CH. 6 - Microscopic Examination of Urine (Lecture)

Question 1

Increases overall visibility of sediment elements being examined using bright field microscopy by changing their refractive index.

Answer 1

Staining

Question 2

The most frequently used stain in urinalysis; consists of crystal violet and safranin O

Answer 2

Sternheimer-Malbin

aka. Sedi-stain (Becton-Dickinson, Parsipanny, N.J.)
aka. KOVA stain (Hycor Biomedical, Inc, Garden Grove, Calif.)

Question 3

A metachromatic stain that provides enhancement of nuclear detail

Answer 3

0.5% solution of toluidine blue

Question 4

A stain that differentiates WBCs and Renal tubular epithelial (RTE) cells

Answer 4

Toluidine blue

Question 5

A stain that delineates structure and contrasting colors of the nucleus and cytoplasm

Answer 5

Sternheimer-Malbin

Question 6

A stain that identifies WBCs, epithelial cells, and casts

Answer 6

Sternheimer-Malbin

Question 7

A stain that lyses RBCs and enhances nuclei of WBCs

Answer 7

2% acetic acid

Question 8

A stain that distinguishes RBCs from WBCs, yeast, oil, droplets, and crystals

Answer 8

2% acetic acid

Question 9

Stains triglycerides and neutral fats orange-red;

identifies free fat droplets and lipid-containing cells and casts

Answer 9

Lipid stains: Oil Red O and Sudan III

Question 10

Differentiates gram+ and gram- bacteria; identifies bacterial casts

Answer 10

Gram stain

Question 11

The preferred stain for urinary eosinophils

Answer 11

Hansel stain

Question 12

Consists of methylene blue and eosin Y (stains eosinophilic granules)

Answer 12

Hansel stain

Question 13

Stains hemosiderin granules a blue color

Answer 13

Prussian blue

Question 14

Stains structures containing iron; identifies yellow-brown granules of hemosiderin in cells and casts

Answer 14

Prussian blue

Question 15

Type of microscopy used when using lipid stains

Answer 15

Polarizing microscopy

Question 16

Type of microscopy wherein objects appear dark against a clear background; most frequently used in the clinical laboratory

Answer 16

Bright-Field microscopy

Question 17

The use of _____ aids in the identification of crystals and lipids. Both substances have the ability to rotate the path of the unidirectional polarized light beam to produce characteristic colors in crystals and Maltese cross formation in lipids.

Answer 17

Polarized light

Question 18

A property indicating that the element can refract light in two dimensions at 90 degrees to each other

Answer 18

Birefringement

Question 19

Type of microscopy that provides a three dimensional image showing very fine structural detail by splitting the light ray so that the beams pass through different areas of the specimen.

Answer 19

Interference contrast microscopy

Question 20

Type of microscopy wherein an object appears bright against a dark background but without the diffraction halo associated with phase-contrast microscopy.

Answer 20

Interference contrast microscopy

Question 21

A technique used in the clinical laboratory to enhance the visualization of specimens that cannot be seen easily viewed with a bright-field microscope.

Answer 21

Dark-field microscopy

Question 22

Type of microscopy used for unstained specimens, and, in particular, to identify the spirochete Treponema pallidum

Answer 22

Dark-field microscopy

Question 23

Used to detect bacteria and viruses within cells and tissues through a technique called immunofluorescence

Answer 23

Fluorescence microsopy

Question 24

In the urine, these aapear as smooth, non-nucleated, biconcave disks measuring approximately 7mm in diameter; must be identified using HPO

Answer 24

RBCs

Question 25

RBCs that vary with size, have cellular protrusions, or are fragmented are termed _____. Associated primarily with glomerular bleeding.

Answer 25

Dysmorphic

Question 26

In concentrated (Hypersthenuric) urine, cells shrink due to loss of water and may appear _____ or irregularly shaped

Answer 26

Crenated

Question 27

In dilute (Hyposthenuric) urine, the cells absorb water, swell. and lyse rapidly, releasing their hemoglobin and leaving only the cell membrane. These large empty cells are called

Answer 27

Ghost cells

Question 28

The presence of RBC in the urine is associated with damage to the _____.

Answer 28

Glomerular membrane or vascular injury with the genitourinary tract

Question 29

When macroscopic hematuria is present, what is the appearance of urine?

Answer 29

Urine appears cloudy with a red to brown color

Question 30

Macroscopic hematuria is frequently associated with what diseases?

Answer 30

Advanced glomerular damage Damage to vascular integrity of the urinary tract caused by trauma, acute inflammation or inflammation, and coagulation dsorders.

