lack of phenylalanine affects the folding of the protein, and it is trapped in the endoplasmic reticulum and degraded in the Golgi, never making it to the cell membrane. You are performing a sweat test using the Macroduct® system. At the end of 30 minutes, you observe that the patient is not producing very much sweat in the Macroduct® coil. Visually, you estimate it is between 5-10 µL. What should you do? - answers-Samples collected in Macroduct® coils that are less than 15 µL should not be analyzed and should be reported as "QNS." Sweat should only be collected for 30 minutes; extending the time increases the opportunity for evaporation. In general, it does not yield more sweat and invalidates the minimum sweat rate based on 30 minutes collection time. Reagent volumes should not be adjusted, and samples collected from different sites should never be combined to bring the total volume up to 15 µL What is the result of the defective cystic fibrosis transmembrane conductance regulator (CFTR) protein on chloride reabsorption in the sweat ducts and chloride concentration in sweat? - answers-Defective CFTR causes decreased chloride reabsorption in the ducts, which results in increased chloride concentration in sweat. What is the goal of physiotherapy with inhaled medications in the treatment of CF? - answers-The goal of the therapy is to improve lung function and decrease lung infections by clearing the airways and loosening mucus secretions. Medications such as bronchodilators and Pulmozyme® (DNase) are used in nebulizers before chest physiotherapy to open the airways and help degrade the DNA found in mucus from white blood cells. Following percussive therapy and postural drainage, inhaled antibiotics like tobramycin and aztreonam are used. In addition to these medications, some patients use inhaled hypertonic saline to aid in airway clearance and some use ibuprofen to decrease pulmonary inflammation. These medications treat the symptoms of CF but not the underlying molecular defect of CFTR. There is currently no cure for CF, and CF patients will continue to require the use of drugs to treat the symptoms. A 3-week-old female with no signs or symptoms of cystic fibrosis (CF) has a positive newborn screening (NBS) test result for CF. The NBS is based on genotyping. The baby is then referred for sweat chloride testing. The sweat chloride result is 15 mmol/L, which is in the normal range. What do these results most likely indicate? - answers-The patient is most likely a carrier of CF. Carriers for CF have no clinical manifestations of the disorder. The positive NBS indicates at least one mutated copy of CFTR (assuming no sample mix up). However, the patient is most likely heterozygous for CF, as demonstrated by the positive NBS and a normal sweat chloride result. Sweat testing for the diagnosis of cystic fibrosis (CF) would be appropriate for which one of the following patients? - answers-A 4-day-old infant with a positive newborn screening test result who is not acutely ill A patient who undergoes sweat testing should be at least 48 hours of age and not acutely ill. There may be a transient elevation in sweat chloride concentration if the newborn is less than 48 hours old. A patient with gastroenteritis may be vomiting or have diarrhea, which would result in dehydration that will affect the ability to collect a sufficient volume of sweat and/or accurately interpret the test results. A sweat test cannot be performed over an area of inflammation, such as in eczema, because serous fluid from the lesions may falsely affect the sweat chloride result. Patients who are homozygous for the F508del mutation of cystic fibrosis transmembrane conductance regulator (CFTR) exhibit which of the following characteristics? - answers-Patients with F508del tend to be pancreatic insufficient and have more severe pulmonary disease. High blood pressure is not a clinical manifestation of CF. Patients who are homozygous for F508del are said to have "classical CF." Which of the following tests is appropriate to confirm the diagnosis of cystic fibrosis (CF)? - answers-A quantitative sweat chloride test is appropriate to confirm the diagnosis of CF. A sweat conductivity test is a screening test. Direct application chloride electrodes have documented problems with evaporation, making them inappropriate for clinical use. The method is not accurate and is not acceptable for diagnosis. Blood immunoreactive trypsinogen (IRT), a pancreatic enzyme, is measured as a primary screening test for NBS. A patient has a sweat conductivity result of 60 mmol/L. What would be the estimated corresponding sweat chloride concentration? - answers-Sweat conductivity is approximately 15 mmol/L higher than sweat chloride due to the presence of other ions. Therefore, a conductivity of 60 mmol/L would roughly correspond to a sweat chloride concentration of 45 mmol/L. What form of triiodothyronine (T3) is formed in circulation under the influence of high stress in conjunction with elevated levels of cortisol? - answers-The stress hormone cortisol influences deiodinases to remove iodine residues from the inner ring of the T4 prohormone to produce an inactive form of T3, known as reverse T3 (RT3). Following a complete removal of the thyroid gland due to an advanced malignancy, one must be concerned with the level of _____________ as the ___________________ may also be removed or damaged secondary to this surgical procedure. - answers-parathyroid hormone (PTH) ; parathyroid glands What marker is important to measure in conjunction with determining thyroglobulin (Tg) levels with an immunoassay? - answers-When determining levels of Tg using any immunoassay principle, it is essential to also determine if TgAb levels are elevated, as such antibodies may bind to circulating Tg molecules and lead to analytical inaccuracy. Which of the following are considered among the classic symptoms of hyperthyroidism? - answers-Among the classic symptoms of hyperthyroidism are: Weight loss Exophthalmos (bulging eyes) Heat intolerance Nervousness Anxiety Feeling jittery Which element is essential for the production of thyroid hormone? - answers-Thyroid hormones are produced by incorporating iodine moieties into tyrosine residues found in the thyroglobulin protein. What common thyroid condition is associated with the production of the highest levels of thyroperoxidase antibody (TPOAb)? - answers-Highly elevated levels of TPOAb are associated most prevalently in Hashimoto's thyroiditis. TPOAb may also be encountered in Graves' disease and in sera of type I insulin-dependent diabetics. In the thyroid hormone feedback mechanism, what is the normal effect of T4 on thyroid-stimulating hormone (TSH) production? - answers-Excessive T4 provides a negative feedback mechanism with the pituitary and production of TSH, meaning that increased production of T4 should normally cause the pituitary to produce less TSH. Which of the following are considered among the classic symptoms of hypothyroidism? - answers-Hypothyroidism presents with the classic symptoms of fatigue, weight gain, and cold intolerance. Below are the laboratory results and chief clinical findings in a 31 year-old woman. Laboratory Results: Thyroid-stimulating hormone (TSH): 0.02 µIU/mL (ref range 0.4 - 4.12 µIU/mL) Free T3 (FT3): 6.8 pg/mL (ref range 2.5 - 3.9 pg/mL) Free T4 (FT4):1.6 ng/dL (ref range 0.6 - 1.3 ng/dL) Thyroperoxidase antibody (TPOAb): 10.4 IU/mL (ref range 9.0 IU/mL) Thyroglobulin antibody (TgAb): 5.5 IU/mL (ref range 4.0 IU/mL) Clinical Findings: Bulging eyes Hand tremors Extreme weight loss Accelerated heartbeat Which of the options below is most likely the diagnosis of this patient? - answers-Hyperthyroidism, possibly due to Graves' disease In Graves' disease, a hyperthyroid state results from the stimulation of the thyroid gland to produce hormone, absent the direct stimulation of TSH from the pituitary. In this case, there is evidence of an autoimmune process with TPOAb elevated, which although not diagnostic in itself for Graves' disease, indicates that anti-thyroid antibodies may be contributing to the findings of increased FT3 and highly decreased TSH. Why is it important to screen expectant mothers for thyroid disorders early in pregnancy? - answers-It is important to screen expectant mothers for thyroid insufficiency, as undetected deficiencies of maternal thyroid could cause mental disabilities and decreased cognitive skills in her newborn. Which of the following statements related to Graves' disease is TRUE? - answers-Graves' disease is an autoimmune condition where the body produces increased amounts of thyroid hormone. Graves' disease is an autoimmune condition where the body produces an autoantibody called thyroid stimulating immunoglbulin, which has an effect similar to that of TSH on stimulating the thyroid to produce excessive T4 and T3. Graves' disease is more