WOLLEGA UNIVERSITY

INSTITUTE OF HEALTH SCIENCE

DEPARTMENT OF MEDICAL LABORATORY

Assignment for Summer Program

Body Fluid Analysis (MeLS 571)

Prepared by: Amanuel Hika

Name : Id no

March 2022

Nekemte
Part one

Answer the following by choosing from given alternatives

1. Cerebrospinal fluid (CSF) is formed by ultrafiltration of plasma through the:

A. Choroid plexus C. Anterior cerebral lymphatics

B. Sagittal sinus D. Arachnoid membrane

2. Which statement regarding CSF is true?

A. Normal values for mononuclear cells are higher for infants than adults

B. Absolute neutrophilia is not significant if the total WBC count is less than 25/μL

C. The first aliquot of CSF should be sent to the microbiology laboratory

D. Neutrophils compose the majority of WBCs in normal CSF

3. When collecting CSF, a difference between opening and closing fluid pressure greater
than 100 mm H2O indicates:

A. Low CSF volume B. Subarachnoid hemorrhage C. Meningitis D. Hydrocephalus

4. Which of the following findings is consistent with a subarachnoid hemorrhage rather than
a traumatic tap?

A. Clearing of the fluid as it is aspirated

B. A clear supernatant after centrifugation

C. Xanthochromia

D. Presence of a clot in the sample

5. The term used to denote a high WBC count in the CSF is:

A. Empyema B. Neutrophilia C. Pleocytosis D. Hyperglycorrhachia

6. The diagnosis of multiple sclerosis is often based upon which finding?

A. The presence of elevated protein and low glucose

B. A decreased IgG index

C. The presence of oligoclonal bands by electrophoresis

D. An increased level of CSF β macroglobulin

7. Which of the following results is consistent with fungal meningitis?

A. Normal CSF glucose

B. Pleocytosis of mixed cellularity

C. Normal CSF protein

D. High CSF lactate

8. In what suspected condition should a wet prep using a warm slide be examined?

A. Cryptococcal meningitis B. Amoebic meningoencephalitis

C. Mycobacterium tuberculosis infection D. Neurosyphilis

9. Which of the following CSF test results is most commonly increased in patients with multiple
sclerosis?

A. Glutamine B. Lactate

C. IgG index D. Ammonia

10. Which of the following is an inappropriate procedure for performing routine CSF analysis?
A. A differential is done only if the total WBC count is greater than 10/μL

