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Analysis of Urine and Other Body Fluids > Chapter 6 - Microscopic Examination of Urine > Flashcards

Chapter 6 - Microscopic Examination of Urine Flashcards

1
Q

How much urine is needed for microscopic exam

A

10-15 mL (ave: 12 mL)

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2
Q

Urine is centrifuged at ____ RCF for ____ mins

A

400 RCF; 5 mins

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3
Q

Decant urine, ____ mL remains

A

0.5 to 1.0 mL

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4
Q

Transfer _____ uL (or _____ mL) sediment to glass slide with ____ x ____ mm coverslip

A

20 uL; 0.02 mL; 22 x 22 mm

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5
Q

Examin urine microscopically ____ LPF and ____ HPF under reduced light (how many fields observed routinely)

A

10 LPF, 10 HPF

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6
Q

Quantitative measure of formed elements of urine using hemacytometer

A

Addis count

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7
Q

Spn for Addis count

A

12 hour urine

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8
Q

Urine preservative for Addis count

A

Formalin

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9
Q

Normal values for Addis count of the following:

RBCs = ?
WBCs & ECs = ?
Hyaline casts = ?

A

0-500,000/12-hr urine
0-1,800,000/12-hr urine
0-5,000/12-hr urine

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10
Q

Determine microscopic technique:

  1. For routine UA
  2. ID of Treponema pallidum
  3. Enhances visualization of translucent elements (forms halo)
  4. ID of chole in oval fat bodies, fatty casts & crystals
  5. Visualization of fluorescent microorganisms or those stained by a fluorescent dye
  6. 3-D microscopy-image & layer-by-layer imaging of a spn
  7. Differential interference-contrast microscope
  8. Modulation interference-contrast microscope
  9. Microscope that can be adapted to Nomarski or Hoffman
A
  1. Bright-field microscopy
  2. Dark-field microscopy
  3. Phase-contrast microscopy
  4. Polarizing microscopy
  5. Fluorescence microscopy
  6. Interference-contrast microscopy
  7. Nomarski
  8. Hoffman
  9. Bright-field microscopy
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11
Q

Determine sediment stain:

  1. Lyses RBCs, enhances nuclei of WBCs
  2. Identifies WBCs, epithelial cells and casts
  3. Identifies bacterial casts
  4. Stains eos granules
  5. Stains DNA
  6. Identifies hemosiderin granules
  7. Stains nuclear membranes, mitochondria & cell membranes
  8. Identifies urinary eos
  9. Enhances nuclear detail; supravital stain
  10. Stains triglycerides and neutral fats orange-red
  11. Differentiates WBCs and RTE cells
  12. Delineates structure & contrasting colors of the nucleus & cytoplasm
  13. Distinguishes RBCs from WBCs, yeast, oil droplets & crystals
  14. Diff gram pos & gram neg bacteria
  15. Crystal violet + Safranin O
  16. Eosin Y + methylene blue
  17. Stains structures containing iron
A
  1. 2% acetic acid
  2. Sternheimer-Malbin
  3. Gram stain
  4. Hansel stain
  5. Phenathridine
  6. Prussian blue
  7. Carbocyanine
  8. Hansel stain
  9. Toluidine blue
  10. Lipid stains (oil red O and sudan III)
  11. Toluidine blue
  12. Sternheimer-Malbin
  13. 2% acetic acid
  14. Gram stain
  15. Sternheimer-Malbin
  16. Hansel stain
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12
Q

Phenathridine stain color

A

Orange

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13
Q

Carbocyanine stain color

A

Green

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14
Q

Stains used by Sysmex UF-100 urine cell analyzer

A

Phenathridine & carbocyanine

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15
Q

Normal value of RBCs in urine

A

0-2 or 0-3 / HPF

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16
Q

Swollen RBCs

A. Hypertonic
B. Hypotonic

A

B

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17
Q

Shrink RBCs

A. Hypertonic
B. Hypotonic

A

A.

