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MTLE > Clinical Microscopy > Flashcards

Clinical Microscopy Flashcards

1
Q

major organic component of urine

A

urea

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2
Q

major inorganic component of urine

A

chloride (sodium comes second)

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3
Q

organic substances in urine

A

urea
creatinine
uric acid
glucose
proteins
hormones
vitamins
metabolized medications

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4
Q

inorganic substances in urine

A

chloride
sodium
potassium
sulfate
phosphate
ammonium
calcium
magnesium

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5
Q

muscular tube that connects the pelvis of the kidney to the bladder

A

ureter

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6
Q

cavity area that is an expansion of the ureter
functions to collect urine from the calyces for transport from the kidney to the ureter

A

renal pelvis

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7
Q

_____ supplies blood to the renal artery, which in turn provides blood to the kidneys and the renal vein which functions to return the blood to the _____

A

abdominal aorta
inferior vena cava

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8
Q

functional unit of the kidney
responsible for urine formation
comprised of a renal corpuscle and a tubular system

A

nephron

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9
Q

renal corpuscles consisting of the ___ and ____

A

glomerulus
Bowman’s capsule

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10
Q

tubular system

A

proximal convoluted tubule
loop of Henle
distal convoluted tubule
collecting duct

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11
Q

____ is a tuft of capillaries that lie in a tubular depression called ____

A

glomerulus
Bowman’s capsule

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12
Q

main function of glomerulus

A

filter the blood

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13
Q

carries blood into the glomerulus

A

afferent arteriole

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14
Q

carries blood away the glomerulus

A

efferent arteriole

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15
Q

proximal convoluted tubule is located in the ____

A

cortex

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16
Q

loop of Henle beings in the cortex with the ____ of the loop extending into the medulla where the bend of the loop that then becomes the ___ which ends in the cortex

A

descending limb
ascending limb

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17
Q

distal convoluted tubule is located in the ____, and join together to direct the urine flow into the ___

A

cortex
collecting duct

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18
Q

collecting duct joins with other collecting ducts forming a _____ to carry urine into a ___ of the renal pelvis

A

papillary duct
calyx

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19
Q

in order to form the excrete urine, three processes function together

A

glomerular filtration
tubular reabsorption
tubular secretion

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20
Q

glomerulus functions as a ___ to make an ultrafiltrate of plasma that is protein free

A

semipermeable membrane

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21
Q

GFR is about ____ of filtrate formed per minute by the glomeruli
renal tubules will reabsorb all but __ of the filtrate, which will be passed in the urine

A

115-125 mL
1mL

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22
Q

process by which filtered water, ions, and molecules leave the tubules for return to the blood via the peritubular capillaries

A

reabsorption

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23
Q

process by which a substance from the blood is transported across the wall of the tubule into the filtrate

A

secretion

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24
Q

responsibility for most of the reabsorption and secretion that occurs in the tubules

A

proximal convoluted tubule

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25
Q

limitation as to how much solute can be reabsorbed

A

renal threshold

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26
Q

renal threshold for glucose

A

160-180mg/dL

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27
Q

descending limb of loop of Henle reabsorbs ____
ascending limb of loop of Henle reabsorbs ___ and ___

A

water
sodium
chloride

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28
Q

DCT reabsorbs ___

A

sodium

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29
Q

controls the reabsorption of water in DCT

A

anti-diuretic hormone

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30
Q

in DCT, secretion of __ and ___ occurs

A

hydrogen ions
potassium

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31
Q

controls the reabsorption of sodium and water and secretion of K and H into the filtrate in DCT

A

aldosterone

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32
Q

final site for water reabsorption, to make urine more diluted or concentrated

A

collecting duct

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33
Q

controls the sodium and chloride reabsorption in collecting duct

A

aldosterone

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34
Q

in collecting duct, water reabsorption occurs by osmosis as well as in response to ___

A

ADH

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35
Q

secreted by the juxtaglomerular apparatus of the kidneys and catalyzes the conversion of angiotensinogen to angiotensin I

A

renin

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36
Q

stimulates the production of angiotensin II
a hormone in the inactive form

A

angiotensin I

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37
Q

regulates renal blood by constriction of renal arterioles and secretion of aldosterone from the adrenal glands to facilitate retention of sodium

A

angiotensin II

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38
Q

made in the cortex of the adrenal glands
acts on the kidneys by promoting the reabsorption of sodium from the filtrate into the blood and the secretion of potassium from the blood into the filtrate
water will be reabsorbed along with sodium

A

aldosterone

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39
Q

secreted by the posterior pituitary gland, promotes water reabsorption from the filtrate into the blood
primarily affects the reabsorption of water from the distal convoluted tubule and the collecting ducts

A

anti-diuretic hormone

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40
Q

promotes calcium reabsorption from the filtrate into the blood and excretion of phosphate ions from the blood into the filtrate

A

parathyroid hormone

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41
Q

alpha-globulin produced by the peritubular fibroblasts in the kidneys to stimulate red blood cell production in response to lowered oxygen levels

