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CLINCIAL MICROSCOPY (Topnotcher QT) > MICROSCOPIC EXAMINATION OF URINE > Flashcards

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

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2
Q

Centrifuge tube at ____ RCF for ___ minutes:

A

Centrifuge tube at 400 RCF for 5 minutes

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3
Q

Transfer 20 uL (0.02 mL) sediment to glass slide with _______ mm coverslip

A

22x22 mm coverslip

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4
Q

Examine microscopically (___ LPF, ____ HPF, under ____ light)

A

10 LPF
10 HPF
Under reduced light

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5
Q

Quantitative measure of formed elements of urine using hemacytometer

A

Addis Count

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6
Q

Specimen used for Addis count:

A

12-hour urine

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7
Q

Preservative used for Addis count:

A

Formalin

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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

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9
Q

Located in the objective & is adjusted to be near the specimen:

A

First lens system

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10
Q

Located in the eyepiece (ocular lens)

A

Second lens system

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11
Q

Used to clean the optical surfaces of the microscope:

A

lens paper

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12
Q

Used to remove dust on the optical surface of the microscope

A

Camel-hair brush

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13
Q

Used to clean any contaminated lens

A

Commercial lens cleaner

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14
Q

To remove oil on lens, use:

A
  • use dry lens paper
  • then lens paper moistened w/ lens cleaner
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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

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16
Q

Lenses which forms primary (initial) image of specimen

A

Objectives

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17
Q

moves stage noticeably up & down, bringing slide into view

A

Coarse Focus knob

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18
Q

Sharpens the image

A

Fine focus knob

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19
Q

Microscope for routine urinalysis

A

Bright-field (BF) microscopy

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20
Q

Enhances visualization of translucent elements (i.e. with low refractive indices [e.g. casts])

A

Phase-contrast microscopy

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21
Q

To convert BF to PC:

A

Replace objective lens & condenser with PC objective lens & PC condenser

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22
Q

To convert BF into polarizing:

A

Add 2 filters (1 below the condenser, 1 between objectives & oculars)

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22
Q

Detects the presence or absence of birefringence; for identification of cholesterol in oval fat bodies, fatty casts, and crystals.

A

polarizing microscopy

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22
Q

It is the ability of an element to refract light in2 dimensions at 90 degrees to each other

A

Birefringence

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23
Q

for identification of Treponema pallidum

A

Dark-Field (DF) microscopy

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24
Q

To convert BF into DF:

A

Replace the condenser with a DF condenser that contains an opaque disk

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25
Q

For visualization of fluorescent substances and microorganisms

A

Fluorescence microscopy

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26
Q

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

A

Interference-contrast microscopy

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27
Q

Can be adapted for interference microscopy:

A

Bright0field microscopy

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28
Q

2 types of interference-contrast microscopy:

A
  1. Nomarski (Differential interference contrast)
  2. Hoffman (Modulation contrast)
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29
Q

Delineates structure & contrasting colors of the nucleus & cytoplasm; Identifies WBCs, epithelial cells and casts; most commonly used supravital stain:

A

Sternheimer-Malbin (SM)
(Crystal violet + Safranin O)

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30
Q

Enhances nuclear detail; Differentiates WBCs and RTE cells:

A

Toluidine blue (supravital stain)

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31
Q

Lyses RBCs, enhances nuclei of WBCs; Distinguishes RBCs from WBCs, yeast, oil droplets & crystals

A

2% acetic acid

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32
Q

Stains triglycerides and neutral fats orange-red; Identifies free fat droplets & lipid-containing cells & casts.

A

Lipid stains
- oil Red O
- Sudan III

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33
Q

Differentiates Gram-positive & -negative bacteria; Identifies bacterial casts

A

Gram stain

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34
Q

Stains eosinophilic granules; Identifies urinary eosinophils

A

Hansel stain (Eosin Y + Methylene blue)

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35
Q

Stains structures containing iron; identifies hemosiderin granules

A

Prussian blue (Rous test)

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36
Q

Stains DNA

A

Phenathridine (orange)

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37
Q

Stains nuclear membranes, mitochondria & cell membranes

A

Carbocyanine (green)

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38
Q

NV of RBCs in microscopy

A

NV = 0-2 or 0-3 / HPF

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39
Q

RBCs in HYPERTONIC URINE:

A

Crenated/Shrink

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40
Q

RBCs in HYPOTONIC URINE:

A

Swell/Hemolyze (Ghost cell)

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41
Q

RBC in glomerular membrane damage:

A

Dysmorphic with projections, Fragmented (acanthocytes)

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42
Q

Sources of error of RBCs in microscopy:

A

Yeasts
Oild droplets
Air bubbles
Monohydrate calcium oxalate crystals

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43
Q

Remedy for sources of error of RBCs:

A

Add 2% acetic acid. It will lyse the RBCs but not the others

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44
Q

NV of WBCs in urine microscopy:

A

NV = 0-5 or 0-8 / HPF

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45
Q

WBCs in HYPOTONIC urine:

