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clin micro hehe pcm > Microscopic Examination > Flashcards

Microscopic Examination Flashcards

1
Q

Reporting of Casts:

A

Average/lpf (10 fields)

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2
Q

Reporting of RBCs and WBCs:

A

Average/hpf (10 fields)

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3
Q

Reporting of Epithelial cells, crystals and other elements

A

Semiquantitative terms such as rare, few, moderate,
and many or as 1+,2+,3+, and 4+

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4
Q

Normal value of RBCs

A

0-2 or 0-3/hpf

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5
Q

Sources of error (RBCs): (4)

A
  1. Yeasts
  2. Oil droplets
  3. Air bubbles
  4. Calcium oxalate crystals
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6
Q

Term used for presence of WBCs in urine:

A

Pyuria
Leukocyturia

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7
Q

Normal value of WBCs in urine:

A

0-5 or 0-8/hpf

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8
Q

Increased presence of WBCs in urine may indicate: (2)

A
  1. Infection
  2. Inflammation
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9
Q

Predominant WBC in urine

A

Neutrophil

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10
Q

What happens to neutrophils in hypotonic urine?

A

granules swell and undergo Brownian movement, producing a sparkling appearance (Glitter cells)

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11
Q

Normal value of Eosinophils:

A

< 1%

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12
Q

Value of > 1% is significant in which WBC?

A

Eosinophils

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13
Q

Eosinophil is primarily associated with:

A

Drug-induced interstitial nephritis

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14
Q

Stain preferred in Eosinophils:

A

Hansel stain

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15
Q

What are the mononuclear cells?

A
  1. Lymphocytes
  2. Monocytes
  3. Macrophages
  4. Histiocytes
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16
Q

This epithelial cell is largest cell with abundant, irregular cytoplasm and prominent nucleus

A

Squamous EC

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17
Q

Variation of Squamous EC that is covered with Gardnerella vaginalis and associated with bacterial vaginosis

A

Clue cells

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18
Q

This EC forms lining of vagina, female urethra and lower portion of male urethra

A

Squamous EC

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19
Q

This EC is spherical, polyhedral or caudate with centrally located nucleus

A

Transitional EC

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20
Q

Other term for Transitional EC

A

Urothelial

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21
Q

This EC is derived from the linings of renal pelvis, ureter, urinary bladder and upper portion of male urethra

A

Transitional/Urothelial EC

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22
Q

This EC is increased numbers are seen following
catheterization

A

Transitional/Urothelial EC

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23
Q

Most clinically significant EC

A

Renal Tubular EC (RTE Cells)

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24
Q

Origin of RTE cells

A

Nephron

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25
Q

This EC is rectangular, polyhedral, cuboidal or columnar with eccentric nucleus

A

RTE Cells

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26
Q

Value of RTE cell/hpf indicates tubular injury

A

2 RTE/hpf

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27
Q

RTE cell variation that is lipid containing, seen in lipiduria and identified by lipid stains such as TG and Neutral fats

A

Oval fat bodies

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28
Q

This appearance is made by cholesterol under polarizing microscope

A

Maltese cross

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29
Q

RTE cell variation that is seen with nonlipid-filled vacuoles

A

Bubble cell

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30
Q

Bubble cells in seen in which condition?

A

Acute tubular necrosis

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31
Q

Indication of true UTI

A

Presence of bacteria + WBCs

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32
Q

Most common cause of UTI

A

Enterobacteriaceae

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33
Q

True yeast infection

A

Presence Yeast + WBCs

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34
Q

This is small, refractile oval structures that may or may not bud

A

Yeast

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35
Q

Yeast species that is usually seen in urine of patients with DM and vaginal moniliasis

A

Candida albicans

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36
Q

This parasite is mistaken as WBC if non-motile

A

Trichomonas vaginalis

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37
Q

Most frequent parasite encountered in urine

A

Trichomonas vaginalis

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38
Q

Trichomonas vaginalis is agent of what disease?

A

Ping pong disease

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39
Q

Appearance and motility of Trichomonas vaginalis

A

Pear shaped flagellate with jerky motility

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40
Q

How is the presence of Trichomonas vaginalis reported?