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18
Q

Crenated RBCs

A. Hypertonic
B. Hypotonic

A

A

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19
Q

Hemolyzed RBCs

A. Hypertonic
B. Hypotonic

A

B

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20
Q

Ghost cell

A. Hypertonic
B. Hypotonic

A

B

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21
Q

Fragmented, dysmorphic, w/ projections RBCs are seen in:

A

Glomerular membrane damage

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22
Q

Remedy for sources of errors when observing RBC under microscope

A

2% acetic acid

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23
Q

Presence of RBCs in the urine

A

Hematuria

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24
Q

Presence of WBCs in the urine

A

Pyuria or leukocyturia

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25
Q

Normal value of WBCs in urine

A

0-5 or 0-8/HPF

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26
Q

Most predominant WBC in urine

A

Neutrophil

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27
Q

In _____ urine, neutrophils swell and granules undergo Brownian movement

A. Hypertonic
B. Hypotonic

A

B.

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28
Q

Neutrophils undergoing Brownian movement with no pathologic significance is referred to as

A

Glitter cells

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29
Q

Normal value of eos in urine

A

<1%

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30
Q

Significant value for eos in urine

A

> 1%

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31
Q

Presence of eos in the urine is assoc with what disease?

A

drug-induced acute interstitial nephritis

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32
Q

Using Sternheimer-Malbin, glitter cells color _____

A

Pale blue

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33
Q

Using Sternheimer-Malbin, leukocytes color _____

A

Pale pink

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34
Q

Point of reference, sediment that serves as a basis in focusing microscope

A

Squamous epithelial cells

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35
Q

Largest cell w/ abundant, irreg cytoplasm & prominent nucleus

A

Squamous epithelial cells

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36
Q

The nucleus of squamous cell is about the size of ___

A

RBCs

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37
Q

Squamous epithelial cells come from?

A

Urethra, vaginal linings

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38
Q

Clue cells are squamous epithelial cells covered with _____

A

Gardnerella vaginalis

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39
Q

Rectangular, polyhedral, cuboidal or columnar w/ eccentric nucleus

A

Renal tubular epithelial cell

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40
Q

Spherical, polyhedral or caudate with centrally located nucleus

A

Transitional epithelial cell

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41
Q

Other names for transitional epithelial cells

A

Bladder cell, urothelial cell

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42
Q

Origin of transitional epithelial cell

A

Urinary bladder, ureter, renal pelvis, calyces, upper male urethra

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43
Q

Transitional epithelial cells are increased following _____ - may be seen singly, in pairs, or in clumps (syncytia)

A

Catheterization

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44
Q

Origin of RTE cells

A

Nephrons

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45
Q

Most clinically significant epithelial cell

A

RTE cell

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46
Q

RTE cells from the DCT may be mistaken for ____

A

WBCs

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47
Q

RTE value indicating tubular injury

A

> 2 RTE/HPF

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48
Q

Lipid containing RTE cells

A

Oval fat bodies

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49
Q

Disease associated with lipiduria (oval fat bodies)

A

Nephrotic syndrome

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50
Q

What type of fat can’t be stained using lipid stains

A

Cholesterol

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51
Q

What type of fat can be stained using lipid stains

A

TAG and neutral fats

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52
Q

What type of fat can form maltese cross under polarizing microscope?

A

Cholesterol

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53
Q

What type of fat can’t form maltese cross under polarizing microscope?

A

TAG and neutral fats

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54
Q

RTE cell with non-lipid vacuoles

A

Bubble cell

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55
Q

Sediments observed in true UTI

A

Bacteria + WBCs

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56
Q

Most common cause of UTI

A

Enterobacteriaceae (ex: E. coli)

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57
Q

Diff amorphous urates or phosphates from bacteria

A

Bacteria are motile

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58
Q

Sediments observed during true yeast infection

A

Yeast + WBCs

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59
Q

Small, refractile oval structure that may or may not bud

A

Yeast

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60
Q

Smooth, non-nucleated, biconcave disks

A

RBCs

61
Q

Increased number of this urine sediment indicate presence of infection or inflammation

A

WBCs

62
Q

Yeast seen in DM and vaginal moniliasis

A

Candida albicans

63
Q

Most frequently encountered parasite in urine

A

Trichomonas vaginalis

64
Q

Parasite considered the most common fecal contaminant

A

Enterobius vermicularis egg

65
Q

Blood fluke with terminal spine

A

Schistosoma haematobium egg

66
Q

Agent of pingpong disease

A

T. vaginalis

67
Q

How is T. vag reported?

