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CLINICAL MICROSCOPY > MICROSCOPIC EXAMINATION > Flashcards

MICROSCOPIC EXAMINATION Flashcards

1
Q

The least standardized and most time- consuming part of the routine urinalysis

A

MICROSCOPIC EXAMINATION OF URINE

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2
Q

WBCs, WBC casts, Bacteria

A

Leukocyte Esterase

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3
Q

Casts, Cells

A

Protein

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4
Q

Bacteria, WBCs

A

Nitrite

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5
Q

Yeast (presence of glucose) + WBC = Fungal infection

A

Glucose

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6
Q

Specimen volume must be?

Adult?

If pedriatic?

A

10-15 mL

12 mL

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7
Q

In sediment preparation, Volumes of ____ and _____ mL are frequently used for microscopic exam.

A

0.5 and 1.0 mL

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8
Q

When using the conventional glass-slide method, the recommended volume is _____ covered by a ______ mm glass cover slip.

A

20uL ( 0.02 mL) covered by 22x22 mm

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9
Q

are reported as the average number per lowpower field (lpf) following examination of 10 fields

A

Casts

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10
Q

as the average number per 10 highpower fields (hpf)

A

Rbcs and Wbcs

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11
Q

are frequently reported in semi-quantitative terms:

  • rare, few, moderate, many
  • 1+, 2+, 3+, 4+
A

Epithelial cells, crystals and other elements

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12
Q

Delineates structure and contrasting colors of the nucleus and cytoplasm.

Identifies WBCs, epithelial cells, and casts. Stains Neutrophil

A

SternheimerMalbin (Crystal Violet & Safranin

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13
Q

Enhances nuclear detail

Differentiates WBCs and renal tubular epithelial cells

A

Toluidine Blue

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14
Q

Lyses RBCs and enhances nuclei of WBCs

Distinguishes RBCs from WBCs, yeast, oil droplets, and crystals

A

2% Acetic Acid

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15
Q

Stains triglycerides and neutral fats orange-red

A

Lipid Stains (Oil Red O, Sudan III)

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16
Q

Differentiates gram-positive and gramnegative bacteria

Identifies bacterial casts

A

Gram stain

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17
Q

Methylene blue and eosin Y stain eosinophilic granules

Identifies urinary eosinophils

A

Hansel Stain (Methylene blue & Eosin Y)

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18
Q

Stains structures containing iron

Identifies yellowbrown granules of hemosiderin in cells and casts

A

Prussian Blue Stain

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19
Q

releasing their hemoglobin and leaving only the cell membrane

A

GHOST CELLS

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20
Q

urine, cells shrink due to loss of water and appear crenated or irregularly shaped

A

Concentrated/ hypersthenuric

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21
Q

Urine cells absorb water swell and lyse rapidly, releasing their

A

In dilute (hyposthenuric)

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22
Q

RBCs are the most difficult for students to recognize:

A

-RBCs’ lack of characteristic structures
- Variations in size
- Close resemblance to other sediment constituents

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23
Q

dissolves RBC, not the Yeast cells

A

Add acetic acid

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24
Q

RBC is red, Yeast is colorless

A

Stain with eosin

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25
Q

RBC with RBC cast (unique to the kidney) –

A

Renal disease

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26
Q

RBC without cast and protein

A

Damaged distal to the kidney

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27
Q

Intact RBC found in?

