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ClinChem Ch6

Practice test for microscopic urinalysis class exam in ClinChem1 DelTech Owens

What physical and chemical properties indicate the need for microscopic analysis of urine samples? 1. color 2. clarity 3. blood 4. protein 5. nitrite 6. leukocyte esterase 7. glucose
Samples from shat special populations should automatically have their urine samples microscopically examined in the lab? 1. pregnant women 2. pediatric patients 3. geriatric patients 4. diabetics 5. immunocompromised patients 6. patients with renal problems
Red or pink urine could have __ in it. RBCs/blood
If clarity of the urine is low, it could mean ? hematuria, hemoglobinuria, myoglobinuria
If nitrite is found in the urine, you should check for the presence of ? WBCs and bacteria
If WBCs and bacteria are found in a urine sample, this could mean the patient has ? UTI
If glucose is high, you should check for ? yeast
Diabetics are prone to having what in their urine? yeast
You should refrigerate a urine sample or use a preservative before it gets to be __ old. 2
What does refrigeration of urine precipitate? crystals
What qualitative feature of urine (something you can see with the naked eye) will be temporarily increased when it is refrigerated? turbidity
Refrigeration preserves urine for how long? 24 hours
What preservative will alter the pH and specific gravity of a urine sample, but won't affect cells or casts for microscopic analysis? Formalin
Which tests does formalin interfere with? blood, leukocyte esterase, urobilinogen
What common item can be used as a preservative? boric acid
What kind of specimen will have fewer contaminants in it? clean-catch midstream
What kind of specimen is more likely to reveal abnormalities? first morning
What volume of urine is considered ideal for centrifuging and testing? 10-15mL
What is the ideal time and RCF for centrifuging a urine sample? 5 mins 400 RCF
What does RCF stand for? relative centrifugal force
What should you always leave off when centrifuging a urine sample? the brake
How do you find the concentration factor of urine? Volume of urine divided by sediment volume
How can you figure out the chance of detecting low quantities of formed elements in urine? Finding the concentration factor
Be __ to achieve consistent results. consistent
When examining urine sediment, you should look at a minimum of how many low power and high power fields? 10 for both
When examining urine sediment with a microscope, how much light should you used? low light
What should you bring into focus when first examining a urine sample in a microscope? epithelial cell
When you find casts in a urine sample, how should they be reported? Average number per lpf
When reporting RBCs and WBCs, how should they be reported? Average number per hpf
What kind of additive can enhance the nuclei of WBCs in urine under a microscope? acetic acid
What kind of stain works well for identifying triglycerides, neutral fats, and cholesterol? lipid stains
What kind of stain works well for identifying bacterial casts? Gram stain
What kind of stain works well for identifying eosinophils? Hansel stain
Hansel stain is a combination of __ __ and __ __. methylene blue and eosin Y
Hemosiderin granules, as seen in hemoglobinuria, are best seen with what kind of stain? Prussian blue
When lowering the light on your microscope to examine a urine sample, do not use the __ __ to adjust the light. aperture diaphragm
A phase-contrast microscope works well in urinalysis because it increases what? refractive index
When seen under a polarizing microscope, cholesterol produces what? Maltese cross formation
A polarizing microscope has the ability to do what to light beams? split them into 2 beams
What kind of sediment constituent looks like smooth rings? RBCs
RBCs will appear crenated in __ urine. hypersthenuric (specific gravity above 1.010)
A RBC that has had all its cytoplasmic contents removed by lysis so only its membrane remains is called a ? ghost cell
Ghost cells can be found in what kind of urine? hyposthenuric (specific gravity lower than 1.010)
RBCs must be identified under __ power. high
How can you tell a yeast cell from an RBC? budding