A

Qualitative per HPF

68
Q

Pear-shaped flagellate with jerky motility

A

T. vag

69
Q

Parasite that can cause hematuria

A

S. haematobium egg

70
Q

Parasite assoc with bladder cancer

A

S. haematobium egg

71
Q

Specific urinary bladder cancer markers

A

Nuclear Matrix Protein (NMP) & Bladder Tumor Antigen (BTA)

72
Q

Urine sediment that is oval, slightly tapered head, long, flagella-like tail

A

Spermatozoa

73
Q

Thread-like structures, has low refractive index w/o clinical significance

A

Mucus threads

74
Q

Major constituent of mucus threads

A

Tamm-Horsfall protein / uromodulin

75
Q

Which sediments are not quantitated?

A

Budding yeast, mycelia elements, trichomonas, sperm

76
Q

Identify whether the following are graded per LPF or per HPF:

  1. Crystals (normal)
  2. RBCs
  3. WBCs
  4. Mucus threads
  5. Casts (normal)
  6. Bacteria
  7. Epithelial cells
  8. Oval fat bodies
  9. crystals (abnormal)
  10. Abnormal casts
  11. Transitional epithelial cells
  12. Yeast
  13. RTE cells
  14. Squamous epithelial cells
A
  1. HPF
  2. HPF
  3. HPF
  4. LPF
  5. LPF
  6. HPF
  7. LPF
  8. HPF
  9. LPF
  10. LPF
  11. HPF
  12. HPF
  13. HPF
  14. LPF
77
Q

Identify how the ff sediments are reported:

  1. Epithelial cells
  2. Normal crystals
  3. Bacteria
  4. Mucus threads
  5. Normal casts
  6. RBCs
  7. WBCs
  8. Squamous epithelial cells
  9. Transitional epithelial cells
  10. Renal tubular epithelial cells
  11. Oval fat bodies
  12. Abnormal crystals
  13. Abnormal casts
  14. Yeasts
A
  1. Rare, few, mod, many per LPF
  2. Rare, few, mod, many per HPF
  3. Rare, few, mod, many per HPF
  4. Rare, few, mod, many per LPF
  5. Numerical ranges per LPF
  6. Numerical ranges per LPF
  7. Numerical ranges per LPF
  8. Rare, few, mod, many per LPF
  9. Rare, few, mod, many per HPF
  10. Average number per 10 HPFs
  11. Average number per HPF
  12. Average number per LPF
  13. Average number per LPF
  14. Rare, few, mod, many per HPF
78
Q

Excretion of casts

A

Cylindruria

79
Q

Sediment that is unique to the kidney

A

Casts

80
Q

Casts are primarily formed in the?

A

DCT & collecting duct

81
Q

Major constituent of casts

A

Uromodulin / Tamm-Horsfall protein

82
Q

What produces uromodulin / Tamm-Horsfall protein?

A

RTE cells

83
Q

Regarding cast production, gels more readily under conditions of ____, ____, and presence of ____ and ____.

A

Urine-flow stasis, acidity; presence of Na+ and Ca+

84
Q

How would you observe casts under microscope?

A

Performed along the coverslip edges with subdued light

85
Q

Order of cast degradation

A

Hyaline cast - cellular cast - coarse granular cast - finely granular casts - waxy cast

86
Q

Prototype cast

A

Hyaline cast

87
Q

Normal value for hyaline cast

A

0-2/LPF

88
Q

Appearance of this cast indicates bleeding within the nephron

A

RBC cast

89
Q

Cast that contains hgb from lysed RBCs

A

Blood cast

90
Q

RBC cast can be easily identified by?

A

Orange-red color

91
Q

Most frequently encountered cast

A

Hyaline cast

92
Q

Physiologic causes of hyaline an RBC cast appearance in urine

A

Strenuous exercise

93
Q

Pathologic cause of the appearance of hyaline and RBC casts

A

Glomerulonephritis

94
Q

Cast that indicates inflammation or infection w/in nephron that resembles RTE cast

A

WBC cast

95
Q

WBC cast may be diff from RTE casts by?

A

Phase microscopy, supravital stain

96
Q

Clinical significance of RTE cell casts

A

Advanced tubular destruction, renal tubular damage

97
Q

Cast identified by gram stain

A

Bacterial stain

98
Q

Cells visible on the cast matrix are smaller, round and oval cells

A

RTE cell cast

99
Q

Final degenerative form of all types of casts

A

Waxy cast

100
Q

Clinical significance of waxy cast

A

Stasis of urine flow, chronic renal failure

101
Q

Fatty cast clinical significance

A

Nephrotic syndrome

Others: toxic tubular necrosis, DM, crush injuries

102
Q

Aka renal failure cast

A

Broad cast

103
Q

Cast that is brittle, highly refractile, w/ jagged ends or cracks

A

Waxy cast

104
Q

How would you diff a fatty cast containing chole from a fatty cast containing TAG/neutral fats?

