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