heme externship - UA 7.2-7.3 Flashcards
which of the following dyes are used to make Sternheimer-Malbin stain
A. hematoxylin and eosin
B. crystal violet and safranin
C. methylene blue and eosin
D. methylene blue and safranin
B.
- most common stain
- ID WBCs, epithelial cells and casts
- WBC = purple
- squamous = blue/purple
which of the following statements regarding WBCs in urinary sediment is true
A. glitter cells seen in urinary sediment are a sign of renal disease
B. bacteriuria in the absence of WBCs indicates lower UTI
C. WBCs and other PMNs are not found in urinary sediment
D. WBC casts indicate that pyuria is of renal, rather than lower urinary origin
D.
- the majority of cells in urine will be PMNs
- glitter cells are WBCs in a hypotonic solution
- Bacteria without cells is usually contamination
Which description of urinary sediment with the sternheimer-malbin stain is correct
A. transitional epithelium: cytoplasm 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 plae blue
A.
- RTE: blue/purple
- squamous: blue/purple
- WBC: purple
- RBC: pink to purple
a 5-mL urine specimen is submitted for routine urinalysis and is analyzed immediately. The SG of the sample is 1.012, and the pH is 6.5. The dry reagent strip blood test result is a large positive (3+), and the microscopic examination shows 11-20 RBCs/hpf. The leukocyte esterase reaction is a small positive (1+), and the microscopic examination shows 0-2 WBCs/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
C. insufficient volume
- given SG and pH most cells will be intact but lower than expected due to volume
which of the followign 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
D. squamous epithelium line the vagina, urethra, and wall of the urinary bladder
B.
which of the statements regarding examination of unstained urinary 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
B.
- due to scraping during entry, many cells are released
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 nucleus
C. trichomonads have an oval shape with a prominent nucleus and a single anterior flagellum
D. clumps of bacteria are frequently mistake for blood casts
B.
- transitional cells easily take in water
- T. vaginalis has indistinct nucleus and two anterior flagella
- urates/phosphates are more likely to be mistaken as blood casts
which of the following statements regarding RBCs in the urinary sediment is true
A. rest 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 class is touched, RBCs will not
C. dysmorphic due to squeezing through pores they shouldn’t fit through
renal tubular epithelial cells are shed into the urine in the largest numbers in which condition
A. malignant renal disease
B. acute glomerularnephritis
C. nephrotic syndrome
D. CMV
D.
- also seen in glomerulonephritis and pyelonephritis just lots more in a viral infection
the ova of which parasite is likely to be found in the urinary sediment
A. T. vaginalis
B. E. histolytics
C. S. hematobium
D. T. trichiura
C.
oval fat bodies are often seen in
A. chronic glomerulonephritis
B. nephrotic syndrome
C. acute tubular nephrosis
D. renal failure of any cause
B.
- due to loss of oncotic pressure from loss of albumin, more serum lipids are made to balance out
- would see marked proteinuria and fat droplets in sediment
which statement regarding urinary casts is true
A. many hyaline casts may appear in urinary sediment after jogging or exercise
B. the finding of even a single cast indicates renal disease
C. casts can be seen in significant numbers even when protein tests are negative
D. hyaline casts will dissolve readily in acid urine
A.
- typically associated with dehydration and strenuous exercise
which condition promotes the formation of casts in urine
A. chronic production of alkaline urine
B. polyuria
C, reduced filtrate formation
D, low urine SG
C.
- promoted by acid filtrate, high solutes, slow movement of filtrate and reduced filtrate formation -> acid, slow and low
the mucoprotein that forms the matrix of a hyaline cast is called
A. bence-jones proteins
B. beta-microglobulin
C, tamm-horsfall protein
D. arginine-rich glycoprotein
C.
‘Pseudocasts’ are often caused by
A. dirty cover glass or slide
B. bacterial contamination
C. amorphous urates
D. mucus in urine
C.
