MICROSCOPIC EXAMINATION OF URINE Flashcards
memorization
1
Q
Average range specimen volume for urinalysis:
Recommended volume:
A
Average range: 10 - 15 mL
Recommended: 12 mL
2
Q
Centrifuge tube at ____ RCF for ___ minutes:
A
Centrifuge tube at 400 RCF for 5 minutes
3
Q
Transfer 20 uL (0.02 mL) sediment to glass slide with _______ mm coverslip
A
22x22 mm coverslip
4
Q
Examine microscopically (___ LPF, ____ HPF, under ____ light)
A
10 LPF
10 HPF
Under reduced light
5
Q
Quantitative measure of formed elements of urine using hemacytometer
A
Addis Count
6
Q
Specimen used for Addis count:
A
12-hour urine
7
Q
Preservative used for Addis count:
A
Formalin
8
Q
Normal values in Addis count:
RBCs =
WBCs & ECs =
Hyaline casts =
A
RBCs = 0 - 500,000/12-hr urine
WBCs = 0 - 1,800,000/12-hr urine
Hyaline casts = 0 - 5000/12-hr urine
9
Q
Located in the objective & is adjusted to be near the specimen:
A
First lens system
10
Q
Located in the eyepiece (ocular lens)
A
Second lens system
11
Q
Used to clean the optical surfaces of the microscope:
A
lens paper
12
Q
Used to remove dust on the optical surface of the microscope
A
Camel-hair brush
13
Q
Used to clean any contaminated lens
A
Commercial lens cleaner
14
Q
To remove oil on lens, use:
A
- use dry lens paper
- then lens paper moistened w/ lens cleaner
15
Q
Using xylene to remove oil on lens is recommended
true or false
A
False
Using xylene to remove oil on lens is not recommended due to its toxic fumes
16
Q
Lenses which forms primary (initial) image of specimen
A
Objectives
17
Q
moves stage noticeably up & down, bringing slide into view
A
Coarse Focus knob
18
Q
Sharpens the image
A
Fine focus knob
19
Q
Microscope for routine urinalysis
A
Bright-field (BF) microscopy
20
Q
Enhances visualization of translucent elements (i.e. with low refractive indices [e.g. casts])
A
Phase-contrast microscopy
21
Q
To convert BF to PC:
A
Replace objective lens & condenser with PC objective lens & PC condenser
22
Q
To convert BF into polarizing:
A
Add 2 filters (1 below the condenser, 1 between objectives & oculars)
22
Q
Detects the presence or absence of birefringence; for identification of cholesterol in oval fat bodies, fatty casts, and crystals.
A
polarizing microscopy
22
Q
It is the ability of an element to refract light in2 dimensions at 90 degrees to each other
A
Birefringence
23
for identification of Treponema pallidum
Dark-Field (DF) microscopy
24
To convert BF into DF:
Replace the condenser with a DF condenser that contains an opaque disk
25
For visualization of fluorescent substances and microorganisms
Fluorescence microscopy
26
3-D microscopy image & layer-by-layer imaging of a specimen
Interference-contrast microscopy
27
Can be adapted for interference microscopy:
Bright0field microscopy
28
2 types of interference-contrast microscopy:
1. Nomarski (Differential interference contrast)
2. Hoffman (Modulation contrast)
29
Delineates structure & contrasting colors of the nucleus & cytoplasm; Identifies WBCs, epithelial cells and casts; most commonly used supravital stain:
Sternheimer-Malbin (SM)
(Crystal violet + Safranin O)
30
Enhances nuclear detail; Differentiates WBCs and RTE cells:
Toluidine blue (supravital stain)
31
Lyses RBCs, enhances nuclei of WBCs; Distinguishes RBCs from WBCs, yeast, oil droplets & crystals
2% acetic acid
32
Stains triglycerides and neutral fats orange-red; Identifies free fat droplets & lipid-containing cells & casts.