Question 31

RBC and these casts may appear after strenuous exercise and are nonpathologic and disappear after rest.

Answer 31

RBC casts Hyaline casts Granular casts

Question 32

What is the predominant WBC found in the urine sediment?

Answer 32

Neutrophil

Question 33

Neutrophils are identified using what type of objective?

Answer 33

High power objective

Question 34

How are neutrophils reported?

Answer 34

Average number seen per 10 hpfs

Question 35

Neutrophils lyse rapidly in (alkaline/acidic) urine and begin to lose nuclear detail.

Answer 35

Alkaline

Question 36

Brownian movement of the granules within the neutrophils exposed to hypotonic urine produce a sparkling appearance, these are referred to as _____.

Answer 36

Glitter cells

Question 37

Neutrophils, when stained with Sternheimer-Malbin, will produce the color _____; on the other hand, neutrophils that were exposed to hypotonic urine will produce the color _____.

Answer 37

Violet; Light blue

Question 38

The presence of this urine sediment is primarily associated with drug-induced interstitial nephritis; small numbers may be seen in UTI and renal transplant rejection.

Answer 38

Eopsinophils

Question 39

What is the preferred eosinophil stain?

Answer 39

Hansel stain; Wright's stain can also be used

Question 40

The finding of more than .1% of eosinophils is considered significant. (T/F)

Answer 40

False (1%)

Question 41

These are the smallest WBCs; may resemble RBCs. | They may be seen in the early stages of renal transplant rejection

Answer 41

Lymphocytes

Question 42

What is the primary concern in the identification of WBCs?

Answer 42

Differentiation of mononuclear cells | Disintegrating neutrophils from renal tubular epithelial (RTE) cells.

Question 43

What type of stain can be used to enhance the nuclear detail of WBCs?

Answer 43

Supravital staining | Addition of acetic acid

Question 44

Usually fewer than 5 leukocytes per hpf are found in normal urine; however, higher numbers may be present in urine from (females/males).

Answer 44

Females

Question 45

This type of WBC are capable of ameboid migration through the tissues to site of infection or inflammation.

Answer 45

Leukocytes

Question 46

Term used to describe increase in urinary WBC.

Answer 46

Pyuria

Question 47

Pyuria indicates the presence of an infection or inflammation in what body system?

Answer 47

Genitourinary

Question 48

Enumerate some frequent bacterial infections that causes of pyuria.

Answer 48

Pyelonephritis Cytitis Prostatitis Urethritis.

Question 49

Enumerate some frequent nonbacterial infections that causes of pyuria.

Answer 49

Glomerulonephritis Lupus erythematosus Interstitial nephritis Tumors

Question 50

Unless present in large numbers or in abnirmal forms, these represent normal sloughing of old cells; these are not unusual to find in the urine because they are derived from the linings of the genitournary system.

Answer 50

Epithelial cells

Question 51

What are the three types of epithelial cells seen in urine?

Answer 51

Squamous Transitional (Urothelial) Renal tubular

Question 52

Largest epithelial cells found in the urine sediment. | They contain abundant, irregular cytoplasm and a prominent nucleus about the size of the RBC.

Answer 52

Squamous Epithelial cells

Question 53

These are the first structures observed when the sediment is examined in under low-power magnification.

Answer 53

Squamous Epithelial cells

Question 54

How is the presence of Squamous cells reported?

Answer 54

Rare, few, moderate, or many | Reported in terms of LPO or HPO

Question 55

These epithelial cells originate from the lining of the vagina and female urethra and the lower portion of the male urethra.

Answer 55

Squamous Epithelial cells

Question 56

These epithelial cells have no pathologic significance

Answer 56

Squamous Epithelial cells

Question 57

To lessen the number of squamous cells present in the specimen, what type of urine sample must be collected?

Answer 57

Midstream clean-catch

Question 58

This is a variation of squamous epithelial cells that are indicative of vaginal infection by the bacterium Gardnerella vaginalis.

Answer 58

Clue cells

Question 59

These epithelial cells appear as squamous cells that are mostly covered with Gardnerella coccobacillus extending beyond the cell. Has a granular, irregular appearance.

Answer 59

Clue cells

Question 60

What is the routine test for clue cells?

Answer 60

Vaginal wet preparation

Question 61

This type of epithelial cells are smaller than squamous cells and appear in several forms including spherical, polyhedral, and caudate.

Answer 61

Transitional (Urothelial) Epithelial cells

Question 62

What causes the different forms of the Transitional (Urothelial) Epithelial cells?

Answer 62

Their ability to absorb large amounts of water