Urinalysis and body fluids- Urine Microscopy and Clinical Correlations Flashcards
1
Q
- Which of the following dyes are used in
Sternheimer–Malbin stain?
A. Hematoxylin and eosin
B. Crystal violet and safranin
C. Methylene blue and eosin
D. Methylene blue and safranin
A
B. Crystal violet and safranin
2
Q
- Which of the following statements regarding
WBCs in urinary sediment is true?
A. “Glitter cells” seen in the urinary sediment are a
sign of renal disease
B. Bacteriuria in the absence of WBCs indicates
lower urinary tract infection (UTI)
C. WBCs other than PMNs are not found in
urinary sediment
D. WBC casts indicate that pyuria is of renal, rather
than lower urinary, origin
A
D. WBC casts indicate that pyuria is of renal, rather
than lower urinary, origin
3
Q
- Which description of sediment with
Sternheimer–Malbin stain is correct?
A. Transitional epithelium: cytoplasm pale blue,
nucleus dark blue
B. Renal epithelium: cytoplasm light blue, nucleus
dark purple
C. Glitter cells: cytoplasm dark blue, nucleus dark
purple
D. Squamous epithelium: cytoplasm pink, nucleus
pale blue
A
A. Transitional epithelium: cytoplasm pale blue,
nucleus dark blue
4
Q
- SITUATION: A 5-mL urine specimen is submitted
for routine urinalysis and analyzed immediately.
The SG of the sample is 1.012 and the pH is 6.5.
The dry reagent strip test for blood is a large
positive (3+) and the microscopic examination
shows 11–20 RBCs per HPF. The leukocyte
esterase reaction is a small positive (1+), and the
microscopic examination shows 0–5 WBCs per
HPF. What is the most likely cause of these
results?
A. Myoglobin is present in the sample
B. Free hemoglobin is present
C. Insufficient volume is causing microscopic results
to be underestimated
D. Some WBCs have been misidentified as RBCs
A
C. Insufficient volume is causing microscopic results
to be underestimated
5
Q
- Which of the following statements regarding
epithelial cells in the urinary system is correct?
A. Caudate epithelial cells originate from the upper
urethra
B. Transitional cells originate from the upper
urethra, ureters, bladder, or renal pelvis
C. Cells from the proximal renal tubule are usually
round in shape
D. Squamous epithelium line the vagina, urethra,
and wall of the urinary bladder
A
B. Transitional cells originate from the upper
urethra, ureters, bladder, or renal pelvis
6
Q
- Which of the statements regarding examination
of unstained sediment is true?
A. Renal cells can be differentiated reliably from
WBCs
B. Large numbers of transitional cells are often seen
after catheterization
C. Neoplastic cells from the bladder are not found
in urinary sediment
D. RBCs are easily differentiated from nonbudding
yeast
A
B. Large numbers of transitional cells are often seen
after catheterization
7
Q
- Which of the following statements regarding cells
found in urinary sediment is true?
A. Transitional cells resist swelling in hypotonic
urine
B. Renal tubular cells are often polyhedral and have
an eccentric round nucleus
C. Trichomonads have an oval shape with a
prominent nucleus and a single anterior
flagellum
D. Clumps of bacteria are frequently mistaken for
blood casts
A
B. Renal tubular cells are often polyhedral and have
an eccentric round nucleus
8
Q
- Which of the following statements regarding
RBCs in the urinary sediment is true?
A. Yeast cells will lyse in dilute acetic acid but RBCs
will not
B. RBCs are often swollen in hypertonic urine
C. RBCs of glomerular origin often appear
dysmorphic
D. Yeast cells will tumble when the cover glass is
touched but RBCs will not
A
C. RBCs of glomerular origin often appear
dysmorphic
9
Q
- Renal tubular epithelial cells are shed into the
urine in largest numbers in which condition?
A. Malignant renal disease
B. Acute glomerulonephritis
C. Nephrotic syndrome
D. Cytomegalovirus (CMV) infection of the kidney
A
D. Cytomegalovirus (CMV) infection of the kidney
10
Q
- The ova of which parasite may be found in the
urinary sediment?
A. T. vaginalis
B. Entamoeba histolytica
C. Schistosoma hematobium
D. Trichuris trichiura
A
C. Schistosoma hematobium
11
Q
- Oval fat bodies are often seen in:
A. Chronic glomerulonephritis
B. Nephrotic syndrome
C. Acute tubular nephrosis
D. Renal failure of any cause
A
B. Nephrotic syndrome
12
Q
- All of the following statements regarding urinary
casts are true except:
A. Many hyaline casts may appear in sediment after
jogging or exercise
B. An occasional granular cast may be seen in a
normal sediment
C. Casts can be seen in significant numbers even
when protein tests are negative
D. Hyaline casts will dissolve readily in alkaline urine
A
C. Casts can be seen in significant numbers even
when protein tests are negative
13
Q
- Which condition promotes the formation of casts
in the urine?
