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Clinical Microscopy > Microscopic Examination of Urine > Flashcards

Microscopic Examination of Urine Flashcards

1
Q

What does the abbreviation CLSI mean

A

Clinical and Laboratory Standards Institute

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2
Q

The CLSI recommends that microscopic analysis of the urine be performed when __ and __.

A
  1. Requested by a physician

2. Abnormal physical/chemical result is obtained

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3
Q

Casts are reported as the average number per _ following an examination of _ fields.

A

LPF; 10

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4
Q

RBCs and WBCs, are reported as the average number per _ following an examination of _ fields.

A

HPF; 10

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5
Q

Point of a reference plane

A

Presence of epithelial cells

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6
Q

Reported semiquantitatively

A

Epithelial cells, crystals, and other elements

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7
Q

This procedure utilizes a hemocytometer to count the number of RBCs, WBCs, casts, and epithelial cells present in a 12-hr specimen

A

Addis count

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8
Q

Most frequently used stain in urinalysis which consists of crystal violet and safranin O

A

Sternheimer-Malbin Stain

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9
Q

This stain delineates the structure and contrasting colors of the nucleus and cytoplasm

A

Sternheimer-Malbin Stain

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10
Q

This stain distinguishes RBCs from WBCs, yeast, crystals, and oil droplets

A

2% Acetic acid

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11
Q

This stain identifies urinary eosinophils

A

Hansel Stain

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12
Q

These stains stain triglycerides and neutral fats orange-red

A

Oil Red O and Sudan III

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13
Q

Lipid stains such as Oil Red O and Sudan III do not stain _

A

Cholesterol

* but cholesterol is capable of polarization

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14
Q

This stain identifies bacterial casts by differentiating gram-positive and gram-negative bacteria

A

Gram stain

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15
Q

This stain differentiates WBCs and RTE cells by enhancing nuclear detail

A

Toluidine blue

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16
Q

Gram-positive stain color; Gram-negative stain color

A

Gram (+)= blue

Gram (-)=red

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17
Q

What must be prepared when gram staining the urine sediment

A

Heat-fixed urine sediment

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18
Q

Hansel stain consists of _ and _

A

methylene blue and eosin Y

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19
Q

Another stain that can also be used for the detection of eosinophils

A

Wright’s stain

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20
Q

Prussian blue stain confirms the presence of _

A

Hemosiderin

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21
Q

Crenated RBCs signify a _ urine

A

Hypersthenuric

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22
Q

Product of hypostenuric urine

A

Ghost cells

* Hyposthenuric (dilute): Cells absorb water, swells, and lyse rapidly releasing hemoglobin. Only the membrane is left.

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23
Q

Normal characteristic of RBCs in urine

A

Smooth, non-nucleated, biconcave disk at 7mm

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24
Q

Morphology of urinary RBCs may aid in the determination of _ .

A

Site of renal bleeding

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25
Q

Dysmorphic RBCs are associated primarily with _

A

Glomerular bleeding

* Dysmorphic na kasi galing pa sa glomerulous kaya dumaan, daan pa sa buong urinary tract. *RBCs are fragile.

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26
Q

Characteristic of dysmorphic RBCs associated with glomerular bleeding

A

Acanthocyte with multiple portrusions

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27
Q

Diameter of WBCs

A

12 mm

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28
Q

Predominant WBC found in urine

A

Neutrophils

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29
Q

Neutrophils lyse rapidly in concentrated/dilute, acidic/alkaline urine, and begin to lose nuclear detail

A

dilute alkaline

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30
Q

Product of neutrophils exposed to hypotonic urine

A

Glitter cells

* Due to the Brownian movement of the granules because the cell has absorbed water

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31
Q

Color of glitter cells when stained with Sternheimer-Malbin

A

Light blue

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32
Q

Urine sediment primarily found in drug-induced interstitial nephritis

A

Eosinophils

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33
Q

The percentage of eosinophils in _ cells is determined.