common in women than men, and most commonly occurs in adults over the age of 60 years. The American Thyroid Association (ATA) recommends the use of which laboratory test in screening all adults for thyroid disease, starting at age 35? - answers-The ATA recommends using TSH to screen for thyroid in all adults over the age of 35 years, and every five years thereafter. Historical methods for determining the free thyroxine index (FTI) have been largely replaced with more sensitive and automated immunoassay methods for determining which hormone? - answers-Free T4 (FT4) Only the unbound fractions of thyroid hormones have biologic activity, and as such should be measured directly to determine their available concentrations in circulation. FT4 is routinely measured using sensitive immunoassay methods, thus eliminating the need for estimation using the FTI. Following the surgical removal of the thyroid in thyroid carcinoma, which of the following proteins may be used as an indicator of cancerous regrowth of thyroid tissue? - answers-If using an assay with a high degree of sensitivity, Tg may be used as a tumor marker to detect thyroid cancer recurrence. Below are the laboratory results and chief clinical findings in a 58 year-old woman. Laboratory Results: Thyroid-stimulating hormone (TSH): 4.21µIU/mL (ref range 0.4 - 4.12 µIU/mL) Free T3 (FT3): 2.5 pg/mL (ref range 2.5 - 3.9 pg/mL) Free T4(FT4): 1.0 ng/dL (ref range 0.6 - 1.3 ng/dL) Thyroperoxidase antibody (TPOAb): 1.0 IU/mL (ref range 9.0 IU/mL) Thyroglobulin antibody (TgAb): 0.5 IU/mL (ref range 4.0 IU/mL) Clinical Findings: Inability to lose weight Constipation Of the options below, what is the most likely diagnosis of this patient? - answers-Mildly symptomatic patients found to have slightly elevated TSH levels, with FT3 and FT4 levels within expected limits, and the absence of detectable thyroid antibodies meet the criteria of subclinical hypothyroidism. These 3 tubes of cerebrospinal fluid (CSF) are delivered to the laboratory for analysis. The tube labeled #1 was the first tube collected. Which one of the tubes should be used by the hematology department for cell count and differential? - answers-Hematology analysis is typically performed on the last tube collected to ensure that any peripheral blood that may have contaminated the sample during the lumbar puncture has cleared. In this case, only 3 tubes were collected. Therefore, tube #3 should be used for cell count and differential. The first tube collected should not be used for hematology analysis because of possible blood contamination from the lumbar puncture. Which of the following is NOT a function of CSF? - answers-Regulating body metabolism is NOT a function of CSF. Cerebrospinal fluid has three main functions: Protect brain and spinal cord from trauma. Supply nutrients to nervous system tissue. Remove waste products from cerebral metabolism. How many white blood cells (WBCs) would be considered normal for adult cerebrospinal fluid? - answers-In an adult, 0 - 5 WBC/µL is considered normal. Children will have slightly higher cell counts. Up to 30 WBC/µL is within normal limits for newborns. Lymphocytes account for 60 - 100% of these cells. A technologist decides to make a 1:20 dilution of cerebrospinal fluid (CSF) after briefly evaluating a portion of the sample microscopically. After making the dilution and charging the chambers, the number of cells that are observed in each of the large squares of the hemocytometer is 100. What should the technologist do to obtain the most accurate count? - answers-The best choice would be to make a larger dilution before performing the cell count. This will provide the most accurate results. These tubes of cerebrospinal fluid (CSF) arrive in the laboratory for evaluation. The tubes were numbered in the order in which they were obtained, with #1 being the first tube collected and #3 being the last tube collected. What may be indicated by the macroscopic appearance of the CSF? - answers-The appearance of the CSF suggests a traumatic tap. This is indicated by the fact that there is decreasing amounts of blood in the sequentially collected tubes; tube #1 contains visible red blood cells, but the amount of blood decreases in the other tubes. Normal CSF is clear and colorless. If the blood was the result of a subarachnoid hemorrhage, all three tubes would contain blood and the amount of blood in each tube would be consistent (unless a traumatic