A

erythropoietin

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42
Q

inflammation of the glomerulus seen in children and young adults
can follow a group A streptococcus respiratory infection, characterized by hematuria, proteinuria, WBCs and casts (RBC, granular, hyaline)

A

acute glomerulonephritis

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43
Q

a more serious condition than acute glomerulonephritis that may result in renal failure; urinalysis results would be similar to acute glomerulonephritis

A

rapid progressive glomerulonephritis

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44
Q

inflammation of the renal interstitium that may be caused by an allergic reaction to medication
characterized by hematuria, proteinuria, WBCs and WCS casts

A

acute interstitial glomerulonephritis

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45
Q

thickening of the glomerular capillary walls and basement membrane
characterized by hematuria and proteinuria

A

membranous glomerulonephritis

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46
Q

may be caused by renal blood pressure irregularities
characterized by proteinuria (>3.5g/24h), hematuria, lipiduria, oval fat bodies, renal tubular epithelial cells and epithelial cell, fatty and waxy cts

A

nephrotic syndrome

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47
Q

affects a specific number of glomeruli, not the entire glomerulus, often seen in HIV patients
characterized by hematuria and proteinuria

A

focal segmental glomerulosclerosis

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48
Q

results in a long term progressive loss of renal function
characterized by hematuria, proteinuria, glucosuria, presence of casts, including broad casts

A

chronic glomerulonephritis (berger disease)

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49
Q

an infection of the renal tubules caused by a urinary tract infection
characterized by hematuria, proteinuria, WBCs, bacteria and WBC and bacterial casts

A

acute pyelonephritis

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50
Q

chronic infection of the tubules and interstitial tissue that may progress to renal failure
characterized by hematuria, proteinuria, WBCs, bacteria, and WBC, bacterial, granular, waxy and broad casts

A

chronic pyelonephritis

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51
Q

tubular necrosis caused by nephrotoxic agents and other disease processes, resulting in a failure of the kidneys to filter blood

A

renal failure

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52
Q

used to detect early renal disease

A

renal tubular reabsorption tests

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53
Q

examples of renal tubular reabsorption tests (also known as concentration tests)

A

osmolality
specific gravity
osmolar/free water clearance

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54
Q

measures the amount of solute dissolved in a solution
evaluates renal concentrating ability, monitor the course of the renal disease and monitor fluid and electrolyte therapy

A

osmolality

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55
Q

depends on the solute dissolved in a solution and the density of this solute
evaluates renal concentrating ability, monitor the course of the renal disease and monitor fluid and electrolyte therapy

A

specific gravity

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56
Q

used in the diagnosis of various types of diabetes mellitus
measures renal clearance of solutes and substance-free water

A

osmolar/free water clearance

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57
Q

tubular secretion or renal blood flow test uses p-aminohippuric acid, a substance that is infused into the patient
PAH is completely removed from the body, by a functional renal tissue

A

secretion test

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58
Q

used to assess renal waste removal and solute reabsorbing abilities
decreased rate indicates compromised kidney function

A

glomerular tests

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59
Q

used to assess glomerular filtrate rate
differ according to age and sex
values decrease with age

A

creatinine clearance

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60
Q

not changed by diet or rate of urine flow

A

creatinine levels

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61
Q

creatinine clearance formula

A

creatinine clearance = urine creatinine x urine volume per 24 hours / plasma creatinine

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62
Q

specimen of choice for creatinine clearance

A

24-hour time urine

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63
Q

uses only blood creatinine and MDRD (modification of diet in renal disease) formula
correction for gender and race required
results only reported as a number if <60ml/min/1.73m2

A

eGFR

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64
Q

determined by the body’s state of hydration

A

volume of urine

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65
Q

normal range of urine output in adult

A

1200-1500 mL/24 hours

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66
Q

decrease in urine output because of dehydration

A

oliguria

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67
Q

no urine output because of kidney damage or renal failure

A

anuria

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68
Q

increased urine output at night
caused by reduction in bladder capacity resulting from pregnancy, stones or prostrate enlargement or increased fluid intake at night

A

nocturia

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69
Q

increased daily output may exceed 2L/day
usually caused by such diseases as diabetes mellitus and diabetes insipidus, or ingestion of diuretics, caffeine and alcohol

A

polyuria

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70
Q

urine should be analyzed within ___ or preserve

A

2 hours

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71
Q

preserve urine: this will decrease bacterial growth but will cause precipitation of amorphous phosphates/urates

A

refrigeration

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72
Q

urine specimen types and collection times: concentrated specimen used for routine screening, pregnancy tests, and for detecting orthostatic proteinuria

A

first morning

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73
Q

urine specimen types and collection times: used for routine screening and microalbuminuria determination, time of collection not a consideration, patient cleans the external urinary meatus, urinates a small volume in the toilet and collects the rest of the voided sample

A

random midstream clean catch

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74
Q

urine specimen types and collection times: used for glucose monitoring usually the second voided specimen of the morning following this

A

fasting

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75
Q

urine specimen types and collection times: void 2 hours after eating, used to monitor glucose contet

