Clinical Microscopy Flashcards
Yellow quadrant in NFPA
Reactivity / stability hazard
White quadrant in NFPA
Specific hazard
Blue quadrant in NFPA
Health hazard
Red quadrant in NFPA
Flammability hazard
Yellow quadrant classification
*SUVSM
0 - Stable
1 - Unstable
2 - Violent
3 - Shock
4 - May detonate
OXY
Oxidizer
COR
Corrosive
Blue quadrant classification
*NSHED
0 - Normal
1 - Slight hazard
2 - Hazardous
3 - Extreme danger
4 - Deadly
Red quadrant flash point
*WABBB
0 - Will not burn
1 - Above 200F
2 - Below 200F
3 - Below 100F
4 - Below 73F
Degree of hazards (hazard index)
*No SMS Ex
0 - No / minimal hazard
1 - Slight hazard
2 - Moderate hazard
3 - Serious hazard
4 - Extreme / severe hazard
Type of extinguisher for ordinary combustibles
Water
Ordinary combustibles such as paper, cloth, plastics, and wood are what type of fire hazard
Type A
Flammable liquids such as gasoline, paints, and oils are what type of fire hazard
Type B
Electrical equipment belongs to what type of fire hazard
Type C
Best extinguisher for Type C fires
Halon
Best extinguisher for Type D fire
Sand
Detonation / arsenal fire belongs to what type of fire hazard
Type E
RACE
Rescue
Alarm
Contain
Extinguish / Evacuate
PASS
Pull the pin
Aim at the base of the fire
Squeeze the nozzle
Sweep side to side
Placing bleach solution directly on urine spills may produce
Chlorine gas fumes
Most important part of handwashing
Friction
Wash fingers for at least
15 to 20 seconds
Wash hands in _____ position
Downward
Last step in handwashing
Turn off faucets
Variables in Cockgroft and Gault formula
Age, Body weight (kg) and Sex
Variables on MDRD Formula
BUN, Ethnicity, Serum Albumin
When do changes in physical, chemical, and microscopic characteristics of urine begin to occur
As soon as urine is voided
In Stamey-Mears test, what is placed in VB2
Midstream urine
Step by step documentation of handling and testing of legal specimen
Chain of custody
Urine volume required for drug testing
30 - 45 mL
In drug testing, urine temperature range of 32.5 - 37.7 must be maintained within
4 minutes
Added to toilet water reservoir to prevent specimen adulteration
Blueing agent
If urine temperature for drug testing is out of range what to do
Record and contact the supervisor immediately
Carotene causes what urine color
Dark yellow to amber
Phenazopyridine causes what urine color
Orange
Phenol and indican causes what urine color
Blue-green
Pink, red urine is caused by
RBCs (cloudy red); Hemoglobin (clear red)
Fuchsin and Rifampin causes what urine color
Pink, red
Porphyrins. What urine color
Portwine / burgundy / purplish-red
Brown / black urine is due to
Methemoglobin, homogentisic acid, melanin
Increase WBCs lead to what urine color
Milky white
No visible particulates, transparent
Clear
Few particulates, print EASILY seen through the urine
Hazy
Many particulates, print BLURRED through the urine
Cloudy
Print CANNOT be seen through the urine
Turbid
May precipitate or be clotted
Milky
Seen in acidic urine
Amorphous urates, radiographic contrast media
Seen in alkaline urine
Amorphous urates, carbonates
Soluble with heat
Amorphous urates, uric acid crystals
SOLUBLE in dilute acetic acid
RBC, amorphous phosphates, carbonates
INSOLUBLE in dilute acetic acid
WBCs, bacteria, yeast, spermatozoa
Soluble in ether
Lipids, lymphatic fluid, chyle
