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RMT BY MARCH 2017!!! > Clinical Microscopy > Flashcards

Clinical Microscopy Flashcards

1
Q

Shorter urethra –> higher chance of UTI

A

Females (3-4cm)

Males (20cm)

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2
Q

1 kidney = _____ number of nephrons

A

1M-1.5M

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3
Q

Part of the nephron that acts as a sieve

A

Glomerulus

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4
Q

Glomerulus allows the filtration of substances with molecular weight of

A

Less than 70000 daltons

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5
Q

Major site of renal absorption

A

Proximal Convoluted Tubule

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6
Q

Part of the nephron impermeable to water

A

Ascending loop of Henle

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7
Q

Hormone that regulates water reabsorption in CT and DCT

A

Anti-diuretic hormone / Vasopressin

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8
Q

Endocrine gland that acts as storage of hormones produced by other glands

A

Post Pituitary Gland

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9
Q

Characterized by deficiency of Anti-diuretic hormone

A

D. insipidus

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10
Q

Major mineralocorticoid

A

Aldosterone

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11
Q

Function of aldosterone

A

Regulate reabsorption of sodium ions

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12
Q

First to be affected by renal disease

A

Tubular reabsorption

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13
Q

Gold standard for clearance test

A

Inulin

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14
Q

Preferred test/s for tubular reabsorption

A

Specific gravity and osmolarity test

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15
Q

Active/Passive Transport

- Glucose

A

Active transport

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16
Q

Active/Passive Transport

- Amino acid

A

Active Transport

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17
Q

Active/Passive Transport

- Water

A

Passive transport

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18
Q

Major organic organic component of urine

A

Urea

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19
Q

Major inorganic organic component of urine

A

Chloride

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20
Q

Principal salt in urine

A

NaCl

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21
Q

Method of collection for anaerobic culture

A

Suprapubic aspiration

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22
Q

Influenced by both number and density of particles in the solution

A

Specific gravity

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23
Q

Influenced by only the number of particles in solution

A

Osmolarity

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24
Q

Causes freezing point depression

A

High osmolarity

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25
Q

Drop in the freezing point with 1Osm/kg water

A

1.86C

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26
Q

Urine collection method for prostatic infection

A

Glass Technique / Three-glass technique

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27
Q

Tube collection for three-glass technique

A

1: first portion of voided urine
2: middle portion = midstream clean catch
3: urine after prostate massage

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28
Q

Volume of urine for drug specimen collection

A

30-45mL in a 60mL container

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29
Q

Optimal temperature for drug specimen

A

32.5-37.7C

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30
Q

Type of urine specimen for routine and qualitative analysis

A

Occasional/single/random

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31
Q

Type of urine specimen for quantitative analysis

A

Timed

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32
Q

Type of urine specimen for urobilinogen

A

Timed - afternoon specimen (2-4PM)

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33
Q

Type of urine specimen for nitrite determination

A

Timed - 4hrs

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34
Q

Ideal specimen for routine urinalysis

A

First morning clean catch

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35
Q

Type of urine specimen for pregnancy test

A

First morning

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36
Q

Type of urine for glucose determination

A

Fasting/second morning

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37
Q

Changes in unpreserved urine : color

A

Modified or darkened due to red-ox metabolism

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38
Q

Changes in unpreserved urine : clarity

A

Decreased due to pot of urates and amorphous phosphates and increase in bacterial count