A

usually reported as rare, few, moderate, or many per hpf

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41
Q

This blood fluke with terminal spine is seen in urine

A

Schistosoma haematobium

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42
Q

Schistosoma haematobium causes what

A

Hematuria

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43
Q

This parasite is associated with bladder cancer

A

Schistosoma haematobium

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44
Q

Most common fecal contaminant

A

Enterobius vermicularis

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45
Q

Presence of mucus threads in urine is clinically significant.

A. True
B. False

A

B. False

Presence of mucus threads is normal.

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46
Q

Major constituent of Mucus threads

A

Tamm-Horsfall protein

47
Q

This is unique to kidney and formed in the distal convoluted tube and collecting ducts; major constituent is Tamm-horsfall protein

A

Casts

48
Q

Term for presence of cast in urine

A

Cylinduria

49
Q

How is microscopic examination for casts performed?

A

Performed along the edges of the coverslip with subdued light

50
Q

Normal value of hyaline cast

A

0-2/lpf

51
Q

Also known as prototype cast

A

Hyaline cast

52
Q

Clinical significance of hyaline cast: (3)

A
  1. Glomerulonephritis
  2. Pyelonephritis
  3. Congestive Heart Failure
53
Q

This cast indicates bleeding within the nephron

A

RBC cast

54
Q

Clinical significance of RBC cast

A

Glomerulonephritis

55
Q

Presence of this cast indicates inflammation within the nephron

A

WBC cast

56
Q

Clinical significance of WBC cast: (2)

A
  1. Pyelonephritis
  2. Acute Interstitial Nephritis
57
Q

Clinical significance of EC cast: (2)

A
  1. Advance tubular destruction
  2. Renal tubular damage
58
Q

How is bacterial casts identified?

A

by performing gram stain

59
Q

Clinical significance of Bacterial casts

A

Pyelonephritis

60
Q

This cast has granules that are derived from the lysosomes of RTE cells during normal metabolism (non-pathologic)

A

Granular cast

61
Q

Clinical significance of granular cast:

A
  1. Glomerulonephritis
  2. Pyelonephritis
62
Q

Fatty cast is significant in

A

Nephrotic syndrome

63
Q

This cast is the final degenerative form of all types of cast

A

Waxy cast

64
Q

This cast appears brittle, highly refractile, with jagged ends; presence is due to stasis of urine flow

A

Waxy cast

65
Q

Presence of waxy cast is significant in

A

Chronic renal failure

66
Q

This cast is also known as renal failure cast

A

Broad cast

67
Q

The presence of this cast indicates extreme urine stasis and destruction (widening) of the tubular walls

A

Broad cast

68
Q

Any type of cast can be broad.

A. True
B. False

A

A. True

69
Q

Clinical significance of Broad cast

A

Renal failure

70
Q

Bonus

Arrange the following urinary cast from least to most significant

  1. Coarse Granular Cast
  2. Cellular Cast
  3. Fine Granular Cast
  4. Waxy Cast
  5. Broad Cast
  6. Hyaline Cast
A

6 - 2 - 1 - 3 - 4 - 5

Seen in acute renal disorders:
- Hyaline cast
- Cellular
- Coarse Granular
- Fine Granular

Seen in chronic renal disorders:
- Waxy
- Broad

71
Q

This is formed by precipitation of urine solutes

A

Crystals

72
Q

Three factors that contribute to crystal formation:

A
  1. pH
  2. Temperature
  3. Solute concentration
73
Q

How are normal crystals reported?

A

Reported as rare, few, moderate or many per hpf

74
Q

How are abnormal crystals reported?