Milky urine from a 24-year old woman would most likely contain
WBCs
Cloudy urine following meals is most likely caused by
Amorphous phosphates (alkaline tide)
Urine component normally found in children
Fuschin
Reagent strip principle of Bilirubin
Diazo reaction
Reagent strip principle of ketones
Sodium nitroprusside reaction (Legal’s test)
Reagent strip principle of glucose
Double sequential enzyme reaction
Reagent strip principle of specific gravity
pKa change of polyelectrolyte
Reagent strip principle of Proteins
Protein (Sorensen’s) error of indicators
Reagent strip principle of pH
Double indicator system
Reagent strip principle of blood
Pseudoperoxidase activity of hemoglobin
Reagent strip principle of Urobilinogen
Ehrlich reaction
Reagent strip principle of Nitrite
Greiss reaction
Reagent strip principle of Leukocytes
Leukocyte esterase
2,4-dichloroaniline diazonium salt is a multistix reagent used for
Bilirubin
Tetrabromphenol, citrate buffer at 3.0 is a multistix and chemstrip reagent used for
Protein
4-methoxybenzene-diazonium-tetrafkuoroborate is a chemstrip reagent used for
Urobilinogen
P-arsanilic acid, tetrahydrobenzo(H)-quinolin-3-ol is a multistix reagent used for
Nitrite
Indoxylcarbonic acid ester, diazonium salt is a multistix reagent used for
Leukocytes
Positive color of bilirubin reagent strip
Pink to violet
Negative color of protein reagent strip
Yellow
Uniform green/blue color of blood reagent strip indicates
Hemoglobin/myoglobin
Positive color of nitire reagent strip
Uniform pink
Positive color of leukocyte reagent strip
Purple
Positive color of ketones reagent strip
Purple
Sensitivity of protein chemstrip
5 mg/dL
Sensitivity of glucose multistix
100 mg/dL
Sensitivity of bilirubin multistix
0.4 to 0.8 mg/dL
Sensitivity of specific gravity multistix and chemstrip
1.000 to 1.030
High SG causes (false-positive/false-negative) results on protein
False-positive
Oxidizing agents and detergent causes (false-positive/false-negative) results on glucose
False-positive
Low temperature causes (false-positive/false-negative) results on glucose
False-negative
P-aminosalicylic acid causes (false-positive/false-negative) results on urobilinogen
False-positive
Formalin causes (false-positive/false-negative) results on urobilinogen
False-negative
Improperly preserved specimen causes (false-positive/false-negative) results on nitrite
False-positive
Non-reductase containing bacteria causes (false-positive/false-negative) results on nitrite
False-negative
Large quantities of bacteria converting nitrite to nitrogen causes (false-positive/false-negative) results on nitrite
False-negative
High SG causes (false-positive/false-negative) results on nitrite
False-negative
Formalin causes (false-positive/false-negative) results on leukocytes
False-positive
Trichomonas causes (false-positive/false-negative) results on leukocytes
False-positive
Protein causes (false-positive/false-negative) results on leukocytes
False-negative
Antibiotics causes (false-positive/false-negative) results on leukocytes
False-negative
Ascorbic acid causes (false-positive/false-negative) results on leukocytes
False-negative
Reagent strip reading of <30 mg/dL protein
Trace
Reagent strip reading of 30 mg/dL protein
1+
Reagent strip reading of 0.5% (500 mg/dL) glucose
2+
SSA reading: Distinct turbidity with no granulation
1+
