Microscopic Examination Flashcards
1
Q
May indicate the presence
of certain sediments
A
Color
2
Q
Pathologic or non-pathologic
causes of turbidity
A
Clarity
3
Q
RBCs, RBC Cast
A
Blood
4
Q
Casts, cells
A
Protein
5
Q
Bacteria, WBCs
A
Nitrite
5
Q
Yeast
A
Glucose
5
Q
Quantitative measure of formed elements using a
hemocytometer
A
ADDIS COUNT
6
Q
Transfer (?) to glass slide with (?) coverslip
A
20 uL, 22 x 22 mm
6
Q
WBCs, WBC Casts, bacteria
A
LE
6
Q
Specimen used in Addis count?
A
12 hr urine
6
Q
Decant urine to remain how many mL of urine?
A
0.5-1 mL remains
6
Q
What mL of urine use in microscopic?
A
12 mL
7
Q
Preservative used in Addis count?
A
NaF (Sodium Fluoride)
8
Q
Delineates
structure and
contrasting colors
of the nucleus
and cytoplasm
A
Sternheimer-Malbin
9
Q
Sternheimer-Malbin was made up of?
A
(CV + Safranin O)
9
Q
Lyses RBCs and enhances nucleus of WBCs
A
2% Acetic acid
10
Q
Enhances nuclear detail
A
0.5% Toluidine Blue
11
Q
2 Example of lipid stains?
A
(ORO-oil red oil and Sudan III)
11
Q
Stains TAG and neutral fats which results in what color?
A
Lipid stains
12
Q
Stains eosinophilic granules
A
Hansel Stain
12
Q
Differentiates
Gram (-) to Gram
(+) bacteria
A
Gram stain
13
Q
Visualization of elements
with low refractive indices
(hyaline, mixed cellular cast,
MT, Trichomonas)
A
Phase-Contrast
Microscopy
13
Q
Hansel Stain is made up of?
A
Eosin Y + Methylene blue)
13
Q
Stains sediments containing iron
A
Prussian Blue
13
Function of Sternheimer-Malbin
WBCs, ECs, and
casts
14
Function of 2% Acetic acid
Distinguishes
RBCs
from WBCs,
yeasts, oil
droplets and
crystals
14
Function of 0.5% Toluidine
Blue
Differentiates
WBCs and RTE
cells (oval;
nucleus centered)
15
Function of GS
Bacterial casts
15
Function of Hansel Stain
Urinary
eosinophils
16
Function of Lipid stains
Identifies free fat
droplets and lipidcontaining cells &
cast
16
Identification of cholesterol
molecules in OFB, fatty casts
and crystals
Polarizing Microscopy
17
Interference-Contrast Microscopy for differential?
Nomarski
17
For fluorescent
microorganisms or those
stained with a fluorescent
dye
Fluorescence Microscopy
17
Function of Prussian Blue
Identifies
hemosiderin
granules in casts
and cells
18
Used for routine urinalysis
Bright-Field Microscopy
18
Identification of Treponema
spp
Dark-Field Microscopy
19
3-D microscopy image and
layer-by-layer imaging of a
specimen
Interference-Contrast
Microscopy
19
Interference-Contrast Microscopy for modulation?
Hoffman
19
Smooth, non-nucleated, biconcave disks-shaped
sediment and what it diameter?
RED BLOOD CELLS (HEMATURIA), 7 um
20
NV of RBC in urinary sediments
0-4 /HPF
21
in Hypotonic urine, RBC is?
ghost cell or large empty cell
21
Sources of errors in RBC?
Yeast, oil droplets, air bubbles,
CaOx monohydrate
21
in Hypertonic urine, RBC is?
crenated or shrink
21
Glomerular bleeding/damage means you have?
RBC casts
21
Remedy in RBC?
Addition of 2% HAc to lyse RBCs
22
Clinical Significance of RBC?
Glomerular membrane damage, vascular
injury within GUT, glomerular bleeding,
glomerulonephritis, renal calculi,
malignancies, Schistosomiasis, strenuous
exercise
22
RBC condition?
HEMATURIA
22
WHITE BLOOD CELLS condition?
PYURIA
23
NV of WBC?
0-5 /HPF
23
What is the predominant in WBC?
Neutrophils
23
Type of WBC that is Granulated and multilobed
Neutrophils
23
Neutrophils Swells in? and the granules undergo what movement?
hypotonic urine and granules undergo Brownian Movement
23
NV of eosinophil?
less than 1%
24
Clinically significant: urinary eosinophils
(associated with drug-induced interstitial
nephritis)
Eosinophils
25
Type of cells that present in small amount?
