🧪 Clinical Microscopy (Urinalysis and Body Fluids) Review for the MedTech Board Exam

What the Urinalysis & Body Fluids course covers

1. Unit 1: The Kidney & Urine Formation

   Renal anatomy, how the nephron makes urine, clearance tests and the hormones the kidney controls.

   Kidney & nephron · Making urine & clearance · Renal hormones

2. Unit 2: Specimens & Quality

   Urine specimen types, preservation, what changes on standing, quality control and chain of custody.

   Specimen types · Handling & changes on standing · Quality control & drug testing

3. Unit 3: Physical Examination

   Color, clarity, odor, volume, specific gravity and osmolality.

   Color & clarity · Odor & volume · Specific gravity & osmolality

4. Unit 4: Chemical Exam: pH to Blood

   Reagent strip technique, pH, protein, glucose, ketones and blood.

   Reagent strips & pH · Protein · Glucose & ketones · Blood: hematuria, hemoglobin & myoglobin

5. Unit 5: Chemical Exam: Bile Pigments to Confirmatory Tests

   Bilirubin, urobilinogen, nitrite, leukocyte esterase, and tablet and precipitation confirmatory tests.

   Bilirubin & urobilinogen · Nitrite & leukocyte esterase · Confirmatory tests

6. Unit 6: Microscopy: Cells & Casts

   Preparing and examining sediment, RBCs, WBCs, epithelial cells and urinary casts.

   Preparing & viewing sediment · Red & white blood cells · Epithelial cells · Casts

7. Unit 7: Microscopy: Crystals & More

   Normal and abnormal crystals, organisms, artifacts and automated urinalysis.

   Normal crystals · Abnormal crystals · Organisms, artifacts & other elements · Automated urinalysis

8. Unit 8: Metabolic Disorders in Urine

   Amino acid disorders, tryptophan and sulfur amino acid disorders, and the porphyrias.

   Phenylalanine & tyrosine disorders · Other metabolic tests & porphyrias

9. Unit 9: Renal Diseases

   Glomerular disorders, tubular and interstitial disease, infections, renal failure and stones.

   Glomerular diseases · Tubular disease & infections · Renal failure & stones

10. Unit 10: Cerebrospinal Fluid

    CSF formation and collection, appearance, chemistry, cell counts and meningitis patterns.

    CSF collection & appearance · CSF chemistry, cells & meningitis

11. Unit 11: Serous, Synovial & Seminal Fluids

    Pleural, peritoneal and pericardial effusions, joint fluid and crystals, and semen analysis.

    Serous fluids · Synovial fluid · Semen analysis

12. Unit 12: Pregnancy, Gastric & Fecal Tests

    hCG pregnancy testing, gastric acid analysis, stool examination and amniotic fluid.

    Pregnancy testing (hCG) · Gastric fluid · Fecal analysis · Amniotic fluid

Sample Urinalysis & Body Fluids board exam questions

A few practice questions from the course, with explanations. Thousands more are in the app.

1. 1. A 24-hour urine has 1,440 mL total volume and creatinine 100 mg/dL; serum creatinine is 1.0 mg/dL. The uncorrected creatinine clearance is:

   1. 100 mL/min
   2. 69 mL/min
   3. 144 mL/min
   4. 1,440 mL/min
   Show answer

   Answer: A. 100 mL/min

   First turn the 24-hour volume into a flow rate: 1,440 mL ÷ 1,440 min = 1.0 mL/min. Then clearance = (urine creatinine × flow) ÷ serum creatinine = (100 × 1.0) ÷ 1.0 = 100 mL/min.

2. 2. A urine sat on the counter for 5 hours. Which set of changes would you expect?

   1. Higher pH, more bacteria, less glucose, fewer casts
   2. Lower pH, fewer bacteria, more glucose
   3. No changes
   4. More bilirubin and urobilinogen
   Show answer

   Answer: A. Higher pH, more bacteria, less glucose, fewer casts

   At room temperature bacteria multiply, split urea into ammonia (raising pH) and use up glucose. In alkaline, dilute urine, cells and casts break down. Bilirubin and urobilinogen are also lost by light and oxidation.