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39
Q

Changes in unpreserved urine : odor

A

Increased due to ammonia build-up

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40
Q

Changes in unpreserved urine : pH

A

Increased due to ammonia build-up

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41
Q

Changes in unpreserved urine : glucose

A

Decreased due to glycolysis

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42
Q

Changes in unpreserved urine : ketones

A

Decreased

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43
Q

Changes in unpreserved urine : bilirubin

A

Decreased because it is light sensitive

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44
Q

Changes in unpreserved urine : urobilinogen

A

Decreased due to transition to oxidation to urobilin

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45
Q

Changes in unpreserved urine : nitrite

A

Increased due to bacteria multiplication

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46
Q

Changes in unpreserved urine : RBC/WBC

A

Decreased due to disintegration at high pH

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47
Q

Changes in unpreserved urine : bacteria

A

Increased

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48
Q

Most common physical method of preservation

A

Refrigeration

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49
Q

Chemical preservative for urine culture

A

Boric acid

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50
Q

Chemical preservative for addis count

A

Formalin

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51
Q

Chemical preservative for urine glucose

A

Sodium fluoride or benzoic acid

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52
Q

Disadvantage of refrigeration as a method of preservation

A

Precipitates amorphous urates and phosphates

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53
Q

Preservation method/technique that does not interfere with chemical tests

A

Refrigeration

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54
Q

Preservative that preserves protein and formed elements well and does not interfere with routine analyses other than pH

A

Boric Acid

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55
Q

Preservative that can act as a reducing agent,thus can interfere with different chemical tests

A

Formalin

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56
Q

Volume of urine specimen for urinalysis

A

10-15mL in a 50mL capacity container

Average of 12mL

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57
Q

Normal volume range of 24hour urine

A

600-2000mL

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58
Q

An increase in daily urine volume of greater than 2.5L/day in adults

A

Polyuria

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59
Q

Cases in which polyuria occurs

A
  • increased fluid intake
  • diuretic medication and drinks
  • nervousness
  • Diabetes mellitus
  • Diabetes insipidus
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60
Q

A decreased in urine output of less than 400mL/day in adults

A

Oliguria

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61
Q

Failure of the kidneys to produce urine due to complete obstruction

A

Anuria

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62
Q

> 500mL, with specific gravity less than 1.018, urine output at night

A

Nocturia

- seen in pregnancy

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63
Q

Increase in fluid intake causes pale urine and a [decrease/increase] of specific gravity

A

Decrease

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64
Q

Differentiate diabetes mellitus from diabetes insipidus

A

Both cause an increase in volume but the specific gravity of the urine in DM is increased compared to the decrease in DI

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65
Q

Roughly indicates degree of hydration and should correlate with the urine specific gravity

A

Urine color

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66
Q

Specific term for yellow pigment in urine

A

Urochrome

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67
Q

Major pigment in urine

A

Urochrome

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68
Q

Specific term for green pigment in urine

A

Uroerythrin

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69
Q

Uroerythrin attaches to ______, producing a pink color t the sediment

A

Uroerythrin attaches to urates —-> amorphous urates

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70
Q

Specific term for urine pigment that is dark yellow or orange in color

A

Urobilin

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71
Q

A urine pigment that the production is dependent on the body’s metabolic state

A

Urochrome

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72
Q

Urine pigment that is an oxidation product of of urobilinogen, and imparts an orange-brown color to standing urine

A

Urobilin

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73
Q

White foam in dark yellow to orange urine

A
  • concentrated urine

- presence of proteins

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74
Q

Color of urine in diabetes mellitus and diabetes insipidus

A

Pale yellow

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75
Q

Color of urine in the presence of bilirubin

A

Dark yellow with yellow foam

76
Q

Treatment for UTI that renders the urine viscous and with yellow foam

77
Q

Yellow-green color of urine

A

Bilirubin oxidized to biliverdin

78
Q

Color of urine in Pseudomonas infection

79
Q

Color of urine the presence of indican

A

Blue-green

80
Q

Most common abnormal urine color

81
Q

Color of the urine in the presence of RBC

A

Cloudy red

82
Q

Color of the urine in the presence of Hemoglobin

83
Q

Color of the urine in the presence of Myoglobin

84
Q

Color of the urine in the presence of porphyrin

A

Red/purplish)

(lead porphyria may render colorless/normal urine

85
Q

Color of the urine in lead porphyria

A

Normal (pale yellow)

