CRYSTALS

Question 1

Urinary Crystals

Detects the presence of the abnormal types in:

Answer 1

• Liver diseases
• inborn error of metabolism
• Renal damage caused by crystallization of medications

Question 2

Crystal Formation:
• Formed by the precipitation of…

Answer 2

urinary solutes (inorganic salts, organic compounds, medications)

Question 3

Factors that causes precipitation

Answer 3

• Temperature
• Solute concentration
• pH (affects solubility)

Question 4

Normal Acid (ACUAS)

Answer 4

Amorphous Urates
Calcium Oxalate
Uric Acid
Acid Urates & Sodium Urates

Question 5

Normal Alkaline (ATA)

Answer 5

Amorphous Phosphates,
Triple Phoshate,
Ammonium Biurate,

Question 6

Abnormal (CCR ang BiLaT)

Answer 6

Cystine,
Cholesterol,
Radiographic Dye,
Bilirubin,
Leucine
Tyrosine,

Question 7

Amorphous urates

• color of granules

Answer 7

Yellow-Brown granules

Question 8

• Occur in clumps resembling granular casts

• Appear after refrigeration producing characteristic pink sediment at pH greater than 5.5, whereas uric acid crystals appear when pH is greater

Answer 8

Amorphous urates

Question 9

Weddellite

Answer 9

Calcium Oxalate (Dihydrate)

Question 10

Whewellite

Answer 10

CaOx Monohydrate

Question 11

• They look like little envelopes (or tetrahedrons, depending upon your point of view), octahedral

• Two pyramids joined at their bases

Answer 11

CaOx dihydrate

Question 12

• Oxalate crystals are common in___urine
• Also found in____urine

Answer 12

acidic

neutral and rarely in
alkaline

Question 13

• Increased Oxalic Acid = Associated with (3)

Answer 13

Tomatoes,
Asparagus and
Vitamin C

Question 14

Normal flora in the intestine

Degrades ingested oxalate

Answer 14

Oxalobacter formigenes

Question 15

• Rarely found, vary in size and may have a spindle, oval, or dumbbell shape

• Appear as flat, elongated, six-sided crystals (“picket fence”)

Answer 15

CaOx monohydrate

Question 16

• Ethylene glycol poisoning

Answer 16

CaOx monohydrate

Question 17

Most pleomorphic crystal

Answer 17

Uric acid

Question 18

crystals may appear as rhombic, whetstones, wedges, rosettes or hexagonal
• Usually yellow-brown and have a six-sided shape

Answer 18

• Uric acid

Question 19

Uric acid

• Increased amounts = Increased
________metabolism (_____ disease?)

Answer 19

Purine and Nucleic Acid

Lesch-Nyhan Syndrome

Question 20

• White precipitates that don’t dissolve on warming

• Granular in appearance and similar to amorphous urates and differentiated through color and pH

Answer 20

Amorphous phosphate

Question 21

Ammonium biurate

Dissolves at

Answer 21

60°C

Question 22

Ammonium Biurate

• Converts to uric acid crystals in the addition of____

Answer 22

acetic acid

Question 23

• Frequently encountered in old specimens and associated with presence of ammonia produced by urea-splitting bacteria

Answer 23

Ammonium biurate

Question 24

Wagon wheel

Answer 24

Ammonium biurate

Question 25

• These crystals generally appear as yellow-brown, radially-striated spheres with irregular "thorny-apple" "ox-horn" projections • They may be seen in acid urine, their formation is favored in neutral to alkaline urine

Answer 25

Ammonium biurate

Question 26

Colorless Prism like Coffin lids

Answer 26

Triple phosphate

Question 27

• Often seen in urine from normal individuals. • Struvite, Staghorn • Fern leaf and Feathery when it disintegrates

Answer 27

Triple phosphate

Question 28

Triple phosphate (3)

Answer 28

Magnesium Ammonium Phosphate

Question 29

Urinary tract infection with urease producing bacteria can promote it and urolithiasis by raising urine pH and increasing free ammonia

Answer 29

Triple phosphate

Question 30

• Seen in Cystinuria • These crystals are shaped like____

Answer 30

Cystine stop signs

Question 31

are seen as flat colorless hexagonal plates • Confirmed using_____test

Answer 31

• Cystine crystals Cyanide-Nitroprusside Test

Question 32

• They are actually rectangles in cross-section with notched ends • They appear to be needle-shaped

Answer 32

cholesterol crystals

Question 33

• Associated with lipiduria together with fatty casts and OFB • Highly birefringent

Answer 33

cholesterol crystals

Question 34

Staircase

Answer 34

•cholesterol

Question 35

• Fine colorless to yellow needles in clumps or rosettes • Usually seen in conjunction with leucine crystals with a positive bilirubin chemical test • May signify also amino acid disorder

Answer 35

Tyrosine

Question 36

• Yellow-brown spheres that demonstrate concentric circles and radial striations • Seen less frequently than tyrosine crystals and, when present, should be accompanied by tyrosine crystals

Answer 36

Leucine

Question 37

• Present in hepatic disorders producing large amounts of it in the urine • Appear as clumped needles or granules with the characteristic yellow color • In disorders that produce renal tubular damage, such as viral hepatitis, bilirubin crystals may be found incorporated into the • matrix of casts.

Answer 37

Bilirubin

Question 38

• are typically yellow to brown in color and often resemble uric acid crystals. However, these crystals are easily distinguished from uric acid by confirmatory tests

Answer 38

Sulfonamide crystals

Question 39

• are readily soluble in ACETONE and positive dextrine/ sulfuric acid test

Answer 39

Sulfa crystals

Question 40

Sulfonamide - confimatory test • Needles, Rhombics, Whetstones, Sheaves of Wheat, and Rosettes

Answer 40

“Old yellow newspaper" test

Question 41

Artifacts

Answer 41

starch, oil droplets, air bubbles, pollen grains, fibers, fecal contamination

Question 42

4 maltese cross formation OFFS

Answer 42

Oval fat bodies Fatty cast Fat droplets Starch granules

Question 43

• Highly refractile and resembles RBC •___ resulting from contamination by immersion oil or lotions and creams • Air bubbles occur when using____

Answer 43

OIL DROPLETS AND AIR BUBBLES Oil droplets cover slip

Question 44

• Seasonal contaminants appearing as spheres with a cell wall and occasional concentric circles

Answer 44

POLLEN GRAINS

Question 45

• From clothing and diapers may be occasionally mistaken for casts but larger and more refractile • Examine under polarized light since they exhibit such

Answer 45

HAIR AND FIBERS