HARR (URINE MICROSCOPY) Flashcards
1
Q
1. Which of the following dyes are used in Sternheimer–Malbin stain? A. Hematoxylin and eosin B. Crystal violet and safranin C. Methylene blue and eosin D. Methylene blue and safranin
A
B
2
Q
- Which of the following statements regarding
WBCs in urinary sediment is true?
A. “Glitter cells” seen in the urinary sediment are a
sign of renal disease
B. Bacteriuria in the absence of WBCs indicates
lower urinary tract infection (UTI)
C. WBCs other than PMNs are not found in
urinary sediment
D. WBC casts indicate that pyuria is of renal, rather
than lower urinary, origin
A
D
3
Q
- Which description of sediment with
Sternheimer–Malbin stain is correct?
A. Transitional epithelium: cytoplasm pale blue,
nucleus dark blue
B. Renal epithelium: cytoplasm light blue, nucleus
dark purple
C. Glitter cells: cytoplasm dark blue, nucleus dark
purple
D. Squamous epithelium: cytoplasm pink, nucleus
pale blue
A
A
4
Q
- SITUATION: A 5-mL urine specimen is submitted
for routine urinalysis and analyzed immediately.
The SG of the sample is 1.012 and the pH is 6.5.
The dry reagent strip test for blood is a large
positive (3+) and the microscopic examination
shows 11–20 RBCs per HPF. The leukocyte
esterase reaction is a small positive (1+), and the
microscopic examination shows 0–5 WBCs per
HPF. What is the most likely cause of these
results?
A. Myoglobin is present in the sample
B. Free hemoglobin is present
C. Insufficient volume is causing microscopic results
to be underestimated
D. Some WBCs have been misidentified as RBCs
A
C
5
Q
- Which of the following statements regarding
epithelial cells in the urinary system is correct?
A. Caudate epithelial cells originate from the upper
urethra
B. Transitional cells originate from the upper
urethra, ureters, bladder, or renal pelvis
C. Cells from the proximal renal tubule are usually
round in shape
D. Squamous epithelium line the vagina, urethra,
and wall of the urinary bladder
A
B
6
Q
- Which of the statements regarding examination
of unstained sediment is true?
A. Renal cells can be differentiated reliably from
WBCs
B. Large numbers of transitional cells are often seen
after catheterization
C. Neoplastic cells from the bladder are not found
in urinary sediment
D. RBCs are easily differentiated from nonbudding
yeast
A
B
7
Q
- Which of the following statements regarding cells
found in urinary sediment is true?
A. Transitional cells resist swelling in hypotonic
urine
B. Renal tubular cells are often polyhedral and have
an eccentric round nucleus
C. Trichomonads have an oval shape with a
prominent nucleus and a single anterior
flagellum
D. Clumps of bacteria are frequently mistaken for
blood casts
A
B
8
Q
- Which of the following statements regarding
RBCs in the urinary sediment is true?
A. Yeast cells will lyse in dilute acetic acid but RBCs
will not
B. RBCs are often swollen in hypertonic urine
C. RBCs of glomerular origin often appear
dysmorphic
D. Yeast cells will tumble when the cover glass is
touched but RBCs will not
A
C
9
Q
- Renal tubular epithelial cells are shed into the
urine in largest numbers in which condition?