A

2-hour postpandrial

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76
Q

urine specimen types and collection times: for creatinine clearance or for quantifying other analytes including sodium and potassium

A

24-hour

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77
Q

urine specimen types and collection times: collected from a tube placed through the urethra into the bladder, used for bacterial culture and routine screening

A

catheterized

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78
Q

urine specimen types and collection times: genital area cleansed with a detergent and urine collected in the middle of urination, used for bacterial culture and is the preferred collection method for routine analysis because it is the most concentrated sample of the day

A

midstream clean-catch

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79
Q

urine specimen types and collection times: needle inserted into the bladder through the abdominal wall; used for bacterial culture and cytologic testing

A

suprapubic aspiration

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80
Q

normal color of urine is derived from ___, which is a pigmented substance excreted at a constant rate
increased production can result from thyroid disease or a fasting urine sample

A

urochrome

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81
Q

formed from the oxidation of urobilinogen as urine stands, adds minimally to the normal yellow color

A

urobilin

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82
Q

colorless/pale yellow random specimen may indicate this condition as a result with increased urine excretion

A

diabetes insipidus or diabetes mellitus

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83
Q

this medication is prescribed for UTI resulting thick orange urine will mask chemical and microscopic analysis

A

pyridium (phenazopyridine)

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84
Q

red/pink urine may signify the presence of these in urine

A

blood, hemoglobin, myoglobin, porphyrins

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85
Q

these can cause green/blue urine

A

medications: amitriptyline, indicant and phenols
infections caused by pseudomonas

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86
Q

brown/black color may signify the presence these in urine

A

denatured hemoglobin
melanin
homogentisic acid

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87
Q

visual inspection of urines

A

clarity

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88
Q

urine clarity: indicates the absence of significant numbers of formed elements

A

clear

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89
Q

urine clarity: may be due to the presence of low numbers of formed eleements

A

hazy/slightly cloudy

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90
Q

urine clarity: in acid urine, may be due to amorphous urates showing a slight pink color, calcium oxalate crystals, or uric acid crystals; in alkaline urine, if the sample is white, may be due to amorphous phosphates and carbonates

A

cloudy

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91
Q

urine clarity: may be due to the presence of large numbers of formed elements

A

turbid

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92
Q

maple syrup odor in urine

A

maple syrup urine disease

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93
Q

sweaty or fruity odor in urine

A

ketone bodies (diabetic ketosis)

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94
Q

determines the kidney’s ability to reabsorb essential chemicals and water from the glomerular filtrate
detects dehydration and ADH abnormalities
density of a substance compared with the density of a similar volume of deionized water a similar temperature and is influenced by the number of particles dissolved and by the particle size

A

specific gravity

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95
Q

first renal function to become impaired

A

reabsorption

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96
Q

measures a refractive index by comparing the velocity of light in air to the velocity of light in a solution
does not require temperature corrections

A

refractometer

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97
Q

plasma filtrate entering the glomerulus has a SG of ___

A

1.010

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98
Q

normal random urine ranges from ___ (average)

A

1.015 - 1.025

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99
Q

fixed SG of 1.010 , indicates loss of concentrating and diluting ability

A

isosthenuric urine

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100
Q

SG < 1.010

A

hyposthenuric urine

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101
Q

SG > 1.010

A

hypersthenuric urine

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102
Q

SG: loss of the kidney’s ability to concentrate urine or presence of disease such as diabetes insipidus, glomerulonephritis and pyelonephritis, or normally if the person has a large fluid intake

A

low SG

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103
Q

SG: may result from adrenal insufficiency, diabetes mellitus, hepatic disease, congestive heart failure, and dehydration due to vomiting, diarrhea, low fluid intake, or strenuous exercise

A

high SG

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104
Q

method of choice for the chemical analysis of urine
used for the following tests: pH, protein, glucose, ketones, blood, bilirubin, urobilinogen, nitrite, leukocytes, creatinine, and specific gravity

A

reagent strips

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105
Q

acid-base balance of the body is primarily regulated by the ___ and ___

A

lungs
kidneys

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106
Q

provide regulation through secretion of hydrogen ions via ammonium ions, hydrogen phosphate and organic weak acid
facilitate reabsorption of bicarbonate from the convoluted tubules

A

kidneys

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107
Q

pH of urine ranges from __ for random urines and from ___ for the first morning void

A

4.5-8.0
5.0-6.0

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108
Q

acid pH in urine can be caused by:

A

high protein diets
after normal sleep
respiratory/metabolic acidosis
uncontrolled diabetes mellitus

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109
Q

alkaline urine can be caused by:

A

excreted after meals in response to gastric HCl
vomiting
increased consumption of vegetables
renal tubular acidosis
respiratory/metabolic alkalosis and UTIs

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110
Q

for urine pH, the reagent strip uses ___ to detect changes in pH
at pH 5.0, the pad is __ and __ at pH 9.0

A

methyl red/bromothymol blue
orange
blue

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111
Q

reagent strip uses ___ to detect protein in urine
indicator is ____ in the absence of protein and the pad changes from shades of ____ when abnormal amounts of protein (albumin) are present