A. Chronic production of alkaline urine
B. Polyuria
C. Reduced filtrate formation
D. Low urine SG
A
C. Reduced filtrate formation
14
Q
- The mucoprotein that forms the matrix of a
hyaline cast is called:
A. Bence–Jones protein
B. β-Microglobulin
C. Tamm–Horsfall protein
D. Arginine-rich glycoprotein
A
C. Tamm–Horsfall protein
15
Q
- “Pseudocasts” are often caused by:
A. A dirty cover glass or slide
B. Bacterial contamination
C. Amorphous urates
D. Mucus in the urine
Body fluids/Apply knowled
A
C. Amorphous urates
16
Q
- Which of the following statements regarding
urinary casts is correct?
A. Fine granular casts are more significant than
coarse granular casts
B. Cylindruria is always clinically significant
C. The appearance of cylindroids signals the onset
of end-stage renal disease
D. Broad casts are associated with severe renal
tubular obstruction
A
D. Broad casts are associated with severe renal
tubular obstruction
17
Q
- A sediment with moderate hematuria and RBC
casts most likely results from:
A. Chronic pyelonephritis
B. Nephrotic syndrome
C. Acute glomerulonephritis
D. Lower urinary tract obstruction
A
C. Acute glomerulonephritis
18
Q
- Urine sediment characterized by pyuria with
bacterial and WBC casts indicates:
A. Nephrotic syndrome
B. Pyelonephritis
C. Polycystic kidney disease
D. Cystitis
A
B. Pyelonephritis
19
Q
- Which type of casts signals the presence of chronic
renal failure?
A. Blood casts
B. Fine granular casts
C. Waxy casts
D. Fatty casts
A
C. Waxy casts
20
Q
- SITUATION: Urinalysis of a sample from a
patient suspected of having a transfusion reaction
reveals small yellow-brown crystals in the
microscopic examination. Dry reagent strip tests
are normal with the exception of a positive blood
reaction (moderate) and trace positive protein.
The pH of the urine is 6.5. What test should be
performed to positively identify the crystals?
A. Confirmatory test for bilirubin
B. Cyanide–nitroprusside test
C. Polarizing microscopy
D. Prussian blue stain
A
D. Prussian blue stain
21
Q
- When examining urinary sediment, which of the
following is considered an abnormal finding?
A. 0–2 RBCs per HPF
B. 0–1 hyaline casts per low-power field (LPF)
C. 0–1 renal cell casts per LPF
D. 2–5 WBCs per HPF
A
C. 0–1 renal cell casts per LPF
22
Q
- SITUATION: A urine sample with a pH of
6.0 produces an abundance of pink sediment
after centrifugation that appears as densely
packed yellow- to reddish-brown granules under
the microscope. The crystals are so dense that no
other formed elements can be evaluated. What is
the best course of action?
A. Request a new urine specimen
B. Suspend the sediment in prewarmed saline,
then repeat centrifugation
C. Acidify a 12-mL aliquot with three drops of
glacial acetic acid and heat to 56°C for
5 minutes before centrifuging
D. Add five drops of 1N HCl to the sediment and
examine
A
B. Suspend the sediment in prewarmed saline,
then repeat centrifugation
23
Q
- How can hexagonal uric acid crystals be
distinguished from cystine crystals?
A. Cystine is insoluble in hydrochloric acid but uric
acid is soluble
B. Cystine gives a positive nitroprusside test after
reduction with sodium cyanide
C. Cystine crystals are more highly pigmented
D. Cystine crystals form at neutral or alkaline pH,
uric acid forms at neutral to acidic pH
A
B. Cystine gives a positive nitroprusside test after
reduction with sodium cyanide
24
Q
- The presence of tyrosine and leucine crystals
together in a urine sediment usually indicates:
A. Renal failure
B. Chronic liver disease
C. Hemolytic anemia
D. Hartnup disease
A
B. Chronic liver disease
25
Q
- Which of the following crystals is considered
nonpathological?
A. Hemosiderin
B. Bilirubin
C. Ammonium biurate
D. Cholesterol
A
C. Ammonium biurate
26
Q
- At which pH are ammonium biurate crystals
usually found in urine?
A. Acid urine only
B. Acid or neutral urine
C. Neutral or alkaline urine
D. Alkaline urine only
A
D. Alkaline urine only
27
Q
- Which of the following crystals is seen commonly
in alkaline and neutral urine?