- urates may deposit in cast ish rods when settling under the cover slip
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 fo cylindroids signals the onset of end stage renal disease
D. broad casts area associated with secure renal tubular obstruction
D.
- no clinical difference between fine and course casts
- cylindruria = presence of casts in the urine
- broad casts are from long term urinary stasis
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
C.
- casts = tubule involvement (renal)
- acute = blood
urine sediment characterized by pyuria with bacterial and WBC casts indicate
A. nephrotic syndrome
B. pyelonephritis
C. polycystic kidney disease
D. cystitis
B.
- pyelonephritis = upper urinary infection
- casts = renal and tubule involvement
which type of casts signals the presence of chronic renal failure
A. blood casts
B. fine granular csts
C. waxy casts
D. fatty casts
C.
- waxy = breakdown of cellular casts over a long period of time = chronic and end stage renal failure
SITUATION: Urinalysis of a sample from a PT suspected of having a transfusion reaction reveals small, yellow-brown crystals in microscopic exam. Strip test are normal w/ exception of pos blood (mod) and trace pos protein. The pH is 6.5. What test should be performed to positively identify the crystals
A. confirmatory test of bilirubin
B. cyanide-nitroprusside test
C. polarizing microscope
D. prussian blue stain
D. prussian blue
- suspect hemosiderin = stain blue with prussian blue
- not bili since bili was not pos on strip
when examining urinary sediment, which of the following is considered an abnormal finding
A. 2RBC/hpf
B. 1 hyaline cast/LPF
C. 1 renal cell cast/LPF
D. 5 WBCs/hpf
C.
- renal cell casts = bad (disease process effecting the tubules)
SITUATION: a urine sample with a pH of 6.0 produces an abundance of pink sediment after centrifugation that appears as a densely packed yellow/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. and then repeat centrifugation
C. acidify a 12 mL aliquot with 3 drops of glacial acetic acid, and heat to 56 C for 5 minutes before centrifuging
D. add 5 drops of 1N HCl to the sediment and examine
B.
- amorphous urates from acidic pH are not clinically significant and can be warmed away
how can hexagonal uric acid crystals be distinguished from cystine crystal
A. cystine is insoluble in HCl but uric acid is soluble
B. cystine give a pos 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
B.
- both form at neutral to acid
- uric urally has more color
the presence of tyrosine and leuciune crystals together in urinary sediment usually indicates:
A. renal failure
B, chronic liver disease
C. hemolytic anemia
D. hartnup disease
B.
- tyrosine can be from a metabolism problem but when with leucine = cirrhosis of the liver
which fo the following crystals is considered nonpathological
A. hemosiderin
B. bilirubin
C. ammonium bi-urate
D. cholesterol
C.
- formed from storage
at which pH are ammonium bi-urate crystals usually found in urine
A. acid only
B. acid or neutral
C. neutrla or alkaline
D. alkaline
D.
- thorny apples
which of the following crystals is seen commonly in alkaline and neutral urine
A. calcium oxalate
B. uric acid
C. magnesium ammonium phosphate (triple phos)
D. cholesterol
C. triple pos
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
B.
- resembles triple phosphate
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
B. bilirubin
C. uric acid
D. cholesterol
D.
- the shape is all wrong
oval fat bodies are derived from
A. RTE cells
B. transitional cells
C degenerated WBCs
D. mucoprotein matrix
A.
- degenerated RTE cells reabsorb cholesterol from filtrate = fat bodies
oval fat bodies are often associated with
A. lipoid necrosis
B. acuteglomerulonephritis
C. aminoaciduria
D. pyelonephritis
A.
-lipid nephrosis = synonym for pirmary nephrotic syndrome associated with proteinuria, edema and hyperlipidemia
urine of a constant SG ranging from 1.008 to 1.010 most likely indicates
A. addison disease
B. renal tubular failure
C. prerenal failure
D. diabetes insipidus
B.