B. A differential should be done on a stained CSF concentrate

C. A minimum of 30 WBCs should be differentiated

D. A Wright’s-stained slide should be examined rather than a chamber differential

11. Which cell is present in the CSF in greater numbers in newborns than in older children
or adults?

A. Eosinophils B. Lymphocytes

C. Monocytes D. Neutrophils

12. Neutrophilic pleocytosis is usually associated with all of the following except:

A. Cerebral infarction B. Malignancy

C. Myelography D. Neurosyphilis
13. Which statement about CSF protein is true?

A. An abnormal serum protein electrophoretic pattern does not affect the CSF pattern

B. The upper reference limit for CSF total protein in newborns is one-half adult levels

C. CSF IgG is increased in panencephalitis, malignancy, and neurosyphilis

D. Antibodies to Treponema pallidum disappear after successful antibiotic therapy

14. Which of the following statements regarding routine microbiological examination of CSF is
true?

A. A Gram stain is performed on the CSF prior to concentration

B. The Gram stain is positive in fewer than 40% of cases of acute bacterial meningitis

C. India ink and acid fast stains are indicated if neutrophilic pleocytosis is present

D. All CSF specimens should be cultured using sheep blood agar, chocolate agar,
and supplemented broth

15. Which organism is the most frequent cause of bacterial meningitis in neonates?

A. Neisseria meningitidis B. Group B Streptococcus

C. Streptococcus pneumonia D. Klebsiella pneumoniae

16. Following a head injury, which protein will identify the presence of CSF leakage through
the nose?

A. Transthyretin B. Myelin basic protein

C. Tau protein D. C-reactive protein

17. Which of the following statements regarding serous fluids is true?

A. The normal volume of pleural fluid is 30–50 mL

B. Mesothelial cells, PMNs, lymphocytes, and macrophages may be present in normal fluids

C. X-ray can detect a 10% increase in the volume of a serous fluid

D. Normal serous fluids are colorless

18. The term effusion refers to:

A. A chest fluid that is purulent B. A serous fluid that is chylous

C. An increased volume of serous fluid

D. An inflammatory process affecting the appearance of a serous fluid

19. Which of the following laboratory results is characteristic of a transudative fluid?

A. SG = 1.018 B. Total protein = 3.2 g/Dl

C. LD fluid/serum ratio = 0.25 D. Total protein fluid/serum ratio = 0.65

20. Which observation is least useful in distinguishing a hemorrhagic serous fluid from
a traumatic tap?

A. Clearing of fluid as it is aspirated B. Presence of xanthochromia

C. The formation of a clot D. Diminished RBC count in successive aliquots

21. Which of the following laboratory results on a serous fluid is most likely to be caused by
a traumatic tap?

A. An RBC count of 8,000/μL B. A WBC count of 6,000/μL

C. A hematocrit of 35% D. A neutrophil count of 55%

22. Which of the following conditions is commonly associated with an exudative effusion?

A. Congestive heart failure B. Malignancy C. Nephrotic syndrome D. Cirrhosis

23. Which of the following conditions is associated with a chylous effusion?

A. Necrosis B. Pulmonary infarction or infection

C. Systemic lupus erythematosus or rheumatoid arthritis

D. Lymphatic obstruction

24. Which of the following conditions is most often associated with a pleural fluid glucose
below 30 mg/dL?

A. Diabetes mellitus B. Pancreatitis C. RA D. Bacterial pneumonia

25. Which of the following statements about amniotic fluid bilirubin measured by
scanning spectrophotometry is true?

A. The 410-nm peak is due to hemoglobin and the 450-nm peak is due to bilirubin

B. Baseline correction is not required if a scanning spectrophotometer is used

C. Chloroform extraction is necessary only when meconium is present

D. In normal amniotic fluid, bilirubin increases with gestational age

26. Which test best correlates with the severity of HDN?

A. Rh antibody titer of the mother

B. Lecithin/sphingomyelin (L/S) ratio

C. Amniotic fluid bilirubin

D. Urinary estradiol

27. Which is the reference method for determining fetal lung maturity?

A. Human placental lactogen B. L/S ratio

C. Amniotic fluid bilirubin D. Urinary estriol

28. Which of the following stains is used to determine sperm viability?

A. Eosin Y B. Hematoxylin C. Papanicolaou D. Methylene blue

29. Which of the following semen analysis results is abnormal?

A. Volume 1.0 mL B. Liquefaction 40 minutes at room temperature

C. pH 7.6 D. Motility 50% progressive movement

30. Which of the following sample collection and processing conditions will lead to
inaccurate seminal fluid analysis results?

A. Sample stored at room temperature for 1 hour before testing

B. Sample collected following coitus

C. Sample collected without an anticoagulant

D. Sample collected without use of a condom

31. A pleural fluid submitted to the laboratory is milky in appearance. Which test would be most
useful in differentiating between a chylous and pseudochylous effusion?

A. Fluid to serum triglyceride ratio B. Fluid WBC count

C. Fluid total protein D. Fluid to serum LD ratio

32. A cerebrospinal fluid sample from an 8-year-old child with a fever of unknown origin was
tested for glucose, total protein, lactate, and IgG index. The glucose was 180 mg/dL but all other
results were within the reference range. The CSF WBC count was 9 × 106/L and the RBC count
was 10 × 106/L. The differential showed 50% lymphocytes, 35% monocytes, 10% macrophages,
3% neutrophils, and 2% neuroectodermal cells. What is the most likely cause of these results?

