Interpretation of urinalysis and laboratory data for patient monitoring MCQs With Answer

Interpretation of urinalysis and laboratory data for patient monitoring MCQs With Answer

Urinalysis and laboratory data interpretation are essential skills for B.Pharm students involved in patient monitoring and pharmacotherapy. This concise guide emphasizes interpretation of urinalysis parameters—color, clarity, specific gravity, pH, protein, glucose, ketones, blood, nitrite, leukocyte esterase—along with microscopic findings (RBCs, WBCs, casts, crystals). It links these results to renal function tests, electrolytes, serum creatinine, BUN, eGFR, urine osmolality, and drug-induced renal toxicity. Practical aspects include sample collection, dipstick limitations, timing, and quantitative assays like urine protein/creatinine ratio. Mastery of these topics helps in detecting renal dysfunction, monitoring therapy, and advising clinicians on drug dosing and adverse effects. Now let’s test your knowledge with 30 MCQs on this topic.

Q1. Which dipstick parameter is most sensitive for detecting bacteriuria caused by gram-negative organisms that reduce nitrate to nitrite?

• Nitrite
• Leukocyte esterase
• Protein
• Specific gravity

Correct Answer: Nitrite

Q2. A markedly low urine specific gravity (≈1.001) with hyponatremia most likely indicates which condition?

• Dehydration
• Syndrome of inappropriate ADH secretion (SIADH)
• Prerenal azotemia
• Diabetes mellitus

Correct Answer: Syndrome of inappropriate ADH secretion (SIADH)

Q3. Presence of fatty casts on urine microscopy is classically associated with:

• Acute tubular necrosis
• Nephrotic syndrome
• Urinary tract infection
• Interstitial nephritis

Correct Answer: Nephrotic syndrome

Q4. A positive blood on dipstick but no RBCs on microscopy suggests which of the following?

• Sample contamination with menstrual blood
• Hemoglobinuria or myoglobinuria
• Glomerulonephritis with occult RBCs
• Improper dipstick storage

Correct Answer: Hemoglobinuria or myoglobinuria

Q5. Which laboratory value best estimates glomerular filtration rate (GFR) for drug dosing adjustments?

• Serum BUN alone
• Serum creatinine clearance (measured 24‑hour)
• eGFR calculated from serum creatinine
• Urine specific gravity

Correct Answer: eGFR calculated from serum creatinine

Q6. A positive leukocyte esterase on dipstick primarily indicates:

• Proteinuria
• Presence of white blood cells in urine
• Glucose in urine
• High urine osmolality

Correct Answer: Presence of white blood cells in urine

Q7. Which of the following best explains a false-negative glucose result on a dipstick in a diabetic patient?

• High urine pH
• Use of non–glucose-specific dipstick oxidase methods
• Presence of ketones
• Recent protein intake

Correct Answer: Use of non–glucose-specific dipstick oxidase methods

Q8. The urine protein-to-creatinine ratio (uPCR) on a spot urine sample is most useful for:

• Detecting bacteriuria
• Quantifying proteinuria without 24‑hour collection
• Measuring urine osmolality
• Estimating serum albumin

Correct Answer: Quantifying proteinuria without 24‑hour collection

Q9. Which crystal type is most commonly associated with acidic urine and uric acid stones?

• Calcium oxalate
• Struvite
• Uric acid
• Cystine

Correct Answer: Uric acid

Q10. An elevated fractional excretion of sodium (FeNa >2%) suggests which mechanism of acute kidney injury?

• Prerenal hypovolemia
• Intrinsic renal (acute tubular necrosis)
• Postrenal obstruction
• Hemodynamic hyperperfusion

Correct Answer: Intrinsic renal (acute tubular necrosis)

Q11. Which medication is known to cause a false-positive protein on urine dipstick due to tetracycline interference?

• Ibuprofen
• Tetracycline itself
• Vitamin C
• Amoxicillin

Correct Answer: Tetracycline itself

Q12. A high urine osmolality with high urine sodium in a patient receiving loop diuretics most likely indicates:

• Accurate assessment of renal concentrating ability
• Diuretic effect causing natriuresis and concentrated urine
• SIADH despite diuretics
• Laboratory error in osmolality measurement

Correct Answer: Diuretic effect causing natriuresis and concentrated urine

Q13. Which urine sediment finding is most specific for glomerulonephritis?

• Hyaline casts
• RBC casts
• Fatty casts
• Calcium oxalate crystals

Correct Answer: RBC casts

Q14. In neonatal patient monitoring, which urinalysis result requires immediate attention due to risk of kidney injury from drugs?

• Mild glycosuria
• Marked oliguria and rising serum creatinine
• Low specific gravity (1.002) with normal creatinine
• Trace protein on dipstick

Correct Answer: Marked oliguria and rising serum creatinine

Q15. Which laboratory marker increases earliest in acute kidney injury and is used for short-term monitoring?