tap also occurred during collection of the sample). Upon centrifugation, a cerebrospinal fluid (CSF) sample supernatant exhibited xanthochromia. The image is a Wright-Giemsa stained smear that was made from that CSF sample. What condition is probably related to these macroscopic and microscopic findings? - answers-Xanthochromia may be an indication of previous subarachnoid hemorrhage (SAH). The presence of dark, granular, iron-laden hemosiderin deposits, indicated by the blue arrows, and yellow, crystalline, iron-free hemotoidin crystals (red arrows) in macrophages, point to an SAH several hours to days prior to CSF analysis. Macrophages begin to appear in CSF approximately two hours after bleeding occurs into the central nervous system. The macrophages start to phagocytize red blood cells (RBCs). As the RBCs degenerate further, the breakdown products are seen in the phagocytic cells as hemosiderin deposits or hematoidin crystals. The appearance of hemosiderin and hematoidin crystals occurs approximately 18 hours following an SAH and may be present in the CSF for several months. If a CSF sample from a traumatic tap is centrifuged, the supernatant would be clear rather than xanthochromic, if the sample was analyzed within one hour of sample collection. Many RBCs would be present, but hemosiderin deposits and hemotoidin crystals would not be present. These findings are also not associated with leukemia or meningitis. The image is a Wright-Giemsa stained smear (1000x) of cerebrospinal fluid (CSF). The arrows point to cells that may indicate which of the following conditions? - answers-The arrows point to immature cells, probably blasts, which may indicate leukemia with CNS involvement. Blasts are not associated with allergic reactions, bacterial meningitis, or viral meningitis. Increased numbers of the cells indicated by the arrows are associated with which of these conditions? - answers-The cells that are indicated by the blue arrows are normal mature lymphocytes. A pleocytosis (increased number) of lymphocytes, including reactive forms (as indicated by the red arrows), is associated with viral meningitis. Where does most cerebrospinal fluid (CSF) originate? - answers-Most CSF originates in the choroid plexus. The choroid plexus is composed of a mass of tiny blood vessels that are located in the third lateral and fourth ventricles. The remaining CSF, about 30%, is formed in other sites such as the subarachnoid space and the ependymal lining of the ventricles. Lymphocyte pleocytosis refers to... - answers-The presence of a greater than normal number of lymphocytes in the spinal fluid is considered lymphocyte pleocytosis. A cerebrospinal fluid (CSF) sample for hematologic evaluation should be tested within how long of collection? - answers-Hematologic analysis of CSF samples should be performed within one hour of fluid aspiration. Both red blood cells (RBCs) and white blood cells (WBCs) have limited stability in CSF because CSF is hypotonic and cells can rapidly lyse. Identify this cell - answers-Presumptive malignant cell Identify this cell - answers-lymphocyte Identify this cell - answers-choroidal cell Identify this cell - answers-monomacrophages A sample of cerebrospinal fluid is diluted 1:100; the standard 9 squares of a hemocytometer are counted on each side for a total of 18 large squares. Side 1-- 186 nucleated cells counted Side 2-- 184 nucleated cells counted total nucleated cells = 370 Using the standard hemocytometer formula shown on the right, what is the nucleated cell count per microliter (µL)? - answers-(186+184) x 100/18 x 0.1= 20,556= 2.06 x 10^4 All of the following viruses are part of the acute hepatitis panel, EXCEPT? - answers-Hepatitis E (HEV) The viruses tested for in the acute hepatitis panel are Hepatitis A (HAV), Hepatitis B (HBV), and Hepatitis C (HCV). What patient symptom does NOT point to acute hepatitis? - answers-Acute hepatitis can exhibit several typical symptoms, clear urine is not one of them. The following symptoms are associated with acute hepatitis: Fever Fatigue Loss of appetite Nausea Vomiting Abdominal pain Dark urine Diarrhea Clay-colored bowel movements Joint pain Jaundice Which hepatitis virus is typically spread by the fecal-oral route? - answers-HAV is stable under normal environmental conditions and can contaminate food or water. It is through the fecal-oral route that it is usually spread. HAV does not result in chronic infection, instead