A

tetrabromophenol blue

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112
Q

normal urine will contain less than ____ of protein or ____

A

10mg/dL
100mg/24 hour

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113
Q

tamm-horsfall

A

uromodulin

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114
Q

very diagnostic for renal disease and many indicate tubular reabsorption problems, increased low-molecular weight proteins, and glomerular membrane damaged caused by toxic agents, lupus or streptococcal glomerulonephritis

A

urine protein

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115
Q

produced due to proliferative disorder of plasma cells as seen in multiple myeloma
light chain monoclonal immunoglobulins

A

bence-jones protein

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116
Q

useful for patients with renal complications of diabetes mellitus

A

microalbumin evaluation

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117
Q

performed only for comparison with the protein level to rule out microalbuminuria

A

creatinine testing in a random urine

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118
Q

sensitivity of the creatinine method for urine specimen

A

10mg/dL

119
Q

this causes false negative result in the creatinine method

A

ascorbic acid

120
Q

most commonly used to detect and monitor diabetes mellitus (urine)

A

glucose testing

121
Q

glucosuria is seen in these conditions

A

DM
fanconi syndrome
advanced tubular disease
central nervous system damage
thyroid disorders
pregnancy

122
Q

reagent strip for glucose testing:
glucose + oxygen catalyzed by glucose oxidase to form ___ and ____ (which then when combined with chromogen, catalyzed by peroxidase to form an oxidized colored chromogen and water)

A

gluconic acid
hydrogen peroxide

123
Q

glucose testing: this method utilizes a reduction reaction, in which glucose (or other reducing substances) reduces copper sulfate (blue) to cuprous oxide (various shades of yellow to green)
mainly used to detect the presence of galactose in urine for patients with galactosemia

A

copper reduction test (Benedict’s, Clinitest tablet)

124
Q

cause of false positive results from copper reduction test

A

antibiotics
ascorbic acid
reducing sugars

125
Q

ketones being detected in the urine
three intermediate products of fatty acid metabolism

A

acetone
acetoacetic acid
beta-hydroxy-butyric acid

126
Q

(T/F) normal urine contains no ketones

A

true

127
Q

causes of ketonuria

A

uncontrolled diabetes mellitus
insulin dosage monitoring
electrolyte imbalance
dehydration

128
Q

methodology of ketone testing: reagent strips use ____ to measure acetoacetic acid and the addition of ____ permits the measurement of acetone and acetoacetic acid

A

sodium nitroprusside (nitroferricyanide)
glycine

129
Q

causes of false positives for ketone testing in urine

A

pigmented urine
dyes
phenylketones

130
Q

causes of false negatives for ketone testing in urine

A

bacterial breakdown of acetoacetic acid

131
Q

methodology of ketone testing: nitroprusside and glycine tablet to detect ketones, gives an enhanced color reaction, permits serial dilutions to be done

A

acetest

132
Q

methodology of ketone testing: enzymatic method uses ____ to detect the presence of ____

A

beta-hydroxybutyrate dehydrogenase
beta-hydroxybutyric acid

133
Q

intact RBCs in the urine

A

hematuria

134
Q

causes of hematuria

A

renal calculi
glomerulonephritis
pyelonephritis
tumors
trauma
toxins
exercise
menstruation
pregnancy

135
Q

hemoglobin in the urine

A

hemoglobinuria

136
Q

causes of hemoglobinuria

A

transfusion reactions
hemolytic anemia
severe burns
infections
exercise

137
Q

presence of heme-containing compound found in the muscles in the urine

A

myoglobinuria

138
Q

causes of myoglobinuria

A

muscle trauma
coma
convulsions
muscle wasting diseases
extensive exercise

139
Q

to screen for myoglobinuria, use ___ to precipitate hemoglobin out of the urine

A

ammonium sulfate

140
Q

reagent strip detects the ___ activity of hemoglobin or myoglobin
chromogen is ____, which forms a green-blue color when oxidized

A

pseudoperoxidase
tetramethylbenzidine

141
Q

blood in urine: this pattern on the reagent strip occurs when low numbers of intact RBCs lyse upon touching the reagent strip pad, releasing hemoglobin

A

speckled pattern

142
Q

false positives for detecting blood in the urine

A

vegetable peroxidase
e. coli peroxidase

143
Q

false negatives for detecting blood in the urine

A

high levels of ascorbic acid and nitrites
formalin preservative
captopril

144
Q

degradation product of hemoglobin
pigmented yellow compound

A

bilirubin

145
Q

one of the metabolic products formed when hemoglobin is degraded
converted to bilirubin by reiticuloendothelial system

A

protoporphyrin

146
Q

bilirubin binds to ___ for transport to the liver as unconjugated bilirubin

A

albumin

147
Q

in the liver, bilirubin is conjugated with ____ to form ___

A

glucuronic acid
bilirubin diglucoronide

148
Q

bilirubin diglucoronide goes into the intestines and is reduced to ___ via bacterial action and excreted in the feces as ___, which gives feces their brown color

