Microscopic Examination Flashcards
1
Q
Reporting of Casts:
A
Average/lpf (10 fields)
2
Q
Reporting of RBCs and WBCs:
A
Average/hpf (10 fields)
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+
4
Q
Normal value of RBCs
A
0-2 or 0-3/hpf
5
Q
Sources of error (RBCs): (4)
A
- Yeasts
- Oil droplets
- Air bubbles
- Calcium oxalate crystals
6
Q
Term used for presence of WBCs in urine:
A
Pyuria
Leukocyturia
7
Q
Normal value of WBCs in urine:
A
0-5 or 0-8/hpf
8
Q
Increased presence of WBCs in urine may indicate: (2)
A
- Infection
- Inflammation
9
Q
Predominant WBC in urine
A
Neutrophil
10
Q
What happens to neutrophils in hypotonic urine?
A
granules swell and undergo Brownian movement, producing a sparkling appearance (Glitter cells)
11
Q
Normal value of Eosinophils:
A
< 1%
12
Q
Value of > 1% is significant in which WBC?
A
Eosinophils
13
Q
Eosinophil is primarily associated with:
A
Drug-induced interstitial nephritis
14
Q
Stain preferred in Eosinophils:
A
Hansel stain
15
Q
What are the mononuclear cells?
A
- Lymphocytes
- Monocytes
- Macrophages
- Histiocytes
16
Q
This epithelial cell is largest cell with abundant, irregular cytoplasm and prominent nucleus
A
Squamous EC
17
Q
Variation of Squamous EC that is covered with Gardnerella vaginalis and associated with bacterial vaginosis
A
Clue cells
18
Q
This EC forms lining of vagina, female urethra and lower portion of male urethra
A
Squamous EC
19
Q
This EC is spherical, polyhedral or caudate with centrally located nucleus
A
Transitional EC
20
Q
Other term for Transitional EC
A
Urothelial
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
22
Q
This EC is increased numbers are seen following
catheterization
A
Transitional/Urothelial EC
23
Q
Most clinically significant EC
A
Renal Tubular EC (RTE Cells)
24
Q
Origin of RTE cells
A
Nephron
25
This EC is rectangular, polyhedral, cuboidal or columnar with eccentric nucleus
RTE Cells
26
Value of RTE cell/hpf indicates tubular injury
2 RTE/hpf
27
RTE cell variation that is lipid containing, seen in lipiduria and identified by lipid stains such as TG and Neutral fats
Oval fat bodies
28
This appearance is made by cholesterol under polarizing microscope
Maltese cross
29
RTE cell variation that is seen with nonlipid-filled vacuoles
Bubble cell
30
Bubble cells in seen in which condition?
Acute tubular necrosis
31
Indication of true UTI
Presence of bacteria + WBCs
32
Most common cause of UTI
Enterobacteriaceae
33
True yeast infection
Presence Yeast + WBCs
34
This is small, refractile oval structures that may or may not bud
Yeast
35
Yeast species that is usually seen in urine of patients with DM and vaginal moniliasis
Candida albicans
36
This parasite is mistaken as WBC if non-motile
Trichomonas vaginalis
37
Most frequent parasite encountered in urine
Trichomonas vaginalis
38
Trichomonas vaginalis is agent of what disease?
Ping pong disease
39
Appearance and motility of Trichomonas vaginalis
Pear shaped flagellate with jerky motility
40
How is the presence of Trichomonas vaginalis reported?
usually reported as rare, few, moderate, or many per hpf
41
This blood fluke with terminal spine is seen in urine
Schistosoma haematobium
42
Schistosoma haematobium causes what
Hematuria
43
This parasite is associated with bladder cancer
Schistosoma haematobium
44
Most common fecal contaminant
Enterobius vermicularis
45
Presence of mucus threads in urine is clinically significant.
A. True
B. False
B. False
Presence of mucus threads is normal.
46
Major constituent of Mucus threads
Tamm-Horsfall protein
47
This is unique to kidney and formed in the distal convoluted tube and collecting ducts; major constituent is Tamm-horsfall protein
Casts
48
Term for presence of cast in urine
Cylinduria
49
How is microscopic examination for casts performed?
Performed along the edges of the coverslip with subdued light
50
Normal value of hyaline cast
0-2/lpf
51
Also known as prototype cast
Hyaline cast
52
Clinical significance of hyaline cast: (3)
1. Glomerulonephritis
2. Pyelonephritis
3. Congestive Heart Failure
53
This cast indicates bleeding within the nephron
RBC cast
54
Clinical significance of RBC cast
Glomerulonephritis
55
Presence of this cast indicates inflammation within the nephron
WBC cast
56
Clinical significance of WBC cast: (2)
1. Pyelonephritis
2. Acute Interstitial Nephritis
57
Clinical significance of EC cast: (2)
1. Advance tubular destruction
2. Renal tubular damage
58
How is bacterial casts identified?
by performing gram stain
59
Clinical significance of Bacterial casts
Pyelonephritis
60
This cast has granules that are derived from the lysosomes of RTE cells during normal metabolism (non-pathologic)
Granular cast
61
Clinical significance of granular cast:
1. Glomerulonephritis
2. Pyelonephritis
62
Fatty cast is significant in
Nephrotic syndrome
63
This cast is the final degenerative form of all types of cast
Waxy cast
64
This cast appears brittle, highly refractile, with jagged ends; presence is due to stasis of urine flow
Waxy cast
65
Presence of waxy cast is significant in
Chronic renal failure
66
This cast is also known as renal failure cast
Broad cast
67
The presence of this cast indicates extreme urine stasis and destruction (widening) of the tubular walls
Broad cast
68
Any type of cast can be broad.
