Urinalysis Exam 2 Flashcards
The presence of heavy proteinuria >3.5 g/dL is most characteristic of:
a. acute glomerulonephritis
b. acute interstitial nephritis
c. pyelonephritis
d. nephrotic syndrome
d. nephrotic syndrome
Broad and waxy casts are most frequently seen with:
a. membranous glomerulonephritis
b. rapidly progressive glomerulonephritis
c. chronic glomerulonephritis
d. membranoproliferative glomerulonephritis
c. chronic glomerulonephritis
The pronounced edema associated with the nephrotic syndrome is related to the:
a. hypolipidemia
b. hypoalbuminemia
c. decreased glomerular filtration rate
d. lipiduria
b. hypoalbuminemia
To differentiate between cystitis and pyelonephritis, which of the following elements can aid in differentiation?
a. bacteria
b. WBC casts
c. WBC clumps
d. RBC casts
b. WBC casts
Which of the following attributes typically contributes most to the formation of urinary crystals?
a. increased urinary temperature
b. urinary pH
c. increased urinary volume output
d. decreased urinary urethra hemoglobin formation
b. urinary pH
Typically seen due to vaginal contamination, a squamous epithelial cell covered with Garnerella vaginalis bacteria is called
a. glitter cell
b. clue cell
c. an oval fat body
d. a hyaline cell
b. clue cell
The most likely pathological cause of increased transitional epithelial cells (urothelial cells) in the urine is:
a. diabetes mellitus
b. hypereosinophilia
c. invasive procedures
d. malignancy
d. malignancy
The type of cells associated with oval fat bodies are:
a. transitional epithelial cells
b. macrophages
c. squamous epithelial cells
d. renal tubular epithelial cells
d. renal tubular epithelial cells
To identify birefringent elements, the following microscopy should be used:
a. polarizing microscopy
b. interference-contrast microscopy
c. bright-field microscopy
d. phase-contrast microscopy
a. polarizing microscopy
The clinical significance of tyrosine crystals in the urine is:
a. disorders producing lipemia
b. severe liver disorders or metabolic disorder
c. acute glomerular nephritis
d. increased consumption of foods like spinach, asparagus and rhubarb
b. severe liver disorders or metabolic disorder
The only type of cast capable of polarization is the:
a. granular
b. fatty
c. hyaline
d. waxy
b. fatty
Which of the following exhibit a cross formation or birefringence under polarized light: (1) starch; (2) cholesterol; (3) uric acid; (4) red blood cells
a. 1,2 and 3
b. 1 and 3
c. 2 and 4
d. 1, 3 and 4
a. 1,2 and 3
A technologist received a refrigerated specimen that is cloudy with pink sediment upon centrifugation. Urine pH is 6.0. What is the mostly likely cause of the pink sediment and what can be done to remove it?
a. amorphous urates; heat the specimen
b. amorphous phosphates; add acetic acid
c. calcium phosphates; add acetic acid
d. uric acid; add acetic acid
a. amorphous urates; heat the specimen
Under polarizing microscopy, if an object does not show birefringent properties, then the object will appear _____ if the background is black:
a. white
b. black
c. colored (a rainbow effect)
d. purple
b. black
The purpose of using a Hansel stain on urine sediment is to identify
a. bacteria
b. trichomonads vaginalis
c. eosinophils
d. hemosiderin granules
c. eosinophils
The primary factor that favors the formation of casts is:
a. urinary stasis
b. increased pH
c. decreased pH
d. specific gravity
a. urinary stasis
The disorder associated with polyuria and low specific gravity is:
a. cystitis
b. renal glycosuria
c. Nephrogenic diabetes insipidus
d. focal segmental glomerulosclerosis
c. Nephrogenic diabetes insipidus
Which of the following elements would most likely be found in a concentrated, hypertonic, acidic urine that contains trace protein?
a. ghost RBC’s and glitter cells
b. casts
c. 4+ bacteria, no WBCs
d. triple phosphate crystals
b. casts
The presence of WBC casts would be most likely associated with:
a. cystinuria
b. cystitis
c. urethritis
d. pyelonephritis
d. pyelonephritis
To differentiate a bacterial cast from a granular cast, a technologist could perform:
a. Hansel Stain
b. gram stain
c. sternheimer-Malbin stain
d. forgo the staining and use polarizing microscopy
b. gram stain
Which one of the following would not be a typical component of renal calculi?
