Urinalysis Exam 2 Flashcards by A S

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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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The only type of cast capable of polarization is the:

a. granular
b. fatty
c. hyaline
d. waxy

b. fatty

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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

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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

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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

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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

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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

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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

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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

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The presence of WBC casts would be most likely associated with:

a. cystinuria
b. cystitis
c. urethritis
d. pyelonephritis

d. pyelonephritis

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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

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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

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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

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Hunter and Hurler syndrome are hereditary disorders associated with:

a. mucopolysaccharides
b. purines
c. tryptophan
d. porphyrins

a. mucopolysaccharides

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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

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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