A

Fatty cast w/ chole - polarizing microscope

Fatty cast w/ TAG or neutral fats - lipid stains

105
Q

What cast is described?

Hyaline matrix w/ coloration due to pigment incorporation

A

Pigmented cast

106
Q

Golden-brown pigmented cast indicates?

A

Bilirubin

107
Q

Yellow to red brown pigmented cast indicates?

A

Hgb or mgb

108
Q

Cast containing multiple cell types

A

Mixed cellular cast

109
Q

Casts containing urates, Ca Ox, and sulfonamides

A

Crystal casts

110
Q

Factors that contribute to crystal formation

A

pH, temp, solute conc

111
Q

How are crystals usually reported?

A

Rare, few, mod, many per HPF

112
Q

How are abnormal crystals reported?

A

Average number per LPF

113
Q

The first consideration when identifying crystals is?

A

Urine pH

114
Q

Identify the ff normal crystals described:

  1. Granular in appearance, white precipitate, soluble in dilute acetic acid
  2. Cigarette butt appearance, soluble in acetic acid
  3. Yellow-brown/colorless elongated prism, soluble in water and ether
  4. Yellow-brown thorny apples
  5. Seen in old spn
  6. Increased in the presence of urea-splitting bacteria
  7. Small, colorless, dumbbell or spherical shaped that forms gas (effervescence) after adding dilute acetic acid
  8. Colorless, flat plates, thin prisms in rosette form
  9. Colorless, prism-shaped or coffin lid; fern leaf
  10. Feathery appearance when they disintegrate
  11. Increased in foods rich in oxalic acid like tomato and asparagus and ascorbic acid
  12. Can be mistaken as cystine crystals
  13. Gold lemon shaped
  14. Brick dust or yellow brown granules soluble in heat and alkali
  15. Product of purine metabolism
  16. Rosettes may resemble sulfonamide crystals
  17. Increased in Lesch-Nyhan syndrome, chemotherapy and gout
  18. Increased in ethylene glycol poisoning (anti-freeze agent)
  19. Rhombic, wedge, hexagonal, 4-sided flat plate/whetstone, soluble in alkali
  20. Pink sediment due to uroerythrin
  21. Most pleomorphic
A
  1. Amorphous phosphates
  2. Calcium sulfates
  3. Hippuric acid
  4. Ammonium biurate
  5. Ammonium biurate
  6. Ammonium biurate & triple phosphate
  7. Calcium carbonate
  8. Calcium phosphate
  9. Triple phosphate
  10. Triple phosphate
  11. Calcium oxalate
  12. Uric acid
  13. Uric acid
  14. Amorphous urates
  15. Uric acid
  16. Calcium phosphate
  17. Uric acid
  18. Calcium oxalate
  19. Uric acid
  20. Amorphous urate
  21. Uric acid
115
Q

Identify whether the ff crystals can be seen in acidic or alkaline urine:

  1. Hippuric acid
  2. Calcium carbonate
  3. Uric acid
  4. Triple phosphate
  5. Calcium phosphate
  6. Calcium oxalate
  7. Calcium sulfate
  8. Ammonium biurate
  9. Amorphous urate
  10. Amorphous phosphate
A
  1. Acidic
  2. Alkaline
  3. Acidic
  4. Alkaline
  5. Alkaline
  6. Acidic
  7. Acidic
  8. Alkaline
  9. Acidic
  10. Alkaline
116
Q

Weddellite

What form of Ca Ox?
What shape?

A

Dihydrate form

Envelope / pyramidal

117
Q

Whewellite

What form of Ca Ox?
What shape?