A

urobilinogen
urobilin

149
Q

bilirubinuria may result from these conditions

A

hepatitis
cirrhosis
biliary obstruction
early liver disease

150
Q

____ bilirubin is water soluble and excreted in urine

A

conjugated

151
Q

____ bilirubin is not water soluble and cannot be excreted in urine

A

unconjugated

152
Q

bile duct obstruction:
urine bilirubin
urine urobilinogen

A

(+)
N

153
Q

hemolytic disease
urine bilirubin
urine urobilinogen

A

(-)
(+)

154
Q

reagent strip for bilirubin test uses ___

A

diazonium salt reaction

155
Q

false positives for bilirubin reagent strip test

A

pigmented urine due to medications, indican and lodine

156
Q

false negatives for bilirubin reagent strip test

A

specimen too old
excessive exposure to light
ascorbic acid
nitrite

157
Q

formed from hemoglobin metabolism
produced from the reduction of bilirubin by bacteria in the small intestines

A

urobilinogen

158
Q

increased urobilinogen in the urine can indicate these conditions

A

early liver disease
hepatitis
hemolytic diseases

159
Q

reagent strip for urobilinogen test uses ___ or ___

A

ehrlich’s reagent
diazo dye

160
Q

false positives for the urobilinogen reagent strip test

A

pigmented urine

161
Q

false negatives for the urobilinogen reagent strip test

A

improper storage
high levels of nitrite

162
Q

rapid test for UTIs
used for evaluation of UTI antibiotic therapy

A

nitrite

163
Q

a positive nitrite can indicate these conditions

A

cystitis
pyelonephritis

164
Q

reagent strip for nitrite test, reacts with an aromatic amine to form a ____, which then reacts with a dye to produce a ___ color

A

diazonium salt
pink

165
Q

false positives for the nitrite reagent strip test

A

old urine samples containing bacteria
pigmented urine

166
Q

false negatives for the nitrite reagent strip test

A

ascorbic acid
antibiotics
bacteria that do not reduce nitrate
diet low in nitrates
inadequate time in a bladder for reduction of nitrate to nitrite
heavy concentration of bacteria that reduces nitrate all the way to nitrogen

167
Q

indicate possible UTI and inflammation of urinary tract in urine specimen

A

leukocytes

168
Q

reagent strip reaction: an ____ reacts with leukocyte esterase to form an aromatic compound that reacts with a diazonium salt, forming a ___ color

A

acid ester
purple

169
Q

false positives for the leukocytes reagent strip test

A

elevated protein or ketone levels

170
Q

false negatives for the leukocytes reagent strip test

A

urine pH>6.5

171
Q

in urine testing, monitors hydration and dehydration, loss of renal tubular concentrating ability and diabetes insipidus

A

specific gravity

172
Q

reagent strip reaction for specific gravity: ionization of ___ in an alkaline solution produces hydrogen ions proportionally to the ions present in the solutions, causing a change in pH that is detected as a decrease in pH thus causing a color change of ___

A

bromothymol blue

173
Q

false positives for specific gravity test

A

elevated protein or ketone levels

174
Q

false negatives for specific gravity test

A

urine pH >6.5

175
Q

normal urine contains:
__ RBCs (hpf)
__ WBCs (hpf)
__ hyaline casts (lpf)
__ epithelial cells (hpf)

A

0-2
0-5
0-2
several

176
Q

increased RBCs in urine is associated with these conditions

A

infections
toxins
cancer
circulatory problems
renal calculi
menstrual contamination
trauma
exercise

177
Q

RBCs in normal urine appear as colorless disks while in concentrated urine they shrink and appear crenated; in dilute or alkaline urine, RBCs swell and lyse with release of hemoglobin, leaving an empty cells which appears as a ___

A

ghost cell

178
Q

this can be used to lyse RBCs as they can be confused with yeast cells or oil droplets

A

dilute acetic acid

179
Q

pyuria can be an indication for:

A

bacterial infections
pyelonephritis
cystitis
prostatitis
urethritis

180
Q

predominant WBC appearing in the urine with cytoplasmic granules and multilobed nuclei

A

neutrophils

181
Q

WBCs swell in dilute alkaline urine producing ____, which have a sparkling appearance due to the ____ of the granules

A

glitter cells
brownian movement

182
Q

when seen in urine may indicate a drug induced nephritis or renal transplant rejections

A

eosinophils

183
Q

these cells are vey common in the urine and usually not clinically significant but excessive numbers of these cells may suggest the sample has not been collected properly by the clean-catch method

A

squamous epithelial cells

184
Q

line the lower urethra and vagina in women and the urethra in males
largest of the cells found in the sediment with abundant, irregular cytoplasm and a central nucleus the size of the rbcs

A

squamous epithelial cells

185
Q

in the presence of a vaginal infection ___ may appear
squamous epithelial cells covered with Gardnerella vaginalis

A

clue cells

186
Q

most significant epithelial cells in the urine
small eccentric nucleus
cell size and shape vary from rectangular, larger cells in the proximal convoluted tubules to cells slightly larger than a WBC-shaped cuboidal or columnar originating from the collecting duct
cytoplasm varies with the PCT being coarsely granulated and the CD being very finely granulated