A. Aseptic meningitis B. Traumatic tap C. Subarachnoid hemorrhage D. Hyperglycemia

33. A WBC count and differential performed on ascites fluid gave a WBC count of 20,000μL
with 90% macrophages. The gross appearance of the fluid was described by the technologist as
“thick and bloody.” It was noted on the report that several clusters of these cells were observed
and that the majority of the cells contained many vacuoles resembling paper-punch holes. What
do the observations above suggest?

A. Malignant mesothelial cells were counted as macrophages

B. Adenocarcinoma from a metastatic site

C. Lymphoma infiltrating the peritoneal cavity

D. Nodular sclerosing type Hodgkin’s disease

34. Given the following data for creatinine clearance, select the most appropriate course of
action. Volume = 2.8 L/day; surface area = 1.73 m2; urine creatinine = 100 mg/dL; serum
creatinine = 1.2 mg/dL

A. Report a creatinine clearance of 162 mL/min

B. Repeat the urine creatinine; results point to a dilution error

C. Request a new 24-hour urine sample

D. Request the patient’s age and sex

Part 2: Short Answer Questions
1. Name the three basic types of examinations performed during the evaluation of body
fluids.
2. A 27-year-old man and his 25-year-old wife visited a family practitioner. They report that
they had hoped to have two children by the wife’s thirtieth birthday but had been
unsuccessful during their 2-year marriage. The physician told the couple that the first step
would be to analyze the semen of the husband, and if the tests proved to be normal, then
the couple would be referred to a fertility specialist. The couple was given instructions to
abstain from having sex for a period of time and then to collect a sample that could be
transported to a nearby hospital laboratory within a few minutes of collection. The
following results were obtained:

Total volume 3.7 mL

Liquefaction 58 min
Sample pH 7.2
Sperm count 28.2 million/mL
Morphology 78% are normal forms
Viability 77% are motile
White blood cells/ mL 0.8 × 106 /mL
Red blood cells Rare

a. What is/are the abnormality(ies) found in this semen evaluation, if any?

b. What would be the most likely solution to the problem(s) if any are present?

3. An elderly gentleman has suffered from several occurrences of respiratory infections,

including pneumonia upon at least two occasions. Since his last bout with respiratory difficulties,
he has had difficulty breathing, with a weak cough, and an accumulation of fluid in his lower
thoracic region. This accumulation has led to a condition resembling congestive heart failure. A
puncture of the thoracic wall, called a thoracentesis, is performed, and a large amount of a
pleural effusion is aspirated. The fluid is referred to the laboratory for several tests.

Gross Fluid Examination:

The fluid is not of the normal consistency of body fluids, which would normally be

viscous, as it is watery and somewhat cloudy.

Total protein 1.1 g/dL Reference value = 1.0–2.0 g/dL

Cell count WBCs = 0.421 × 109/L Reference value ≤0.50 × 109 /L
Blood values Total serum protein = 7.1 g/dL Reference range = 6.1–8.0 g/dL

Cell Differential: Predominantly lymphocytes and monocytes, few neutrophils, few RBCs.

Gram Stain: Cytofuged sample reveals no organisms; reported as a sterile culture also.

Blood cell count: 13 × 109/L.

Leukocyte differential: 71% lymphocytes and 17% neutrophils; the remainder of the cells
totaled 1% eosinophils and 11% monocytes.

Reference values: WBCs 0.15 × 109/L and more than 25% neutrophils

a. In comparing the serum protein and the value of the protein of the effusion, is this an exudates
or a transudate? Discuss the answer you provide.

b. What would be the significance of increased lymphocytes?

c. Why is another reason that this fluid not considered an exudate, even when the ratio of fluid
to serum protein that matches that for a transudate is known?