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Analysis of Urine and Body Fluids > Microscopic Examination of Urine > Flashcards

Microscopic Examination of Urine Flashcards

1
Q

The main purpose is to identify and/or quantify
insoluble materials in the urine such as red blood cells (RBs), white blood cells (WBCs), epithelial cells, casts, bacteria, yeast, parasites, mucus, spermatozoa, crystals, and artifacts

A

MICROSCOPIC EXAMINATION

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2
Q

MICROSCOPIC EXAMINATION is where we detect and identify __________ materials.

A

INSOLUBLE

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3
Q

In ROUTINE ANALYSIS, _______ specimen must be utilized

A

FRESH

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4
Q

The refrigeration of urine can lead to the precipitation of _____________ (alkaline pH) and ______________ (acidic pH)

A

Amorphous phosphates; Amorphous urates

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5
Q

In the three step analysis, what should be done in order in urine testing?

A

Gross Appearance, Biochemistry, Microscopy

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6
Q

Before performing microscopic

examination is that the specimen must be ________________.

A

Centrifugation

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7
Q

Urine is prepared in ________ tube (conical vial), before microscopic examination?

A

Falcon Tube

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8
Q

The urine sample must be centrifuge at ______ rpm for ______ minutes at ______ temperature, to avoid lysis of the formed elements

A

1,800; 10; 15-30 degree celsius

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9
Q

T/F: In the Philippines, we are using Decislide as we are also using conventional microscopy.

A

False- In the Philippines, we are still not using
Decislide but we are still using conventional
microscopy

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10
Q

Identify the magnification of microscope:
Scanning: _____
LPO: _______
HPO: ______

A

4x ; 10x; 40x

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11
Q

The total magnification is evaluated by:

A

Magnification X Total Eyepiece

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12
Q

In determining cast counts at the microscope, what magnification should be used?

A

10x

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13
Q

In determining cellular counts, what magnification should be used?

A

40x

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14
Q

T/F: The condenser must be down at a certain level to have proper contrast of hyaline cast?

A

TRUE

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15
Q

T/F: HYALINE CAST can be mistaken with Squamous Epithelial Cells.

A

TRUE

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16
Q

If a formed element is approximated under LPO, but is mistakenly read and graded under HPO, then you’ll tend to have false ________ results; If a cellular element is supposed to be read under
HPO, but is mistakenly read under LPO, then there will
be a false ______ in results.

A

Decrease; Increase

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17
Q

T/F: In common laboratory practice, when using 10ml/5mL test tube, turning it over and decanting is usually done.

A

TRUE

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18
Q

Where does urine sediment gets trapped at the top or bottom?

A

BOTTOM

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19
Q

T/F: After centrifugation, urine sediments are discarded before examining microscopically?

A

FALSE: Do not discard the sediments. Make sure that you have adequate sediments to be examined microscopically.

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20
Q

When does urine reagent strip testing must be done? Is it BEFORE or AFTER centriugation?

A

BEFORE - Urine reagent strip testing is done in a homogenous specimen and not after centrifugation.

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21
Q

Performing urine reagent strip testing after centrifugation can cause _____.

A

FALSE DECREASE RESULT

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22
Q

Is there a standardized amount of resuspended urine

sample that needs to be dispensed?

A

There is no standardized amount.

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23
Q

Is there a difference in reading when you put

coverslip in the reading?

A

Yes, reading of cellular elements tends to be HIGHER if you do not use coverslip since your reading is not standardized.

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24
Q

T/F: The importance of using a coverslip is it distribute the cellular elements.

A

TRUE

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25
Q

IDEALLY, _____ of urine supernatant is
left, and a dropper is used to mix them with the
sediment

A

0.5mL - 1mL of urine

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26
Q

A product that enables the ease in the preparation of

smear sample and microscopic observation.