A

may be averaged and reported per lpf

75
Q

Enumerate normal acidic crystals: (5)

A
  1. Amorphous urates
  2. Uric acid
  3. Calcium oxalate
  4. Calcium sulfate
  5. Hippuric acid
76
Q

Normal acidic urine crystal that has yellow-brown or colorless elongated prisms

A

Hippuric acid

77
Q

Normal acidic urine crystal that has cigarette-butt in appearance

A

Calcium sulfate

78
Q

Two forms of calcium oxalate with their respective appearance:

A

Dihydrate - envelope/pyramidal
Monohydrate - dumbbell/oval

79
Q

Normal acidic urine crystal that is seen in increased intake of food high in ascorbic acid

A

Calcium oxalate

80
Q

Normal acidic urine crystal that is a product of purine metabolism

A

Uric acid

81
Q

Normal acidic urine crystal with rhombic, wedge, hexagonal, 4 sided flat plate appearance

A

Uric acid

82
Q

Uric acid can be mistaken as

A

cystine crystal

83
Q

Increased presence of uric acid may indicate: (2)

A

Lesch-Nyhan syndrome
Gout

84
Q

Normal acidic urine crystal with brick dust/yellow brown granules

A

Amorphous urates

85
Q

Normal crystals in alkaline urine: (5)

A
  1. Amorphous phosphates
  2. Ammonium biurate
  3. Triple phosphate/Struvite
  4. Calcium phosphate/Apatite
  5. Calcium carbonate
86
Q

Abnormal Crystals: (8)

A
  1. Cystine
  2. Cholesterol
  3. Radiographic dye
  4. Tyrosine
  5. Leucine
  6. Bilirubin
  7. Sulfonamide
  8. Ampicillin
87
Q

Appearance of amorphous phoshates

A

Granular; white precipitate

88
Q

Normal alkaline urine crystal that has an appearance of yellow-brown thorny apples

A

Ammonium biurate

89
Q

Normal alkaline crystal that is seen in old specimens and is seen in presence of urea-splitting bacteria

A

Ammonium biurate

90
Q

Normal alkaline crystal that is colorless and has prism/coffin lid shape; indicates presence of urea-splitting bacteria

A

Triple phosphate/struvite

91
Q

Appearance of triple phosphate when disintegrated

A

Feathery appearance

92
Q

Normal alkaline crystal that is colorless, flat plates, thin prisms in rosette form

A

Calcium phosphate/apatite

93
Q

Normal alkaline crystal that is small, colorless, dumbbells or spherical-shaped

A

Calcium carbonate

94
Q

Calcium carbonate crystal forms effervescence when added with what substance?

A

Acetic acid

95
Q

This abnormal crystal has colorless hexagonal appearance that is mistaken as uric acid crystals

A

Cystine

96
Q

Clinical significance of Cystine: (2)

A
  1. Cystinuria
  2. Cystinosis
97
Q

Abnormal crystal that has an appearance of rectangular plates with a notch in one or more corners

A

Cholesterol

98
Q

Pattern that cholesterol crystal makes

A

Staircase patter

99
Q

This abnormal crystal resembles crystal of radiographic dye

A

Cholesterol

100
Q

Clinical significance of cholesterol crystal

A

Nephrotic syndrome

101
Q

How is radiographic dye crystals differentiated from cholesterol crystals?

A

Differentiated by:
1. Patient history
2. Correlation with other UA results
3. SG: > 1.040 (R. dye in refractometer)

102
Q

Abnormal crystal that has appearance of colorless to yellow needles in clumps

A

Tyrosine

103
Q

Clinical significance of tyrosine

A

Liver disease

104
Q

Abnormal crystal that has yellow brown spheres with concentric circles and radial striations

A

Leucine

105
Q

Clinical significance of Leucine

A

Liver disease

106
Q

Abnormal crystal with bright yellow color and clumped needles or granules appearance

A

Bilirubin

107
Q

Clinical significance of Bilirubin crystals

A

Liver disease

108
Q

Abnormal crystal with colorless to yellow brown needles, sheaves of wheat, rosettes, arrowheads, petals and round forms

A

Sulfonamide

109
Q

This abnormal crystal may be mistaken as calcium phosphate crystals

A

Sulfonamide

110
Q

How do you differentiate sulfonamide from calcium phosphate crystal?

A

Lignin Test
Diazo reaction

111
Q

Clinical significance of sulfonamide

A

Possible tubular damage

112
Q

Abnormal crystal with colorless needles that tend to form bundles following refrigeration

A

Ampicillin

113
Q

Clinical significance of ampicillin

A

Massive doses of penicillin

clin micro hehe pcm (4 decks)

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