A. Malignant renal disease
B. Acute glomerulonephritis
C. Nephrotic syndrome
D. Cytomegalovirus (CMV) infection of the kidney
A
D
10
Q
10. The ova of which parasite may be found in the urinary sediment? A. T. vaginalis B. Entamoeba histolytica C. Schistosoma hematobium D. Trichuris trichiura
A
C
11
Q
11. Oval fat bodies are often seen in: A. Chronic glomerulonephritis B. Nephrotic syndrome C. Acute tubular nephrosis D. Renal failure of any cause
A
B
12
Q
- All of the following statements regarding urinary
casts are true except:
A. Many hyaline casts may appear in sediment after
jogging or exercise
B. An occasional granular cast may be seen in a
normal sediment
C. Casts can be seen in significant numbers even
when protein tests are negative
D. Hyaline casts will dissolve readily in alkaline urine
A
C
13
Q
13. Which condition promotes the formation of casts in the urine? A. Chronic production of alkaline urine B. Polyuria C. Reduced filtrate formation D. Low urine SG
A
C
14
Q
14. The mucoprotein that forms the matrix of a hyaline cast is called: A. Bence–Jones protein B. β-Microglobulin C. Tamm–Horsfall protein D. Arginine-rich glycoprotein
A
C
15
Q
15. “Pseudocasts” are often caused by: A. A dirty cover glass or slide B. Bacterial contamination C. Amorphous urates D. Mucus in the urine
A
C
16
Q
- Which of the following statements regarding
urinary casts is correct?
A. Fine granular casts are more significant than
coarse granular casts
B. Cylindruria is always clinically significant
C. The appearance of cylindroids signals the onset
of end-stage renal disease
D. Broad casts are associated with severe renal
tubular obstruction
A
D
17
Q
17. A sediment with moderate hematuria and RBC casts most likely results from: A. Chronic pyelonephritis B. Nephrotic syndrome C. Acute glomerulonephritis D. Lower urinary tract obstruction
A
C
18
Q
18. Urine sediment characterized by pyuria with bacterial and WBC casts indicates: A. Nephrotic syndrome B. Pyelonephritis C. Polycystic kidney disease D. Cystitis
A
B
19
Q
19. Which type of casts signals the presence of chronic renal failure? A. Blood casts B. Fine granular casts C. Waxy casts D. Fatty casts
A
C
20
Q
- SITUATION: Urinalysis of a sample from a
patient suspected of having a transfusion reaction
reveals small yellow-brown crystals in the
microscopic examination. Dry reagent strip tests
are normal with the exception of a positive blood
reaction (moderate) and trace positive protein.
The pH of the urine is 6.5. What test should be
performed to positively identify the crystals?
A. Confirmatory test for bilirubin
B. Cyanide–nitroprusside test
C. Polarizing microscopy
D. Prussian blue stain
A
D
21
Q
- When examining urinary sediment, which of the
following is considered an abnormal finding?
A. 0–2 RBCs per HPF
B. 0–1 hyaline casts per low-power field (LPF)
C. 0–1 renal cell casts per LPF
D. 2–5 WBCs per HPF
A
C
22
Q
- SITUATION: A urine sample with a pH of
6.0 produces an abundance of pink sediment
after centrifugation that appears as densely
packed yellow- to reddish-brown granules under
the microscope. The crystals are so dense that no
other formed elements can be evaluated. What is
the best course of action?
A. Request a new urine specimen
B. Suspend the sediment in prewarmed saline,
then repeat centrifugation
C. Acidify a 12-mL aliquot with three drops of
glacial acetic acid and heat to 56°C for
5 minutes before centrifuging
D. Add five drops of 1N HCl to the sediment and
examine
A
B
23
Q
- How can hexagonal uric acid crystals be
distinguished from cystine crystals?
A. Cystine is insoluble in hydrochloric acid but uric
acid is soluble
B. Cystine gives a positive nitroprusside test after
reduction with sodium cyanide
C. Cystine crystals are more highly pigmented
D. Cystine crystals form at neutral or alkaline pH,
uric acid forms at neutral to acidic pH
A
B
24
Q
- The presence of tyrosine and leucine crystals
together in a urine sediment usually indicates:
A. Renal failure
B. Chronic liver disease
C. Hemolytic anemia
D. Hartnup disease
A
B
25
Q
25. Which of the following crystals is considered nonpathological? A. Hemosiderin B. Bilirubin C. Ammonium biurate D. Cholesterol
A
C
26
Q
26. At which pH are ammonium biurate crystals usually found in urine? A. Acid urine only B. Acid or neutral urine C. Neutral or alkaline urine D. Alkaline urine only
A
D
27
Q
27. Which of the following crystals is seen commonly in alkaline and neutral urine? A. Calcium oxalate B. Uric acid C. Magnesium ammonium phosphate D. Cholesterol
A
C
28
Q
- Which crystal appears in urine as a long, thin
hexagonal plate, and is linked to ingestion of large
amounts of benzoic acid?