A

Urisystem Deci-slide

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27
Q

It eliminates the process of you applying a cover slip, you just directly apply the suspended urine sediment

A

Urisystem Deci-slide

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28
Q

T/F: We use stain in the laboratory especially

for routine urinalysis

A

FALSE: We don’t use stain in the laboratory especially for routine urinalysis

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29
Q

What kind of microscope is mostly used in examining urine sediments?

A

Bright field Microscope

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30
Q

The presence of blood in the urine

A

Hematuria

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31
Q

It is crenated or irregularly shaped RBC in Hematuria

A

HYPERSTHENURIC

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32
Q

Crenated cells are mistaken for ______.

A

WBC

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33
Q

Are known as Ghost Cells

A

HYPOSTHENURIC:

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34
Q

T/F: HYPOSTHENURIC must be examined under reduced light

A

TRUE

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35
Q

Red blood cells that are exposed in a

hypotonic solution

A

HYPOSTHENURIC: “GHOST CELLS”

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36
Q

This appears in glomerular bleeding as it passed through the tubules

A

DYSMORPHIC RBC

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37
Q

A dysmorphic RBC with multiple protrusions

A

ACANTHOCYTE

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38
Q

DYSMORPHIC RBC can be seen in average number in ________.

A

10 hpfs

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39
Q

The normal values for RBCs in high power field

A

Below 3 hpf

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40
Q

Hematuria is seen in:

A

Damage to the glomerular membrane; Vascular injury within the genitourinary tract

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41
Q

Gross-bleeding or Very red bleeding

A

Frank Hematuria

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42
Q

Advanced glomerular damage

A

Macroscopic hematuria

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43
Q

Early diagnosis of glomerular

disorders

A

Microscopic hematuria

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44
Q

Red blood cells are seen as biconcave cells with central depression, they appear as ______

A

HEMATURIA ; discoid cells

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45
Q

The most conspicuous and acts as a good marker that you are on the correct plane in HEMATURIA

A

Squamous epithelial cell

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46
Q

This can be mistaken for RBCs: ______, ________, ________ and _________.

A

Yeast cells; Oil droplets; Fat bodies/Fat globules and Air bubbles

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47
Q

It contains granules and multilobed nuclei

A

PYURIA OR LEUKOCYTURIA

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48
Q

This pyuria are circular and nucleated, they are mistaken for

A

renal tubular epithelial cells

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49
Q

The predominant WBC found in the urine sediment

A

NEUTROPHIL

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50
Q

Neutrophils exposed to hypotonic urine are known as ____________.

A

Glitter Cells

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51
Q

What stain is used in Glitter Cells causing a light blue color? This is used to identify the cellular elements in the urine

A

Sternheimer-Malbin stain

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52
Q

The Average Number seen in PYURIA

A

10 hpfs

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53
Q

The Normal Values for WBC seen in hpfs are?

A

0-8 hpf

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54
Q

T/F: All Pyuria are infection

A

FALSE - Not All

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55
Q

Signify and most commonly associated with Drug-induced interstitial nephritis (DIIN)

A

EOSINOPHILURIA

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56
Q

This stain is used for eosinophils which is technically methylene blue thus eosin y

A

EOSINOPHILURIA

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57
Q

Seen in early stages of renal transplant rejection and mistaken for renal transitional epithelial cell (RTE)

A

Lymphocytes

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58
Q

This EC is abundant, irregular cytoplasm and prominent nucleus; as it has a large cell with irregular borders

A

SQUAMOUS EPITHELIAL CELL

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59
Q

Clue cells is a indication of _________.

A 
Gardnerella vaginalis (causative agent of
bacterial vaginosis)
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60
Q

The most common EC in the urinary sediment

A

SQUAMOUS EPITHELIAL CELL

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61
Q

Spherical, polyhedral or caudate with CENTRALLY located nucleus

A

TRANSITIONAL EPITHELIAL CELL (UROTHELIAL CELLS)

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62
Q

It is smaller than squamous epithelial cells

A

TRANSITIONAL EPITHELIAL CELL (UROTHELIAL CELLS)

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63
Q

This term is referred as singly, in pairs, in clumps, in UROTHELIAL CELLS

A

Syncitia

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64
Q

An __________ TEC with with abnormal morphology indicates Malignancy or viral infection.

