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Urinalysis and Body Fluids 4214 > LAB- Microscopic Examination > Flashcards

LAB- Microscopic Examination Flashcards

1
Q

Brightfield microscope:
Contrast is obtained by…

A

lowering the condenser and
stopping down the iris diaphragm

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2
Q

Requires a special condenser and objective with phase rings – produces a halo effect and increases contrast

A

Phase-contrast microscope

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3
Q

-Used for examining lipid material
-Lipids and cholesterol have a Maltese-cross appearance

A

Polarized microscope

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4
Q

Provides a three-dimensional image showing very fine structural detail

A

Interference-contrast microscope

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5
Q

Stain that provides clear delineation of structure and contrasting colors of the nucleus and cytoplasm

A

Sternheimer-Malbin stain (crystal violet and safranin O)

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6
Q

Stains triglycerides and neutral fats orange-red

A

Lipid stains: Oil Red O and Sudan III

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7
Q

What is the Hansel stain? and what is it used for?

A

Methylene blue and eosin Y stain eosinophilic granules

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8
Q

Stains structures containing iron

A

Prussian blue stain

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9
Q

Casts and crystals are recorded as number per ____ power field

A

low (x100)

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10
Q

Cells are recorded as number per _____ power field

A

high (x400)

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11
Q

How many fields should be examined in each case?

A

10

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12
Q

Reaction of body tissues to injury?

A

-Capillaries dilate and plasma proteins “leak” into the
surrounding tissue spaces
-WBCs are mobilized to combat the injury and repair the damage
-Neutrophils, monocytes, lymphocytes, occ. Eosinophils, histocytes, and macrophages

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13
Q

Congested, dilated glomerular capillaries
release

A

red cells and protein into the urine

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14
Q

With bacterial infection in the kidney or bladder,
neutrophils are…

A

mobilized and excreted w/
bacteria in the urine

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15
Q

___________ appear when a transplanted kidney is rejected.

A

lymphocytes

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16
Q

What can cause increased numbers of epithelial cells from the tubules?

A

-infections
-diminished blood supply
-tubules being affected by drugs or chemicals

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17
Q

What distinguishes kidney disease from lower urinary tract disease?

A

urinary casts

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18
Q

urinary casts only form in the kidney _______ and _________.

A

tubules, collecting ducts

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19
Q

contents of normal urinary sediment includes:
RBCs (_____ per hpf)
WBCs (_____ per hpf) – mostly neutrophils
Epithelial cells
Squamous and transitional cells
Casts (Hyaline)
Mucus
Crystals
Artifacts
Spermatozoa

A

0-3 (7 micrometers)

0-8

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20
Q

Increased ______ in urine may be one of the first
clinical signs of malignancy of kidney or bladder

A

RBCs

*presence is clinically significant!

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21
Q

When RBCs are seen with RBC casts, the source of hematuria is _______.

A

renal

(Inflammatory diseases, acute glomerulonephritis,
pyelonephritis, hypertension, bleeding due to trauma,
stones or tumors, and use of anticoagulants)

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22
Q

Red blood cells act as ___________ because they are altered by the specific gravity.

A

osmometers

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23
Q

How can RBCs and yeast be differentiated?

A

Yeast are oval in shape and show budding
Can use Eosin dye (RBC – red, yeast- colorless)
Can use acetic acid (RBC – lyse, yeast – no change)

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24
Q

WBC are best preserved in what type of urine?

A

acidic

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25
Q

What does greater than 50 WBCs suggest?

A

acute inflammation of genitourinary tract – culture should be done

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26
Q

> 50 WBCs accompanied with

proteinuria suggests….

A

pyelonephritis

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27
Q

> 50 WBC accompanied WITHOUT

proteinuria suggests…

A

lower urinary tract
infection (cystitis, urethritis, and prostatitis)

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28
Q

Neutrophils are most common WBC seen - multi lobed nucleus (_____ µm)

A

10-14

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29
Q

What can be confused with renal tubular cells?

A

Neutrophils.

acetic acid clarifies nuclei

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30
Q

Degenerated neutrophils are called “glitter cells” and is seen with…

A

hypotonic urine, and pyelonephritis

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31
Q

What may be the first sign of kidney transplant rejection?

A

Lymphocytes (6 to 9 µm)

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32
Q

What do monocytes suggest?

