MIDTERM-microscopic exam - urinary sediments - 11111 Flashcards
what are the urine sediments constituents
red blood cells
white blood cells
epithelial cells
bacteria
yeast
parasites
spermatozoa
mucus
casts
urinary crystals
___
determine the actual concentration of the sediment and, there
fore, the number of elements that may be present in a microscopic field.
urine sediment preparation methods
Of all the urine sediment elements, which sediment is the most difficult for students to recognize.
RBCs
In hyposthenuria, rbc tends to swell and burst leaving only the cell membrane.
These large empty
cells are called ____ and can be easily missed if specimens are not examined under reduced light
ghost cells
why do rbc is the hardest sediment to recognize among the urine sediments ?
lack of characteristics structures
variations in size
close resemblance to other urine sediment constituents
3 sediments that rbc’s are misidentified due to high resemblancy
yeast
oil droplets
air bubbles
what will aid us in differentiating yeast, oil droplets, and air bubbles from rbc?
yeast exhibits budding
oil ad air bubbles is highly refractile when the fine adjustment is focused up and down
The rough appearance of crenated RBCs may resemble the ___, but they are much smaller
than it.
granules seen in WBCs
____ staining can be used to confirm the presence of rbc and differentiate with wbc, yeast, oil, and air.
Supra vital
Should the identification continue to be doubtful, adding ___ to a portion of the sediment will lyse the RBCs, leaving the yeast, oil droplets, and WBCs intact. Supra
vital staining may also be helpful.
acetic acid
RBCs that vary in size, have cellular protrusions, or are fragmented are
termed __ and have been associated primarily with glomerular bleeding.
dysmorphic
The presence of RBCs in the urine is associated with damage
to the ___ or __ within the
genitourinary tract.
glomerular membrane or vascular injury
Macroscopic hematuria is fre
quently associated with advanced glomerular damage but is
also seen with damage to the vascular integrity of the urinary
tract caused by ___ , __, and ___
trauma, acute infection or inflammation, and
coagulation disorders.
The observation of microscopic hematuria can be critical
to the early diagnosis of glomerular disorders and malignancy
of the urinary tract and to confirm the presence of ___
renal calculi
The presence of not only RBCs but also hyaline, granular, and rbc cast. It sometimes can be caused by
strenuous exercise
The predominant WBC found in the urine sediment is
the ___.
neutrophil
Neutrophils are much easier to identify than
RBCs because they contain ___ and ___
granules and multilobed nuclei
Neutrophils lyse rapidly in ____ and begin to lose nuclear detail.
dilute alkaline urine
Neutrophils exposed to hypotonic urine absorb water and
swell. Brownian movement of the granules within these larger
cells produces a sparkling appearance, and they are referred to
as “____.”
glitter cells
neutrophils in hypotonic urine produces sparkling appearance and can be stained by __ appearing colored ____
sternheimer-malbin stain appearing colored light blue
The presence of urinary eosinophils is primarily associated
with ___.
drug-induced interstitial nephritis
The preferred urinary eosinophil test stain is __
Hansel stain
ifthere’s no hansel stain for eosinophil test, what stain we can used instead?
wright’s stain
Eosinophils are not normally seen in the
urine; therefore, the finding of more than how many percent eosinophils is
considered significant.
1%
WBC
Resembles RTE or renal tubular epithelial cells.
the difference is
RTE is larger with eccentrically located nucleus
what are the mononuclear cells
lymphocytes, monocytes, macrophages, and histiocytes
wbc that are large cells and may appear vacuolated or contain inclusions.
MONOCYTE, MACROPHAGES, HISTIOCYTES
WBCs in the process of ameboid motion
may be difficult to distinguish from epithelial cells because
of their irregular shape. ___ or the addition of
___ can be used to enhance nuclear detail if necessary.
Supravital staining; acetic acid
complete urinalysis correlation of wbc
Leukocyte esterase
Nitrite
Specific gravity
pH
source of identification erroe of wbc
RTE cells
An increase in urinary WBCs is
called ___ and indicates the presence of an infection or inflammation in the genitourinary system
pyuria
It is not unusual to find epithelial cells in the urine, because
they are derived from the linings of the ___.
genitourinary system
what are the Three types of
epithelial cells are seen in urine:
squamous, transitional (urothelial), and renal tubular
___are the largest cells found in the urine sediment.
Squamous epithelial cells
morphology of SQUAMOUS epithelial cells
They contain abundant, irregular cytoplasm and a prominent nucleus about the size of an RBC
They are often the first structures observed when the urine sediment
is examined under low-power magnification.
squamous epithelial cells
Squamous epithelial cells originate from the linings of the
female orga such as the ___ and the lower portion of the male
___.
vagina and female urethra; urethra
Difficulty identifying squamous cells is rare. However, they
may occasionally appear folded, possibly resembling a ___,
and will begin to disintegrate in urine that is not fresh
cast
A variation of the squamous epithelial cell is the ___,
which does have pathologic significance.
clue cell
Increased amounts are more frequently
seen in urine from ___ patients.
female
Specimens collected using
the __ technique contain less squamous
cell contamination.
midstream clean-catch
Clue cells are indicative of vaginal infection by the bacterium ___.
Gardnerella vaginalis
To be considered a clue cell, the
bacteria should cover most of the cell surface and extend beyond the edges of the cell. . This gives the cell a granular, irregular appearance
true or false
true
Transitional epithelial cells are smaller than squamous cells and
appear in several forms, including ___
spherical, polyhedral, and caudate
the differences of shape of transitional epithelial cells are due to the ability of transitional epithelial cells to___
absorb
large amounts of water.