A

Increased

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65
Q

Most clinically significant epithelial cell as it originates from the kidney

A

RENAL TUBULAR EPITHELIAL CELLS (RTE)

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66
Q

Looks like FRIED EGG

A

RENAL TUBULAR EPITHELIAL CELLS (RTE)

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67
Q

Mistaken as lymphocyte wherein its shape: rectangular, polyhedral, cuboidal or columnar with
ECCENTRIC nucleus

A

RENAL TUBULAR EPITHELIAL CELLS

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68
Q

Can be sometimes mistaken for other shapes of transitional cells

A

RENAL TUBULAR EPITHELIAL CELLS (RTE)

69
Q

A RTE that has rectangular and large in appearance

A

Proximal Convoluted Tubule (PCT)

70
Q

A RTE that has spherical, circular, cuboidal and small cells

A

Distal Convoluted Tubule (DCT)

71
Q

A more than 2 RTE/hpf is an indication of

A

TUBULAR INJURY (kidney damage)

72
Q

An RTE with an oval fat body is an indication of __.

A

Nephrotic Syndrome

73
Q

A bubble cell in RTE is an indication of

A

Acute Tubular Necrosis

74
Q

An EC that is reported per LPF

A

SQUAMOUS EPITHELIAL CELL

75
Q

An EC that is reported per HPF

A

TRANSITIONAL EPITHELIAL CELL

76
Q

An EC is reported as per 10 HPF

A

Renal Tubular Epithelial Cells

77
Q

Can sometimes looks like maltese cross, which can usually birefringence crystals or formed elements.

A

Nephrotic Syndrome

78
Q

The characteristic elongated shape and

flattened on the sides (cylinder).

A

CASTS

79
Q

CYLINDURIA is formed within the ________ and ___________.

A

Distal convoluted tubule and Collecting duct

80
Q

The ONLY FORMED ELEMENTS that are UNIQUE

to the KIDNEY.

A

CASTS

81
Q

CASTS is casually examined in under ____ power magnification

A

LOW

82
Q

T/F: Casts is reported high low power field

A

FALSE - Low

83
Q

CASTS is composed of mostly the ________.

A

UROMODULIN/ TAMM HORSFALL PROTEIN

84
Q

A Prototype cast

A

HYALINE CASTS

85
Q

The normal values for Hyaline casts is ____ /lpf

A

0-2 / lpf

86
Q

The color stain for Hyaline Cast when Sternheimer-Malbin is used.

A

Light Pink

87
Q

The clinical significance of Hyaline Cast, if the levels are more than > 2/ lpf

A

● Glomerulonephritis
● Pyelonephritis
● Congestive heart failure
● Chronic renal disease

88
Q

True cellular casts must already be formed in

A

Distal convoluted tubule and Collecting duct

89
Q

Bleeding within nephron/kidney

A

RBC CAST

90
Q

Have a slight ORANGE-ISH stain compared to the

other casts

A

RBC CAST

91
Q

T/F: It is a TRUE RBC CAST, if there are no free-floating RBCs

A

FALSE

92
Q

We can utilize this to differentiate lower UTI from upper UTI

A

WBC CAST

93
Q

Primary marker for distinguishing pyelonephritis (upper UTI) from cystitis (lower UTI)

A

WBC CAST

94
Q

It is wherein EOSINOPHILS predominate, this would present a WBC cast without bacteria or free-floating WBC.

A

Acute interstitial nephritis

95
Q

This to check if the WBCs are from eosinophils

A

Acute Interstitial Nephritis

96
Q

Renal Tubular Epithelial cells (RTE)

A

It is a marker of advanced tubular destruction

97
Q

The predominant cell for glomerulonephritis is ________.

A

RBC

98
Q

The predominant cell for pyelonephritis is _________.