- that SG is equivalent to the bowman space (same osmolality as plasma) indicating that nothing is being reabsorbed or released into the urine = tubule re-absorption issue
which of the following characterizes prerenal failure, and helps to differentiate it from acute renal failure cased by renal disease
A. a BUN:creatinine ratio >20:1
B. urine: plasma osmolal ratio of less than 2:1
C. excess loss of sodium in urine
D. dehydration
A.
- pre renal failure is due to loss of blood flow to the kidney
- tubules are undamaged and will reabsorb more BUN than normal since filtrate is slow but reabsorb sodium at a constant rate
- in renal disease BUN: creatinine ratio is 10 or less
which of the following conditions characterizes chronic glomerulonephritis and helps differentiate it from acute glomerulonephritis
A. hematura
B. polyuria
C. hypertension
D. azotemia
B.
- polyuria = slight decrease in urine (chronic is from scaring of the tubules), in acute failure it progresses to anuria
which of the following conditions is seen in acute renal failure and helps differentiate it from pre-renal failure
A. hyperkalemia and uremia
B. oliguria and edema
C. low creatinine clearance
D. abnormal urinary sediment
D.
- pre renal failure would have normal urine sediment since the tubules are re-absorbing what they should and the kidney isn’t the issue
- acute renal failure will have RBCs and RBC casts
which of the following conditions characterizes acute renal failure and helps differentiate it from chronic renal failure
A. hyperkalemia
B. hematuria
C. cylindruria
D. proteinuria
A.
- chronic = scarring = no salt or water re-abs
- acute = glom filtration low = decreased tubular secretion = hyperkalemia
the serum concentration of which analyte is likely to be decreased in untreated cases of acute renal failure
A. H ions
B. inorganic phosphorus
C. calcium
D> uric acid
C.
- due to failure to respond to parathyroid hormone = loss of calcium
which of the following conditions is associated with the greatest proteinuria
A. acute glomerulonephritis
B. chronic glomerulonephritis
C. nephrotic syndrome
D. acute pyelonephritis
C. nephrotic syndrome
- marked proteinuria and edema and oval fat bodies
which fo the following conditions is often a cause of glomerulonephritis
A. hypertension
B. CMV
C. SLE
D. heavy metal poisoning
C.
- autoimmune diseases, diabetes mellitus and nephrotoxic drugs are common causes of acute glomerulonephritis
- autoimmune from Ab-Ag complexes and compliment-mediated damage
acute pyelonephritis is commonly caused by
A. bacterial infection of medullary interstitium
B. ciculatory failure
C. renal calculi
D. Ag-Ab reactions within the glomeruli
A.
- pyelonephritis = infection of medullary interstitium (tubule area) from upwardly migrating bacteria
which of the following is associated with nephrotic syndrome
A. hyperlipidemia
B. uremia
C. hematuria and pyuria
D. dehydration
A.
- body’s normal response to loss of albumin and oncotic pressure to retain balance = production of lipoproteins
which of the following conditions is a characteristic finding in patients with obstructive renal disease
A. polyuria
B. azotemia
C. dehydration
D. alkalosis
B.
- usually obstructive diseases are from kidney stones causing hydrostatic pressure to increase which opposes filtration
- azotemia = build up of BUN
- if no filtration then build-up/backup of BUN and what not into the plasma
whewellite and weddellite kidney stones are composed of
A. magnesium ammonium phosphate
B. calcium oxalate
C. calcium phosphate
D. calcium carbonate
B.
- stupidest name I have ever heard = calcium oxalate
which of the following abnormal crystals is often associated with the formation of renal calculi
A. cystine
B. ampicillin
C. tyrosine
D. leucine
A.
- cystine crystals are insoluble and form crystals that lodge in tissues in the body
which statement about renal calculi is true
A. calcium oxalate and calcium phosphate account for about 3/4s of all stones
B. uric acid stones can be seen on radiography
C. triple phosphate stones are found principally in ureters
D. stones are usually composed of single salts
A.