Mononuclear cells (Lympho, Mono, Macro, Histio)
26
An increase mononuclear cells indicates an?
inflammatory response or renal transplant rejection
27
Clinical Significance:
- Infection or inflammation in the GUT
- Bacterial infection: cystitis,
pyelonephritis, prostatitis, urethritis
- Non-bacterial infection:
glomerulonephritis, SLE, tumors
Mononuclear cells (Lympho, Mono, Macro, Histio)
27
SEC studded with Gardnerella vaginalis; associated with
bacterial vaginosis
CLUE CELLS
28
Largest cell epithelial cell? and what its size?
SEC (Surface Epithelial Cells), 30-40 um
29
Tye of EC that is folded cell may resemble casts. It also found in the ?
linings of vagina, female urethra, and lower portion
of male urethra
29
Spherical,
polyhedral or
caudate with
centrally located
nucleus
TEC (Transitional Epithelial Cells)
30
TEC is also called?
Urothelial
31
TEC can be found in what part of the urinary system?
From linings of
renal pelvis,
calyces, ureter,
urinary bladder
and upper
portion of male
urethra.
32
- Most clinically significant epithelial cell
RTE
32
-Significant numbers can be seen after catheterization (single, pairs, or in clumps {syncytia})
- Not usually seen
in urine
TEC
33
2 VARIATIONS OF RTE
Oval Fat Bodies
Bubble cells
33
* Oblong or round to oval or rectangular and contain an
eccentric nucleus and coarsely granulated cytoplasm
RTE
33
>2 RTE/HPF indicates what disease?
TUBULAR DAMAGE
33
RTE cell with nonlipid-filled vacuoles and Seen in acute tubular necrosis
Bubble cells
33
Most frequently associated with UTI
BACTERIA
34
Most common bacteria causes UTI?
Enterobacteriaceae
34
Oval Fat Bodies use what stains?
Lipid Stains (TAG and Neutral fats)
34
Lipid-containing RTE cell and seen in lipiduria (nephrotic syndrome)
Oval Fat Bodies
34
Oval Fat Bodies use what microscope and what its appearnce?
Polarizing Microscope: maltese cross
35
- Most frequent parasite encountered in urine
- Pear-shaped flagellate (rapid darting motility)
T. vaginalis
36
- Blood fluke with terminal spine
- Causes hematuria; associated with bladder
cancer
S. haematobium ova (bladder)
36
T. vaginalis Method of reporting?
RFMoMa
37
parasite that is Most common fecal contaminant
E. vermicularis
37
S. haematobium ova (bladder) specimen used?
24hr unpreserved urine
38
Small, refractile oval structures that may or may not
bud
YEASTS
38
seen in DM patients and IMC PX
Candida albicans
39
True yeast infection
+ WBCs
39
(+) in RGT strip of glucose means?
YEASTS
40
- Major constituent: Tamm-horsfall protein or
Uromodulin
- 95% water, mucin, CHONs, minerals, salts
and traces of lipid and nucleic acid
MUCUS THREAD
40
* Unique to the kidneys
* Primarily formed in the DCT and collecting ducts
* Seen primarily along the coverslip edges with subdued
light
CASTS (CYLINDRURIA)
40
Condition of cast?
CYLINDRURIA
40
CASTS reported as?
average number/10 lpfs
40
CASTS major constituents?
Uromodulin produced by RTE cells
41
1. Aggregation and concentration of THP into fibrils that
attaches to RTE cells.
2. Interweaving of protein fibrils into a mesh-like pattern.
3. (Possible) attachment of urinary sediments to the matrix
4. Detachment and excretion
FORMATION OF CASTS
41
4 ORDER OF CAST DEGENERATION
1. Hyaline
2. Cellular
3. Coarsely granular
4. Waxy granular (kidney failure)
41
* Beginning of all casts
* Most frequently
seen cas
Hyaline cast
42
Hyaline cast NV
0-2/lpf
43
Hyalin cast: Exercise, dehydration, heat exposure, emotional
stress is Physioligic or Pathologic?
Physiologic
43
CLINS:
* Advanced tubular
destruction
* Allograft rejection
* Pyelonephritis (w/ WBC
casts)
RTE cell cast
43
(Hyaline cast) Acute glomerulonephritis, pyelonephritis, CHF, CRD is Physioligic or Pathologic?
Pathologic
44
CLINS:
* Glomerulonephritis
* Associated with
proteinuria and
dysmorphic RBCs
RBC cast
44
* Nephron bleeding
* Reporting: number
per lpf
RBC cast
45
What are you going to use in WBC cast to see it?
use phase contrast or a supravital stain
45
* Infection or
inflammation within
the nephron
* May be confused
with EC casts
WBC cast
46
* Granules are derived
from the lysosomes
of RTE cells during
normal metabolism
Granular
cast
46
* Resemble granular
casts
* Identific
Bacterial cast
46
It is cast that means Toxicity and Viral infections
RTE cell cast
46
* Identified using lipid
stains and polarizing
microscope
Fatty cast
47
* Final degenerative
form of all types of
casts.