86
Q

What is deficient in Alkaptonuria

A

Homogentisic acid oxidase deficiency

87
Q

Color of the urine in the presence of RBCs oxidized as metHb

A

Brown-Black

88
Q

Color of the urine in the presence of mepacrime (antimalaria)

89
Q

Color of the urine in the presence of rifampin

A

Bright orange-red

90
Q

Viewing of urine

A

Against white background using adequate light source

91
Q

Describe clear urine

A

Transparents; no visible particulates

92
Q

Describe hazy urine

A

Few particulates, print easity seen through urine

93
Q

Describe cloudy urine

A

Many particulates, print is blurred through urine

94
Q

Describe turbid urine

A

Print cannot be seen through urine

95
Q

Describe milky urine

A

May precipitate or clot

96
Q

Pathologic causes of turbidity

A 
RBCs
WBCs
Bacteria
Yeast
Non-squamous epithelial cells
Abnormal crystals
Lymph fluid
Lipids
97
Q

Non-pathologic causes of turbidiy

A 
Squamous cells
Mucus
Amorphous crystals
Semen and/or spermatozoa
Decal contamination
Radiographic contrast media
Talcum powder
Vaginal cream
98
Q

Substances correlated to acidic urine

A

Amorphous urates

Radiographic contrast media

99
Q

Substances correlated to alkaline urine

A

Amorphous phosphates

Carbonates

100
Q

Substances found in urine that are soluble in heat

A

Amorphous urates

Uric acid crystals

101
Q

Substances found in urine that are soluble in dilute acetic acid

A

RBCs
Amorphous phosphates
Carbonates

102
Q

Substances found in urine that are insoluble in dilute acetic acid

A

WBCs
Bacteria
Yeast
Spermatozoa

103
Q

Substances found in urine that are soluble in ether

A

Lipids
Lymphatic fluid
Chyle

104
Q

Color of urine with bilirubin-biliverdin

A

Yellow green with yellow foam OR beer-brown with yellow foam

105
Q

Color of urine with fuscin (food with additive/food coloring)

106
Q

Color of urine with bilifuscin (unstable hemoglobin)

107
Q

Color of urine with methemoglobin

A

Brown-black rendering an acidic pH

108
Q

Specific gravity of isothenuria

A

1.010 (glomerular filtrate)

109
Q

Determination of specific gravity that measures total solutes of the urine and its refractive indices

A

Refractometry

110
Q

Refractometry is compensated to ________ and needs corrections for __________

A

Compensated to TEMPERATURE (15-38C) and needs corrections for GLUCOSE AND PROTEIN

111
Q

Compensation for the specific gravity from refractometry

A

1g/dL glucose = - 0.004

1g/dL protein = - 0.003

112
Q

Substances for the calibration of refractometry

A

Distilled water (1.000)
5% NaCl (1.022 +/- 0.001)
9% sucrose (1.034+/- 0.001)

113
Q

Refractometry reading is [lower/higher] than urometer by [value]

A

Lower by 0.002

114
Q

Urometer needs corrections for __________

A

TEMPERATURE

+/- 0.001 for every 3C the specimen is above/below the calibration temperature (20C) respectively

115
Q

Principle of the reagent strip test for specific gravity of urine

A

pKa change of a polyelectrolyte (dissociation constant)

116
Q

Principle of the Harmonic oscillation densitometry

A

Frequency of sound waves entering a solution will change in proportion to the density of the solution

117
Q

Normal pH of (random) sample urine

118
Q

Conditions that cause acidic urine

A 
Emphysema
Diabetes mellitus
Starvation
Dehydration
Acid-producing bacteria
High protein diet
Cranberry juice
119
Q

Conditions that cause alkaline urine

A 
Vomiting
Renal tubular acidoses
Vegetarian diet
Old specimen
Urease-profucing bacteria
120
Q