a. leucine
b. calcium oxalate
c. uric acid
d. cystine
a. leucine
A seven year old female is recovering from pharyngitis. A positive rapid Strep screening test was noted at the physician’s office soon after symptoms developed. On the next office visit, laboratory tests were performed. The following were noted:
Urinalysis macroscopic:
Color: light red
Clarity: turbid
SG: 1.015
pH: 6.0
protein: 3+
Glucose: neg
ketones: neg
blood: 3+ (large)
Bilirubin: neg
Urobilinogen: normal
Nitrite: neg
Leukocyte: trace
Urinalysis Microscopic:
RBC: 60-80/hpf
WBC: 3-5 hpf
hyaline cast: 0-1/lpf
RBC cast: 2-3/lpf
Granular cast: 1-2/lpf
Chemistry:
Blood urea Nitrogen (BUN) (kidney function test): 45 mg/dL
(reference range: 8-23 mg/dL)
Serology:
ASO (antistreptolysin O antibodies) titer: 1:800
(reference range: less than 1:100)
Based on the history, clinical indications and the laboratory tests, which one of the following disorders is the most likely for this patient?
a. acute pyelonephritis
b. nephrotic syndrome
c. acute glomerulonephritis
d. chronic tubular necrosis
c. acute glomerulonephritis
Hunter and Hurler syndrome are hereditary disorders associated with:
a. mucopolysaccharides
b. purines
c. tryptophan
d. porphyrins
a. mucopolysaccharides
Which disease do the following tests coordinate with?
Ferric chloride test: blue
Clinitest: yellow precipitate
Urine color darkens upon addition of alkali
a. mucopolysaccharide disorders
b. alkaptonuria
c. porphobilinogen/porphyria
d. tyrosyluria
b. alkaptonuria
Which disease do the following test coordinate with?
CTAB: white turbidity
Acid-Albumin: white turbidity
Metachromic staining spot test: blue spot
a. mucopolysaccharide disorders
b. alkaptonuria
c. porphobilinogen/porphyria
d. tyrosyluria
a. mucopolysaccharide disorders
Which disease do the following test coordinate with?
Ferric chloride test: green color, rapidly fades
Nitroso-napthol: orange-red color
a. mucopolysaccharide disorders
b. alkaptonuria
c. porphobilinogen/porphyria
d. tyrosyluria
d. tyrosyluria
Differentiation between RBC’s, yeast and oil droplets may be accomplished by all of the following EXCEPT:
a. lysis of yeast cells by acetic acid
b. increased refractivity of oil droplets using polarized light
c. observation of budding yeast cells
d. lysis of RBC’s by acetic acid
a. lysis of yeast cells by acetic acid
Increased urinary eosinophils are diagnostic for:
a. acute pyelonephritis
b. chronic pyelonephritis
c. acute tubular necrosis
d. actue interstitial nephritis
d. actue interstitial nephritis
A patient being considered for a possible diagnosis of acute interstitial nephritis (AIN). Which one of the following would be most useful and why would it be useful in order to help in the diagnosis?
a. urinary eosinophil because AIN is primarily an allergic reaction and not an infection
b. 24 hour quantitative protein because AIN is primarily a bacterial infection leading to cystitis
c. IgA and IgG quantitative immunoglobulins because AIN primarily involves the glomerulus and will measure M protein
d. Urinary triglycerides and cholesterol because AIN primarily is a lipid metabolic disorder involving the basement membrane of the glomerulus
a. urinary eosinophil because AIN is primarily an allergic reaction and not an infection
Cystine crystals could most easily be confused with:
a. cholesterol crystals
b. triple phosphate crystals
c. leucine crystals
d. uric acid crystals
d. uric acid crystals
Broad casts may form as a result of:
a. extreme urinary stasis and strenuous exercise
b. increased urinary output and strenuous exercise
c. extreme urinary stasis and tubular destruction
d. increased urinary output and tubular destruction
c. extreme urinary stasis and tubular destruction
A routine urinalysis is performed on a specimen that has turned black upon standing. The urine is acidic and has negative chemical tests. Ferric chloride added to a freshly voided urine on this patient turns black with a black precipitate. One should suspect:
a. phenylketonuria
b. diabetic ketosis
c. alkaptonuria
d. melanuria
d. melanuria
The urinary sediment element most closely associated with bleeding within the nephron is:
a. whole and lysed RBCs
b. RBC cast
c. WBC cast
d. Granular cast
b. RBC cast
To distinguish a cellular cast from a clump of cells, the microscopist should:
a. check for dysmorphic cells
b. look carefully for a cast matrix with parallel sides
c. determine if free-standing cells are present
d. examine the sediment using polarizing microscopy
b. look carefully for a cast matrix with parallel sides
Abnormal amounts of indigo blue (indican) in the urine are indicative of a defect in the metabolism of:
a. tryptophan
b. tyrosine
c. cystine
d. phenylalanine
a. tryptophan
TURE or FALSE.