* Brittle, highly
refractile with jagged
edges
Waxy cast
48
What is the color of Waxy cast under the supra vital stain?
Dark pink
48
* Casts containing
urates, CaOx, and
sulfonamides are
occasionally seen
* Deposition of crystals
in the tubule or
collecting duct
Crystal
cast
48
* Renal failure cast
* All types of casts may
occur in the broad
form; most
common: WAXY &
GRANULAR
Broad cast
49
Bile-stained broad,
waxy casts are seen
as the result of the
tubular necrosis
caused by viral
hepatitis
Broad cast
49
* Hyaline matrix with
coloration due to
pigmentation
incorporation
Pigmented
cast
49
* Casts containing
multiple cell types
Mixed
cellular
cast
50
CLINS:
* Pyelonephritis -
Bacterial casts
containing bacilli both
within and bound to the
protein matrix
Bacterial
cast
50
CLINS:
* Glomerulonephritis
* Pyelonephritis
* Stress
* Strenuous exercis
Granular
cast
50
CLINS:
* Nephrotic syndrome
(lipiduria – OVB)
* Toxic tubular necrosis
* Diabetes mellitus
* Crush injuries
Fatty cast
50
CLINS:
* Extreme urine stasis
* Renal failure
Broad cast
50
CLINS:
* Stasis of urine flow
* Chronic renal failure
Waxy cast
50
In pigmented cast, Incorporated bilirubin color is?
(golden brown)
51
In pigmented cast, Hemoglobin or myoglobin color is?
(yellow to red brown)
51
Mixed cellular cast (WBC, RTE casts or WBC and bacterial casts)
Pyelonephritis
51
* Formed by precipitation of urinary solutes (organic
compounds, salts, medication)
CRYSTALS (CRYSTALLURIA)
51
Mixed cellular cast (RBC and WBCs)
Glomerulonephritis
51
Condition of Crystals?
CRYSTALLURIA
52
In crystals, ref temperature amorphous urates color?
pink ppt
52
* Casts containing urates, CaOx, and sulfonamides are
occasionally seen
* Deposition of crystals in the tubule or collecting duct
Crystal cast
52
In crystals, ref temperature amorphous phosphate color?
white
52
Factors that contribute to crystal formation?
- Temperature
- Solute conc.
- pH
53
- all abnormal crystals are found in (pH)
acidic urine
53
* Brick dust
* Yellow-brown granules
* Refrigerated specimens
* pH >5.5
* Dissolved when warm
Amorphous
urates
54
Amorphous urates pH?
>5.5
54
- Dissolved by acetic acid; only normal crystal that appears
colored
Amorphous phosphate
55
* Clumps - formation of
renal calculi
* Increased in food rich in
oxalic acid (tomatoes,
asparagus, and ascorbic
acid)
* Mistaken as RBC
CaOx
55
Type of CaOx that is:
- colorless, octahedral
envelope or as two
pyramids joined at their
bases
- most common form;
enveloped form
Dihydrate (Wheddelite)
55
Type of CaOx that is:
- oval or dumbbell shaped
- ethylene glycol
(antifreeze) poisoning (in
children & pets; sweet &
tempting
Monohydrate (Whewellite)
55
CaOx is soluble in? and insoluble in?
* Dilute HCl;
* Insoluble in HAc
55
“Cigarette-butt” in
appearance
Calcium sulfate
56
Calcium sulfate is soluble in?
Acetic acid
56
* Yellow-brown or
colorless elongated
prisms
* Less significant
Hippuric acid
56
- rhombic, four-sided flat plates (whetstones), wedges,
and rosettes
Pleomorphic
56
* Large granules and may
have spicules
* Resembles ammonium
biurate in alkaline urine
* Less clinical
Acid urate
56
Hippuric acid is soluble in?