A

renal tubular epithelial cells (RTE)

187
Q

this is suggested when >5 RTE cells/hpf are present

A

tubular injury

188
Q

tubular injury can indicate these conditions

A

renal cancer
renal tubular damage
pyelonephritis
toxic and allergic reactions
viral infection

189
Q

RTE cells that contain large, non lipid-filled vacuoles
can be seen in renal tubular necrosis
associated with the dilation of the endoplasmic reticulum before the death of injured cells

A

bubble cells

190
Q

RTE cells that have absorbed lipids that are highly refractile and stain with Sudan III or oil red O
may indicate nephrotic syndrome

A

oval fat bodies

191
Q

RTE cells: histiocytes in the urine may indicate lipid-storage disease
cells are filled with fat and are larger than oval fat bodies

A

miscellaneous cells

192
Q

formed elements in the urine unique to the kidneys

A

casts

193
Q

term for casts in the urine

A

cylindruria

194
Q

casts are formed within the lumen of the ____ taking on a shaped similar to the tubular lumen

A

distal convoluted tubules
collecting duct

195
Q

major constituent of casts and is poorly detected in reagent strip methods
made by the RTE cells that line the DCT and upper CD

A

uromodulin
tamm-horsfall glycoprotein

196
Q

most commonly seen cast
due to exercise, dehydration, heat and emotional stress but can be associated with acute glomerulonephritis, pyelonephritis, chronic renal disease, and congestive heart failure
colorless, with varied morphology

A

hyaline cast

197
Q

cellular casts containing erythrocytes
associated diseases: a bleeding within the nephron, damage to glomerulus or renal capillaries as found in post-streptococcal infections
following strenuous contact sports

A

RBC cast

198
Q

cellular cast containing wbc
associated diseases: infection or inflammation within the nephron
primarily contain neutrophils thus appearing granular with multilobed nuclei

A

WBC cast

199
Q

associated diseases: pyelonephritis
bacilli contained within the cast and bound to the surface, mixed cast containing bacteria and wbcs may occur

A

bacterial cast

200
Q

associated diseases: advanced renal tubular damage, seen in heavy metal, chemical, or drug toxicity, viral infections and allograft rejection
contain RTE cells

A

epithelial cell cast

201
Q

associated diseases: the granular appearance may result from glomerular precipitants such cellular casts or protein aggregates
seen with hyaline casts following stress and exercise
can be coarse or fine

A

granular casts

202
Q

contains surface protein, granules adhere to the cast matrix, formed from degeneration of granular casts
associated diseases: chronic renal failure with significant urine statis
can have cracks or fissures on the sides

A

waxy cast

203
Q

seen with oval fat bodies in disease states that result in lipiduria
associated diseases: nephrotic syndrome, toxic tubular necrosis, dm
highly refractile, contains yellow-brown fat droplets

A

fatty cast

204
Q

identification of fatty cast is by sudan III stain or polarized light, which shows a characteristic ____

A

maltese cross formation

205
Q

formed in the dct and cd due to anuria
associated disease: suggests renal failure
all types of casts can occur

A

broad cast

206
Q

most common types of cast that can form a broad cast

A

granular cast
waxy cast

207
Q

not present in normal sterile urine
associated with lower and upper UTI
can be distinguished from amorphous crystals by their motility

A

bacteria

208
Q

associated diseases when present in urine: UTI, vaginal infections, dm, and immunocompromised individuals
can be confused with erythrocytes

A

yeast

209
Q

protein substance produced by the RTE cells and the urogenital glands
not considered clinically significant
thread like structures with low refractive index, view under reduced light

A

mucus

209
Q

most common parasite in the urine

A

trichomonas vaginalis

210
Q

formed by the precipitation of urine salts, organic compounds and medications

A

crystals

211
Q

all clinically significant crystals are in a ___ and ___ urine

A

acidic
neutral

212
Q

acidic urine crystals: formed from the urate salts of sodium, potassium, magnesium and calcium
no clinical significance
small, yellow to brown granules usually in large amounts, may make other urine elements
will dissolve at alkaline pH or by heating above 60degC

A

amorphous urates

213
Q

acidic urine crystals: seen in gout, with chemotherapy for leukemia, and in lesch-nyhan syndrome
appear yellow to orange/brown but can be colorless
pleomorphic shapes

A

uric acid

214
Q

acidic urine crystals: found in such foods as tomatoes, asparagus, spinach, berries, and oranges
metabolite of ascorbic acid

A

oxalic acid

215
Q

acidic urine crystals: colorless, dehydrated for, appears as octahedral envelope or two pyramids, joined at their bases, monohydrate form appears as dumbbell or oval-shaped
associated with renal calculi formation or ingestion of ethylene glycol

A

calcium oxalate

216
Q

acidic urine crystals: abnormal crystals that are formed when urine bilirubin exceeds its solubility, and they appear as fine needles or granules that are yellow to brown in color
most often seen in liver disease especially in viral hepatitis when there is renal tubular damage