A

Lower Tract

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28
Q

Crenated RBC

A

Upper tract

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29
Q

Dysmorphic RBC found in:

A
  • Abnormal urine concentration
  • Glomerular bleeding
  • Non glomerular hematuria (in small amount)
  • Strenuous exercise (in small amount
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30
Q

cloudy with a red to brown color. Microscopic analysis may be reported in terms of greater than 100/hpf. TNTC (too numerous to count)

A

Hematuria

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31
Q

Larger than RBCs, measuring an average of about 12 um in diameter

A

White blood cells

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32
Q

The predominant WBC in urine

• Exhibit Brownian movement (false motility) – because of the presence of granules with sparkling appearance

A

Neutrophils

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33
Q

Stain for for glitter cell

A

Sternheimer malbin

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34
Q

Associated with drug-induced interstitial nephritis
• Small amount urinary tract infection (UTI) and renal transplant rejection

A

Eosinophils

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35
Q

True or false more than 1% eosinophils is considered significant

A

True

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36
Q

Stain use for eosinophil

A

Hansel stain

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37
Q

Lymphocytes, Monocytes, Macrophage, Histiocytes

• Found in small amount

A

Mononuclear cells

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38
Q

mistaken as RBC because of its small size

A

Lymphocytes (agranulocyte)

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39
Q

Increased amount in early renal transplant rejection

A

Mononuclear cells

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40
Q

increased urinary WBC

A

Pyuria

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41
Q

↑ WBC infection + cast • Cystitis + protein + bacteria • + turbidity + nitrite(gram negative) • - nitrite (gram positive)

A

Pyelonephritis
Cystitis
Prostatitis
Urethritis

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42
Q

↑WBC infection + cast + protein +turbidity - nitrite

A

Glomerulonephritis
Tumor
Interstitial nephritis
Lupus Erythematosus

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43
Q

Derived from the linings of the genitourinary system

A

Epithelial cells

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44
Q

Three types of epithelial cells are seen in urine:

A

Squamous
Rte cells
Transitional cells

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45
Q

•Largest cells found in the urine sediment

•Contain abundant, irregular cytoplasm and a
prominent nucleus about the size of an RBC

A

Squamous epithelial cells

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46
Q

Originate from the linings of the vagina and female urethra and the lower portion of the male urethra

A

Squamous epithelial cells

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47
Q

A variation of the squamous epithelial cell is called as?

A

Clue cells

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48
Q

indicative of vaginal infection by gardenella vaginalis

A

Clue cells

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49
Q

Smaller than squamous and appear in several forms:

  • Spherical
  • Polyhedral
  • Caudate/ Cuboidal
A

Transitional epithelial cells

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50
Q

Originate from the lining of the renal pelvis (UT), calyces, ureters, bladder, and upper portion of male urethra

A

Transitional cells

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51
Q

•Most significant epithelial cell.
Vary in size and shape depending on the area of the renal tubules from which they originate – cuboidal, columnar with eccentrically located nucleus

A

RTE CELLS

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52
Q

More than 2 RTE cells/hpf caused what injury

A

Tubular injury

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53
Q

Lipid containing RTE CELLS
Seen in lipiduria

A

Oval fat bodies

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54
Q

Stain use to oval fat bodies

A

Sudan III / oil red o

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55
Q
  • larger than other RTE cells
  • Rectangular shape
  • referred as columnar or convoluted cells
A

RTE IN PCT

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56
Q

smaller than those from the PCT

  • round or oval/ spherical
A

RTE IN DCT

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57
Q

• Only elements found in urinary sediment that are unique to the kidney

• Formed within the lumens of the DCT and collecting ducts, providing a microscopic view of conditions within the nephron

• Condition associated with upper urinary tract

A

Casts

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58
Q

main component of casts matrix

A

Uromodulin

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59
Q

Matrix (boundary/ cell membrane) –

A

Tamm Horsfall Protein

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60
Q

(glycoprotein secreted by RTE cells in DCT and collecting ducts

A

Tamm Horsfall Protein

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61
Q

final degenerative form of all types of casts)

A

Waxy cast

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62
Q

presence of cast in urine

A

Cylinduria

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63
Q

Most frequently seen cast

• Least clinical significance

• Consists almost entirely of Tamm-Horsfall protein

• Presence of 0-2 hyaline casts /lpf is considered normal

A

Hyaline casts

64
Q

strenuous exercise, dehydration, heat exposure, and emotional stress

A

Non-pathological causes of increase

65
Q

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

A

Pathological causes of increase

66
Q

Rbc casts is Easily detected under LPO by their ______ color

A

Orange red

67
Q

Indicates bleeding from an area within the GUT

• If the RBC observed microscopically is crenated, morphic which have damage in cell membrane that is associated with upper bleeding