A

WBC

99
Q

Derived from lysosomes of RTE cells

A

GRANULAR CAST

100
Q

It is caused by toxic effects of hemoglobinuria, leading to eventually renal failure

A

Acute Tubular Necrosis

101
Q

DARK-BROWN casts representing degradation products of hemoglobin such as the methemoglobin

A

GRANULAR CAST

102
Q

T/F: Fine and coarse granular casts cannot be pathologic.

A

FALSE - can be and cannot be.

103
Q

T/F: There is no need to differentiate fine granular casts from coarse granular casts. We just report it as granular casts.

A

TRUE

104
Q

It is usually in LIPIDURIA

A

FATTY CAST

105
Q

T/F: FATTY CAST can be stained with Sternheimer-Malbin stain.

A

FALSE - cannot

106
Q

In fatty cast, this maltese cross appearance, this seen under polarizing microscope.

A

Oil Red O / Sudan III.

107
Q

A maltese cross appearance signifies

a. cholesterol
b. triglyceride

A

A. cholesterol

108
Q

It is the clinical significance demonstrating Toxic (severe) tubular necrosis.

A

Fatty Cast

109
Q

It is a chronic renal failure cast

A

BROAD CAST

110
Q

Indicates destruction or WIDENING of the tubular walls

A

BROAD CAST

111
Q

The most common type of Broad Cast

A

Granular and Waxy

112
Q

Usually a marker of extreme urine stasis

A

WAXY CAST

113
Q

It is the final degenerative form of all types of cast

A

WAXY CAST

114
Q

It entails that the cast is already old and it’s edges are starting to be destroyed.

Fragmented with jagged ends

A
115
Q

Waxy casts stain a homogenous in supravital stain.

A

DARK PINK

116
Q

Factors that contribute to crystal formation

A

pH, Temperature, Solute Concentration

117
Q

Normal crystals is read in

A

HPO

118
Q

Abnormal crystals is read in

A

LPO

119
Q

Dissolve upon heating or by adding a weakly alkaline

solution:

A

Amorphous urates

120
Q

Amorphous urates is found in

A

Acidic urine

121
Q

Dissolve in dilute acetic acid:

A

amorphous phosphates

122
Q

Amorphous phosphates is found in

A

alkaline urine

123
Q

There are dumbbell shape, appearance of a cross,

diamond

A

DIHYDRATE (WHEDDELITE) or MONOHYDRATE (WHEWELLITE)

124
Q

The only crystal seen in acidic -neutral and alkaline urine.

A

DIHYDRATE (WHEDDELITE) or MONOHYDRATE (WHEWELLITE)

125
Q

Calcium Oxalate Crystals is found in

A

Acidic Urine

126
Q

Increased intake of Vitamin C or Ascorbic acid & Exposure to chemicals leading to chemical toxicity

A

CALCIUM OXALATE CRYSTALS

127
Q

Cigarette-butt

A

CALCIUM SULFATE CRYSTALS IN URINE

128
Q

Calcium Phosphate is found in ____.

A

Alkaline Urine

129
Q

Rosette Apatite

A

CALCIUM PHOSPHATE

130
Q

It is mistaken as sulfonamide.

A

CALCIUM PHOSPHATE

131
Q

T/F: Calcium phosphate is soluble in acetic acid

A

TRUE

132
Q

Dumbbell (Effervescence after HAc)

A

CALCIUM CARBONATE

133
Q

This indicates Gouty arthritis

A

URIC ACID CRYSTALS

134
Q

URIC ACID CRYSTALS is found in

A

acidic, slightly acidic, and neutral urine

135
Q

Also known as Nyhan’s syndrome, Kelley-Seegmiller

syndrome and Juvenile gout

A

LESCH-NYHAN SYNDROME

136
Q

a hereditary disorder or purine metabolism,
characterized by mental retardation, self mutilation of the fingers and lips by biting, impaired renal function and abnormal physical development

