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ANURBF > Microscopic Examination > Flashcards

Microscopic Examination Flashcards

1
Q

May indicate the presence
of certain sediments

A

Color

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2
Q

Pathologic or non-pathologic
causes of turbidity

A

Clarity

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3
Q

RBCs, RBC Cast

A

Blood

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4
Q

Casts, cells

A

Protein

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5
Q

Bacteria, WBCs

A

Nitrite

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5
Q

Yeast

A

Glucose

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5
Q

Quantitative measure of formed elements using a
hemocytometer

A

ADDIS COUNT

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6
Q

Transfer (?) to glass slide with (?) coverslip

A

20 uL, 22 x 22 mm

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6
Q

WBCs, WBC Casts, bacteria

A

LE

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6
Q

Specimen used in Addis count?

A

12 hr urine

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6
Q

Decant urine to remain how many mL of urine?

A

0.5-1 mL remains

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6
Q

What mL of urine use in microscopic?

A

12 mL

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7
Q

Preservative used in Addis count?

A

NaF (Sodium Fluoride)

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8
Q

Delineates
structure and
contrasting colors
of the nucleus
and cytoplasm

A

Sternheimer-Malbin

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9
Q

Sternheimer-Malbin was made up of?

A

(CV + Safranin O)

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9
Q

Lyses RBCs and enhances nucleus of WBCs

A

2% Acetic acid

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10
Q

Enhances nuclear detail

A

0.5% Toluidine Blue

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11
Q

2 Example of lipid stains?

A

(ORO-oil red oil and Sudan III)

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11
Q

Stains TAG and neutral fats which results in what color?

A

Lipid stains

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12
Q

Stains eosinophilic granules

A

Hansel Stain

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12
Q

Differentiates
Gram (-) to Gram
(+) bacteria

A

Gram stain

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13
Q

Visualization of elements
with low refractive indices
(hyaline, mixed cellular cast,
MT, Trichomonas)

A

Phase-Contrast
Microscopy

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13
Q

Hansel Stain is made up of?

A

Eosin Y + Methylene blue)

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13
Q

Stains sediments containing iron

A

Prussian Blue

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13
Q

Function of Sternheimer-Malbin

A

WBCs, ECs, and
casts

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14
Q

Function of 2% Acetic acid

A

Distinguishes
RBCs
from WBCs,
yeasts, oil
droplets and
crystals

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14
Q

Function of 0.5% Toluidine
Blue

A

Differentiates
WBCs and RTE
cells (oval;
nucleus centered)

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15
Q

Function of GS

A

Bacterial casts

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15
Q

Function of Hansel Stain

A

Urinary
eosinophils

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16
Q

Function of Lipid stains

A

Identifies free fat
droplets and lipidcontaining cells &
cast

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16
Q

Identification of cholesterol
molecules in OFB, fatty casts
and crystals

A

Polarizing Microscopy

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17
Q

Interference-Contrast Microscopy for differential?

A

Nomarski

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17
Q

For fluorescent
microorganisms or those
stained with a fluorescent
dye

A

Fluorescence Microscopy

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17
Q

Function of Prussian Blue

A

Identifies
hemosiderin
granules in casts
and cells

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18
Q

Used for routine urinalysis

A

Bright-Field Microscopy

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18
Q

Identification of Treponema
spp

A

Dark-Field Microscopy

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19
Q

3-D microscopy image and
layer-by-layer imaging of a
specimen

A

Interference-Contrast
Microscopy

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19
Q

Interference-Contrast Microscopy for modulation?

A

Hoffman

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19
Q

Smooth, non-nucleated, biconcave disks-shaped
sediment and what it diameter?

A

RED BLOOD CELLS (HEMATURIA), 7 um

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20
Q

NV of RBC in urinary sediments

A

0-4 /HPF

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21
Q

in Hypotonic urine, RBC is?

A

ghost cell or large empty cell

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21
Q

Sources of errors in RBC?

A

Yeast, oil droplets, air bubbles,
CaOx monohydrate

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21
Q

in Hypertonic urine, RBC is?

A

crenated or shrink

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21
Q

Glomerular bleeding/damage means you have?

A

RBC casts

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21
Q

Remedy in RBC?