A. True
B. False
A. True
69
Clinical significance of Broad cast
Renal failure
70
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
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
This is formed by precipitation of urine solutes
Crystals
72
Three factors that contribute to crystal formation:
1. pH
2. Temperature
3. Solute concentration
73
How are normal crystals reported?
Reported as rare, few, moderate or many per hpf
74
How are abnormal crystals reported?
may be averaged and reported per lpf
75
Enumerate normal acidic crystals: (5)
1. Amorphous urates
2. Uric acid
3. Calcium oxalate
4. Calcium sulfate
5. Hippuric acid
76
Normal acidic urine crystal that has yellow-brown or colorless elongated prisms
Hippuric acid
77
Normal acidic urine crystal that has cigarette-butt in appearance
Calcium sulfate
78
Two forms of calcium oxalate with their respective appearance:
Dihydrate - envelope/pyramidal
Monohydrate - dumbbell/oval
79
Normal acidic urine crystal that is seen in increased intake of food high in ascorbic acid
Calcium oxalate
80
Normal acidic urine crystal that is a product of purine metabolism
Uric acid
81
Normal acidic urine crystal with rhombic, wedge, hexagonal, 4 sided flat plate appearance
Uric acid
82
Uric acid can be mistaken as
cystine crystal
83
Increased presence of uric acid may indicate: (2)
Lesch-Nyhan syndrome
Gout
84
Normal acidic urine crystal with brick dust/yellow brown granules
Amorphous urates
85
Normal crystals in alkaline urine: (5)
1. Amorphous phosphates
2. Ammonium biurate
3. Triple phosphate/Struvite
4. Calcium phosphate/Apatite
5. Calcium carbonate
86
Abnormal Crystals: (8)
1. Cystine
2. Cholesterol
3. Radiographic dye
4. Tyrosine
5. Leucine
6. Bilirubin
7. Sulfonamide
8. Ampicillin
87
Appearance of amorphous phoshates
Granular; white precipitate
88
Normal alkaline urine crystal that has an appearance of yellow-brown thorny apples
Ammonium biurate
89
Normal alkaline crystal that is seen in old specimens and is seen in presence of urea-splitting bacteria
Ammonium biurate
90
Normal alkaline crystal that is colorless and has prism/coffin lid shape; indicates presence of urea-splitting bacteria
Triple phosphate/struvite
91
Appearance of triple phosphate when disintegrated
Feathery appearance
92
Normal alkaline crystal that is colorless, flat plates, thin prisms in rosette form
Calcium phosphate/apatite
93
Normal alkaline crystal that is small, colorless, dumbbells or spherical-shaped
Calcium carbonate
94
Calcium carbonate crystal forms effervescence when added with what substance?
Acetic acid
95
This abnormal crystal has colorless hexagonal appearance that is mistaken as uric acid crystals
Cystine
96
Clinical significance of Cystine: (2)
1. Cystinuria
2. Cystinosis
97
Abnormal crystal that has an appearance of rectangular plates with a notch in one or more corners
Cholesterol
98
Pattern that cholesterol crystal makes
Staircase patter
99
This abnormal crystal resembles crystal of radiographic dye
Cholesterol
100
Clinical significance of cholesterol crystal
Nephrotic syndrome
101
How is radiographic dye crystals differentiated from cholesterol crystals?
Differentiated by:
1. Patient history
2. Correlation with other UA results
3. SG: > 1.040 (R. dye in refractometer)
102
Abnormal crystal that has appearance of colorless to yellow needles in clumps
Tyrosine
103
Clinical significance of tyrosine
Liver disease
104
Abnormal crystal that has yellow brown spheres with concentric circles and radial striations
Leucine
105
Clinical significance of Leucine
Liver disease
106
Abnormal crystal with bright yellow color and clumped needles or granules appearance
Bilirubin
107
Clinical significance of Bilirubin crystals
Liver disease
108
Abnormal crystal with colorless to yellow brown needles, sheaves of wheat, rosettes, arrowheads, petals and round forms
Sulfonamide
109
This abnormal crystal may be mistaken as calcium phosphate crystals
Sulfonamide
110
How do you differentiate sulfonamide from calcium phosphate crystal?
Lignin Test
Diazo reaction
111
Clinical significance of sulfonamide
Possible tubular damage
112
Abnormal crystal with colorless needles that tend to form bundles following refrigeration
Ampicillin
113
Clinical significance of ampicillin
Massive doses of penicillin