A

Rbc casts

68
Q

RBC casts associated with glomerular damage are usually associated with

A

increase proteinuria and dysmorphic erythrocytes

69
Q

Primarily associated with damage to the glomerulus (glomerulonephritis) that allows passage of the cells through the glomerular membrane

A

Rbc casts

70
Q

Signifies infection/inflammation within the nephron

•Infection depends on other structures that can be observe

A

Wbc casts

71
Q

Most frequently associated with ________and an ________marker for distinguishing

A

pyelonephritis and upper uti from lower uti

72
Q

(+) bacteria
(+) wbc cells
(+) wbc cast

A

Upper uti

73
Q

(+) bacteria
(+) wbc
(-) wbc casts

A

Lower uti

74
Q

with matrix as compared to WBC in clumps

A

Wbc casts

75
Q

is bacterial infection,

A

Pyelonephritis

76
Q

is nonbacterial infection

A

glomerulonephritis

77
Q

Contain bacilli both within and bound to the protein matrix – seen in pyelonephritis

A

Bacterial casts

78
Q

Confirmation of bacterial casts is best made by performing a?

A

cytocentrifuged sediment or Gram stain

79
Q

Represent the presence of advanced tubular destruction, producing urinary stasis along with disruption of the tubular linings

A

Epithelial casts

80
Q

epithelial cells that can be observed in urinary sediment:

A

Squamous
Rte
Transitional

81
Q

never seen in epithelial cells casts; nonpathological; lower urinary tract)

A

Epithelial cell

82
Q

stained RTE cells (Spherical) are seen in cases of hepatitis

A

Bilirubin

83
Q

Fats do not stain with

A

Sternheimer-Malbin stains

84
Q

Combination of Cellular Cast components in one matrix

A

MIXED CELLULAR CASTS

85
Q

Most frequently encountered include:

  • RBC and WBC casts in glomerulonephritis
  • WBC and RTE cell casts, or WBC and bacterial casts in pyelonephritis
A

Mixed cellular casts

86
Q

• Coarsely and finely granular casts are frequently seen in the urinary sediment

• May be of pathologic or non-pathologic significance

A

Granular casts

87
Q

Representative of extreme urine stasis, indicating chronic renal failure

Usually seen in conjunction with other types of casts associated with the condition that caused the renal failure (granular casts

brittle, highly refractive cast matrix f

A

Waxy casts

88
Q

They often appear fragmented with jagged ends and have notches in their sides

A

Waxy casts

89
Q

Represent extreme urine stasis

•

Indicates destruction (widening) of the tubular walls.

A

Broad / renal failure casts

90
Q

Most commonly – granular and waxy casts

• Associated with renal failure

A

Broad casts

91
Q

Not normally present in urine (because the bladder is sterile where the urine stored)

A

Bacteria

92
Q

To be considered significant for UTI, bacteria should be accompanied by

A

Wbc

93
Q

UTI caused by

A

SES

Enterobacteriaceae, Staphylococcus and Enterococcus

94
Q

• Small, refractile oval structures that may or may not contain a bud

• They may appear as branched, mycelial forms

A

Yeast

95
Q

A true yeast infection should be accompanied by the presence of ____

and correlate to what analyte

A

WBC
Glucose

96
Q

Yeast cells, primarily _______ (fungi), seen in diabetic, immunocompromised patients and women with

A

Candida albicans with vaginal moniliasis

97
Q

The most frequent parasite encountered in the urine is ____________ easily identified in wet preparations of the urine sediment by its rapid darting movement in the microscopic field

A

Trichomonas vaginalis,

98
Q

When not moving, Trichomonas is more difficult to identify and may resemble a

A

WBC,rte cells and transitional cells

99
Q

Bacteria, parasite, fungi same manner of reporting which is

A

Semi quantitative

100
Q

Oval, slightly tapered heads and long, flagella - like tails

A

Spermatozoa

101
Q

instead going out to the urethra, it will going up to urinary bladder (sperm cell) and combine with urine which having a traces of sperm cell in sediment.