is self-limited and usually resolves within two months of infection. Chronic HBV is least likely to develop in what patient group? - answers-Adults The chances of an HBV infection becoming chronic in an individual is highest among young children. Around 90% of infants and 25% to 50% of children 1 to 5 years old infected with HBV will develop chronic HBV. These rates are lower with adults. Only 5% of adults who contract HBV will develop a chronic infection. Which hepatitis virus is most prevalent in the US? - answers-HCV 2016 data estimate the number of chronic HBV infections at 862,000. Meanwhile, the number of chronic HCV infections is estimated to be around 2.4 million. This is partially due to the lack of a vaccine against HCV, and a higher rate of chronic HCV infections compared to HBV. As illicit opiate drug use skyrockets, more HepC infections are expected. Between HAV, HBV, and HCV; which one of these does NOT have a vaccine? - answers-There is no vaccine for hepatitis C available. However, there is currently research being performed for the development of one. If both HBsAg and HBc IgM are positive - answers-acute HBV If the HBsAg is positive, and the HBc IgM is negative, what form of hepatitis does the patient have? - answers-Chronic HBV If both HBsAg and HBc IgM are negative - answers-negative for HBV If only the HBc IgM is positive - answers-the test is inconclusive, probably patient is recovering from acute HBV EIA has better specificity and better positive predictive values than CIA, leading to EIA methodology being more widely used, particularly in high-volume clinical laboratories. - answers-False EIA assays have a history of false-positive results due to the lack of specificity. This is due to the potential for other substances in the patient's serum to bind to the antibody of the assay. Chemiluminescent immunoassays (CIA) utilize an immobilized capture ______ that attaches to the target serological marker in the patient's serum. - answers-Protein Chemiluminescent immunoassay involves an immobilized capture protein that attaches to the target serological marker in the patient's serum. This process involves presenting the corresponding antibody to the patient's serum. Chemiluminescent immunoassays (CIAs) also exploit the very strong and specific binding between an antibody and the epitope binding site on an antigen. Like EIAs, a CIA will have an immobilized capture protein (either an antigen or an antibody). The assay steps are then very similar to an EIA with the exception that instead of color production, or a change in fluorescence, the CIA uses reporter enzymes that produce light. The detection and quantitation for a CIA are performed using a luminometer (a component that measures photons) rather than a spectrophotometer or fluorometer (that measures absorbance or fluorescence respectively). CIAs are much more sensitive than EIAs. CIAs can detect concentrations of analytes with 1000Xs more sensitivity than traditional EIAs. For this reason, most high-volume serology tests are now performed using instruments that perform CIAs. What type of medication is used to cure the majority of cases of chronic HCV? - answers-Direct-acting antiviral (DAA) medications are prescribed.They are oral medications and are specific to certain viral genotypes. It is possible to be infected with more than one strain. Medications are taken for 8 to 12 weeks. HBsAg is used to make the HBV vaccine. - answers-True The vaccine uses HBsAg to induce the body to make anti-HBs. If levels of anti-HBs are ≥ 10 mIU/mL, then the patient is considered protected. The vaccine is given in three or two rounds, depending on the manufacturer. A reactive HBc IgM assay is selective for chronic HBV. - answers-FALSE. Hepatitis B core IgM Ab (HBc IgM) appears at the onset of symptoms in acute hepatitis B. It is detectable at the time symptoms appear but becomes undetectable after six to nine months. After this period, Hepatitis B core IgG Ab is developed. So, this assay is selective for acute HBV. What is the definition of dyslipidemia? - answers-Dyslipidemia is elevation of plasma cholesterol, triglycerides, or both, or a low high-density lipoprotein (HDL); it is one of the factors that can lead to a diagnosis of metabolic syndrome. HDL cholesterol plays a vital role in the transport of excess cholesterol to the liver, which decreases total plasma cholesterol. Which of the following statements is true regarding