• Serum creatinine
• Urine protein
• Serum cystatin C
• Urine RBC count

Correct Answer: Serum cystatin C

Q16. For which condition would urinalysis most likely show positive bilirubin and dark yellow/brown urine?

• Hematuria from urolithiasis
• Obstructive jaundice with conjugated hyperbilirubinemia
• Nephrotic syndrome
• Urinary tract infection

Correct Answer: Obstructive jaundice with conjugated hyperbilirubinemia

Q17. Which pre-analytical factor most commonly causes false-positive leukocyte esterase on dipstick?

• Contaminated collection from vaginal secretions
• Prolonged refrigeration of sample
• High urine specific gravity
• Recent antibiotic use

Correct Answer: Contaminated collection from vaginal secretions

Q18. A diabetic patient has large ketones in urine. This finding primarily indicates:

• Poor glycemic control with fat breakdown (ketosis)
• Renal tubular acidosis
• Urinary tract infection
• False-positive due to vitamin C

Correct Answer: Poor glycemic control with fat breakdown (ketosis)

Q19. Which of the following urine findings suggests myoglobinuria rather than hematuria?

• Positive blood on dipstick and numerous RBCs on microscopy
• Positive blood on dipstick with no RBCs and elevated CK
• Positive nitrite and leukocyte esterase
• High urine specific gravity with crystals

Correct Answer: Positive blood on dipstick with no RBCs and elevated CK

Q20. Which laboratory pattern is typical of prerenal azotemia?

• High BUN:creatinine ratio (>20:1), low urine sodium
• Low BUN:creatinine ratio (<10:1), high urine sodium
• Proteinuria >3.5 g/day
• Positive RBC casts

Correct Answer: High BUN:creatinine ratio (>20:1), low urine sodium

Q21. Which urine dipstick component does NOT detect Bence Jones proteins (light chains) reliably?

• Protein pad (albumin‑sensitive)
• Sulfosalicylic acid test
• Immunofixation electrophoresis
• Urine protein electrophoresis

Correct Answer: Protein pad (albumin‑sensitive)

Q22. A patient on ACE inhibitors shows rising serum creatinine by 30% after initiation. The appropriate pharmacist action is:

• Immediately discontinue ACE inhibitor permanently
• Recognize expected hemodynamic effect and assess volume status and renal artery stenosis risk
• Ignore the change if urine dipstick is negative for protein
• Double ACE inhibitor dose to overcome rise

Correct Answer: Recognize expected hemodynamic effect and assess volume status and renal artery stenosis risk

Q23. Which test is most appropriate to confirm orthostatic proteinuria in an adolescent?

• Random urine protein dipstick only
• First‑morning urine protein-to-creatinine ratio
• Serum albumin concentration
• 24‑hour urine creatinine clearance

Correct Answer: First‑morning urine protein-to-creatinine ratio

Q24. In a patient with suspected tubular dysfunction from aminoglycosides, which urine finding is most indicative?

• Heavy albuminuria (>3.5 g/day)
• Glycosuria with normal serum glucose and renal tubular proteinuria
• Positive nitrite
• Uric acid crystals

Correct Answer: Glycosuria with normal serum glucose and renal tubular proteinuria

Q25. Which change in urinalysis would you expect with uncontrolled diabetes mellitus?

• Negative glucose, positive ketones
• Glucosuria and ketonuria with low specific gravity
• Urobilinogen absent
• High leukocyte esterase without nitrite

Correct Answer: Glucosuria and ketonuria with low specific gravity

Q26. Which laboratory feature distinguishes intravascular hemolysis from hematuria when dipstick is positive for blood?

• Presence of RBCs on microscopy confirms hemolysis
• Elevated plasma free hemoglobin and negative RBCs in urine
• Positive nitrite test
• Low urine specific gravity

Correct Answer: Elevated plasma free hemoglobin and negative RBCs in urine

Q27. Which urine cast type can be seen transiently after strenuous exercise and is usually benign?

• RBC casts
• Granular casts
• Hyaline casts
• Waxy casts

Correct Answer: Hyaline casts

Q28. For monitoring an aminoglycoside antibiotic, which lab parameter is most critical to prevent toxicity?

• Urine nitrite
• Serum trough concentration and serum creatinine
• Urine ketone level
• Serum albumin only

Correct Answer: Serum trough concentration and serum creatinine

Q29. A urine sample left at room temperature for several hours may show which artifactual change?

• Decreased nitrite levels due to bacterial overgrowth
• False elevation of leukocyte esterase due to cell lysis
• False decrease in urobilinogen due to oxidation
• All of the above

Correct Answer: All of the above

Q30. A patient presents with cola‑colored urine, edema, and recent sore throat. Urinalysis shows RBC casts and proteinuria. The most likely diagnosis is:

• Nephritic syndrome due to poststreptococcal glomerulonephritis
• Nephrotic syndrome from minimal change disease
• Acute tubular necrosis
• Urinary tract infection

Correct Answer: Nephritic syndrome due to poststreptococcal glomerulonephritis

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