A

bilirubin

217
Q

acidic urine crystals: abnormal crystals that appear fine delicate needles, colorless to yellow, found in clumps or rosettes
associated with severe liver disease and in inherited diseases that affect amino acid metabolism
may be seen with leucine crystals in urine that tests positive for bilirubin

A

tyrosine

218
Q

acidic urine crystals: abnormal crystals that appear yellow to brown, oily-looking spheres with concentric circles and radial striations, may be found with tyrosine crystals
associated with severe liver disease and in inherited diseases that affect amino acid metabolism

A

leucine

219
Q

acidic urine crystals: abnormal crystals that appear colorless, hexagonal plates
result from congenital disorder that inhibits renal tubular reabsorption of cysteine
other amino acids such as lysine, arginine and ornithine will also be present but they are more soluble so not visible
associated with renal calculi formation

A

cystine

220
Q

acidic urine crystals: abnormal crystals that appear clear, flat, rectangular plates with a notch in one or more corners
more commonly seen following refrigeration
seen with fatty casts and oval fat bodies
associated with nephrotic syndrome and other disorders that produce lipiduria

A

cholesterol

221
Q

acidic urine crystals: appear colorless in the form of needles sometimes may form bundles
from medications

A

ampicillin crystals

222
Q

acidic urine crystals: appear colorless to yellow-brown in the form of needles, sheaves of wheat, fan formation or rosettes
from medications

A

sulfonamides crystals

223
Q

acidic urine crystals: resemble cholesterol
correlate with increased specific gravity > 1.050

A

radiographic dyes

224
Q

alkaline urine crystals: identical in appearance to amorphous urates and generally colorless
refrigerated samples appear as a white sediment
soluble in acetic acid and will not dissolve when heated above 60 deg C
not clinically significant

A

amorphous phospate

225
Q

alkaline urine crystals: colorless, three-to-six sided prism often resembling a coffin lid
not clinically significant, may be associated with UTI

A

triple phosphate
ammonium magnesium phosphate

226
Q

alkaline urine crystals: colorless, thin prisms or rectangular plates
not clinically significant; may be associated with renal calculi formation

A

calcium phosphate

227
Q

alkaline urine crystals: normal crystal commonly seen in old urine samples
converts to uric acid crystals if acetic acid added and dissolves at 60 deg C
yellow to brown with irregular thorny projections (thorny apples)

A

ammonium biurate

228
Q

alkaline urine crystals: appear as small, colorless crystals having dumbbell or spherical shapes
not clinically significant

A

calcium carbonate

229
Q

presence of phenylalanine in the urine which indicates defective metabolic conversion of phenylalanine to tyrosine, which is caused by a gene failure to produce phenylalanine hydroxylase
occurs in 1:10,000 births and if undetected will result in severe mental retardation
mousy odor associated with phenylpyruvate because of increased ketones

A

phenylketonuria

230
Q

conditions that cause tyrosinosis

A

transitory tyrosinemia
premature infants with an underdeveloped liver
acquired severe liver disease

231
Q

tyrosinosis
screening test: ___
confirmatory test: ___

A

nitrosonaphthol
chromatography

232
Q

genetic defect resulting in failure to produce homogentisic acid oxidase, which causes accumulation in blood and urine
produces brown pigment deposits in body tissue that can lead to arthritis, liver, and cardiac problems

A

alkaptonuria

233
Q

screening tests for alkaptonuria

A

ferric chloride tube test (blue)
benedict’s test (yellow)
alkalinization of fresh urine (urine darkens)

234
Q

indicates malignant melanoma
produced from tyrosine hence urine darkens upon standing

A

melanuria

235
Q

caused by low levels of branched-chained keto acid decarboxylase
inhibits metabolism of leucine, isoleucine and valine
if untreated causes severe mental retardation, convulsions, acidosis, and hypoglycemia

A

maple syrup urine disease

236
Q

screening test for maple syrup urine disease

A

2,4-dinitrophenylhydrazine

237
Q

arise from enterochromaffin cells of the GI tract
produce increased blood serotonin, whose major urinary excretion product is 5-hydroxyindole acetic acid

A

argentaffinoma

238
Q

this is used to detect argentaffinoma

A

1-nitrose-2-maphthol (purple)

239
Q

CSF is made by the brain’s ____ as an ultrafiltrate of plasma

A

third choroid plexus

240
Q

supplies nutrients to nervous tissue, removes wastes and cushions the brain and spinal cord against trauma

A

CSF

241
Q

how much CSF is produced each hour

A

20mL

242
Q

total adult volume of CSF

A

140-170mL

243
Q

total neonate volume of CSF

A

10-60mL

244
Q

lumbar puncture is done where to collect CSF

A

3-4 or 4-5 lumbar vertebrae

245
Q

CSF collection: tube#1

A

chemistry and serology (glucose, protein, antibodies)

246
Q

CSF collection: tube#2

A

microbiology (culture and sensitivity)