Lipid stains
- oil Red O
- Sudan III
33
Differentiates Gram-positive & -negative bacteria; Identifies bacterial casts
Gram stain
34
Stains eosinophilic granules; Identifies urinary eosinophils
Hansel stain (Eosin Y + Methylene blue)
35
Stains structures containing iron; identifies hemosiderin granules
Prussian blue (Rous test)
36
Stains DNA
Phenathridine (orange)
37
Stains nuclear membranes, mitochondria & cell membranes
Carbocyanine (green)
38
NV of RBCs in microscopy
NV = 0-2 or 0-3 / HPF
39
RBCs in HYPERTONIC URINE:
Crenated/Shrink
40
RBCs in HYPOTONIC URINE:
Swell/Hemolyze (Ghost cell)
41
RBC in glomerular membrane damage:
Dysmorphic with projections, Fragmented (acanthocytes)
42
Sources of error of RBCs in microscopy:
Yeasts
Oild droplets
Air bubbles
Monohydrate calcium oxalate crystals
43
Remedy for sources of error of RBCs:
Add 2% acetic acid. It will lyse the RBCs but not the others
44
NV of WBCs in urine microscopy:
NV = 0-5 or 0-8 / HPF
45
WBCs in HYPOTONIC urine:
they swell and granules undergo BROWNIAN MOVEMENT, producing a sparkling appearance (Glitter cells)
46
Using Sternheimer-Malbin Stain, glitter cells stain _______, and leukocytes stain _______
Sternheimer-Malbin Stain:
Glitter cells - pale blue
Leukocytes - pale pink
47
Significant value of eosinophils in urine: ___%
>1% (seen in acute interstitial nephritis)
48
largest cell with abundant, irregular cytoplasm & prominent nucleus
Squamous epithelial cells (SEC)
49
SE cells origin:
from linings of vagina, female urethra & lower male urethra
50
SEC covered with Gardnerella vaginalis; associated with bacterial vaginosis
Clue cells
51
Spherical, polyhedral or caudate with CENTRALLY located nucleus; they tend to take on water and can look like large round balloons
Transitional epithelial (uroerithral) cells (TEC)/Bladder cell
52
Where is TEC derived from:
Derived from the renal pelvis, calyces, ureter, urinary bladder & upper male urethra
53
Most clinically significant epithelial cell
Renal tubular epithelial cell
54
Origin pof RTE cells:
Nephron
55
RTE cell is known for its ______ location of its nucleus
ECCENTRIC nucleus
56
RTE cell if from the PCT:
large, oblong, or cigar-shaped with grainy cytoplasm
57
RTE cell if from DCT:
smaller, round to oval, may be mistaken for WBCs
58
RTE cells if from CD:
columnar, polygonal or cuboidal with flat edge
59
>2 RTE/HPF indicates:
tubular injury
60
lipid containing RTE cell (may also be a monocyte/macrophage); Highly refractile RTE cell; Seen in lipiduria (Ex: nephrotic syndrome)
Oval Fat Bodies (renal tubular fat)
61
Oval Fat Bodies are identified by using:
- Lipid stains (TAG and neutral fats)
- Polarizing microscope
62
"MALTESE CROSS" formation seen in polarizing microscopy suggests the presence of:
Cholesterol
63
RTE cell with non-lipid vacuoles; injured cells in which the endoplasmic reticulum has dilated prior to cell death; seen in acute tubular necrosis
BUBBLE CELL
64
the microorganism most common cause of UTI
Enterobacteriaceae (Ex: E. coli)
65
What differentiates amorphous urates & phosphates from bacteria?
Motility
66
TRUE UTI suggests the presence of:
Bacteria + WBCs
67
True Yeasy infection:
Yeast + WBCs
68
yeast commonly seen in DM and vaginal moniliasis:
Candida albicans
69
Most frequently encountered parasite in urine; pear-shaped flagellate with undulating membrane & jerky motility:
Trichomonas vaginalis
70
T. vaginalis is an agent of what disease:
Pingpong disease
71
Parasite that is most common fecal contamination:P
Enterobius vermicularis egg
72
Schistosoma spp. egg commonly seen in urine:
Schistosoma haematobium egg
73
habitat of S. haematobium in human body:
Urinary bladder
74
Urinary bladder cancer markers:
NMP - nuclear matrix protein
BTA - bladder tumor antigen
75
major constituent of mucus threads:
Tamm-Horsfall protein (uromodulin)
76
Microscopic quantitations:
Epithelial cells
Quantified:
None:
Rare:
Few:
Moderate:
Many:
Epithelial cells
Quantified: per LPF
None: 0
Rare: 0-5
Few: 5-20
Moderate: 20-100
Many: >100
77
Microscopic quantitations:
Crystals (Normal)
Quantified:
None:
Rare:
Few:
Moderate:
Many:
Crystals (Normal)
Quantified: per HPF
None: 0
Rare: 0-2
Few: 2-5
Moderate: 5-20
Many: >20
78
Microscopic quantitations:
Bacteria
Quantified:
None:
Rare:
Few:
Moderate:
Many:
Microscopic quantitations:
Bacteria
Quantified: per HPF
None: 0
Rare: 0-10
Few: 10-50
Moderate: 50-200
Many: >200
79
Microscopic quantitations:
Mucus threads
Quantified:
None:
Rare:
Few:
Moderate:
Many:
Microscopic quantitations:
Mucus threads
Quantified: per LPF
None: 0
Rare: 0-1
Few: 1-3
Moderate: 3-10
Many: >10
80
Microscopic quantitations:
Casts
Quantified:
None:
Numerical ranges:
Microscopic quantitations:
Casts
Quantified: per LPF
None: 0