A

tissue damage
accompanied by severe inflammation (20 to 40
µm)

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33
Q

specialized white cells
formed in the reticuloendothelial system

-May contain inclusion bodies such as bacteria or
epithelial cells
-Suggest inflammation, immune mechanisms, or
other host defense reactions

A

Phagocytic histocytes

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34
Q

-Squamous (pavement) epithelial cells (40 to 60 µm w/ N:C ratio of ____)

A

1:6

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35
Q

Where do squamous epithelial cells originate?

A

terminal portion of the urethra in men and women, and the vagina in women

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36
Q

How do squamous epithelial cells appear when stained?

A

pink or violet

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37
Q

Occurrence of squamous epithelial cells is __________, and may indicate vaginal
contamination due to improper specimen collection

A

common

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38
Q

How are squamous epithelial cells reported?

A

Report as rare, moderate, or many per lpf (only cell to
report on lpf)

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39
Q

What is the second major epithelial cells?

A

Transitional epithelial cells (20 to 40 µm w/ N:C ratio of
1:3)

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40
Q

Where are transitional cells located?

A

Line the renal pelvis and calices, ureters, bladder, and
two-thirds of the urethra

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41
Q

Polyhedral in shape, appear pear-shaped, or oval with one or more nuclei

A

transitional epithelial cells

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42
Q

transitional cells are the same size as renal tubular cells, but may become larger
due to _________.

A

swelling

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43
Q

How do transitional cells appear when stained?

A

cells show dk. Blue nuclei w/ pale blue cytoplasm

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44
Q

Transitional cells are found in normal urine, but in large numbers these cells indicate…

A

disease of the bladder or renal pelvis, or the use
of a catheter

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45
Q

Renal tubular epithelial cells (12 to 20 µm w/ N:C ratio of
____)

A

1:1

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46
Q

What is the most clinically significant epithelial cell?

A

Renal tubular

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47
Q

Where do renal tubular cells come from?

A

Originate from the epithelial lining of the nephron’s tubular portions

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48
Q

Polyhedral in shape w/ slightly granular cytoplasm

A

renal tubular epithelial cells

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49
Q

When stained, appear purple w/ orange-purple cytoplasm

A

renal tubular epithelial cells

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50
Q

What cell type can undergo fatty degeneration – oval fat bodies?

A

renal tubular epithelial cells

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51
Q

What can >2 RTEs indicate?

A

acute tubular necrosis,
glomerulonephritis, acute infection, renal toxicity, and
renal infection

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52
Q

-Lipid-containing RTE cells
-Usually seen in conjunction with free-floating fat
droplets

A

Oval Fat Bodies

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53
Q

How is identification of oval fat bodies confirmed?

A

w/ Sudan III or Oil Red
O stains (orange-red), and the use of polarized
microscopy (Maltese cross formation)

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54
Q

What are oval fat bodies associated with?

A

nephrotic syndrome, acute tubular necrosis, diabetes mellitus, trauma cases where
bone marrow is released from the long bones

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55
Q

What does the presence of cytomegalic inclusion bodies suggest?

A

cytomegalic inclusion
disease, Hodgkin’s disease, lymphosarcoma,
leukemia, and aplastic anemia

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56
Q

What is it called when renal tubular cells have viral
inclusions in the nucleus of these cells?

A

Cytomegalic inclusion bodies

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57
Q

What is referred to as “owl-eye” cells?

A

When Cytomegalic inclusion bodies are stained w/ eosin or Giemsa stain, these
inclusion bodies appear separated by a clear halo

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58
Q

How do tumor cells appear?

A

Appearance varies, but most are identified on the basis of distinct nuclear changes
-Nucleus is much larger than normal

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59
Q

Tumor cells readily accept ___________ stain.

A

Papanicolaou

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60
Q

Tumor cells are usually accompanied by…

A

hematuria

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61
Q

> _______ bacteria per ml indicates a urinary tract infection.

Counts between _______ and _________ need to be repeated.

A

100,000

10,000 and 100,000

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62
Q

A count of _________ bacteria usually signifies urine contaminated from the
urethra or perineum

A

<10,000

Very low counts occur in patients on antibiotic therapy

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63
Q

Large quantities of bacteria accompanied by WBCs
and/or white cell or mixed casts indicate the presence of…

A

acute pyelonephritis

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64
Q

yeast can be found in patients with…

A

-diabetes mellitus
-urinary tract infections
-also common contaminate from skin and hair yeast

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65
Q

Characteristics of yeast that differentiates it from RBCs?