A

Addition of 2% HAc to lyse RBCs

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22
Q

Clinical Significance of RBC?

A

Glomerular membrane damage, vascular
injury within GUT, glomerular bleeding,
glomerulonephritis, renal calculi,
malignancies, Schistosomiasis, strenuous
exercise

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22
Q

RBC condition?

A

HEMATURIA

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22
Q

WHITE BLOOD CELLS condition?

A

PYURIA

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23
Q

NV of WBC?

A

0-5 /HPF

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23
Q

What is the predominant in WBC?

A

Neutrophils

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23
Q

Type of WBC that is Granulated and multilobed

A

Neutrophils

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23
Q

Neutrophils Swells in? and the granules undergo what movement?

A

hypotonic urine and granules undergo Brownian Movement

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23
Q

NV of eosinophil?

A

less than 1%

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24
Q

Clinically significant: urinary eosinophils
(associated with drug-induced interstitial
nephritis)

A

Eosinophils

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25
Q

Type of cells that present in small amount?

A

Mononuclear cells (Lympho, Mono, Macro, Histio)

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26
Q

An increase mononuclear cells indicates an?

A

inflammatory response or renal transplant rejection

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27
Q

Clinical Significance:
- Infection or inflammation in the GUT
- Bacterial infection: cystitis,
pyelonephritis, prostatitis, urethritis
- Non-bacterial infection:
glomerulonephritis, SLE, tumors

A

Mononuclear cells (Lympho, Mono, Macro, Histio)

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27
Q

SEC studded with Gardnerella vaginalis; associated with
bacterial vaginosis

A

CLUE CELLS

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28
Q

Largest cell epithelial cell? and what its size?

A

SEC (Surface Epithelial Cells), 30-40 um

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29
Q

Tye of EC that is folded cell may resemble casts. It also found in the ?

A

linings of vagina, female urethra, and lower portion
of male urethra

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29
Q

Spherical,
polyhedral or
caudate with
centrally located
nucleus

A

TEC (Transitional Epithelial Cells)

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30
Q

TEC is also called?

A

Urothelial

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31
Q

TEC can be found in what part of the urinary system?

A

From linings of
renal pelvis,
calyces, ureter,
urinary bladder
and upper
portion of male
urethra.

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32
Q
  • Most clinically significant epithelial cell
A

RTE

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32
Q

-Significant numbers can be seen after catheterization (single, pairs, or in clumps {syncytia})
- Not usually seen
in urine

A

TEC

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33
Q

2 VARIATIONS OF RTE

A

Oval Fat Bodies
Bubble cells

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33
Q
  • Oblong or round to oval or rectangular and contain an
    eccentric nucleus and coarsely granulated cytoplasm
A

RTE

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33
Q

> 2 RTE/HPF indicates what disease?

A

TUBULAR DAMAGE

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33
Q

RTE cell with nonlipid-filled vacuoles and Seen in acute tubular necrosis

A

Bubble cells

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33
Q

Most frequently associated with UTI

A

BACTERIA

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34
Q

Most common bacteria causes UTI?

A

Enterobacteriaceae

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34
Q

Oval Fat Bodies use what stains?

A

Lipid Stains (TAG and Neutral fats)

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34
Q

Lipid-containing RTE cell and seen in lipiduria (nephrotic syndrome)

A

Oval Fat Bodies

34
Q

Oval Fat Bodies use what microscope and what its appearnce?

A

Polarizing Microscope: maltese cross

35
Q
  • Most frequent parasite encountered in urine
  • Pear-shaped flagellate (rapid darting motility)
A

T. vaginalis

36
Q
  • Blood fluke with terminal spine
  • Causes hematuria; associated with bladder
    cancer
A

S. haematobium ova (bladder)

36
Q

T. vaginalis Method of reporting?

A

RFMoMa

37
Q

parasite that is Most common fecal contaminant

A

E. vermicularis

37
Q

S. haematobium ova (bladder) specimen used?

A

24hr unpreserved urine

38
Q

Small, refractile oval structures that may or may not
bud

A

YEASTS

38
Q

seen in DM patients and IMC PX

A

Candida albicans

39
Q

True yeast infection

A

+ WBCs

39
Q

(+) in RGT strip of glucose means?