A

they swell and granules undergo BROWNIAN MOVEMENT, producing a sparkling appearance (Glitter cells)

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46
Q

Using Sternheimer-Malbin Stain, glitter cells stain _______, and leukocytes stain _______

A

Sternheimer-Malbin Stain:

Glitter cells - pale blue
Leukocytes - pale pink

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47
Q

Significant value of eosinophils in urine: ___%

A

> 1% (seen in acute interstitial nephritis)

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48
Q

largest cell with abundant, irregular cytoplasm & prominent nucleus

A

Squamous epithelial cells (SEC)

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49
Q

SE cells origin:

A

from linings of vagina, female urethra & lower male urethra

50
Q

SEC covered with Gardnerella vaginalis; associated with bacterial vaginosis

A

Clue cells

51
Q

Spherical, polyhedral or caudate with CENTRALLY located nucleus; they tend to take on water and can look like large round balloons

A

Transitional epithelial (uroerithral) cells (TEC)/Bladder cell

52
Q

Where is TEC derived from:

A

Derived from the renal pelvis, calyces, ureter, urinary bladder & upper male urethra

53
Q

Most clinically significant epithelial cell

A

Renal tubular epithelial cell

54
Q

Origin pof RTE cells:

55
Q

RTE cell is known for its ______ location of its nucleus

A

ECCENTRIC nucleus

56
Q

RTE cell if from the PCT:

A

large, oblong, or cigar-shaped with grainy cytoplasm

57
Q

RTE cell if from DCT:

A

smaller, round to oval, may be mistaken for WBCs

58
Q

RTE cells if from CD:

A

columnar, polygonal or cuboidal with flat edge

59
Q

> 2 RTE/HPF indicates:

A

tubular injury

60
Q

lipid containing RTE cell (may also be a monocyte/macrophage); Highly refractile RTE cell; Seen in lipiduria (Ex: nephrotic syndrome)

A

Oval Fat Bodies (renal tubular fat)

61
Q

Oval Fat Bodies are identified by using:

A
  • Lipid stains (TAG and neutral fats)
  • Polarizing microscope
62
Q

“MALTESE CROSS” formation seen in polarizing microscopy suggests the presence of:

A

Cholesterol

63
Q

RTE cell with non-lipid vacuoles; injured cells in which the endoplasmic reticulum has dilated prior to cell death; seen in acute tubular necrosis

A

BUBBLE CELL

64
Q

the microorganism most common cause of UTI

A

Enterobacteriaceae (Ex: E. coli)

65
Q

What differentiates amorphous urates & phosphates from bacteria?

66
Q

TRUE UTI suggests the presence of:

A

Bacteria + WBCs

67
Q

True Yeasy infection:

A

Yeast + WBCs

68
Q

yeast commonly seen in DM and vaginal moniliasis:

A

Candida albicans

69
Q

Most frequently encountered parasite in urine; pear-shaped flagellate with undulating membrane & jerky motility:

A

Trichomonas vaginalis

70
Q

T. vaginalis is an agent of what disease:

A

Pingpong disease

71
Q

Parasite that is most common fecal contamination:P

A

Enterobius vermicularis egg

72
Q

Schistosoma spp. egg commonly seen in urine:

A

Schistosoma haematobium egg

73
Q

habitat of S. haematobium in human body:

A

Urinary bladder

74
Q

Urinary bladder cancer markers:

A

NMP - nuclear matrix protein
BTA - bladder tumor antigen

75
Q

major constituent of mucus threads:

A

Tamm-Horsfall protein (uromodulin)

76
Q

Microscopic quantitations:
Epithelial cells

Quantified:
None:
Rare:
Few:
Moderate:
Many:

A

Epithelial cells

Quantified: per LPF
None: 0
Rare: 0-5
Few: 5-20
Moderate: 20-100
Many: >100

77
Q

Microscopic quantitations:
Crystals (Normal)

Quantified:
None:
Rare:
Few:
Moderate:
Many:

A

Crystals (Normal)

Quantified: per HPF
None: 0
Rare: 0-2
Few: 2-5
Moderate: 5-20
Many: >20

78
Q

Microscopic quantitations:
Bacteria

Quantified:
None:
Rare:
Few:
Moderate:
Many:

A

Microscopic quantitations:
Bacteria

Quantified: per HPF
None: 0
Rare: 0-10
Few: 10-50
Moderate: 50-200
Many: >200

79
Q

Microscopic quantitations:
Mucus threads

Quantified:
None:
Rare:
Few:
Moderate:
Many:

A

Microscopic quantitations:
Mucus threads

Quantified: per LPF
None: 0
Rare: 0-1
Few: 1-3
Moderate: 3-10
Many: >10

80
Q

Microscopic quantitations:
Casts

Quantified:
None:
Numerical ranges:

A

Microscopic quantitations:
Casts

Quantified: per LPF
None: 0
Numerical ranges: 0-2, 2-5, 5-10, >10

81
Q

Microscopic quantitations:
RBCs, WBCs

Quantified:
Numerical ranges:

A

Microscopic quantitations:
RBCs, WBCs

Quantified: per HPF
Numerical ranges: 0-2, 2-5, 5-10, 10-25, 25-50, 50-100, >100

82
Q

Reporting of Squamous cells:

A

Quantitated: per LPF
Rare
Few
Moderate
Many

83
Q

Reporting of Transitional epithelial cells, yeasts:

A

Quantitated: per HPF
Rare
Few
Moderate
Many

84
Q

Reporting of Renal tubular epithelial cells:

A

Quantitated: Average number per 10 HPFs

85
Q

Reporting of oval fat bodies:

A

Average number per HPF

86
Q

Reporting of abnormal crystals and casts:

A

Average number per LPF

87
Q

The most difficult & the most important urinary sediment constituent; Represents a biopsy of an individual tubule;

88
Q

Casts are primarily formed in the:

A

DCT & collecting ducts (CD)

89
Q

Major constituent of casts:

A

Uromodulin (THP) (produced by RTE cells)

90
Q

Cylindroids doesn’t have the same significance as casts

true or false:

A

False

Cylindroids have the same significance as casts

91
Q

Examination of casts is performed along the:

A

Coverslip edge with subdued light

92
Q

Order of casts:

A
  1. Hyalie
  2. Cellular (RBCs, WBCs, RTE casts)
  3. Degenerating cellular
  4. Coarsely granular
  5. Finely granular
  6. Waxy
93
Q

Prototype casts (beginning of all types of casts); most frequently encountered & the most difficult cast to discover; colorless and translucent:

A

hyaline cast

94
Q

NV of Hyaline casts:

95
Q

Most fragile cast; Easily identified by its orange-red color

96
Q

RBC casts usually indicates:

A

bleeding within the nephron

97
Q

Cast that contains hemoglobin from lysed RBCs; Homogenous appearance with orange-red color; same significance as RBC cast:

A

Blood cast or Hemoglobin cast/ Muddy brown cast

98
Q

Type of cast which indicates inflammation or infection within the nephron; Resembles RTE cast.

A

WBC/leukocyte/PUS cast

99
Q

To distinguish WBC casts from RTE casts, use:

A

use phase microscopy and supravital stain

100
Q

Not a true cast (DO NOT report as cast!); Clump of leukocytes; seen in lower UTI

A

Pseudoleukocyte cast

101
Q

Cells visible on the cast matrix are smaller, round and oval cells; Significance = advanced tubular destruction, tubular damage

A

Epithelial (RTE) cast

102
Q

Confirmation is done by performing Gram stain; significance = Pyelonephritis

A

Bacterial cast

103
Q

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

A

Granular cast (coarse and fine)

104
Q

Significance of Granular casts:

A

Can be seen in:
Glomerulonephritis, pyelonephritis, stress

Most commonly:
Strenuous exercise

105
Q

Significance of fatty casts:

A

Nephrotic syndrome
Toxic tubular necrosis
Diabetes mellitus
Crush injuries

106
Q

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

107
Q

Significance of waxy cast:

A

CHRONIC RENAL FAILURE
Urinary stasis
ESRD

108
Q

Indicates destruction (widening) of the tubular walls

A

Broad cast

109
Q

Broad cast is often referred to as:

A

Renal Failure Cast

110
Q

The most recognized but the most insignificant part of urine sediment; Formed by precipitation of urine solute:

111
Q

Factors that contribute to crystal formation:

A
  1. pH
  2. Solute concentration
  3. Temperature
112
Q

Normal Acid Crystals:

A
  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
Q

Fluffy orange or pink sediment (Brick dust) due to uroerythrin; yellow-brown granules (microscopic);

A

Amorphous urates

114
Q

Amorphous urates are soluble in heat (___C) and _____

A

soluble in heat at 60C and Alkali

115
Q

Product of purine metabolism; rhombic (diamond), 4-sided flat plate (whetstone), lemon-shaped; Hexagonal forms may be mistaken as cystine crystals:

A

Uric acid crystals

116
Q

The most frequently observed urinary crystals

A

Calcium oxalate

117
Q

Dihydrate (Wddelite) Calcium oxalate:

A

Envelope / bipyramidal / octahedral / emerald-cut diamond

118
Q

Monohydrate (Whewellite) Calcium oxalate:

A

Oval / dumbbell

119
Q

“Cigarette-butt” appearance; soluble in acetic acid

A

Calcium sulfate

120
Q

Yellow-brown/colorless elongated prism; soluble in water and ether

A

Hippuric acid

121
Q

Rare form of uric acid; brown spheres or clusters; resembles ammonium biurate, leucine & sulfamethoxazole crystals; turns into uric acid after adding acetic acid:

A

Acid urates (Na, K, NH4)

122
Q

Normal Alkaline Crytals:

A
  1. Amorphous Phosphates
  2. Ammonium Biurate
  3. Triple Phosphate (Magnesium Ammonium Phosphate, Struvite)
  4. Magnesium Phosphate
  5. Calcium Phosphate (Apatite)
  6. Calcium Carbonate

CLINCIAL MICROSCOPY (Topnotcher QT) (6 decks)

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