HDL concentration in the blood? - answers-Concentration of HDL cholesterol is decreased by triglyceride-rich VLDL in the blood. Which statement best describes small dense LDL particles that can occur in atherogenic dyslipidemia? - answers-In excess triglycerides, the triglycerides reduce the amount of cholesterol in LDL particles producing small dense LDL molecules. Because of size and density, these molecules more easily enter damaged endothelium and vessel walls and are more easily incorporated as plaque is formed. Which of these triglyceride values would be considered a risk factor for metabolic syndrome? - answers-Triglycerides greater than 150 mg/dL is considered one of the risk factors for metabolic syndrome. High triglycerides in combination with at least two other risk factors would lead to a diagnosis of metabolic syndrome. Which one of the following adipose tissue hormones (adipokines) inhibits appetite and stimulates metabolism? - answers-Leptin inhibits appetite and stimulates metabolism. Resistin increases insulin resistance and enhances adhesion molecules present on endothelial cells. Adiponectin increases fatty acid oxidation. Adipokines can be pro-inflammatory or anti-inflammatory. - answers-True Adipokines modulate inflammation and insulin resistance. Obesity-induced insulin resistance may result, at least in part, from an imbalance in the expression of pro- and anti-inflammatory adipokines. Below are the laboratory results on a 20-year-old male. His waist circumference is 41 inches and blood pressure is 140/90. Fasting Blood Glucose: 90 mg/dL Triglycerides: 180 mg/dL HDL: 45 mg/dL Which of these results would lead to a diagnosis of metabolic syndrome? - answers-Three of the five criteria that are needed to diagnose metabolic syndrome are met: waist circumference 40 inches high blood pressure elevated triglycerides. In insulin resistance, plasma glucose and non-esterified fatty acids (NEFAs) increase. - answers-True In insulin resistance, insulin action is inhibited. Lipolysis increases and glycolysis and glucogenesis are decreased. This increases blood glucose and NEFAs. Metabolic syndrome ___________ the risk of developing type 2 diabetes. - answers-Metabolic syndrome increases the risk of developing type 2 diabetes. The insulin resistance state impairs carbohydrate metabolism and elevates blood glucose levels. However, diabetes is often diagnosed before a patient is evaluated for metabolic syndrome. Which of the following blood tests would aid in the diagnosis of metabolic syndrome? - answers-Fasting blood glucose, triglycerides, HDL-C along with waist circumference and blood pressure are the measurements used in the diagnosis of metabolic syndrome. Which of these is a function of the kidney? - answers-Primary functions of the kidneys include: Regulating water/electrolyte content Contributing to acid-base balance through retention or excretion of acids Removing and excretion of metabolic waste products and xenobiotics Regulating arterial pressure through production and release of renin Regulating red blood cell production through production of erythropoietin Participating in calcium/phosphorus metabolism through production of 1,25-dihydroxyvitamin D The nephron is considered the functional unit of the kidney. - answers-TRUE. The nephron is the major functional component of the kidney where plasma filtration takes place. Chronic Kidney Disease is defined as abnormalities of kidney structure and/or function that have implications for long-term health. To be diagnosed, abnormalities must be present for greater than 1 month. - answers-FALSE. For diagnosis, abnormalities must be present for greater than 3 months. CKD is more prevalent in: - answers-CKD prevalence is linked to numerous factors, to include sex, race, and socioeconomics. The disease is: More common in women than men (16% vs 13%) More common in non-Hispanic blacks than non-Hispanic whites (18% vs 13%) More common in Hispanics than non-Hispanic whites (15% vs 13%) Which of these factors are associated with CKD? More than one option may be correct. - answers-Genetics Socioeconomic status Obesity All of these are risk factors for development of CKD. In addition, family history, gender, ethnicity, age, birth weight, smoking status, exposure to nephrotoxins, and prior acute kidney injury may be associated with development of the disease. Which of these is the leading associative cause of CKD? - answers-Diabetes