A

YEASTS

40
Q
  • Major constituent: Tamm-horsfall protein or
    Uromodulin
  • 95% water, mucin, CHONs, minerals, salts
    and traces of lipid and nucleic acid
A

MUCUS THREAD

40
Q
  • Unique to the kidneys
  • Primarily formed in the DCT and collecting ducts
  • Seen primarily along the coverslip edges with subdued
    light
A

CASTS (CYLINDRURIA)

40
Q

Condition of cast?

A

CYLINDRURIA

40
Q

CASTS reported as?

A

average number/10 lpfs

40
Q

CASTS major constituents?

A

Uromodulin produced by RTE cells

41
Q
  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
A

FORMATION OF CASTS

41
Q

4 ORDER OF CAST DEGENERATION

A
  1. Hyaline
  2. Cellular
  3. Coarsely granular
  4. Waxy granular (kidney failure)
41
Q
  • Beginning of all casts
  • Most frequently
    seen cas
A

Hyaline cast

42
Q

Hyaline cast NV

A

0-2/lpf

43
Q

Hyalin cast: Exercise, dehydration, heat exposure, emotional
stress is Physioligic or Pathologic?

A

Physiologic

43
Q

CLINS:
* Advanced tubular
destruction
* Allograft rejection
* Pyelonephritis (w/ WBC
casts)

A

RTE cell cast

43
Q

(Hyaline cast) Acute glomerulonephritis, pyelonephritis, CHF, CRD is Physioligic or Pathologic?

A

Pathologic

44
Q

CLINS:
* Glomerulonephritis
* Associated with
proteinuria and
dysmorphic RBCs

A

RBC cast

44
Q
  • Nephron bleeding
  • Reporting: number
    per lpf
A

RBC cast

45
Q

What are you going to use in WBC cast to see it?

A

use phase contrast or a supravital stain

45
Q
  • Infection or
    inflammation within
    the nephron
  • May be confused
    with EC casts
A

WBC cast

46
Q
  • Granules are derived
    from the lysosomes
    of RTE cells during
    normal metabolism
A

Granular
cast

46
Q
  • Resemble granular
    casts
  • Identific
A

Bacterial cast

46
Q

It is cast that means Toxicity and Viral infections

A

RTE cell cast

46
Q
  • Identified using lipid
    stains and polarizing
    microscope
A

Fatty cast

47
Q
  • Final degenerative
    form of all types of
    casts.
  • Brittle, highly
    refractile with jagged
    edges
A

Waxy cast

48
Q

What is the color of Waxy cast under the supra vital stain?

A

Dark pink

48
Q
  • Casts containing
    urates, CaOx, and
    sulfonamides are
    occasionally seen
  • Deposition of crystals
    in the tubule or
    collecting duct
A

Crystal
cast

48
Q
  • Renal failure cast
  • All types of casts may
    occur in the broad
    form; most
    common: WAXY &
    GRANULAR
A

Broad cast

49
Q

Bile-stained broad,
waxy casts are seen
as the result of the
tubular necrosis
caused by viral
hepatitis

A

Broad cast

49
Q
  • Hyaline matrix with
    coloration due to
    pigmentation
    incorporation
A

Pigmented
cast

49
Q
  • Casts containing
    multiple cell types
A

Mixed
cellular
cast

50
Q

CLINS:
* Pyelonephritis -
Bacterial casts
containing bacilli both
within and bound to the
protein matrix

A

Bacterial
cast

50
Q

CLINS:
* Glomerulonephritis
* Pyelonephritis
* Stress
* Strenuous exercis

A

Granular
cast

50
Q

CLINS:
* Nephrotic syndrome
(lipiduria – OVB)
* Toxic tubular necrosis
* Diabetes mellitus
* Crush injuries

A

Fatty cast

50
Q

CLINS:
* Extreme urine stasis
* Renal failure

A

Broad cast

50
Q

CLINS:
* Stasis of urine flow
* Chronic renal failure

A

Waxy cast

50
Q

In pigmented cast, Incorporated bilirubin color is?

A

(golden brown)

51
Q

In pigmented cast, Hemoglobin or myoglobin color is?