A

-ovoid
-higher refractive index
-budding
-does not take on eosin stain

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66
Q

a blood fluke that may be seen in the urine

A

Schistosoma hematobium

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67
Q

anterior flagellae and undulating membrane parasite

A

Trichomonas

-found in patients w/
urethritis or in the contaminated urine of
women w/ trichomonas vaginitis

68
Q

parasite of the anus that may be seen during microscopic evaluation

A

Enterobius vermicularis

69
Q

Protein material
produces by glands
and epi cells of the
lower GI tract and
RTE cells

A

Mucus (report per low power field)

70
Q

Mucus consists of ___________ protein.

A

Tamm-Horsfall

71
Q

Where are casts formed?

A

-distal convoluted tubule
-collecting duct

72
Q

What are the two ways casts can be formed?

A

From the precipitation and gelling of the mucoprotein
found in the tubular fluid. Acid pH and high salt
concentration promote this gelling and precipitation
process.
From the conglutination of cells in the mucoprotein of
the tubular fluid

73
Q

Casts are reported as number per ____ power field.

A

low

74
Q

Hyaline casts are formed from…

A

plasma proteins and/or TammHorsfall mucoprotein (a protein gel secreted by
the RTE cells lining the distal portion of the renal tubule

-basis upon which all casts are formed

75
Q

What is a normal amount of hyaline casts?

A

0-2 hyaline casts/lpf

76
Q

Increased numbers of hyaline casts are associated with….

A

acute glomerulonephritis, acute pyelonephritis,
congestive heart failure, and chronic renal failure

77
Q

Hyaline casts have a low refractive index. How are they stained?

A

Pale pink color w/ Sternheimer-Malbin stain

78
Q

Hyaline casts dissolve easily in what type of urine?

A

alkaline

Few appear in standing urine (>1 hr) since bacterial
contamination causes urea to decompose to form
ammonia, an alkaline medium

79
Q

Red blood cell casts almost always indicates…

A

renal disease

80
Q

How do RBC casts appear stained and unstained?

A

High refractive index

 Unstained are yellow-orange in color
 Stained are pale lavender

81
Q

Red blood cell casts usually occurs in diseases where what has been damaged?

A

the basement
membrane of the glomerulus has been damaged, thus
allowing RBC passage into Bowman’s capsular space

82
Q

What are two diseases RBCs are associated with?

A

acute glomerulonephritis and lupus nephritis

83
Q

RBC casts are always observed with?

A

free-standing RBCs

84
Q

What are WBC casts commonly called?

A

“pus” casts

85
Q

WBC casts can be difficult to distinguish from __________ casts.

A

epithelial

86
Q

WBC casts are always observed with…

A

free standing WBCs

87
Q

How do WBC casts appear?

A

-highly refractive
-Degeneration may cause granular appearance
-Can be difficult to differentiate from Epithelial
casts

88
Q

WBC casts can be reported as either cellular or _________.

A

cellular-granular

89
Q

What color are WBC casts when stained?

A

purple to blue-green

90
Q

What is the most common cause of WBC casts?

A

acute pyelonephritis***

91
Q

Acute pyelonephritis is usually accompanied by…

A

large number of WBCs
in sediment, proteinuria and bacteriuria

92
Q

WBC casts play a secondary role in….

A

acute
glomerulonephritis

93
Q

Casts may contain a few fat droplets w/in a hyaline
matrix, or may be filled w/ fat globules of different sizes

A

Fatty Casts

-Fat is globular in shape, brownish-tan in color, and highly refractive

94
Q

Fatty casts are best recognized using a __________ microscope, which gives
lipid globules a distinctive Maltese cross configuration and double refractive appearance

A

polarized

95
Q

When fatty casts are accompanied by passive proteinuria, associated with…

A

nephrotic syndrome

-Also seen w/ diabetes mellitus, and poisoning from mercury or ethylene glycol

96
Q

Consist of renal tubular epithelial cells
-Highly refractive, with single large round nucleus

A

Epithelial Cell Casts

97
Q

How do Epithelial Cell Casts appear when stained?

A

have a purple nuclei surrounded by pale pink matrix

98
Q

Epithelial Cell Casts are usually arranged in a symmetric manner,
indicating…

A

damage to an entire portion of the tubule

When in random manner, indicates damage to
different and separate portions of the tubule

99
Q

Epithelial Cell Casts suggests…

A

intrinsic kidney disease involving the renal tubules

Glomerulonephritis, vascular disease, exposure
to a toxin, or presence of a virus
Injured cells may contain inclusions which suggest the primary injury affecting their
degeneration

100
Q

Regarded as those casts which have at least two well defined and distinct portions
Ex: part epithelial and part granular, or part granular and part waxy

A

Mixed Casts

101
Q

The presence of different cellular constituents in a cast often implies that…

A

more than one part of the nephron has
been injured
Ex: if both red and white blood cells appear in a
cast, both glomerular and interstitial damage
may be indicated

102
Q

Opaque and are characterized by the
presence of course or fine granules
Some casts may represent degeneration of cellular casts
Shrinkage and fragmentation of cell nuclei,
membrane disruption, and granulated cytoplasm
Granules contain aggregates of plasma
proteins

A

Granular Casts

103
Q

Granular casts accompany heavy….