A. Calcium oxalate
B. Uric acid
C. Magnesium ammonium phosphate
D. Cholesterol
A
C. Magnesium ammonium phosphate
28
Q
- Which crystal appears in urine as a long, thin
hexagonal plate, and is linked to ingestion of large
amounts of benzoic acid?
A. Cystine
B. Hippuric acid
C. Oxalic acid
D. Uric acid
A
B. Hippuric acid
29
Q
- Small yellow needles are seen in the sediment
of a urine sample with a pH of 6.0. Which of
the following crystals can be ruled out?
A. Sulfa crystals
B. Bilirubin crystals
C. Uric acid crystals
D. Cholesterol crystals
A
D. Cholesterol crystals
30
Q
- Oval fat bodies are derived from:
A. Renal tubular epithelium
B. Transitional epithelium
C. Degenerated WBCs
D. Mucoprotein matrix
A
A. Renal tubular epithelium
31
Q
- Oval fat bodies are often associated with:
A. Lipoid nephrosis
B. Acute glomerulonephritis
C. Aminoaciduria
D. Pyelonephritis
A
A. Lipoid nephrosis
32
Q
- Urine of constant SG ranging from 1.008 to 1.010
most likely indicates:
A. Addison’s disease
B. Renal tubular failure
C. Prerenal failure
D. Diabetes insipidus
A
B. Renal tubular failure
33
Q
- Which of the following characterizes prerenal
failure, and helps to differentiate it from acute
renal failure caused by renal disease?
A. BUN:creatinine ratio of 20:1 or higher
B. Urine:plasma osmolal ratio less than 2:1
C. Excess loss of sodium in the urine
D. Dehydration
A
A. BUN:creatinine ratio of 20:1 or higher
34
Q
- Which of the following conditions characterizes
chronic glomerulonephritis and helps to
differentiate it from acute glomerulonephritis?
A. Hematuria
B. Polyuria
C. Hypertension
D. Azotemia
A
B. Polyuria
35
Q
- Which of the following conditions is seen in acute
renal failure and helps to differentiate it from
prerenal failure?
A. Hyperkalemia and uremia
B. Oliguria and edema
C. Low creatinine clearance
D. Abnormal urinary sediment
A
D. Abnormal urinary sediment
36
Q
- Which of the following conditions characterizes
acute renal failure and helps to differentiate it from
chronic renal failure?
A. Hyperkalemia
B. Hematuria
C. Cylindruria
D. Proteinuria
A
A. Hyperkalemia
37
Q
- The serum concentration of which analyte is likely
to be decreased in untreated cases of acute renal
failure?
A. Hydrogen ions
B. Inorganic phosphorus
C. Calcium
D. Uric acid
A
C. Calcium
38
Q
- Which of the following conditions is associated
with the greatest proteinuria?
A. Acute glomerulonephritis
B. Chronic glomerulonephritis
C. Nephrotic syndrome
D. Acute pyelonephritis
A
C. Nephrotic syndrome
39
Q
- Which of the following conditions is often a cause
of glomerulonephritis?
A. Hypertension
B. Cytomegalovirus infection
C. Systemic lupus erythematosus
D. Heavy metal poisoning
A
C. Systemic lupus erythematosus
40
Q
- Acute pyelonephritis is commonly caused by:
A. Bacterial infection of medullary interstitium
B. Circulatory failure
C. Renal calculi
D. Antigen–antibody reactions within the glomeruli
A
A. Bacterial infection of medullary interstitium
41
Q
- All of the following are common characteristics
of the nephrotic syndrome except:
A. Hyperlipidemia
B. Hypoalbuminemia
C. Hematuria and pyuria
D. Severe edema
A
C. Hematuria and pyuria
42
Q
- Which of the following conditions is a
characteristic finding in patients with
obstructive renal disease?
A. Polyuria
B. Azotemia
C. Dehydration
D. Alkalosis
A
B. Azotemia
43
Q
- Whewellite and weddellite kidney stones are
composed of:
A. Magnesium ammonium phosphate
B. Calcium oxalate
C. Calcium phosphate
D. Calcium carbonate
A
B. Calcium oxalate
44
Q
- Which of the following abnormal crystals is often
associated with formation of renal calculi?
A. Cystine
B. Ampicillin
C. Tyrosine
D. Leucine
A
A. Cystine
45
Q
- Which statement about renal calculi is true?
A. Calcium oxalate and calcium phosphate account
for about three-fourths of all stones
B. Uric acid stones can be seen by x-ray
C. Triple phosphate stones are found principally
in the ureters
D. Stones are usually comprised of single salts
A
A. Calcium oxalate and calcium phosphate account
for about three-fourths of all stones