Numerical ranges: 0-2, 2-5, 5-10, >10
81
Microscopic quantitations:
RBCs, WBCs
Quantified:
Numerical ranges:
Microscopic quantitations:
RBCs, WBCs
Quantified: per HPF
Numerical ranges: 0-2, 2-5, 5-10, 10-25, 25-50, 50-100, >100
82
Reporting of Squamous cells:
Quantitated: per LPF
Rare
Few
Moderate
Many
83
Reporting of Transitional epithelial cells, yeasts:
Quantitated: per HPF
Rare
Few
Moderate
Many
84
Reporting of Renal tubular epithelial cells:
Quantitated: Average number per 10 HPFs
85
Reporting of oval fat bodies:
Average number per HPF
86
Reporting of abnormal crystals and casts:
Average number per LPF
87
The most difficult & the most important urinary sediment constituent; Represents a biopsy of an individual tubule;
Casts
88
Casts are primarily formed in the:
DCT & collecting ducts (CD)
89
Major constituent of casts:
Uromodulin (THP) (produced by RTE cells)
90
Cylindroids doesn't have the same significance as casts
true or false:
False
Cylindroids have the same significance as casts
91
Examination of casts is performed along the:
Coverslip edge with subdued light
92
Order of casts:
1. Hyalie
2. Cellular (RBCs, WBCs, RTE casts)
3. Degenerating cellular
4. Coarsely granular
5. Finely granular
6. Waxy
93
Prototype casts (beginning of all types of casts); most frequently encountered & the most difficult cast to discover; colorless and translucent:
hyaline cast
94
NV of Hyaline casts:
0-2/ LPF
95
Most fragile cast; Easily identified by its orange-red color
RBC cast
96
RBC casts usually indicates:
bleeding within the nephron
97
Cast that contains hemoglobin from lysed RBCs; Homogenous appearance with orange-red color; same significance as RBC cast:
Blood cast or Hemoglobin cast/ Muddy brown cast
98
Type of cast which indicates inflammation or infection within the nephron; Resembles RTE cast.
WBC/leukocyte/PUS cast
99
To distinguish WBC casts from RTE casts, use:
use phase microscopy and supravital stain
100
Not a true cast (DO NOT report as cast!); Clump of leukocytes; seen in lower UTI
Pseudoleukocyte cast
101
Cells visible on the cast matrix are smaller, round and oval cells; Significance = advanced tubular destruction, tubular damage
Epithelial (RTE) cast
102
Confirmation is done by performing Gram stain; significance = Pyelonephritis
Bacterial cast
103
Granules are derived from the lysosomes of RTE cells during normal metabolism (nonpathologic); cells disintegrate when the cast is retained in the tubule before being flushed out
Granular cast (coarse and fine)
104
Significance of Granular casts:
Can be seen in:
Glomerulonephritis, pyelonephritis, stress
Most commonly:
Strenuous exercise
105
Significance of fatty casts:
Nephrotic syndrome
Toxic tubular necrosis
Diabetes mellitus
Crush injuries
106
Final degenerative form of all types of casts; Brittle, highly refractile, with JAGGED ENDS; GROUND GLASS APPEARANCE; Tend to look like paraffin shavings sitting on top of the urine
WAXY CAST
107
Significance of waxy cast:
CHRONIC RENAL FAILURE
Urinary stasis
ESRD
108
Indicates destruction (widening) of the tubular walls
Broad cast
109
Broad cast is often referred to as:
Renal Failure Cast
110
The most recognized but the most insignificant part of urine sediment; Formed by precipitation of urine solute:
Crystals
111
Factors that contribute to crystal formation:
1. pH
2. Solute concentration
3. Temperature
112
Normal Acid Crystals:
1. Amorphous Urates
2. Uric acid
3. Calcium oxalate (Dihydrate and Monohydrate)
other normal acid crystals
4. Calcium sulfate
5. Hippuric acid
6. Acid urates
7 Monosodium or sodium urates
113
Fluffy orange or pink sediment (Brick dust) due to uroerythrin; yellow-brown granules (microscopic);
Amorphous urates
114
Amorphous urates are soluble in heat (___C) and _____
soluble in heat at 60C and Alkali
115
Product of purine metabolism; rhombic (diamond), 4-sided flat plate (whetstone), lemon-shaped; Hexagonal forms may be mistaken as cystine crystals:
Uric acid crystals
116
The most frequently observed urinary crystals
Calcium oxalate
117
Dihydrate (Wddelite) Calcium oxalate:
Envelope / bipyramidal / octahedral / emerald-cut diamond
118
Monohydrate (Whewellite) Calcium oxalate:
Oval / dumbbell
119
"Cigarette-butt" appearance; soluble in acetic acid
Calcium sulfate
120
Yellow-brown/colorless elongated prism; soluble in water and ether
Hippuric acid
121
Rare form of uric acid; brown spheres or clusters; resembles ammonium biurate, leucine & sulfamethoxazole crystals; turns into uric acid after adding acetic acid:
Acid urates (Na, K, NH4)
122
Normal Alkaline Crytals:
1. Amorphous Phosphates
2. Ammonium Biurate
3. Triple Phosphate (Magnesium Ammonium Phosphate, Struvite)
4. Magnesium Phosphate
5. Calcium Phosphate (Apatite)
6. Calcium Carbonate
123