Odor of urine with Proteus

A

Urease-producing bacteria –> ammoniacal

121
Q

Odor of urine with DM

A

Fruity/sweet due to metabolism of ketones

122
Q

Rancid butter odor of urine

A

Due to tyrosinemia

123
Q

Rotting fish odor of urine

A

Trimethylaminouria

124
Q

Sweaty feet odor of urine

A

Isovoleric acidemia

125
Q

Mousy odor of urine

126
Q

Cabbage odor of urine

A

Methionine malabsorption

127
Q

Bleach odor of urine

A

Contamination

128
Q

Sulfur odor of urine

A

Cystine disease

129
Q

Major serum protein found in urine

130
Q

Normal protein levels of urine

A

<10mg/dL or 100 mg/24 hours

131
Q

Conditions leading to pre-renal proteinuria

A
  • Intravascular hemolysis (Hb)
  • Muscle injury (Myoglobin)
  • Sever infection and inflammation (APRs)
  • Multiple myeloma (proliferation of Igs by plasma cells)
132
Q

Glomerular disorders leading to renal proteinuria

A
  • Diabetic nephropathy (not detected by routine reagent strip)
  • Orthostatic or postural proteinuria (due to pressure on renal veins)
133
Q

Tubular disorders leading to renal proteinuria

A
  • Fanconi’s dis
  • Toxic agents/heavy metals
  • Severe viral infections
134
Q

Conditions leading to post-renal proteinuria

A

Lower UTI/inflammations

135
Q

Tests for proteinuria

A
  • Protein Reagent Strip (+ blue-green)

- Sulfosalicyclic Acid Precipitation Test (clumps)

136
Q

Renal threshold for glucose

A

160-180mg/dL

137
Q

Hyperglycemia associated glucosuria

A 
* Glucose is high in BOTH blood and urine*
DM
Pancreatic cancer
Cushing's syndrome
Acromegaly
Hyperthyroidism
Stress
Gestational diabetes
138
Q

Renal associated glucosuria

A
  • NORMAL blood glucose; HIGH urine glucose*
    Fanconi’s syndrome
    Advanced renal disease
    Pregnancy
139
Q

Tests for glucosuria

A
  • Reagent Strip (+ blue-green)
  • Copper Reduction Test (+ brick red)
  • Glucose oxidase and clinitest reactions
140
Q

Significance of ketones in the urine

A
  • inability to metabolize glucose (DM)
  • increased loss of carbs (vomiting)
  • inadequate intake of carbs (starvation and malabsorption)
141
Q

Hematuria

A

RBC in urine –> cloudy red appearance

142
Q

Hemoglobinuria

A

Intravascular hemolysis –> clear red appearance

143
Q

Myoglobinua

A

Rhabdomyolysis –> muscle destruction –> clear red appearace

144
Q

Hemoglobinuria vs Myoglobinuria : Plasma examination

A

Hb: Pink/Red (high CK and aldolase)
Myoglobin: yellow (low haptoglobin)

145
Q

Hemoglobinuria vs Myoglobinuria : Blondheim’s test (ammonium sulfate)

A

Hb: Clear supernatant; neg. reagent strip
Myoglobin: Red supernant; pos. reagent strip

146
Q

Significance of bilirubin (conjugated) in urine

A

Early indication of liver disease

147
Q

Micral Test:

  • Test for
  • Principle
A

Test for proteinuria (glomerular - renal)

Principle: Enzyme immunoassay

148
Q

Sulfosalicyclic acid precipitation test

  • Test for
  • Principle
A

Test for general proteinuria

Principle: Cold precipitation (reacts equally to all forms of protein)

149
Q

Principle for the reagent strip for proteinuria

A

Protein error of ndicators

150
Q

Principle for the reagent strip for glucosuria

A

Double sequential enzyme reaction

+ blue-green

151
Q

Copper reduction test

  • test for
  • principle
A

Test for glucose to reduce copper sulfate with alkali and heat
- color change progressing from negative blue through green, yellow, and orange/red