A

(yellow to red brown)

51
Q

Mixed cellular cast (WBC, RTE casts or WBC and bacterial casts)

A

Pyelonephritis

51
Q
  • Formed by precipitation of urinary solutes (organic
    compounds, salts, medication)
A

CRYSTALS (CRYSTALLURIA)

51
Q

Mixed cellular cast (RBC and WBCs)

A

Glomerulonephritis

51
Q

Condition of Crystals?

A

CRYSTALLURIA

52
Q

In crystals, ref temperature amorphous urates color?

A

pink ppt

52
Q
  • Casts containing urates, CaOx, and sulfonamides are
    occasionally seen
  • Deposition of crystals in the tubule or collecting duct
A

Crystal cast

52
Q

In crystals, ref temperature amorphous phosphate color?

A

white

52
Q

Factors that contribute to crystal formation?

A
  • Temperature
  • Solute conc.
  • pH
53
Q
  • all abnormal crystals are found in (pH)
A

acidic urine

53
Q
  • Brick dust
  • Yellow-brown granules
  • Refrigerated specimens
  • pH >5.5
  • Dissolved when warm
A

Amorphous
urates

54
Q

Amorphous urates pH?

A

> 5.5

54
Q
  • Dissolved by acetic acid; only normal crystal that appears
    colored
A

Amorphous phosphate

55
Q
  • Clumps - formation of
    renal calculi
  • Increased in food rich in
    oxalic acid (tomatoes,
    asparagus, and ascorbic
    acid)
  • Mistaken as RBC
A

CaOx

55
Q

Type of CaOx that is:
- colorless, octahedral
envelope or as two
pyramids joined at their
bases
- most common form;
enveloped form

A

Dihydrate (Wheddelite)

55
Q

Type of CaOx that is:
- oval or dumbbell shaped
- ethylene glycol
(antifreeze) poisoning (in
children & pets; sweet &
tempting

A

Monohydrate (Whewellite)

55
Q

CaOx is soluble in? and insoluble in?

A
  • Dilute HCl;
  • Insoluble in HAc
55
Q

“Cigarette-butt” in
appearance

A

Calcium sulfate

56
Q

Calcium sulfate is soluble in?

A

Acetic acid

56
Q
  • Yellow-brown or
    colorless elongated
    prisms
  • Less significant
A

Hippuric acid

56
Q
  • rhombic, four-sided flat plates (whetstones), wedges,
    and rosettes
A

Pleomorphic

56
Q
  • Large granules and may
    have spicules
  • Resembles ammonium
    biurate in alkaline urine
  • Less clinical
A

Acid urate

56
Q

Hippuric acid is soluble in?

A

Water and Ether

57
Q
  • 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
A

Uric acid

57
Q
  • Slender prisms arranged
    in fan or sheaf-like
    structures
  • Synovial fluid during
    episode of gout
A

Sodium urate

57
Q
  • Colorless, flat rectangular
    plates
  • Thin prisms often in(?)– resemble
    sulfonamide crystals
  • Common constituent of
    renal calculi
A

Calcium Phosphate /apatite, rosette formations

57
Q
  • Yellow-brown thorny apples
  • Seen in old specimens
A

Ammonium
biurate

57
Q
  • Long slender prisms with one
    end pointed; found in clusters
A

Dicalcium
phosphate

58
Q
  • Granular
  • Refrigerated samples – white
    precipitate
A

Amorphous phosphate

58
Q
  • Not clinically significant
  • Bacteria splitting
  • “Ammonium magnesium
    phosphate” crystal
  • Colorless, prism-shape or
    “coffin-lid”
  • Feathery appearance when
    they disintegrate
  • Fern-leaf (Harr)
A

Triple phosphate /
Struvite

59
Q
  • Small, colorless, dumbbell-shaped
  • Formation of gas (effervescence) after the
    addition of acetic acid
A

Calcium
carbonate

60
Q

What are the normal crystals in ACIDIC urine?

