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UA Spring > Microscopic exam of urine pt 3 > Flashcards

Microscopic exam of urine pt 3 Flashcards

1
Q

Two types of amorphous crystals

A
  1. Amorphous urates: acidic urine
  2. Amorphous phosphates: alkaline urine
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2
Q

Color of amorphous urates and phosphates

A

Urates = pink
Phosphates = white

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3
Q

Amorphous urates and phosphates solubility

A

Urates = heat and alkaline pH
Phosphates = acetic acid

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4
Q

ID the element

A

Amorphous crystals

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5
Q

Sodium urate

A
  • Normal, appears by refrigeration
  • Caused by protein rich diet, typically NOT reported if seen
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6
Q

List normal crystals found in acidic urine

A
  • Uric acid
  • Calcium oxalate
  • Hippuric acid
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7
Q

List normal crystals found in alkaline urine

A
  • Ammonium biurate
  • Calcium carbonate
  • Calcium phosphate
  • Triple phosphate
  • Calcium oxalate possible
  • Hippuric acid possible
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8
Q

List abnormal crystals

A
  • Cystine
  • Cholesterol
  • Tyrosine
  • Leucine
  • Bilirubin
  • Radiographic dye
  • Sulfonamide
  • Acyclovir
  • Ampicillin
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9
Q

Abnormal crystals are typically found in what pH?

A

Acidic urine

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10
Q

ID the element

A

Sodium urates

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11
Q

ID the element

A

Uric acid
lemon

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12
Q

ID the element

A

Uric acid
rhombus

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13
Q

ID the element

A

Uric acid
barrels

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14
Q

ID the element

A

Uric acid
rosettes

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15
Q

Are uric acid crystals birefringent?

A

Yes

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16
Q

How to distinguish between uric acid and cystine crystals?

A
  • Polarizing microscopy
  • Uric acid polarizes light and cystine does not
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17
Q

ID the element

A

Calcium oxalate
octahedral
dihydrate most common form

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18
Q

ID the element

A

Calcium oxalate
rectangular
monohydrate
Looks like rice

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19
Q

ID the element

A

Calcium oxalate
dumbell
monohydrate

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20
Q

ID the element

A

Calcium oxalate
ovoid
monohydrate

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21
Q

Can calcium oxalate polarize light?

A

Yes, so can help distinguish from RBCs (don’t polarize light)

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22
Q

Major component of kidney stones

A

Calcium oxalate

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23
Q

Foods high in oxalic acid

A
  • Asparagus
  • Spinach
  • Tomatoes
  • Rhubarb
  • Garlic
  • Ascorbic acid
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24
Q

Pathologic conditions involving calcium oxalate

A
  • Kidney stones
  • Oxalic acid poisoning
  • Liver disease
  • Ethylene glycol (anti-freeze) poisoning
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25
Q

Which form of calcium oxalate crystal is most frequently associated with ethylene glycol poisoning?

A

Long, monohydrate form (can be confused with hippuric acid)

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26
Q

Hippuric acid pH and solubility

A
  • Found in acidic urine, but also neutral or alkaline urine
  • Soluble in alkaline and hot water
  • Rare crystal
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27
Q

Hippuric acid crystals can be a sign of

A

Toluene exposure

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28
Q

Hippuric acid crystals associated with

A

Diets high in fruits/veggies high in benzoic acid

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29
Q

ID element

A

Hippuric acid (sharp ends)

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30
Q

Ammonium biurate crystals are also known as

A

“Thorny apples”

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31
Q

Ammonium biurate crystal solubility

A

Acetic acid and heat

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32
Q

Ammonium biurate crystal clinical significance

A
  • Only significant if seen in freshly voided urine
  • Usually artifact of old/improperly stored urine
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33
Q

What happens to ammonium biurate if you add acetic acid?

A

They convert to uric acid crystals

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34
Q

ID element

A

Ammonium biurate crystal

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35
Q

ID the element

A

Ammonium biurate crystals

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36
Q

Calcium carbonate solubility

A

Effervesces (bubbles) in HCl and acetic acid

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37
Q

Calcium carbonate crystals confused with

A

RBCs and yeast

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38
Q

ID the element

A

Calcium carbonate crystals (dumbell)

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39
Q

ID the element

A

Calcium carbonate crystals (spherical)

40
Q

Calcium phosphate shape variations

A
  • Large flat plates
  • Rosette
  • Wedge-shaped prisms
41
Q

Calcium phosphate solubility

A

Dilute acetic acid

42
Q

ID the element

A

Calcium phosphate (most common form)

43
Q

ID the element

A

Calcium phosphate

44
Q

ID the element

A

Calcium phosphate

45
Q

Calcium phosphate clinical significance

A

May be associated with kidney stones

46
Q

Triple phosphate solubility

A

Acetic acid

47
Q

Does triple phosphate polarize light?