A

LESCH-NYHAN SYNDROME

137
Q

It is caused by a deficiency of the enzyme hypoxanthine-guanine phosphoribosyltransferase (HPRT)

A

LESCH-NYHAN SYNDROME

138
Q

Looks the same having 6 sides

A

URIC ACID OR CYSTINE

139
Q

T/F: Uric Acid is colorless while Cystine is Yellow-brown

A

FALSE: Uric Acid is Yellow-brown while Cystine is colorless

140
Q

Birefringence of Cystine

A

Non birefringent

141
Q

Cyanide- nitroprusside reaction of Uric Acid ____ and Cystine _____.

A

Negative; Positive

142
Q

Thorny Apple Crystal

A

AMMONIUM BIURATE

143
Q

Coffin-Lid Crystal

A

TRIPLE PHOSPHATE

144
Q

Bilirubin Crystals is found in

A

Acidic urine

145
Q

Bilirubin Crystals is pigmented with _______.

A

Yellowish brown granules

145
Q

Bilirubin Crystals is pigmented with _______.

A

Yellowish brown granules

146
Q

LEUCINE CRYSTAL is found in

A

Acidic Urine

147
Q

Spheroids with concentric striations

A

LEUCINE CRYSTAL

148
Q

Colorless or yellow, fine silky needles in sheaves or clumps. It is seen in liver disease and tyrosinemia (an inborn error of
metabolism)

A

TYROSINE CRYSTALS

149
Q

Yellow-brown sheaves of wheat with central bindings, striated sheaves with eccentric bindings, round forms with radial striations etc.

A

SULFONAMIDE CRYSTALS

150
Q

Occurs following sulfonamide therapy

A

SULFONAMIDE CRYSTALS

151
Q

Staircase crystal : Notched plate

A

CHOLESTEROL

152
Q

Cause of HIGH specific gravity in the urine

A

RADIOGRAPHIC DYE

153
Q

It is an indicative of nephrotic syndrome or progressive/progression of kidney
damage

A

CHOLESTEROL

154
Q

The accumulation of crystals [non pathologic] such as calcium oxalate, calcium phosphate, uric acid , cholesterol, and cystine crystals may lead to _________.

A

Kidney stones or renal calculi

155
Q

Asymmetric “Maltese cross” in polarized light

A

STARCH GRANULE

156
Q

This can be confused with fat bodies/fatty casts; Irregularly round with dark striation to the center

A

STARCH GRANULE

157
Q

Most commonly trace from contamination from the rubber gloves

A

Starch polarized

158
Q

Contains large spherical, highly refractile fat droplets; Polarized light show “Maltese-cross” pattern; Associated with marked proteinuria and nephrotic syndrome

A

FATTY CAST

159
Q

The diagnostic feature of the spine at the terminal end of an oval structure. (Schistosoma haematobium)

A

METAZOANS (MULTICELLULAR) PARASITES

160
Q

Enterobius vermicularis: D-shaped ova or egg

A

METAZOANS (MULTICELLULAR) PARASITES

161
Q

The most common that can be found in urine from both males and females is Trichomonas vaginalis.

A

PROTOZOANS (UNICELLULAR) PARASITES

162
Q

This can be found in urine sample is Acanthamoeba.

A

PROTOZOANS (UNICELLULAR) PARASITES

163
Q

Acanthamoeba keratitis (most common) is the destruction of the eyes

A

PROTOZOANS (UNICELLULAR) PARASITES

164
Q

Most commonly due to grease in the slide (dirty slide)

A

Oil droplets

165
Q

May be mistaken as oil droplets or protozoan

elements

A

Air bubbles

166
Q

This looks like cholesterol crystals

A

Talcum Powder Particles and Glass Fragments / Glass Shards

167
Q

The following medical procedures or

intake of therapeutic drugs can formed this crystals

A

Radiographic dye,

ampicillin, sulfonamide

Analysis of Urine and Body Fluids (2 decks)

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