SSA grading: Turbidity with granulation but NO flocculation
1+
SSA grading: Turbidity with granulation AND flocculation
3+
SSA grading: Clumps pf protein
4+
SSA grading: 30-100 mg/dL
1+
SSA grading: 100-200 mg/dL
2+
SSA grading: Approximately 50 mg/dL
1+
Radiographic contrast media causes (false-positive/false-negative) interference on SSA reaction
False-positive
Tolbutamide and penicillins causes (false-positive/false-negative) interference on SSA reaction
False-positive
Highly buffered alkaline urine causes (false-positive/false-negative) interference on SSA reaction
False-negative
Normal albumin excretion rate
0-20 ug/min
Albumin excretion rate for microalbuminuria
20-200 ug/min
Clinical albuminuria AER
> 300 mg/day
Bluish-green color in Benedict’s test
Trace
Green color, green or yellow precipitate on Benedict’s test
1+
Yellow-orange color, yellow-orange precipitate on Benedict’s test
3+
5-20 normal crystals seen in urine. How to report
Moderate
0-10 bacteria seen in urine. How to report
Rare
10-50 bacteria seen in urine. How to report
Few
Reporting for squamous epithelial cells
RFMoMa / LPF
Reporting for transitional epithelial cells
RFMoMa / HPF
Reporting for renal tubular epithelial cells
Average per 10 HPFs
Reporting for oval fat bodies
Average per HPF
Reporting for abnormal crystals and casts
Average per LPF
Appearance of leukocytes in Sternheimer-Malbin stain
Pale pink
Appearance of “glitter” cells in Sternheimer-Malbin stain
Pale blue
Appearance of hyaline casts/waxy casts in Sternheimer-Malbin stain
Pale pink (or may not stain at all)
Appearance of Trichomonas in Sternheimer-Malbin stain
Pale blue
Sternheimer-Malbin stain is commercially known as
Kova stain or sedi-stain
What is the clinical significance of a cylindroid
Same as cast
Color of uric acid and cystine
Uric acid = yellow-brown
Cystine = colorless
Birefringent hexagonal uric acid crystal
Uric acid
Non birefringent hexagonal crystal (weak if crystal is thick)
Cystine
Elevated in congenital erythropoietic porphyria
Uroporphyrin
Major constituent of renal calculi; VERY HARD, dark in color with rough surface
Calcium oxalate
Yellowish to brownish red and MODERATELY HARD calculi
Uric acid and urate
Calculi described as yellow-brown, GREASY and resembles an old soap
Cystine
Least common (least frequently encountered) calculi
Cystine
Branching or staghorn calculi resembling antlers of a deer
Triple phosphate
Pale and friable renal calculi
Phosphate
Acceptable squamous epithelial cell for sputum sample
<10/lpf
Acceptable WBC for sputum sample
> 25/lpf
Appearance of undiluted CSF
Clear
Appearance of diluted CSF with 1:10 dilution
Slightly hazy
Appearance of diluted CSF with 1:100 dilution
Slightly cloudy
Appearance of diluted CSF with 1:200 (or 1:20) dilution
Cloudy
Appearance of diluted CSF with 1:200 dilution
Slightly bloody
Appearance of diluted CSF with 1:10,000 diltution
Bloody/turbid
In 3 CSF tube collection, CSF tube 1 is for
Chemistry/serology
In 3 CSF tube collection, CSF tube 2 is for
Microbiology
In 3 CSF tube collection, CSF tube 3 is for
Hematology (for cell count)
In 3 CSF tube collection, CSF tube 4 may be given to
Serology (or Microbiology)
CSF specimen storage
Room temperature = CM
37C = Microbiology
1 CSF tube collection pattern
Microbiology ➡️ Hematology ➡️ Chemistry/Serology
Physical examination of CSF sample may be done using tube no.