A

100-500

* 1% Eo = clinically significant

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34
Q

Recommended urine sediment when using a conventional glass slide method

A

20 uL (0.02 mL) covered by 22x22 mm glass coverslip

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35
Q

Frequently used volume for sediment preparation

A

0.5 and 1mL

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36
Q

Distinguishing color of stained T. vaginalis in urine

A

Light blue-green

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37
Q

Stain of motile vs non-motile bacteria

A

Motile: Do not stain; non-motile: Purple

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38
Q

Microscope needed in order to distinguish cholesterol

A

Polarizing microscope

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39
Q

Specimen for the detection of eosinophil urine sediment using Hansel stain

A

Centrifuged / cytocentrifuged urine

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40
Q

Microscope needed to detect treponema pallidum

A

Darkfield microscopy

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41
Q

The microscope that produces a three-dimensional microscopy image

A

Interference microscope

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42
Q

Enhances visualization of low refractive indices such as hyaline casts, mixed cellular casts, mucous threads and Trichomonas

A

Phase-contrast microscopy

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43
Q

Estimate report for a macroscopic hematuria

A

> 100 RBCs/hpf

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44
Q

Color of Glitter cells when stained with Sternheimer-Malbin stain

A

Light blue

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45
Q

The presence of urinary eosinophils is primarily associated with _

A

Drug-induced interstitial nephritis

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46
Q

The largest cell found in a urine sediment

A

Epithelial cells

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47
Q

These cells are an indication of vaginal infection by the bacterium Gardenerellla vaginallis

A

Clue cells

*Clue cells are epithelial cells w/ attached G. vaginiallis coccobacillus

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48
Q

Difference of a transitional epithelial cell from RTE cells

A

Transitional epithelial cells: central nucleus

RTE cells: eccentric nucleus

49
Q

Largest RTE cell

A

RTE cells from the PCT (rectangular shape)

  • DCT=round/oval
  • Collecting Duct= Cuboid
50
Q

The presence of _RTE cells /HPF is indicative of tubular injury

A

> 2 RTE cells/hpf

51
Q

Hemoglobin present in the filtrate is absorbed by the RTE cells and converted to _

A

Hemosiderin

52
Q

Lipid containing RTE cells

A

Oval fat bodies

53
Q

Lipiduria is most commonly associated with the damage to the glomerulus caused by _

A

Nephrotic syndrome

54
Q

Represents injured cells in which the endoplasmic reticulum has dilated prior to cell death

A

Bubble cells

55
Q

Unacceptable specimen pH

A

pH 8

56
Q

True UTI

A

Bacteria accompanied by WBCs

57
Q

Most frequently assoc. bacteria with UTI

A

Enterobacteriaceae (gram - rods)

  • Staphylococcus and Enterococcus are also capable of producing UTI
58
Q

Primary yeast seen in diabetic patients, immunocompromised patients, and women with vaginal moniliasis

A

Candida albicans

59
Q

True yeast infection

A

yeast accompanied by WBCs

60
Q

The most frequent parasite encountered in the urine

A

T. vaginalis

61
Q

Movement of T. vaginalis

A

Rapid darting movement

62
Q

Parasites seen in urine

A
  1. T. vaginalis
  2. Schistosoma haematobium (bladder parasite)
  3. Enterobius vermicularis
63
Q

Most common fecal contaminant in the urine

A

E. vermicularis

64
Q

Major constituent of mucous

A

uromodulin

65
Q

The shape is representative of the tubular lumen

A

Casts

66
Q

Major constituent of casts

A

Uromodulin

  • Uromodulin is found in both normal and abnormal urine
67
Q

Term to casts when they are formed at the junction of the ascending loop of Henle and the distal convoluted tubule

A

Cylindroids

68
Q

Color of casts when stained with Sterheimer-Malbin

A

Pink

69
Q

RBC casts are primarily associated with

A

Glomerulonephritis

70
Q

Fats do NOT stain with _

A

Sternheimer-Malbin stains

71
Q

The shape of renal tubular cells in
PCT:
DCT:
Collecting Duct:

A

The shape of renal tubular cells in
PCT: Rectangular (biggest)
DCT: Round or oval
Collecting Duct: Cuboidal

72
Q

Most clinically significant of the epithelial cells

A

Renal Tubular Epithelial cells

73
Q

Characteristic of cholesterol under the polarizing microscope

A

Maltese cross

74
Q

True / False

Urine is not toxic to spermatozoa, therefore they may exhibit motility

A

False. Urine is toxic to spermatozoa

75
Q

WBC casts are most associated with _

A

Pyelonephritis

76
Q

Two types of granular casts

A

Fine and coarse granular casts

77
Q

Waxy casts are indicative of

A

CHRONIC RENAL FAILURE

78
Q

Casts that are indicative of chronic renal failure

A

WAXY CAST

79
Q

Color of waxy casts when stained with Supravital stain

A

Homogenous pink ** jagged ends

80
Q

Often referred to as the “Renal Failure Cast”