An inherited metabolic “overflow” disorder, is a disorder where there is a malfunction of renal tubular reabsorption due to a decrease in RTE receptors
FALSE
Identification of crystals is based on shape and:
a. urine pH and crystal solubility properties
b. urine protein and crystal size
c. urine bilirubin and glucose
d. urine pH and crystal size
a. urine pH and crystal
When performing microscopic examination of urinary sediment the low-power (10x) objective is used to enumerate: (1) bacteria; (2) crystals; (3) cells; (4) casts
a. 1,2 and 3
b. 1 and 2 only
c. 2 only
d. 4 only
d. 4 only
Normal crystals found in acidic urine include:
a. calcium oxalate, uric acid, calcium phosphate
b. uric acid, amorphous urates, triple phosphate
c. calcium oxalate, uric acid, amorphous urates
d. uric acid, calcium carbonate, bilirubin
c. calcium oxalate, uric acid, amorphous urates
Formation of crystals due to medications is most frequently caused by:
a. inadequate hydration
b. incorrect timing of medication doses
c. not taking enough medication
d. use of expired antibiotics
a. inadequate hydration
Of the following urinary sediment results, which one should be rechecked:
a. pH: 6.5, positive blood and protein
b. pH: 6.5 with uric acid crystals
c. pH: 7.0 positive bilirubin and urobilinogen
d. pH: 5.5 bacteria and triple phosphate crystals
d. pH: 5.5 bacteria and triple phosphate crystals
The best stain to use in order to enhance nuclear detail would be:
a. Sudan III
b. Prussian blue
c. Toluidine blue
d. Hansel stain
c. Toluidine blue
Abnormal urine screening tests categorized as an overflow disorder include all of the following except:
a. alkaptionuria
b. galactosemia
c. PKU
d. cystinuria
d. cystinuria
Which of the following pair of elements could be found in both a vaginal wet prep and a urine sediment?
a. schistosoma heamatobium and Trichomonas vaginalis
b. Trichomonas vaginalis and yeast
c. Trichomonas vaginalis and Giardia lamblia
d. Enterobius vermicularis and Giardia lamblia
b. Trichomonas vaginalis and yeast
The major cause of nephrotic syndrome in children is:
a. IgA nephropathy
b. minimal change disease
c. membranous glomerulonephritis
d. rapidly progressive glomerulonephritis
b. minimal change disease
The best description for ammonium biurate crystals would be:
a. thorny apple
b. coffin lid
c. hexagonal shaped
d. dumbbell shaped
a. thorny apple
The classic urine color associated with porphyria is:
a. dark yellow
b. blue
c. pink
d. port wine
d. port wine
A lipid droplet that does not stain with Sudan III may be composed of:
a. triglycerides
b. cholesterol
c. neutral fats
d. none of the above stain with Sudan III
b. cholesterol
The most common method for testing/diagnosing newborns for metabolic disease is:
a. Ferric chloride test
b. MS/MS tandom mass spectroscopy
c. clinitest
d. Guthrie test
b. MS/MS tandom mass spectroscopy
Characteristic urine odors are associated with all of the following disorders except:
a. alkaptonuria
b. phenylketonuria
c. maple syrup urine disease
d. isovaleric acidemia
a. alkaptonuria
What substance is causing the positive reagent strip reaction for blood?
Color: Red/Brown
Clarity: Hazy
Specific Gravity: 1.012
pH: 7.0
Macroscopic Strip test
Glucose: Negative
Ketone: Negative
Bilirubin: Negative
Urobilinogen: 8.0 EU
Protein: 1+
Blood: Large
Nitrite: Negative
Leukocyte esterase: Negative
Microscopic
6-10 RTE cells/HPF (with intracellular yellow/brown granules)
3-4 homogenous RBC casts/LPF
1-2 dirty brown casts/LPF
1-2 RTE cell casts/LPF
Many yellow brown granules
a. hemoglobin
b. urobilinogen
c. bilirubin
d. ketones
a. hemoglobin
What is the significance of the elevated urobilinogen reading but normal bilirubin?
Color: Red/Brown
Clarity: Hazy
Specific Gravity: 1.012
pH: 7.0
Macroscopic Strip test
Glucose: Negative
Ketone: Negative
Bilirubin: Negative
Urobilinogen: 8.0 EU
Protein: 1+
Blood: Large
Nitrite: Negative
Leukocyte esterase: Negative
Microscopic
6-10 RTE cells/HPF (with intracellular yellow/brown granules)
3-4 homogenous RBC casts/LPF
1-2 dirty brown casts/LPF
1-2 RTE cell casts/LPF
Many yellow brown granules
a. constipation
b. liver damage
c. intravascular hemolysis
d. bile duct obstruction
c. intravascular hemolysis
What is the composition of the dirty, brown casts?