A

Retrograde ejaculation

102
Q

Protein material produced by the glands and epithelial cells of the lower GUT and the RTE cells

A

Mucus

103
Q

is a major constituent of mucus

A

Tamm-Horsfall protein

104
Q

• Appears microscopically as thread-like structures with a low refractive index

A

Mucus

105
Q

• Appears microscopically as thread-like structures with a low refractive index

A

Rte cells

106
Q

Appear as true geometrically formed structures or as amorphous material

A

Urinary crystals

107
Q

Formed by the precipitation of urine solutes, including inorganic salts, organic compounds, and medications

A

Crystal formation

108
Q

appear yellow to reddish brown and are the only normal crystals found in acidic urine that appear colored

A

Urates crystals

109
Q

not found in urine (Synovial fluid)

A

Sodium urates

110
Q

Example of urates crystals

A
  • Amorphous urates
  • Uric acid
  • Acid urates
  • Sodium urates
111
Q

• Appear as yellow- brown granules

• May occur in clumps resembling granular casts

• Common in refrigerated specimen

A

AMORPHOUS URATES

112
Q

on the surface of the granules is the cause of the pink color

A

Uroerythrin

113
Q

Seen in a variety of shapes – rhombic, four-sided flat plates (whetstones), wedges, and rosettes

• Usually appear yellow-brown, but may be colorless and have a six-sided shape, similar to cystine crystals

• Highly birefringent under polarized light, which aids in distinguishing from cystine crystals

A

Uric acid crystals

114
Q

Increased amounts of uric acid crystals are associated with increased levels of purines and nucleic acids seen in patients with

A

Leukemia undergo to chemotherapy, and , Lesch-Nyhan syndrome and gout

115
Q

appear as larger granules and may have spicules similar to the ammonium biurate crystals seen in alkaline urine

A

Acid urates

116
Q

crystals are needle-shaped and are seen in synovial fluid during episodes of gout, but do appear in the urine

A

Sodium urates

117
Q

• Rarely encountered

• Frequently seen in conjunction with amorphous urates

• have little clinical significance

A

Acid urates and sodium urates

118
Q

Frequently seen in acidic urine, but can be found in neutral urine and rarely in alkaline urine

A

Calcium oxalate

119
Q

Most common form of calcium oxalate

A

Dihydrate

120
Q

Most common easily recognized as colorless, octahedral envelope or two pyramids joined at their bases

A

Dihydrate

121
Q

Less common in calcium oxalate

A

Monohydrate

122
Q

which are oval or dumbbell shaped

A

Monohydrate

123
Q

Clumps of calcium oxalate crystals may be related to

A

Renal calculi

124
Q

Common constituents of kidney stone

A

Calcium oxalate

125
Q

__________ is form in cases of ethylene glycol poisoning

A

Monohydrate

126
Q

• Common

• pH acid or neutral

• Envelope or dumb bell shaped

• Oval – may be mistaken for RBC

• Soluble in HCl; Insoluble in acetic acid

A

Calcium oxalate

127
Q

represent the majority of crystals seen in alkaline urine

A

Phosphates crystals

128
Q

Types of phosphates crystals

A
  • Amorphous phosphates
  • Triple phosphates
  • Calcium phosphates
129
Q

What are the NORMAL CRYSTALS SEEN IN ALKALINE URINE

A

• Calcium carbonate
• Ammonium biurate • Phosphates crystals

130
Q

• Granular in appearance, similar to amorphous urates

• When present in large quantities following specimen refrigeration, they cause a white precipitate that does not dissolve on warming