A

BROAD CAST

81
Q

Broad casts are otherwise known as

A

RENAL FAILURE CASTS

82
Q

Most commonly seen broad casts

A

Granular and Waxy broad casts

83
Q

Broad casts are a mold of the _ tubule

A

Distal convoluted tubule ** Broad casts indicate widening of the tubular walls

84
Q

Reporting of crystals

A

Rare, few, moderate or many per hpf

85
Q

Factors involved in crystal formation

A
  1. pH
  2. Solute concentration
  3. Temperature
  • Slower crystallization produces larger crystals
86
Q

T/F:
Solutes precipitate more readily at low temperatures, therefore the majority of crystal formation takes place in specimens that have remained at room temperature/ has been refrigerated

A

True

87
Q

The crystal which precipitates in acidic, neutral, and alkaline urine

A

Calcium Oxalate

88
Q

All abnormal crystals are found in _ urine

A

Acidic

89
Q

T/F

Polarization may be used for identifying crytals

A

FALSE. Polarization is constant for all crystals. pH is used to identify the crystal

90
Q

Crystals that are frequently seen in refrigerated specimens

A

Amorphous Urates

*uR(efrigerated)ates

91
Q

Amorphous urates may be dissolved if the specimen is _

A

If the specimen is warmed (37C)

92
Q

Amorphous phosphates cannot be dissolved through warming, and require _ in order to dissolve

A

Acetic acid

*RBCs will also be destroyed

93
Q

Normal crystals that are seen in acidic urine:

A
  1. Amorphous urates
  2. Uric acid
  3. Acid urates
  4. Sodium urates
94
Q

Amorphous urates are seen in acidic urine with a pH greater than _

A
  1. 5 pH

* Uric acid crystals appear when the pH is lower

95
Q

Disease associated with increased production of uric acid

A

Lesch-Nyhan syndrome

96
Q

Most common form of calcium oxalate

A

Dihydrate form (octahedral envelope / 2 pyramids joined at their bases)

97
Q

Shape of monohydrate calcium oxalate

A

Dumbell shape

98
Q

Majority of renal calculi care composed of _

A

Calcium oxalate

99
Q

High ascorbic acid levels in the body may result to what crystal in urine?

A

Calcium oxalate

because oxalic acid is the end product of acid metabolism

100
Q

_ is seen in cases of ethylene glycol (antifreeze) poisoning

A

Monohydrate form of calcium oxalate

101
Q

Phosphates represent the majority of the crystals seen in _ urine

A

Alkaline urine

102
Q

Difference of amorphous urates from amorphous phosphates:

A

Urates: Acidic, yellow-brown in color
Phosphates: Alkaline, white in color

103
Q

Most commonly seen crystal in ALKALINE urine

A

Triple phosphate (ammonium magnesium phosphate)

104
Q

Shape of triple phosphate

A

Coffin-lid / Prism shape

  • as they disintegrate, they may produce a feathery appearance
105
Q

Calcium phosphate crystals dissolve in _

A

Dilute acetic acid

*Sulfonamides do not dissolve in dilute acetic acid

106
Q

The crystal that forms gas after the addition of acetic acid

A

Calcium carbonate crystals

107
Q

Characteristic of Ammonium Biurtate crystals

A

“Thorny apples” / Spicule covered spheres

108
Q

Ammonium biurate crystals dissolve at _ and convert to _ when glacial acetic acid is added

A

dissolve at 60C

convert to uric acid crystals

109
Q

Most commonly encountered crystal in old specimens

A

Ammonium biurate

* Associated with the presence of ammonia produced by urea-splitting bacteria

110
Q

Positive confirmation of cystine crystals is made using _ _

A

Cyanide nitroprusside test

111
Q

Characteristic of cystine crystals in urine

A

Colorless, thick/thin hexagonal plates (benzene)

112
Q

Characteristic of cholesterol crystals in urine

A

Colorless, rectangular plate with a notched in 1/more corners

113
Q

Crystals associated with liver disorder

A

TaLagang Bugbog na Liver (TLB)

Tyrosine, Leucine and Bilirubin

114
Q

Crystal confused with Cholesterol crystals

A

Radiographic dye

*to differentiate=check patient history and compare urinalysis results.

115
Q

Colorless-yellow needles that frequently form clumps or rosettes

A

Tyrosine crystals

116
Q

Yellow-brown spheres that demonstrate concentric circles and radial striations

A

Leucine crystals

117
Q

Clumped needles/granules with yellow color of bilirubin

A

Bilirubin crystals

118
Q

Common crystals found in patients being treated with UTI

A

Sulfonamide crystals

*Inadequate hydration is the primary cause of sulfonamide crystals

119
Q

Result of precipitation of antibiotics

A

Ampicillin crystals

Clinical Microscopy (7 decks)

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