A

proteinuria (nephrotic syndrome)

104
Q

Granular casts could indicate…

A

orthostatic proteinuria,
congestive heart failure w/ proteinuria, as
well as chronic or acute renal disease

105
Q

What is the order of different cast formation?

A

Cellular cast → coarsely granular cast → finely granular cast → waxy cast

106
Q

When stained, course granules are _____ purple, and fine granules are a ______ purple color

A

deep, light

107
Q

Waxy casts represent final phase of cellular degeneration
Identified easily due to sharp refractive outlines, and “broken off” ends
When stained, appear light to dark _______

A

purple

108
Q

What are waxy casts associated with?

A

-extreme urine stasis, seen with chronic renal disease/failure, or kidney
disease resulting from diabetes mellitus
-Numerous waxy casts indicate a fairly long
renal transit time

109
Q

Broad casts are Larger diameter and believed to be formed in __________ which have undergone dilation and
destruction

A

renal tubules

110
Q

What is referred to as “renal failure casts”?

A

Broad casts

111
Q

Broad casts indicate __________ renal diseases, caused by hypertrophy of tubules and ducts, which results in excessive urea absorption
Acute tubular necrosis, severe chronic renal disease,
and urinary tract obstruction
Prognosis is grave when found in numbers

A

degenerative

112
Q

Are most urinary crystals significant?

A

appear in normal urine and most are NOT clinically significant (only a few are)

113
Q

What are normal crystals that can be seen in acid urine?

A

Amorphous urate, uric acid, and calcium oxalate crystals

114
Q

What are normal crystals that can be found in alkaline urine?

A

Amorphous phosphates, triple phosphate, ammonium biurate, calcium phosphate, and calcium carbonate crystals

115
Q

Consists of calcium,
magnesium, or
potassium salts
Appear colorless or
yellow-brown

A

Amorphous urate
crystals

116
Q

crystal that is readily soluble upon warming to 60°C and in alkaline substances
Frequently appear in
sediment and not
considered significant

A

Amorphous urate
crystals

117
Q

Crystal that is Common in small numbers, but large numbers may indicate gout

A

Uric acid crystals

118
Q

What are uric acid crystals soluble in?

A

in alkali, but
insoluble in alcohol and
acids

119
Q

How do uric acid crystals appear?

A

– square, diamond-shaped, prism shaped, wedge-shaped, or grouped in rosettes
 Colored yellow-brown or
red-brown

120
Q

What are Calcium oxalate crystals soluble in?

A

dilute hydrochloric acid

121
Q

Calcium oxalate crystals are mostly seen in…

A

acid urine (occasionally in neutral, or alkaline urine)

122
Q

How do calcium oxalate crystals appear?

A

-Appear octahedral or
dumbbell-shaped
-Double refractive index

123
Q

Calcium oxalate crystals in large numbers are associated with…

A

the formation of urinary calculi

124
Q

Small, colorless
granules
Readily soluble in dilute
acetic acid
Usually nonpathologic

A

Amorphous phosphate

125
Q

Triple phosphate (ammonium magnesium) crystals are seen mostly in what type of urine?

A

alkaline urine
(occ. In neutral, and acidic
urine

126
Q

How do Triple phosphate (ammonium magnesium) crystals appear?

A

colorless, three-tosix-sided prisms (“coffin-lids”),
or as feathery crystals shaped like fern leaves

127
Q

Triple phosphate (ammonium magnesium) crystals readily dissolve in…

A

dilute acetic acid

128
Q

What are Triple phosphate (ammonium magnesium) crystals associated with?

A

Usually nonpathologic, but
may be associated w/ urine
stasis and chronic urinary tract infection

129
Q

Appear as a yellow brown spicule resembling a thorny
apple, or a yellow brown sphere

A

Ammonium biurate crystals

130
Q

What dissolves ammonium biurate crystals?

A

acetic above 60°C or in
strong alkaline solutions

131
Q

What are ammonium biurate crystals associated with?