152
Q

Principle of reagent strip for ketones in urine

A

Sodium nitroprissude reaction

+ purple

153
Q

Principle for reagent strip for hemoglobinuria

A

Pseudoperoxidase activity of hemoglobin

+ blue/green

154
Q

Principle for reagent strip for bilirubinuria

A

Diazo reaction

+ tan or pink-purple

155
Q

Ictotest

A

More sensitive to bilirubin in urine and less subjective to interfering substances

156
Q

Principle for reagent strip for urobilinogen

A

Ehrlich’s reaction

+ = red azodye

157
Q

Watson Schwartz Test

A

For differentiating urobilinogen and porphobilinogen

  • urobilinogen is soluble to both butanol and chloroform
  • porphybilinogen is insoluble
158
Q

Rapid screening test for urine porphobilinogen (> 2mg/dL)

A

Hoesch test

159
Q

Principle for Hoesch test

A

Inverse ehrlich’s test

160
Q

Substances tested for the detection of bacteriuria

161
Q

Principle for reagent strip for nitrite

A

Greiss reaction
(Gram-negative bacteria have nitroreductase)
+ = uniform pink azodye = 100,000 orgm/mL

162
Q

Significance of leukocyte in urine

A

UTI

Inflammation

163
Q

Principle for the reagent strip for leukocyte in urine

A

Leukocyte esterase
(detect all WBCS except lymphocytes)
+ puple azodye

164
Q

Microscopic examination of urine : bright-field microscopy

A

Routine U/A

165
Q

Microscopic examination of urine : polarizing microscopy

A

ID of cholesterol in oval fat bodies, fatty acids, crystals

166
Q

Microscopic examination of urine : phase-contrast microscopy

A

Visualization of elements with low RI

167
Q

Microscopic examination of urine : dark-field microscopy

A

Treponema pallidum

168
Q

Microscopic examination of urine : interference-contrast

A

Produced 3F image and layer-by-layer imaging

169
Q

Stemheimer-Malbin stain

A

ID WBCs, epithelial cells, and casts

170
Q

Toluidine Blue

A

Differentiate WBCs

171
Q

Lipid Stains (Oil Red O, Sudan III)

A

ID free fat droplets

172
Q

Gram stain

A

ID bacterial casts

173
Q

Hansel Stain

A

ID eosinophils

174
Q

Prussian blue stain

A

Hemoderisin (yellow-brown)

175
Q

HYALINE CAST

  • reporting
  • disease and other conditions
A 
Average per LPF
Congestive heart failure
Strenuous exercise
Heat exposure
Emotional stress
176
Q

RBC CAST

  • reporting
  • disease and other conditions
A

Average per 10 HPF
Glomerulonephritis (bleeding within nephron)
Strenuous exercise

177
Q

WBC CAST

  • reporting
  • disease and other conditions
A

Average per 10 HPF
Pyelonephritis (inflamm of renal tubule)
Acute interstitial nephritis

178
Q

BACTERIAL CAST

  • reporting
  • disease and other conditions
A

RFMM per HPF

Pyelonephritis

179
Q

RTE CAST

  • reporting
  • disease and other conditions
A

Average per 10 HPF
Renal tubule destruction
Acute tubular necrosis

180
Q

MALTESE CROSS appearace

A

Oval fat bodies
Fatty casts
Starch

181
Q

GRANULAR CAST

- disease and other conditions

A

Glomerulonephritis
Pyelonephritis
Stress and exercise

182
Q

FATTY CAST

- disease and other conditions

A

Nephrotic syndrome
Toxic tubular necrosis
Diabetes mellitus
Crush injuries

183
Q

WAXY CAST

- disease and other conditions

A

Chronic renal failure

Stasis of urine flow

184
Q

BROAD CAST

- disease and other conditions

A 
Extreme urine stasis
Renal failure (destruction of tubular walls)
185
Q

Most common type of broad cast

A

Granular and waxy cast

186
Q

Most common urinary sediment in renal calculi

187
Q

Least common urinary sediment in renal calculi

RMT BY MARCH 2017!!! (6 decks)

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