A

ACCHUAS

  • Amorphous urates
  • CaOx
  • Calcium sulfate
  • Hippuric acid
  • Uric acid
  • Acid urate
  • Sodium urate
60
Q

What are the normal crystals in ALKALINE urine

A
  • Amorphous phosphate
  • Ammonium biurate
  • Calcium Phosphate/apatite
  • Dicalcium phosphate
    -Triple phosphate / Struvite
  • Calcium carbonate
60
Q

basic calcium phosphate

A

Hydroxyapatite

60
Q

calcium hydrogen phosphate

A

Brushite

61
Q

COLOR: URIC ACID

A

Yellow-brown

61
Q

COLOR: CYSTINE

A

Colorless

61
Q

SOLUBILITY IN AMMONIA: Uric acid

A

Soluble

62
Q

Solubility in
ammonia: Cystine

A

Soluble

63
Q

Solubility in dilute
HCl: Uric Acid

A

Insoluble

64
Q

Solubility in dilute
HCl: Cystine

A

Soluble

65
Q

Birefringence: Uric Acid

A

Birefringent

66
Q

Birefringence: Cystine

A

Not Birefringent

67
Q

nitroprusside
reaction: Uric acid

A

Negative

68
Q

nitroprusside
reaction: Cystine

A

Positive

69
Q

ASSOCIATED WITH LIVER DISEASES:
Oily
-looking
yellow
-brown
spheres with
concentric circles
and radial
striations

A

Leucine

70
Q

Appearance of leucine in ASSOCIATED WITH LIVER DISEASES

A

Oily looking yellow brown spheres

71
Q

ASSOCIATED WITH LIVER DISEASES:
Fine colorless to
yellow needles
that frequently
form clumps or
rosettes

A

Tyrosine

72
Q

ASSOCIATED WITH LIVER DISEASES:
Usually seen in
conjunction with
leucine crystals
in specimens with
positive chemical
test results for
bilirubin

A

Tyrosine

73
Q

ASSOCIATED WITH LIVER DISEASES:
Inherited disorders
of amino
-acid
metabolism

A

Tyrosine

74
Q

Appearance of Tyrosine in associated with liver diseases

A

Fine colorless to
yellow needles
that frequently
form clumps or
rosettes

75
Q

ASSOCIATED WITH LIVER DISEASES:
Hepatic disorders

A

Bilirubin

76
Q

ASSOCIATED WITH LIVER DISEASES:Clumped needles
or granules with
the characteristic
yellow color of
bilirubin

A

Bilirubin

77
Q

Appearance of Bilirubin in ASSOCIATED WITH LIVER DISEASES

A

Clumped needles
or granules with
the characteristic
yellow color of
bilirubin

78
Q
  • Colorless, hexagonal
    plates
  • Mistaken as uric acid
    crystals
A

Cystine

79
Q
  • Rectangular plates
    with notched edges
    (staircase pattern)
A

Cholesterol crystals

80
Q
  • Nephrotic syndrome
    (lipiduria)
  • Seen in conjunction
    with fatty casts and
    oval fat bodies
  • Soluble in
    Chloroform
A

Cholesterol crystals

81
Q

a metabolic disorder that
prevents reabsorption
of cystine by the renal
tubules

A

Cystinuria

82
Q

accumulation of cystine
in cells

A

Cystinosis

83
Q

CLIN.SIG:
Nephrotic syndrome
(OFB, fatty casts,
choles.cryst)

A

Cholesterol crystal

84
Q
  • ## Colorless to yellowbrown needles
    –
    “sheaves of wheat”
  • Rosettes, arrowheads,
    petals, or round
    *
    Mistaken as calcium
    phosphate crystals
A

Sulfonamide
(acid/neutral)

84
Q
  • Colorless needles that
    form bundles after
    refrigeration
  • Precipitation of
    antibiotics following
    massive doses without
    adequate hydration
  • Overdose of penicillin
    drugs
A

Ampicillin
(acid/neutral)

85
Q

TO DIFFERENTIATE
FROM PHOSPHATE
CRYST:

A

Lignin Test: - Newspaper:
Urine + 25%
HCl
= (+)
Yellow
Diazo reaction

85
Q

CLIN sig:
* Possible tubular
damage
* Primary cause:
inadequate patient
hydration

A

Sulfonamide
(acid/neutral

86
Q
  • Nephrotic syndrome
    (lipiduria)
  • Seen in conjunction
    with fatty casts and
    oval fat bodies
  • Soluble in
    Chloroform
A

Cholesterol
crystal

ANURBF (4 decks)

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