247
Q

CSF collection: tube#3

A

hematology

248
Q

normal CSF fluid appearance

A

clear and colorless

249
Q

cloudy CSF appearance indicates presence of WBCS, RBCs, protein or bacteria which are seen in these conditions

A

meningitis
hemorrhage
disorders of the blood brain barriers

250
Q

causes of bloody CSF appearance

A

subarachnoid hemorrhage
traumatic tap

251
Q

xanthochromic CSF

A

increased hemoglobin, bilirubin, protein, immature liver in premature infants

252
Q

CSF glucose

A

60-70% of the patient’s plasma glucose

253
Q

CSF total protein is assayed using this

A

trichloroacetic acid precipitation or Coomassie brilliant blue

254
Q

normal CSF contains ___ WBCs/uL, and what cells do predominate

A

0-5
lymphocytes and monocytes

255
Q

presence of PMNs in CSF may indicate this

A

bacterial meningitis (cerebral abscesses)

256
Q

early cells forms in CSF can be associated with ___

A

acute leukemia

257
Q

plasma cells in CSF can be associated with these conditions

A

multiple sclerosis
lymphocytic reactions

258
Q

used in microbiology testing of CSF to detect Cryptococcus neoformans, which is possible complication of AIDs

A

india ink

259
Q

used in microbiology testing of CSF to detect bacteria

A

gram stain and culture

260
Q

used to evaluate infertility, post-vasectomy and forensic medicine cases
should be collected in sterile containers after 3-day period of no-sexual activity

A

seminal fluid

261
Q

normal semen analysis
volume:
viscosity:
appearance:
pH:
sperm count:
motility:
morphology:

A

volume: 2-5mL
viscosity: no clumps or strings, liquefied after 30-60m
appearance: translucent, gray-white color
pH: 7.2-8.0
sperm count: 20-160 million/mL
motility: 50-60% grade 2, motile with strong forward progression
morphology: oval shaped head with a long, flagellar tail

262
Q

plasma ultrafiltrate, joint fluid
functions as a lubricant and nutrient transport to articular cartilage
normal color is clear to straw colored

A

synovial fluid

263
Q

most crystals found in synovial fluid are associated with what kind of deposits

A

uric acid (gout)
calcium phosphate

264
Q

gastric fluid collection is performed by ____
analysis involves physical appearance, volume, titratable acidity and pH
for toxicology and for the diagnosis of Zollinger Ellison syndrome

A

gastric fluid

265
Q

term for needle aspiration of amniotic fluid

A

amniocentesis

266
Q

for genetic studies but may be used to check bilirubin, fetal bleeding, infection, fetal lung maturity or meconium content

A

amniotic fluid

267
Q

level of phospholipids will ___ as the fetus lung mature

A

increase

268
Q

clear or yellow fluid contained between the parietal and visceral membranes
laboratory analysis includes cell counts, gram stains, gross color examination and specific gravity

A

peritoneal fluid

268
Q

serous membrane that covers the walls of the abdomen and pelvis

A

peritoneum

269
Q

aspiration of peritoneal fluid

A

peritoneocentesis or paracentesis

270
Q

aspiration of pericardial fluid

A

pericardiocentesis

271
Q

aspiration of pleural fluid

A

thoracentesis

272
Q

increase in volume in peritoneal, pleural or pericardial fluids

A

effusion

273
Q

if the mechanism for effusion is non-inflammatory
fewer than 10,000 cells/uL and less than 3g/dL protein

A

transudate

274
Q

inflammatory effusions
higher than 1000 cells per uL and more than 3g/dL

A

exudate

275
Q

used in the detection of GI bleeding, liver and biliary duct disorders, malabsorption syndromes and infections

A

fecal analysis

276
Q

fecal analysis: black tarry stools

A

upper GI bleeding
iron therapy

277
Q

fecalysis: red stool

A

lower GI bleeding

278
Q

fecal analysis: steatorrhea

A

fat malabsorption

279
Q

fecal analysis: ribbon-like stools

A

bowel obstruction

280
Q

fecal analysis: mucus

A

colitis

281
Q

fecal analysis: clay-colored, pale stool

A

bile-duct obstruction/obstructive jaundice

282
Q

suggestive of steatorrhea

A

> 60 droplets/hpf

283
Q

detects fat malabsorption disorders by staining fecal fats with ___ or ___

A

sudan III
oil red

284
Q

fecal analysis: undigested straited muscle fibers may indicate what condition

A

pancreatic insufficiency in cystic fibrosis

285
Q
A
286
Q

used for early detection of colorectal cancer (guaiac test)

A

occult blood

287
Q

occult blood test: pseudoperoxidase activity of hemoglobin reacts with hydrogen peroxide to oxidize a colorless reagent to a colored product (blue)

A

orthotoluidine

288
Q

occult blood test: least sensitive and most common

A

gum guaiac

289
Q

occult blood test: use of an anti-hemoglobin to react with the patient’s hemoglobin has the advantage of not requiring any special diet before sample collection

A

immunological

290
Q

special fecal analysis: DNA test detects ___ which is associated with colorectal cancer

A

K-ras mutation

291
Q
A

MTLE (5 decks)

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