is associated with greater than 37% of cases of CKD hypertension is associated with approximately 27%. Other factors associated with CKD include: Genetics and family history Gender, ethnicity, age, birth weight Socioeconomic status Obesity, smoking Exposure to nephrotoxins Prior acute kidney injury Which of these organizations is responsible for the formal definition of CKD developed in 2002? - answers-NKF-K/DOQI developed the original defition in 2002. KDIGO is responsible for the most recent guidelines developed in 2013. While many laboratory tests are employed in diagnosis and monitoring of CKD, which two are the primary ones used to diagnose, risk stratify, and monitor the disease (select two)? - answers-Urine albumin (as a creatinine ratio) and creatinine (to calculate GFR) are the most common tests used to diagnose, risk stratify, and monitor CKD. Decreases in GFR may be caused by both benign and pathologic conditions. - answers-TRUE. Both benign and pathologic conditions may result in a decreased GFR. Many benign conditions may not effect true disease in affected patients Both direct measurement and indirect estimates of GFR can be performed. Which one of these is more common? - answers-Indirect estimates are by far more common. Then are relatively non-invasive (a simple blood draw only) and simple to perform in contrast to methods of direct measurement. ________ assays are often based on coupled enzymatic reactions involving creatinase. - answers-Enzymatic Interference, when present, is often due to suppression or inadvertent consumption of produced peroxide reporter molecules (H2O2). - answers-Enzymatic cross-reaction with other metabolites and the presence of background color (e.g., high bilirubin due to liver disease) can lead to interference. - answers-Jaffe (alkaline-picrate) _________ reaction is an alkaline-picrate reaction that forms a yellow/orange/red complex with creatinine. - answers-Jaffe (alkaline-picrate) The currently recommended equation to estimate the GFR is the: - answers-The CKD-EPI equation is currently recommended by KDIGO for use to estimate GFR due to its superior performance in contrast to the other options presented. Microalbumin is the preferred and recommended term to describe the presence of increased urine albumin. - answers-False Microalbumin and microalbuminuria are historical terms used to describe the presence of "small" amounts of urine albumin. The terms urine albumin and albuminuria are recommended by the KDIGO and National Kidney Foundation. Moderate albuminuria - answers-30-300 mg/g Severe albuminuria - answers-300 mg/g normal/mild albuminuria - answers-30 mg/g Which of these is NOT correct? - answers-Decreases in serum creatinine are associated with higher levels of kidney function. Which of the following are considered potential treatment options for patients with CKD? Choose all that apply. - answers-Reducing blood pressure Improving lifestyle choices associated with poor health Controlling diabetes Kidney transplant Which of the following statements regarding semen analysis are TRUE? - answers-Two or three semen samples are recommended to be obtained and evaluated to provide more information for an accurate interpretation of fertility status. In addition to determining male fertility status, a semen analysis can be used to assess the success of vasectomy and vasectomy reversal. Which of the following represents the lower reference limit for semen volume? - answers-1.5mL Liquefaction of a semen specimen always occurs immediately after ejaculation. - answers-This statement is false. Liquefaction, or the resolution of the gel-like consistency, is expected within 15 minutes at room temperature. If liquefaction does not occur within 60 minutes, you should note this on the report sheet. Normal liquefied semen may contain jelly-like granules (gelatinous bodies) that do not liquefy. Which of the following statements is true regarding the normal viscosity of semen? - answers-A normal sample leaves the pipette in small drops with very little trailing thread. A semen sample that is abnormally viscous will form a thread more than 2 cm long. A specimen that is more viscous than normal after liquefaction may have reduced sperm motility. Sperm concentration - answers-The number of sperm/mL in a sample is typically determined by counting sperm in a counting chamber. According to the WHO 5th edition, the lower reference limit for sperm concentration