IS TRASITIONAL EPITHELIAL CELLS LARGER THAN SQUAMOUS?
NO, smaller than squamous cells and
appear in several forms
among the forms of transitional epithelial cells, which is the largest when in contact with the urine?
spherical
Transitional epithelial cells originate from the lining of the ____
renal pelvis, calyces, ureters, and bladder, and from the upper portion of the male urethra.
Increased numbers of transitional cells seen singly, in pairs,
or in clumps are called
syncytia
Increased numbers of transitional cells seen singly, in pairs,
or in clumps (syncytia) are present following invasive urologic procedures such as __
catheterization and are of no clinical significance
An increase in transitional cells exhibiting abnormal morphology such as vacuoles and irregular nuclei
may be indicative of __ or __
malignancy or viral infection
RTE cell’s size and shape depends on its ____
location or the area they originate
The cells from ___ are larger than other RTE cells.
the proximal convoluted tubule (PCT)
The cells from proximal convoluted tubule sis much larger than other rte cells, which they tend to have ___ shape
rectangular shape
The cells from proximal convoluted tubule sis much larger than other rte cells, which they tend to have rectangular shape and are commonly referred to as __ or ___
columnar or convoluted cells.
RTE often resembles
cast
how to differentiate RTE from cast
They should be closely
examined for the presence of a nucleus, as a nucleus would not be present in a cast.
Cells from the collecting duct that appear in groups of three or more are called ___
renal fragments.
RTE cells are commonly present as a result of ___, the nucleus is not easily visible in unstained sediment
tissue destruction or necrosis
Renal tubular epithelial cells
___ are cuboidal and are never
round.
Collecting duct RTE cells
renal tubular epithelial Cells from the___ are smaller
than those from the PCT and are round or oval.
distal convoluted tubule (DCT)
a renal tubular cells that are frequently
seen as large sheets of cells.
collecting duct cells
The presence of more than ____ RTE
cells per high-power field indicates tubular injury, and
such specimens should be referred for cytologic urine
testing.
two
___ are the most clinically significant of the epithelial cells
RTE cells
The presence of increased amounts of RTE cells is indicative of ___
necrosis of the renal tubules,
Conditions producing tubular necrosis include exposure
to___
heavy metals, drug-induced toxicity, hemoglobin and myo
globin toxicity, viral infections (hepatitis B), pyelonephritis, al
lergic reactions, malignant infiltrations, salicylate poisoning,
and acute allogenic transplant rejection.
RTE cells may also be
seen as secondary effects of __
glomerular disorders
Single cuboidal cells are particularly noticeable in cases of ___
salicylate poisoning
Renal fragments are an indication of ___ with __- disruption
(collecting duct cells )
severe tubular injury with basement
membrane disruption
Because one of the functions of RTE cells is reabsorption
of the glomerular filtrate, it is NOT UNUSUAL for them to contain
substances from the filtrate.
true or false
true
aside from absorbing hemoglobin that was beenc onverted by the rte cells to hemosiderin, what is the component or sediment that it can absorb as well resulting it to become highly refractile
lipids and the RTE cells will be called as oval fat bodies
These lipid-containing RTE cells
are __
called oval fat bodies
the oval fat bodies
droplets are composed of
triglycerides, neutral fats, and cholesterol
Urine sediments negative for fat after
staining should still be checked using ___ in case
only cholesterol is present.
polarized light
To be considered significant for UTI, bacteria should be accompanied by __.
WBCs
The use of ___microscopy aids in the visualization of bacteria
phase
The presence of bacteria can be indicative of either ___ or __
lower or upper UTI.
The bacteria most frequently associated
with UTI are the ___
Enterobacteriaceae (referred to as gram
negative rods)
example of cocci shaped bacteria that can as well cause UTI
staphylococcus and enterococcus
The actual bacteria producing an UTI cannot be identified with the microscopic examination
true or false
true
Yeast, In severe infections, they
may appear as branched, ____
mycelial forms
appear in the urine as small, refractile oval structures
that may or may not contain a bud
yeast
Yeast cells, primarily ____, are seen in the urine
of diabetic patients, immunocompromised patients, and
women with vaginal moniliasis.
Candida albicans
Ideal medium for yeast to grow
acidic glucose-containing urine of diabetic patients
A true yeast infection
should be accompanied by the presence of ___.
WBCs
The most frequent parasite encountered in the urine is
___
Trichomonas vaginalis
a bladder parasite seen usually in US. It has been associated with bladder
cancer in other countries
Schistosoma haematobium
Fecal contamination of
a urine specimen can also result in the presence of ova from intestinal parasites in the urine sediment. The most common
contaminant is ova from the pinworm ___
Enterobius vermicularis
are easily identified in the urine sediment by
their oval, slightly tapered heads and long, flagella-like tails
spermatozoa
is urine toxic for sperms?
yes, therefore, they
rarely exhibit the motility observed when examining a semen specimen.
which reagent strip indicator will turn positive if spermatozoa is present in the urine?
protein
mucus are produced by ___
glands and the epithelial cells of the lower genitourinary tract and the RTE cells
major constituent of mucus
uromodulin
is a glycoprotein excreted
by the RTE cells of the distal convoluted tubules and upper
collecting ducts.
Uromodulin