- stones are usually many salts
- uric acid stones are red-brown but not on radiography
- triple phosphate (struvite) stones are radio-dense and lodge in pelvis = radiographically visible
CSF is formed by ultrafiltration of plasma through the
A. choroid plexus
B. sagittal sinus
C. anterior cerebral lymphatics
D. arachnoid membrane
A.
- glucose in CSF = 60% of plasma
- TP in CSF = 15-45 mg/dL
- Cl levels = 10-15% higher than plasma
- recirculate via saggital sinus
which statement regarding CSF is true
A. normal values for mononuclear cells are higher for infants than for adults
B. absolute neutrophilia is not significant if the total WBC count is less than 25 uL
C, the first aliquot of CSF should be sent to the micro department
D. neutrophils compose the majority of WBCs in normal CSD
A.
- kid CSF = higher monos and macrophages than PMNs (opp for adults)
when collecting CSF, a difference between opening and closing fluid pressure greater than 100 mm H2O indicates
A. Low CSF volume
B. subarachnoid hemorrhage
C. meningitis
D< hydrocephalus
A.
- the difference is normally 10-30 mm H2O after removal of 15-20mL of CSF
- if low volume the pressure difference is greater
whihc of the following findings is consistent with a subarachnoid hemorrhage rather than a traumatic tap
A. clearing of the fluid as it is aspirated
B. a clear supernatant after centrifugation
C. xanthochromia
D. presence of protein in the sample
C.
the term used to denote high WBC in the CSF
A. empyema
B. neutrophilia
C. pleocytosis
D. hyperglycorrhachia
C,
given the following data, determine the corrected CSF WBC count
- CSF: (1) RBC: 6000/uL (2) WBC: 150/uL
- PS (1) RBC: 4.0 x 10^6 (2) WBC: 5.0 x 10^6
A. 8/uL
B. 142
C. 120
D. 145
B.
equation = WBCs in CSF - [(blood WBC x CSF RBC)/ blood RBCs]
- corrected = 150 - [(5000 x 6000)/ 4,000,000]
= 142
SITUATION: what is the most likely cause of the following
- CSF: (1) glucose: 20mg/dL (2) protein: 200 mg/dL (3) lactat: 50 mg/dL [RR:5-35]
A. viral meningitis
B. viral enxephalitis
C. cryptococcal meningitis
D. acute bacterial meningitis
D.
- due to increased Ig, low glucose and lactate
- lactate levels rise from increased pressure and hypoxia from bacterial oxidation
which of the following conditions is most often associated with normal CSF glucose and protein
A, MS
B. malignancy
C. subarachnoid hemorrhage
D. viral meningitis
D.
the diagnosis of MS is suggested by which finding
A. presence of elevated protein and low glucose
B. decreased IgG index
C. presence of oligoclonal bands by electrophoresis
D< increased level of CSF beta-microglobulin
C.w
Which of the following results is consistent with fungal meningitis
A, NOrmal glucose
B. pleocytosis of mixed cellularity
C. normal CSF protein
D. high CSF lactate
B.
- would see; low glucose, high TP, slightly increase in lactate
in what suspected condition should a wet prep using a warm slide be examined
A. cryptococcal meningitis
B. amoebic meningoencephalitis
C. mycobacterium tuberculosis
D. neurosyphilis
B.
- keeps the bugs warm and moving
which of the following CSF test results is most commonly increased in patients with MS
A. glutamine
B. lactate
C. IgG index
D. ammonia
C. an index greater than 0.85 suggest MS
which of the following is an inappropriate procedure for performing routine CSF analysis
A. differential is done only if the total WBC sount is greater than 10/uL
B. differential should be done on a stained CSF concentrate
C. a minimum of 30 WBCs should be differentiated
D. a wright stain slide should be examined rather than a chamber differential
A.
which cell is present in CSF in greater numbers in newborns than in older children or adults
A, eos
B. lymphs
C. monos
D. PMNS
C. monos
neutrophilic pleocytosis is usually associated wiht all of the following except
A. cerebral infarction
B. malignancy
C. myelography
D. neurosyphilis
D.