Color: Red/Brown
Clarity: Hazy
Specific Gravity: 1.012
pH: 7.0
Macroscopic Strip test
Glucose: Negative
Ketone: Negative
Bilirubin: Negative
Urobilinogen: 8.0 EU
Protein: 1+
Blood: Large
Nitrite: Negative
Leukocyte esterase: Negative
Microscopic
6-10 RTE cells/HPF (with intracellular yellow/brown granules)
3-4 homogenous RBC casts/LPF
1-2 dirty brown casts/LPF
1-2 RTE cell casts/LPF
Many yellow brown granules
a. melanin
b. methemoglobin
c. hemoglobin
d. homogentistic acid
b. methemoglobin
What is the probable composition of the yellow-brown granules?
Color: Red/Brown
Clarity: Hazy
Specific Gravity: 1.012
pH: 7.0
Macroscopic Strip test
Glucose: Negative
Ketone: Negative
Bilirubin: Negative
Urobilinogen: 8.0 EU
Protein: 1+
Blood: Large
Nitrite: Negative
Leukocyte esterase: Negative
Microscopic
6-10 RTE cells/HPF (with intracellular yellow/brown granules)
3-4 homogenous RBC casts/LPF
1-2 dirty brown casts/LPF
1-2 RTE cell casts/LPF
Many yellow brown granules
a. hemoglobin
b. uric acid
c. hemosiderin
d. bilirubin
c. hemosiderin
How could the composition of the granules be confirmed?
Color: Red/Brown
Clarity: Hazy
Specific Gravity: 1.012
pH: 7.0
Macroscopic Strip test
Glucose: Negative
Ketone: Negative
Bilirubin: Negative
Urobilinogen: 8.0 EU
Protein: 1+
Blood: Large
Nitrite: Negative
Leukocyte esterase: Negative
Microscopic
6-10 RTE cells/HPF (with intracellular yellow/brown granules)
3-4 homogenous RBC casts/LPF
1-2 dirty brown casts/LPF
1-2 RTE cell casts/LPF
Many yellow brown granules
a. bright field microscopy
b. polarized microscopy
c. toluidine blue stain
d. Prussian blue stain
d. Prussian blue stain
The presence of urinary reducing substances is of particular concern in:
a. pregnant women
b. newborns 24 months
c. adolescent males
d. non-pregnant women
b. newborns 24 months
Phenylketonuria is caused by:
a. inherited disorder of galactose- 1- phosphate uridylyltransferase
b. inability to metabolize the enzyme tyrosine decarboxylase
c. lack of the enzyme homogentisic acid oxidase
d. lack of the enzyme phenylalanine hydroxylase
d. lack of the enzyme phenylalanine hydroxylase
The presence of “orange sand” in an infant’s diaper is indicative of:
a. Lesch- Nyhan disease
b. bilirubinuria
c. cystinuria
d. maple syrup urine disease
a. Lesch- Nyhan disease
The difference between cystinuria and cystinosis is:
a. Cystinuria is an inborn error of metabolism, whereas cystinosis is a defect in the renal tubular transport of amino acids
b. Cystinuria will cause crystalline deposits of cysteine in the body, whereas cystinosis is the primary cause of renal calculi in children
c. There is no difference, they are the same disease, the terminology is different because cystinuria means cysteine in the urine and cystinosis means cysteine in the blood
d. Cystinuria is a defect in the renal tubular transport of amino acids, whereas cystinosis is an inborn error of metabolism.
d. Cystinuria is a defect in the renal tubular transport of amino acids, whereas cystinosis is an inborn error of metabolism.
Leucine crystals may be detected in:
a. tyrosyluria
b. maple syrup urine disease
c. cystinuria
d. porphyrinuria
a. tyrosyluria
Which of the following crystals would be insoluble in acetic acid
a. calcium carbonate, calcium oxalate, cystine
b. triple phosphate, calcium phosphate, calcium carbonate
c. triple phosphate, uric acid, calcium oxalate
d. uric acid, calcium oxalate, cystine
d. uric acid, calcium oxalate, cystine
Patients who produce kidney stones at an early age should be tested for the presence of:
a. organic acidemia
b. maple syrup urine disease
c. phenylketonuria (PKU)
d. cystinuria
c. phenylketonuria (PKU)
Which of the following casts is most likely found in healthy people (in 0-2/lpf)
a. hyaline cast
b. red blood cell cast
c. waxy cast
d. white blood cell cast
a. hyaline cast
The following urinalysis results are obtained from a newborn
Color: dark brown
Protein: negative
Blood: negative
Clarity: hazy
Glucose: negative
Urobilinogen: 0.4 E.U.