is 15 x 106 spermatozoa/mL. Sperm count - answers-To determine the sperm count, sperm concentration is multiplied by the total sample volume submitted. The lower reference limit for sperm count is 39 x 106 spermatozoa per ejaculate. If no sperm are seen on the concentrated sample, a report of "no sperm seen on a concentrated sample" can be made. The absence of sperm suggests a diagnosis of___ - answers-azoospermia What is the recommended MINIMUM number of spermatozoa that should be counted on each side of the hemocytometer when a manual sperm count is performed using an improved Neubauer hemocytometer? - answers-200 A sperm concentration of 25 x 106 spermatozoa/ mL would be considered an abnormally low concentration, according to the WHO 5th edition. - answers-false, According to WHO 5th edition, the lower reference limit for sperm concentration is 15 x 106 spermatozoa per ml. Epithelial cells are frequently found in semen - answers-true round cells may either be _______ - answers-Spermatids or WBCs Cells present in semen include - answers-Epithelial cells, RBCs (blue), WBCs & Spermatids (red) Increased WBCs may indicate inflammation of the accessory glands Round cells are either Spermatids or WBCs differentiated using 1000x Semen analysis includes - answers-Volume Viscosity Concentration Total # (Viability) Motility - just keep swimming # of normal and defective Coagulation Fructose pH - 7.2-8.0 (alkaline) # of immature sperm WBCs, bacteria, parasites (infection) Liquifaction of sperm - answers-occurs after 30min Mucus strands may increase liquification time to 60min - answers-true Stains used for semen include - answers-Papanicolaou (PAP) stain Differential Quik Stain Kit (Modified Giemsa) Shorr stain Sperm Morphology - answers-Smear evaluation General (Head, Neck, Midpiece & Tail) Headstaining characteristics Tailstaining characteristics Abnormal Sperm morphology - answers-Abnormal heads can include enlarged head, double head, round head, constricted head, amorphous head, pinhead, and acute tapering forms. There are also heads with abnormal numbers of vacuoles (2 in the acrosomal region and/or vacuoles in the post-acrosomal region are abnormal). Midpiece abnormalities include distended and thin midpiece regions. Abnormal tails include short tails, double, triple, or multiple tails, coiled tail, broken tail, or absent tail. Cytoplasmic droplets are also seen in some specimens. These are large cytoplasm regions just below the head, assumed to represent a failure of complete sperm maturation or a sign of either toxicity or oxidation. There have also been reports that cytoplasmic droplets may be artifacts from the fixation and staining for morphology analysis. Lower reference limits for a normal semen analysis. - answers-Liquefaction: ≤30 minutes (no greater than 1 hour) Volume: 1.5 mL pH: ≥7.2 Sperm concentration: ≥15 x 106 / mL Motility: Progressive motility 32%. The lower reference limit for total motility (progressive + non-progressive) 40%. WHO 5th edition: ≥4% normal forms Which of the following is directly involved in the production of semen? - answers-The structures involved in producing semen include the prostate, the seminal vesicles, the bulbourethral gland, and the testes and epididymis. Semen is produced as a combination of secretions from the different regions of the male reproductive tract. Each fraction differs in chemical composition and function. Spermatozoa are produced in the testes. They mature in the epididymis. The testes also produce testosterone and inhibin. Fluid from the seminal vesicles accounts for approximately 70% of semen volume. The seminal vesicles are the source of fructose in semen. Spermatozoa use fructose as an energy source. The prostate gland supplies about 20% of the volume of semen. Its fluids include acid phosphatase and proteolytic enzymes that lead to coagulation and subsequent liquefaction of semen. The prostate also contains most of the IgA found in semen. The bulbourethral gland produces mucoproteins that makeup about 5% of the volume of semen. The pituitary gland is not directly involved in producing semen; instead, hormones are released which stimulate the production of sperm. The urethra is not involved in the production of semen. Semen viscosity can be estimated by aspirating the sample into a wide-bore plastic disposable pipette, allowing the semen to drop by gravity, and observing the length of the thread that is formed. A semen samp