- neurosyphilus is viral so lymphocytosis
which statement about CSF protein is true
A. an abnormal serum protein electrophoretic pattern does not affect the CSF pattern
B. the upper reference limit for CSF total protein in newborns is one half the adult level
C, CSF IgG is increased in pancephalitis, malignancy and neurosyphilis
D. antibodies to Treponemia pallidum disappear after successful antibiotic therapy
C
which of the following statements regarding routine microbiological examination of CSF is true
A. a grma stain is performed on the CSD prior to concentration
B. the gram stain is positive in fewer than 40% of cases of acute bacterial meningitis
C. India ink and acid fast stains are indicated if neutrophilic pleocytosis is present
D< all CSF specimens should be cultured using SBA. CHOC, and broth
D.
which organism is the most frequent cause of bacterial meningitis in neonates
A. N. meningitidis
B. group B strep
C. h. influenza
D. kleb pneumonia
B.
- grp B strep and e coli are most common in neonates
- s. pneumoniae, h. influ and n. meningitidis are commin in children
- s. pneumoniae is most common in adults
following a head injury. which protien will identify the presence of CSF leakage through the nose
A. transthyretin
B. myelin basic protein
C, tau protein
D. CRP
C. tau protein
which of the following statements regaring serous fluids is true
A. the normal volume of plerual fluid is 30-50mL
B. mesothelial cells, PMNs, lymphs and macros may be present in normal fluids
C. radiography can detect a 1-% increase in the vol of serous fluid
D. normal seorus fluids are colorless
B.
the term effusion refers to
A. chest fluid that is purulent
B. serous fluid that is chylous
C, increased volume of serous fluid
D. inflammatory process affecting the appearance of a serous fluid
C.
- either transudates, exudates or chylous
which of the following laboratroy results is characteristic of a transudative fluid
A. SG of 1.018
B. TP = 3.2 g/dL
C. LD fluid:serum = 0.25
D. TP fluid:serum = 0.65
C.
- exudate ratio is greater than 0.6 from the release of enzymes from inflammatory or malignant cells
which observation is least useful in distinguishing a hemorrhagic serous fluid from a traumatic tap
A. clearing of fluid as it is aspirated
B. presence of xanthochromia
C. the formation of a clot
D. diminished RBC count in successive aliquotes
C.
- clot can form in both except for transudative fluid (will not clot)
which of the following laboratory results on a serous fluid is most likely to be caused by a traumatic tap
A. a RBC count of 8,000 uL
B. a WBC count of 6,000/uL
C. a hematocrit of 35%
D. a neutrophil count of 55%
A.
which of the following conditions is commonly associated with an exudative effusion
A. congestive heart failure
B. malignancy
C. nephrotic syndrome
D. cirrhosis
B.
- transudate = circulatory problems (the fluid build-up is secondary to another issue)
- exudate = inflammatory process (fluid build up is a direct issue)
which of the following conditions is associated with a chylous effusion
A. necrosis
B. pulmonary infarction or infection
C. systemic lupus erythematosus or rheumatoid arthritis
D. lymphatic obstruction
D.
- all the others are characterized by inflammation
- chylous = lymphatic build-up around the lungs (pseudo= cholesterol, real chylous= trigs)
which of the following conditions is most often associated with a pleural fluid glucose below 30 mg/dL
A. diabetes mellitus
B. pancreatitis
C. rheumatoid arthritis
D. bacterial pneumoniaia
C.
- pleural fluid usually has the same glucose as plasma
- glucose levels are lowest in RA affecting the lungs
in which condition is the pleural fluid pH likely to be above 7.3
A. bacterial pneumonia with paraoneumonic exudate
B. RA
C. esophageal rupture
D. pneumothorax
D.