A

Monohydrate form

Dumbbell / oval

118
Q

Crystal that appears in an acidic urine but soluble in acetic acid

A

Calcium sulfate

119
Q

Crystal that is soluble in water & ether

A

Hippuric acid

120
Q

Identify the following abnormal urinary crystals:

  1. Resembles sofa pillow
  2. Fine colorless to yellow needles in clumps or rosettes
  3. Rectangular plate w/ notch in 1 or more corners (staircase pattern)
  4. Soluble in 10% NaOH (Chole or radio dye)
  5. Soluble in chloroform (Chole or radio dye)
  6. Clumped granules or needles w/ bright yellow color
  7. Needles, sheaves of wheat, rosettes, arrowheads, petals or round
  8. Colorless needles, that tend to form bundles following refrigeration
  9. Mistaken as calcium phosphate crystals
  10. Precipitated with tyrosine after adding alcohol
  11. Crystals increased in liver disease
  12. Crystal increased in nephrotic syndrome
  13. yellow-brown spheres w/ concentric circles & radial striations
  14. Lignin test positive & diazo rxn positive
  15. Soluble in acetone
  16. Colorless hexagonal plates
  17. Increased in cystinuria and cystinosis
A
  1. Leucine
  2. Tyrosine
  3. Cholesterol and radiographic dye
  4. Radiographic dye
  5. Cholesterol
  6. Bilirubin
  7. Sulfonamide
  8. Ampicillin
  9. Sulfonamide
  10. Leucine
  11. Bilirubin, Leucine, Tyrosine
  12. Cholesterol
  13. Leucine
  14. Sulfonamide
  15. Sulfonamide
  16. Cystine
  17. Cystine
121
Q

Other names of triple phosphate

A

Struvite, Magnesium ammonium phosphate

122
Q

Other name for calcium phosphate

A

Apatite

123
Q

How would you diff cystine from uric acid crystals in terms of color?

A

UA: yellow-brown
Cystine: colorless

124
Q

How would you diff cystine from uric acid crystals in terms of solubility in HCl?

A

UA: insoluble
Cystine: soluble

125
Q

How would you diff cystine from uric acid crystals in terms of birefringence?

A

UA: birefringent
Cystine: not birefringent

126
Q

How would you diff cystine from uric acid crystals in terms of solubility in ammonia?

A

You cannot. Both are soluble in ammonia

127
Q

How would you diff cystine from uric acid crystals in terms of cyanide-nitroprusside rxn?

A

UA: neg
Cystine: pos

128
Q

How would you diff cholesterol from radiographic dye crystals?

A

Check px history, correlate w/ other UA results like SG (>1.040 for radio dye)

Others: chole is soluble to ether, radio dye is soluble to 10% NaOH

129
Q

How would you diff sulfonamides from calcium phosphates?

A

CP: soluble in acetic acid
Sulfo: positive lignin test & positive diazo rxn

130
Q

Spheres w/ dimpled center

A

Starch granules

131
Q

Name 4 sediments that form maltese cross

A

Oval fat bodies (contains chole)
Fatty casts (contains chole)
Fat droplets (contains chole)
Starch granules

132
Q

What does the term chemical sieving mean?

A

Macroscopic screening / microscopic exam

133
Q

What does RCF stand for?

A

Relative centrifugal force

134
Q

Formula for RCF

A

10^-5 x radius (in cm) x RPM^2

135
Q

The most frequently used stain in UA

A

Sternheimer-Malbin stain

136
Q

The recommended spn for cytodiagnostic urine testing

A

First morning

137
Q

The ______ system is located in the objective & is adjusted to be near the spn

A

First lens

138
Q

The _____ system, the ocular lens, is located in the eyepiece

A

Second lens

139
Q

The ability of the lens to distinguish 2 small objects that are a specific distance apart

A

Resolution

140
Q

Most microscopes are designed to be ____, indicating that they require only minimum adjustment when switching among objectives

A

Parfocal

141
Q

If any optical surface of the microscope becomes coated with dust, it should be carefully removed with a?

A

Camel-hair brush

142
Q

Optical surfaces of microscope should be cleaned with?

A

Lens paper

143
Q

The ability of an element to refract light in 2 dimensions at 90 deg to each other

A

Birefringence

144
Q

What type of microscope can be adapted for polarizing microscopy?

A

Bright-field

145
Q

______ microscope is easily adapted for dark-field microscopy by replacing the condenser w/ dark-field condenser that contain opaque disk

A

Bright-field

146
Q

Of all the urine sediment elements, ____ are the most difficult for students to recognize

A

RBCs

147
Q

Dysmorphic RBCs most closely assoc w/ _____ (what dse) appear to be acanthocytes

A

Glomerular bleeding

148
Q

Other forms of calcium phosphate include ____ (basic calcium phosphate) & ____ (calcium hydrogen phosphate)

A

Hydroxyapatite

Brushite

Analysis of Urine and Other Body Fluids (18 decks)

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