3. 3. A urine has a refractometer SG of 1.045, a strip SG of 1.015, and flat plate crystals. The patient had an imaging study today. The best action is:

   1. Diagnose cystinuria
   2. Repeat with a urinometer
   3. Report the strip SG and note likely contrast dye
   4. Report 1.045 as true dehydration
   Show answer

   Answer: C. Report the strip SG and note likely contrast dye

   Radiographic contrast dye is a large molecule that raises the refractive index, giving SG above 1.040, and can form flat crystals. The strip SG measures ionic concentration and isn’t affected, so it reflects true concentrating ability.

4. 4. Blood pad large, no RBCs on microscopy, clear red urine, plasma clear, serum CK 40,000 U/L. The pigment is most likely:

   1. Myoglobin
   2. Porphyrin
   3. Hemoglobin
   4. Beet pigment
   Show answer

   Answer: A. Myoglobin

   Both hemoglobin and myoglobin make the blood pad positive with no RBCs in the sediment. Free hemoglobin would turn plasma pink, but myoglobin is cleared fast, so plasma stays clear. A very high CK confirms muscle breakdown.

5. 5. Urine bilirubin positive, urobilinogen 0.1 EU (decreased), dark urine and pale stools. The pattern indicates:

   1. Gilbert syndrome
   2. Hemolytic jaundice
   3. Hepatitis
   4. Posthepatic (obstructive) jaundice
   Show answer

   Answer: D. Posthepatic (obstructive) jaundice

   With blocked bile ducts, conjugated bilirubin backs up into blood and spills into urine (dark urine). Little bilirubin reaches the gut, so urobilinogen falls and stools turn pale (clay-colored).

6. 6. A child has cola-colored urine 2 weeks after a sore throat; sediment shows RBC casts and dysmorphic RBCs. The likely diagnosis and supportive test:

   1. Nephrotic syndrome — serum lipids
   2. Post-streptococcal glomerulonephritis — ASO/anti-DNase B
   3. Pyelonephritis — urine culture
   4. Kidney stone — X-ray
   Show answer

   Answer: B. Post-streptococcal glomerulonephritis — ASO/anti-DNase B

   RBC casts and dysmorphic RBCs show glomerular bleeding. Two weeks after a strep throat, immune complexes cause post-streptococcal glomerulonephritis. Raised ASO or anti-DNase B confirms recent strep infection.

7. 7. A patient who drank antifreeze has metabolic acidosis; urine shows many oval/dumbbell crystals. They are:

   1. Cystine
   2. Triple phosphate
   3. Calcium oxalate monohydrate
   4. Uric acid
   Show answer

   Answer: C. Calcium oxalate monohydrate

   Ethylene glycol in antifreeze is metabolized to glycolic acid (causing acidosis) and oxalic acid. Oxalate binds calcium, forming oval, dumbbell or picket-fence calcium oxalate monohydrate crystals.

8. 8. A 2-week-old has a mousy odor and developmental delay begins later if untreated. The best confirmatory test is:

   1. Urine Clinitest
   2. Urine DNPH
   3. Plasma phenylalanine (and Phe/Tyr ratio)
   4. Watson–Schwartz test
   Show answer

   Answer: C. Plasma phenylalanine (and Phe/Tyr ratio)

   PKU is caused by phenylalanine hydroxylase deficiency, so phenylalanine builds up. Newborn screening and plasma phenylalanine with a high Phe/Tyr ratio confirm it. Urine tests turn positive only later and are not reliable.

Practice more Urinalysis & Body Fluids questions

How you review in MedTech Reviewer

• Learning path: short lessons, each followed by questions, with a checkpoint at the end of every unit.
• Spaced repetition: questions you miss come back sooner, so key facts stick for exam day.
• Flashcards and timed quizzes in exam style, with an explanation for every answer.
• Board-readiness score per subject, so you know where to focus.
• Arcade games, PvP battles and Guilds to keep reviewing fun with classmates.

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