A

Presence does not
indicate disease

132
Q

Appear as colorless
prism or rosettes

A

Calcium phosphate
crystals

133
Q

What are Calcium phosphate crystals soluble in?

A

dilute acetic acid

134
Q

What are calcium phosphate crystals associated with?

A

Usually not pathologic,
but may be associated
w/ urine stasis and
chronic infection of the
urinary tract

135
Q

What type of urine are calcium carbonate crystals found in?

A

Usually found in alkaline
urine, but also seen in
neutral or faintly acidic
urine

136
Q

Appear colorless and
amorphous (dumbbells,
rhombi, and needles)

A

Calcium carbonate crystals

137
Q

What does calcium carbonate dissolve in?

A

acetic acid

138
Q

What are calcium carbonate crystals associated with?

A

Usually nonpathologic,
but large numbers may
indicate inorganic calculi
formation

139
Q

When tyrosine or leucine are found alone what does it indicate?
When found together?

A

-rare inherited metabolic disturbance
-usually signify severe liver
disease

140
Q

highly refractile – appear as thin ,dark needles arranged in sheaves or clumps – may be colorless, but usually yellow due to bilirubin

A

Tyrosine crystals

141
Q

What are tyrosine crystals soluble in?

A

alkali, mineral acid, and acetic acid

142
Q

highly refractile – appear as
yellow to yellow-brown spheres w/ radial striations

A

Leucine crystals

143
Q

What are leucine crystals soluble in?

A

hot alcohol and alkali

144
Q

Cystine crystals are rarely seen except with…

A

an inborn error of metabolism called cystinuria

Renal tubules fail to reabsorb cystine and three other amino acids – cystine crystallizes and forms renal
calculi

145
Q

How do cystine crystals appear?

A

Highly refractive clear hexagonal plates

146
Q

What are cystine crystals readily destroyed by?

A

bacteria

147
Q

What are cystine crystals soluble in?

A

Readily soluble in alkali (ammonia and dilute
HCL)

148
Q

Appear as star
-shaped clusters of needles,
rhombic plates, or elongated prisms
–may be colorless, or yellow/brown

A

Hippuric acid crystals

149
Q

What are Hippuric acid crystals soluble in?

A

hot water, alkali, and ether

150
Q

What are Hippuric acid crystals associated with?

A

Generally nonpathologic and have little diagnostic
significance

151
Q

What do bilirubin crystals indicate?

A

hepatic disease

152
Q

Appear red-brown,
shaped like needles or
rhombic plates

A

Bilirubin crystals

153
Q

Bilirubin crystals may alter the color and structure of other crystals, particularly _________ crystals.

A

uric acid

154
Q

What are bilirubin crystals soluble in?

A

acids, alkali and
chloroform

155
Q

Cholesterol crystals usually appear with…what disease

A

chyluria, or w/ severe urinary
tract infections

156
Q

Appear as colorless, transparent plates w/ regular or irregular corner notches

A

Cholesterol crystals

157
Q

What can cholesterol crystals be easily detected by?

A

e Lieberman-Burchard
reaction
addition of acetic anhydride and concentrated sulfuric
acid to an ether extract of urine – green color

158
Q

What are cholesterol crystals soluble in?

A

Highly soluble in chloroform and ether

159
Q

Appear as colorless
prismatic or star-like
forms
Confirm w/ 1 ml of 10%
ferric chloride – purple
Urine should be heated
gently to remove any
acetone bodies, in
order to prevent false
positive results

A

Aspirin crystals

160
Q

Seen in the urine of
children, and in adults
suffering from
progressive destruction
of muscle tissue due to
muscular dystrophies,
atrophies, and myositis
Appear as
pseudohexagonal plates

A

Creatine crystals

161
Q

Caused by
crystallization of
sulfonamide drugs
Variety of forms, seen
as dumbbells,
asymmetrical sheaves,
rosettes, or hexagonal
plates – colorless or
yellow-brown

A

Sulfonamide crystals

162
Q

What are Sulfonamide crystals soluble in?

A

acetone

163
Q

What do ampicillin crystals look like?

A

-Crystallized penicillin in
acid urine
Seen w/ large doses of
penicillin
Colorless long and thin
crystals

164
Q

Crystallized meglumine
diatrizoate in acid urine

A

X-ray crystals

165
Q

-Appear as long, thin,
clear rectangles; or as
flat, four-sided notched
plates
Soluble in 10% NaOH
solution
Causes very high
specific gravities

A

X-ray crystals

166
Q

Normal pH of urine is

A

4.5-7.8

Urinalysis and Body Fluids 4214 (14 decks)

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