Specific gravity: 1.020
Ketones: large
Nitrite: negative
pH: 6.0
Bilirubin: negative
LEU: negative
Clinitest: negative
What additional unusual characteristic might be found in this urine?
a. uric acid crystals
b. RTE cells
c. odor (sweet smell)
d. taste
c. odor (sweet smell)
The primary component of most urinary calculi (kidney stones) is:
a. sodium
b. magnesium
c. calcium
d. chloride
c. calcium
What is the significance of the RTE cells and RTE casts?
a. tubular damage
b. decreased urine flow
c. glomerular damage
d. possibly malignancy
a. tubular damage
The following urinalysis results are obtained from a newborn
Color: dark brown
Protein: negative
Blood: negative
Clarity: hazy
Glucose: negative
Urobilinogen: 0.4 E.U.
Specific gravity: 1.020
Ketones: large
Nitrite: negative
pH: 6.0
Bilirubin: negative
LEU: negative
Clinitest: negative
What is the infant’s most probable disorder?
a. leach-nyhan disease
b. cystinosis
c. galactosemia
d. maple syrup urine disease
d. maple syrup urine disease
Damage glomerulus can occur as a result of all of the following except:
a. increased filtration of electrolytes
b. deposition of immune complexes
c. deposition of amyloid materials
d. cellular infiltration
a. increased filtration of electrolytes
Blood tests to confirm the diagnosis of acute glomerulonephritis detect the presence of:
a. anti-glomerular membrane antibodies
b. electrolyte imbalance
c. anti streptococcal antibodies
d. decreased serum albumin
c. anti streptococcal antibodies
Which of the following best describes the significant UA findings in pyelonephritis?
a. hematuria, decreased pH, oval fat bodies, leukocytes
b. proteinuria, transitional epithelial cells, broad casts, glycosuria
c. RTE casts, bacteria, hematuria, tyrosine
d. WBC casts, proteinuria, bacteria, leukocytes
d. WBC casts, proteinuria, bacteria, leukocytes
The most common cause of end-stage renal disease is:
a. acute glomerulonephritis
b. toxic chemicals
c. diabetic nephropathy
d. minimal change disease
c. diabetic nephropathy
Anti-glomerular basement membrane antibody is seen with:
a. wegeners granulomatosis
b. diabetic nephropathy
c. nephrotic syndrome
d. goodpasture syndrome
d. goodpasture syndrome
Lithotripsy is performed to:
a. prevent the formation of renal calculi
b. determine the composition of renal calculi
c. breakup and remove renal calculi
d. identify the presence of renal calculi
c. breakup and remove renal calculi
Which one of the following is a condition that is not typically involved in renal calculi formation?
a. glucosuria
b. urinary stasis
c. pH
d. chemical concentration
a. glucosuria
All of the following conditions could least to acute tubular necrosis EXCEPT:
a. hemorrhage/ blood clot
b. anti fungal agents
c. hemoglobinuria
d. polyuria
d. polyuria
The major protein composition of casts is:
a. lipoprotein
b. Bence jones protein
c. Tamm-Horsfall protein (uromodulin)
d. albumin
c. Tamm-Horsfall protein (uromodulin)
Which of the following best describes the significant UA findings in nephrotic syndrome?
a. microscopic hematuria, calcium oxalate crystals, bacteria
b. mucous, white blood cells, fatty casts
c. fat droplets, renal tubular epithelial cells, bilirubin
d. proteinuria, oval fat bodies, renal tubular epithelial cells, fat droplets
d. proteinuria, oval fat bodies, renal tubular epithelial cells, fat droplets
The presence of crenated RBCs in the urine sediment is associated with:
a. trauma
b. hypersthenuria
c. hyposthenuria
d. urinary tract infection
b. hypersthenuria
Urine with an odor of “sweaty feet” and a positive ketone test indicates:
a. cystinuria
b. alkaptonuria
c. isovaleric acidemia
d. tyrosyluria
c. isovaleric acidemia
Which disease do the following test coordinate with?
Hoesch test: pink layer on top
600nm Fluorescence in glacial acetic acid: pink fluorescence
a. mucopolysaccharide disorders
b. alkaptonuria
c. porphobilinogen/porphyria
d. tyrosyluria
c. porphobilinogen/porphyria