A

AMORPHOUS PHOSPHATES

131
Q

• Ammonium Magnesium phosphate crystals

• Commonly seen in alkaline urine

A

TRIPLE PHOSPHATE

132
Q

Easily identified by their prism shape that frequently resembles a “coffin lid”

A

TRIPLE PHOSPHATE

133
Q

Dissolve in dilute acetic acid and sulfonamides do not Resembles sulfonamide crystals (needle shape

A

CALCIUM PHOSPHATE

134
Q

• “Sheets of Ice”

• Rosettes

• Associated with Cystitis and Urine retention

A

CALCIUM PHOSPHATE

135
Q

Small and colorless, with dumbbell or spherical shapes

A

CALCIUM CARBONATE

136
Q

• May occur in clumps that resemble amorphous material, but they can be distinguished by the formation of gas after the addition of acetic acid

• They are also birefringent, which differentiates them from bacteria

• No clinical significance

A

CALCIUM CARBONATE

137
Q

Acidic normal crystals are?

A
  1. URATES CRYSTALS
  • Amorphous urates
  • Uric acid
  • Acid urates
  1. CALCIUM OXALATE
138
Q

Alkaline normal crystals are?

A
  1. Phosphates crystals
  • Amorphous phosphates
  • Triple phosphates
  • Calcium phosphates
  1. Calcium carbonate
  2. Ammonium biurat
139
Q

ABNORMAL CRYSTALS are

A

Cystine

• Cholesterol

• Crystals Associated with Liver Disorders – in s

  • Tyrosine
  • Leucine
  • Bilirubin

• Sulfonamides

• Ampicillin

140
Q

severe liver disorders, three rarely seen crystals may be found in the urine sediment:

A
  • Tyrosine
  • Leucine
  • Bilirubin
141
Q

Found in the urine of persons who inherit a metabolic disorder that prevents reabsorption of cystine by the renal tubules (cystinuria)

A

CYSTINE

142
Q

Disintegrating forms may be seen in the presence of ammonia

• They may be difficult to diff

A

Cystine

143
Q

Appear as colorless, hexagonal plates and may be thick or thin; not birefringent

A

Cystine

144
Q

• Rarely seen unless specimens have been refrigerated, because lipids remain in droplet form

• Resembling a rectangular plate with a notch in one or more corners

A

Cholesterol

145
Q

Associated with disorders producing lipiduria, such as the nephrotic syndrome, and are seen in conjunction with fatty casts and oval fat bodies

A

Cholesterol crystals

146
Q

• appear as fine colorless to yellow needles that frequently form clumps or rosettes

• usually seen in conjunction with leucine crystals in specimens with positive chemical test results for bilirubin

A

Tyrosine

147
Q

Encountered in inherited disorders of amino-acid metabolism

A

Tyrosine

148
Q

Yellow-brown to golden yellow spheres that demonstrate concentric circles and radial striations

• They are seen less frequently than tyrosine

A

Leucine

149
Q

• Present in hepatic disorders producing large amounts of bilirubin in the urine

• Appear as clumped needles or granules with the characteristic yellow color of bilirubin

A

Bilirubin

150
Q

bilirubin crystals may be found incorporated into the

A

Matrix of casts

151
Q

In disorders that produce renal tubular damage, such as viral hepatitis

A

Bilirubin

152
Q

• Common among patients treated with UTI

• Inadequate patient hydration was and still is the primary cause of sulfonamide crystallization

A

Sulfonamides

153
Q

• Shapes most frequently encountered include needles, rhombics, whetstones, sheaves of wheat, and rosettes with colors ranging from colorless to yellow-brown

A

Sulfonamides

154
Q

Appear as colorless needles that tend to form bundles following refrigeration

A

Ampicilin

155
Q

Precipitation of antibiotics is not frequently encountered

A

Ampicilin

CLINICAL MICROSCOPY (7 decks)

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