- pneumothorax = air entering pleural pace
which of the following hematology values best frames the URLs for peritonealfluid
A. WBC: 300/uL, PMN%: 25, RBC: 100,000/uL
B. WBC: 10,000/uL, PMN%: 50%, RBC: 500,000/uL
C. WBC: 50,000/uL, PMN%: 50%, RBC: 500,000/uL
D. WBC: 100,000/uL, PMN%: 75%, RBC: 1,000,000/uL
A.
- WBC <300/uL and PMNS no more than 25% of cell population
which of the following characteristics is higher for synovial fluid than for serous fluids
A. specific gravity
B. glucose
C. total protein
D. viscosity
D.
- synovial fluids are more viscous due to higher hyaluronate (mucoprotein)
in which type of arthritis is the synovial WBC count likely to be greater than 50,000/uL
A. septic arthritis
B. osteoarthritis
C. rheumatoid arthritis
D. hemorrhagic arthritis
A.
- elevated in all but highest in septic (due to infection)
what type of cell is a ‘ragocyte’
A. cartilage cell seen in inflammatory arthritis
B. a PMN with inclusions formed by immune complexes
C. a plasma cell seen in RA
D. a macrophage containing inclusions
B.
- PMNs with dark granules of Igs seen in gout, septic arthritis and RA
which of the following crystals is the cause of gout
A. uric acid or monosodium urate
B. calcium pyrophosphate or apatite
C. calcium oxalate
D. cholesterol
A.
- MSU: needle crystals with yellow perpendicular polarization in red compensator
- uric acid: lemons or needles in toes
which crystal causes ‘pseudogout’
A. oxalic acid
B. calcium pyrophosphate
C. calcium oxalate
D. cholesterol
B.
- needles or rhomnic plates that look like uric acid which gives the name pseudogout
- collect synovial in sodium heparin since the crystals may form in vitro
a synovial fluid sample is examined by using a polarizing microscope with a red compensating filter. Crystals are seen that are yellow when then long axis of the crystal is parallel to the slow vibrating light. When the long axis of the crystal is perpendicular to the slow vibrating light, the crystals appear blue. What type of crystal is present
A. calcium oxalate
B. calcium pyrophosphate
C. uric acid
D. cholesterol
C.
- uric acid and MSU polarize the same (needles vs plates)
- the yellow parallel distinguishes uric acid from calcium pyrophosphate (gout v pseudogout) since pyrophosphate is the opposite
in which condition is the synoial fluid glucose most likely to be within normal limits
A. septic arthritic
B. inflammatory arthritis
C. hemorrhagic arthritis
D. gout
C.
- septic = lower
- gout = lower
- osteoarthritis and hemorrhagic = normal
which statement about synovial fluid in RA is true
A. synovial:serum IgG is usually 1:2 higher
B. total hemolytic complement is elevated
C. nintey percent of RA cases test positive for rheumatoid factor in synovial fluid
D. demonstration of rheumatoid factor in joind fluid is diagnostic for RA
A.
- present in serum and synovial fluids for RA, SLE and inflammatory disease patients
- present in about 60% of patients in synovial
which of the following organisms accounts for the majority of septic arthritis cases in young and middle age adults
A. H. influenza
B. neisseria gonorrhea
C. staph aures
D borrelia burgodorferi
B.
-all may cause septic arthritis but N. gonorrhoeae = 75% of cases
- staph = older adult majority (infected joint replacements)
- haemophilus, staph and strep = young children arthritis
which of the following hematology values best frames the URLs for synovial fluid
A. WBC: 200/uL, PMNs: 25%, RBC: 2,000/uL
B. WBC: 5,000/uL, PMNs:50%, RBC:10,000/uL
C. WBC:10,000/uL, PMNs:50%, RBC: 50,000/uL
D. WBC: 20,000/uL, PMNs: 5%, RBC: 500,000/uL
A.