48
Q

Triple phosphate formation

A

Bacteria split urea into ammonia and CO2 in alkaline urines

49
Q

ID the element

A

Triple phosphate

50
Q

Cystine solubility

A
  • HCl
  • NaOH
  • NH4OH (ammonium hydroxide)
51
Q

Does cystine polarize light?

52
Q

Cystine clinical significance

A
  • Cystinuria (metabolic disorder)
  • Most freq cause of kidney stones in kids
53
Q

Cholesterol solubility

A

Chloroform, ether

54
Q

Does cholesterol polarize light?

55
Q

ID the element

A

Cholesterol
Note notch on one or more corners

56
Q

Cholesterol clinical significance

A
  • Nephritis
  • Nephrotic conditions
  • Chyluria due to obstruction of lymph drainage
  • Tumors
  • Filariasis
  • Lymph node enlargement
  • Rarely seen
57
Q

Cholesterol formation

A

Lipids getting refrigerated

58
Q

Tyrosine frequency and color

A
  • Very rare
  • Colorless to yellow-brown
59
Q

Tyrosine shapes

A
  • Single, fine needles with sharp points
  • Sheaves
  • Rosettes
60
Q

Tyrosine clinical significance

A
  • Severe liver disorders
  • Inherited aa metabolism disorders
  • Frequently seen with leucine crystals
60
Q

Chemical strip test result if tyrosine present

A

Bilirubin positive bc Tyr crystals in liver damage

61
Q

ID the element

A

Tyrosine crystals

62
Q

Leucine appearance

A
  • Yellow-brown spheroids
  • Concentric rings
63
Q

Chemical strip test result if leucine present

A

Bilirubin positive

64
Q

ID the element

A

Leucine crystal

65
Q

Leucine crystals confused with

A

Sulfonamide crystals

66
Q

Bilirubin crystal appearance

A
  • Yellow-brown needles or granules in clumps
  • Sometimes attached to cells
67
Q

Bilirubin crystal clinical significance

A
  • Severe liver disorders
  • Jaundice
68
Q

ID the element

A

Bilirubin crystal

69
Q

Radiographic dye appearance

A

Mostly flat needles or sheaves

70
Q

Radiographic dye may be confused with

A
  • Cholesterol
  • Tyrosine
  • Sulfonamides
71
Q

How does radiographic dye affect the physical properties of urine?

A

Very high specific gravity (>1.035)
Note that chemical reagent strips only detect ionic solutes so radiographic dye not detected. Use refractometer to detect

72
Q

Does radiographic dye polarize light?

73
Q

Sulfonamide appearance

A
  • Flat needles
  • Sheaves of small needles
  • Spheroids
  • Brown
74
Q

ID the element

A

Sulfonamides

75
Q

ID the element

A

Sulfonamides

76
Q

Sulfonamides confused with

A

Tyrosine, radiographic dye, leucine

77
Q

Sulfonamide clinical significance

A
  • Seen in pt taking sulfonamide abx
  • May crystallize if not adequately hydrated -> nephron tubular damage and/or kidney stones
78
Q

Acyclovir crystals

A
  • Anti-viral medication
  • Confused with tyrosine crystals
79
Q

ID the element

A

Acyclovir crystals

80
Q

Ampicillin crystals seen when

A

Pt is receiving large ampicillin doses without adequate hydration

81
Q

ID the element

A

Ampicillin crystals

82
Q

ID the element

A

Ampicillin crystals

83
Q

Artifacts seen when

A
  • Urine is improperly collected or in unclean containers
  • More common in pediatric or nursing home patients
84
Q

Are artifacts reported?

A

No
Only reported if gross contamination prevents proper analysis

85
Q

List artifacts found in urine

A
  • Talcum powder
  • Starch
  • Oil droplets
  • Air bubbles
  • Pollen
  • Hair/cloth fibers
  • Fecal contamination
86
Q

ID the element

A

Talcum powder (artifact)

87
Q

ID the element

88
Q

How to distinguish starch from RBCs?

A

Polarized light
Starch shows pseudo-maltese cross

89
Q

ID the element

A

Starch under polarized light microscopy
Characteristic pseudo-maltese cross

90
Q

ID the element

A

Oil droplet artifact

91
Q

ID the element

A

Air bubble artifact

92
Q

ID the element

A

Pollen artifact

93
Q

Hair and cloth fibers mistaken for __
Distinguish by __

A
  • Casts and parasites
  • Fibers are refractile whilst casts are not
94
Q

Fecal contamination seen when

A
  • Urine improperly collected (infants)
  • Fistula between intestinal and urinary tracts

UA Spring (8 decks)

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