3
UNEVEN distribution of blood on 3 tubes
Traumatic tap
EVEN distribution of blood on 3 tubes
Intracranial hemorrhage
TT vs. IH: WITH clot formation
Traumatic tap
TT vs. IH: NO clot formation
Intracranial hemorrhage
TT vs. IH: D-dimer positive
Intracranial hemorrhage
Oligoclonal banding in CSF but not in serum
*MS NENG
Multiple Sclerosis
Neurosyphilis
Encephalitis
Neoplastic disorders
Guillain-Barre syndrome
Oligoclonal banding in SERUM but not in CSF
Leukemia
Lymphoma
Viral infections
Oligoclonal banding in BOTH serum and CSF
HIV
Sperm concentration formula
(No. of sperms x dilution factor) / (total area of square x depth factor)
Sperm count formula
Sperm concentration x specimen volume
Round cell count formula (spermatid count)
(No. of spermatids x sperm concentration) / 100
Viscosity graded as 0
Watery
Sperm motility grading: Rapid, straight-line motility
4.0 (a)
Sperm motility grading: Slower speed, some lateral movement
3.0 (b)
Sperm motility grading: Slow forward progression, noticeable lateral movement
2.0 (b)
Sperm motility grading: No forward progression
1.0 (c)
Sperm motility grading: No movement
0 (d)
Acrosomal cap size
1/2 of head
2/3 of nucleus
Size of sperm head
3 um x 5 um
Size of sperm neck
7 um
Size of sperm tail
45 um
Smoking and drinking alcohol would cause _____ in sperm count
Decrease
Sperm moving linearly or in a large circle
Progressive
Sperm with an absence of progression
Nonprogressive
Sperm with decreased motility with normal count has a possible abnormality in
Viability (vitality)
Sperm with decreased motility with clumping has a possible abnormality in
Male antisperm antibodies
Eosin-nigrosin stain is a test used for
Sperm viability
Synovial fluid in a plain red top tube (no anticoagulant) is used for
Chemical (or immunologic) evaluation
Synovial fluid in a plain red top tube (with sodium fluoride) is used for
Glucose analysis
Synovial fluid in a liquid EDTA is used for
Hematology / cell count (microscopic examinations)
Powdered anticoagulants and _____ interfere with crystal identification in a synovial fluid specimen
Lithium heparin
Synovial fluid in a sterile anticoagulant tube is used for
Microbiological studies
Joint disorder findings: <1,000 / uL WBC count.
Non-inflammatory (I)
Joint disorder findings: Cloudy yellow color, positive in autoantibodies
Immunologic Inflammatory (IIa)
Joint disorder findings: Cloudy red color, positive for RBCs
Hemorrhagic (IV)
Joint disorder findings: Milky specimen, positive for crystals
Crystal-induced inflammatory (IIb)
Joint disorder findings: Cloudy yellow green color, positive for culture and gram stain
Septic (III)
Milky pleural fluid with >110 mg/dL triglycerides
Chylous effusion
Milky pleural fluid positive in Sudan III staining
Chylous effusion
Milky pleural fluid with <50 mg/dL triglycerides
Pseudochylous effusion
O.D. 650
Fetal lung maturity
O.D. 450
HDN
Neural tube defects
Alpha-fetoprotein
Acetylcholinesterase
Principle of home-based pregnancy test kits
Enzyme immunoassay
Effect of proteinuria on urine pregnancy test result
False-positive
Effect of dilute urine on pregnancy test kit result
False-negative
Normal stool color
Brown
Brown stool is due to
Urobilin / stercobilin
Black stool is due to
Upper GI bleeding
Ferrous sulfate
Charcoal
Bismuth
Black tarry stool
Melena
Gray stool is due to
Barium sulfate
Pancreatic disorders, bile duct obstruction, steatorrhea causes _____ stool
Frothy
Ribbon-like stool is due to
Intestinal constriction
Rice watery stool
Cholera
Reagents used in Split fat stain
36% acetic acid and Sudan III
Reagents used in the Neutral fat stain
95% ethanol and Sudan III
Disinfection of centrifuge is performed
Weekly
Calibration of centrifuge is done every
3 months (quarterly)
Devices used for centrifuge calibration
Tachometer
Stopwatch
Strobe light
Principle used by automated strip readers
Reflectance photometry
Volume required by Yellow IRIS instrument
2 mL
Principle (s) applied in the mechanism of the slideless automated instrument for urine microscope
Fluorescence
Impedance
Light scatter
How can bacteria be quantitated using automated slideless urinalysis analyzers
Use of histogram and scattergram
How many categories are used in iQ200 for classification of urine sediment particles
12
Measurement principle of semi-automated urine chemistry analyzer
Reflectance photometry