A. Cystine
B. Hippuric acid
C. Oxalic acid
D. Uric acid
A
B
29
Q
- Small yellow needles are seen in the sediment
of a urine sample with a pH of 6.0. Which of
the following crystals can be ruled out?
A. Sulfa crystals
B. Bilirubin crystals
C. Uric acid crystals
D. Cholesterol crystals
A
D
30
Q
30. Oval fat bodies are derived from: A. Renal tubular epithelium B. Transitional epithelium C. Degenerated WBCs D. Mucoprotein matrix
A
A
31
Q
31. Oval fat bodies are often associated with: A. Lipoid nephrosis B. Acute glomerulonephritis C. Aminoaciduria D. Pyelonephritis
A
A
32
Q
32. Urine of constant SG ranging from 1.008 to 1.010 most likely indicates: A. Addison’s disease B. Renal tubular failure C. Prerenal failure D. Diabetes insipidus
A
B
33
Q
- Which of the following characterizes prerenal
failure, and helps to differentiate it from acute
renal failure caused by renal disease?
A. BUN:creatinine ratio of 20:1 or higher
B. Urine:plasma osmolal ratio less than 2:1
C. Excess loss of sodium in the urine
D. Dehydration
A
A
34
Q
- Which of the following conditions characterizes
chronic glomerulonephritis and helps to
differentiate it from acute glomerulonephritis?
A. Hematuria
B. Polyuria
C. Hypertension
D. Azotemia
A
B
35
Q
- Which of the following conditions is seen in acute
renal failure and helps to differentiate it from
prerenal failure?
A. Hyperkalemia and uremia
B. Oliguria and edema
C. Low creatinine clearance
D. Abnormal urinary sediment
A
D
36
Q
- Which of the following conditions characterizes
acute renal failure and helps to differentiate it from
chronic renal failure?
A. Hyperkalemia
B. Hematuria
C. Cylindruria
D. Proteinuria
A
A
37
Q
- The serum concentration of which analyte is likely
to be decreased in untreated cases of acute renal
failure?
A. Hydrogen ions
B. Inorganic phosphorus
C. Calcium
D. Uric acid
A
C
38
Q
38. Which of the following conditions is associated with the greatest proteinuria? A. Acute glomerulonephritis B. Chronic glomerulonephritis C. Nephrotic syndrome D. Acute pyelonephritis
A
C
39
Q
39. Which of the following conditions is often a cause of glomerulonephritis? A. Hypertension B. Cytomegalovirus infection C. Systemic lupus erythematosus D. Heavy metal poisoning
A
C
40
Q
- Acute pyelonephritis is commonly caused by:
A. Bacterial infection of medullary interstitium
B. Circulatory failure
C. Renal calculi
D. Antigen–antibody reactions within the glomeruli
A
A
41
Q
41. All of the following are common characteristics of the nephrotic syndrome except: A. Hyperlipidemia B. Hypoalbuminemia C. Hematuria and pyuria D. Severe edema
A
C
42
Q
42. Which of the following conditions is a characteristic finding in patients with obstructive renal disease? A. Polyuria B. Azotemia C. Dehydration D. Alkalosis
A
B
43
Q
43. Whewellite and weddellite kidney stones are composed of: A. Magnesium ammonium phosphate B. Calcium oxalate C. Calcium phosphate D. Calcium carbonate
A
B
44
Q
- Which of the following abnormal crystals is often
associated with formation of renal calculi?
A. Cystine
B. Ampicillin
C. Tyrosine
D. Leucine
A
A
45
Q
- Which statement about renal calculi is true?
A. Calcium oxalate and calcium phosphate account
for about three-fourths of all stones
B. Uric acid stones can be seen by x-ray
C. Triple phosphate stones are found principally
in the ureters
D. Stones are usually comprised of single salts
A
A