Water and Ether
57
* Yellow-brown or
colorless
* Misidentified w/ cystine
crystals
* Birefringent
* Increased amounts:
- Increased levels of
purine and nucleic
acid
- Leukemia patients
receiving
chemotherapy
- Lesch-Nyhan
syndrome (orangesand in diapers)
- Gout
Uric acid
57
* Slender prisms arranged
in fan or sheaf-like
structures
* Synovial fluid during
episode of gout
Sodium urate
57
* Colorless, flat rectangular
plates
* Thin prisms often in(?)– resemble
sulfonamide crystals
* Common constituent of
renal calculi
Calcium Phosphate /apatite, rosette formations
57
* Yellow-brown thorny apples
* Seen in old specimens
Ammonium
biurate
57
* Long slender prisms with one
end pointed; found in clusters
Dicalcium
phosphate
58
* Granular
* Refrigerated samples – white
precipitate
Amorphous phosphate
58
* Not clinically significant
* Bacteria splitting
* “Ammonium magnesium
phosphate” crystal
* Colorless, prism-shape or
“coffin-lid”
* Feathery appearance when
they disintegrate
* Fern-leaf (Harr)
Triple phosphate /
Struvite
59
* Small, colorless, dumbbell-shaped
* Formation of gas (effervescence) after the
addition of acetic acid
Calcium
carbonate
60
What are the normal crystals in ACIDIC urine?
ACCHUAS
- Amorphous urates
- CaOx
- Calcium sulfate
- Hippuric acid
- Uric acid
- Acid urate
- Sodium urate
60
What are the normal crystals in ALKALINE urine
- Amorphous phosphate
- Ammonium biurate
- Calcium Phosphate/apatite
- Dicalcium phosphate
-Triple phosphate / Struvite
- Calcium carbonate
60
basic calcium phosphate
Hydroxyapatite
60
calcium hydrogen phosphate
Brushite
61
COLOR: URIC ACID
Yellow-brown
61
COLOR: CYSTINE
Colorless
61
SOLUBILITY IN AMMONIA: Uric acid
Soluble
62
Solubility in
ammonia: Cystine
Soluble
63
Solubility in dilute
HCl: Uric Acid
Insoluble
64
Solubility in dilute
HCl: Cystine
Soluble
65
Birefringence: Uric Acid
Birefringent
66
Birefringence: Cystine
Not Birefringent
67
Cyanide
-
nitroprusside
reaction: Uric acid
Negative
68
Cyanide
-
nitroprusside
reaction: Cystine
Positive
69
ASSOCIATED WITH LIVER DISEASES:
Oily
-looking
yellow
-brown
spheres with
concentric circles
and radial
striations
Leucine
70
Appearance of leucine in ASSOCIATED WITH LIVER DISEASES
Oily looking yellow brown spheres
71
ASSOCIATED WITH LIVER DISEASES:
Fine colorless to
yellow needles
that frequently
form clumps or
rosettes
Tyrosine
72
ASSOCIATED WITH LIVER DISEASES:
Usually seen in
conjunction with
leucine crystals
in specimens with
positive chemical
test results for
bilirubin
Tyrosine
73
ASSOCIATED WITH LIVER DISEASES:
Inherited disorders
of amino
-acid
metabolism
Tyrosine
74
Appearance of Tyrosine in associated with liver diseases
Fine colorless to
yellow needles
that frequently
form clumps or
rosettes
75
ASSOCIATED WITH LIVER DISEASES:
Hepatic disorders
Bilirubin
76
ASSOCIATED WITH LIVER DISEASES:Clumped needles
or granules with
the characteristic
yellow color of
bilirubin
Bilirubin
77
Appearance of Bilirubin in ASSOCIATED WITH LIVER DISEASES
Clumped needles
or granules with
the characteristic
yellow color of
bilirubin
78
* Colorless, hexagonal
plates
* Mistaken as uric acid
crystals
Cystine
79
* Rectangular plates
with notched edges
(staircase pattern)
Cholesterol crystals
80
* Nephrotic syndrome
(lipiduria)
* Seen in conjunction
with fatty casts and
oval fat bodies
* Soluble in
Chloroform
Cholesterol crystals
81
a metabolic disorder that
prevents reabsorption
of cystine by the renal
tubules
Cystinuria
82
accumulation of cystine
in cells
Cystinosis
83
CLIN.SIG:
Nephrotic syndrome
(OFB, fatty casts,
choles.cryst)
Cholesterol crystal
84
* Colorless to yellow
-
brown needles
–
“sheaves of wheat”
* Rosettes, arrowheads,
petals, or round
*
Mistaken as calcium
phosphate crystals
Sulfonamide
(acid/neutral)
84
* Colorless needles that
form bundles after
refrigeration
* Precipitation of
antibiotics following
massive doses without
adequate hydration
* Overdose of penicillin
drugs
Ampicillin
(acid/neutral)
85
TO DIFFERENTIATE
FROM PHOSPHATE
CRYST:
Lignin Test: - Newspaper:
Urine + 25%
HCl
= (+)
Yellow
Diazo reaction
85
CLIN sig:
* Possible tubular
damage
* Primary cause:
inadequate patient
hydration
Sulfonamide
(acid/neutral
86
* Nephrotic syndrome
(lipiduria)
* Seen in conjunction
with fatty casts and
oval fat bodies
* Soluble in
Chloroform
Cholesterol
crystal