Dysmorphic RBCs can due to what causes? 1. glomerular bleeding 2. strenuous exercise 3. acanthrocytic blebs 4. fragmented hypochromic cells
How many RBCs per hpf are considered OK? Less than 5
What nonpathogenic reason is there for finding more than 5 RBCs per hpf in urine? menstruation
RBCs seen in clear urine can indicate what if seen with renal calculi? kidney stones
What kind of organ damage can cause significant numbers of RBCs in urine? Glomerular membrane damage or vascular injury to genitourinary tract
What kind of WBC is most likely to be find in urine? neutrophils
What's another term for WBCs found in urine? glitter cells
Neutrophils in the urine, without any other indications of disease, are indicative of what? They're nonpathological
If WBCs in urine are lymphocytes, what could this indicate? 1. Cancer 2. severe viral infection 3. early transplant rejection
Eosinophils in the urine could indicate ? 1. drug induced interstitial nephritis 2. renal transplant rejection
What do you call increased WBCs found in urine? pyuria
5 infectious causes of WBCs appearing in urine are? 1. cystitis 2. pyelonephritis 3. lupus 4. interstitial nephritis 5. tumors
Report WBCs in urine if found with ? bacteria
What are the 3 basic kinds of epithelial cells that might be found in urine? 1. squamous 2. transitional/uroethelial 3. RTE
What is the largest kind of epithelial cell that might be found in urine? squamous
How is the quantity of squamous epithelial cells reported? rare, few, moderate, many
Are squamous epithelial cells normally considered pathological? no
Gardnerella vaginalis cells on top of epithelial cells are better known as __ cells. clue
Transitional (urothelial) cells come in what 3 forms? 1. spherical 2. caudate 3. polyhedral
Transitional cell syncytia, or clumping of unicellular cells, can result from catheterization or what other condition? Bladder cancer (renal transitional cell carcinoma)
What 3 shapes do RTE cells appear in? 1. columnar 2. round/oval 3. cuboidal
Columnar RTE cells come from where? proximal convoluted tubule (PCT)
Round or oval RTE cells come from where? distal convoluted tubule (DCT)
Cuboidal or squarish RTE cells come from where? collecting duct
What is the largest kind of RTE cell? PCT cells/Columnar
Which kind of RTE cell is often seen in clumps? (Hint: PCT and DCT cells are never seen in clumps) Collecting Duct/Cuboidal RTEs
Are RTE cells clinically significant? Yes-they are the most clinically significant epithelial cell found in urine
Single cuboidal RTE cells indicate what? salicylate poisoning
What could cause RTE cells to appear in urine? 1. heavy metal poisoning 2. toxic drugs 3. hemoglobin 4. myoglobin 5. viral infections 6. pyelonephritis 7. transplant rejection 8. salicylate poisoning
Oval fat bodies are RTE cells that have absorbed ? lipids
Oval fat bodies have what shape under polarized light? Maltese cross formation
Bacteria in urine without WBCs indicates __ of the specimen. contamination
How is the quantity per hpf of bacteria in the urine reported? few, moderate, many per hpf
How is the quantity of yeast per hpf in urine reported? few, moderate, many per hpf
What 3 conditions are suggested when yeast is found in a patient's urine? 1. yeast infection 2. diabetes 3. immunocompromised
If you see yeast, but there's no budding, it's more likely to be ? RBCs
What parasite is most commonly found in urine? Trichomonas vaginalis
Name 3 parasites that can be found in urine? 1. Trichomonas vaginalis 2. Schistosoma haematobium 3. Enterobisu vermicularis
Sperm found is urine is __ significant. rarely
If sperm is found in a urine sample, it may be clinically significant if what 2 criteria are met? 1. patient is male 2. sample is clean-catch midstream
Mucus and casts in the urine are usually made from what protein? Tamm-Horsfall
When reporting the number of casts, how do you report them? Number per lpf
Tamm-Horsfall protein is secreted by what 3 things? 1. RTE 2. DCT 3. collecting duct
Is Tamm-Horsfall protein normally detectable by reagent strips? no
What nonpathogenic cause can increase the number of casts? strenuous exercise or stress
Which cast is most commonly found in urine? hyaline
Are hyaline casts associated with renal disease? no
How many hyaline casts per lpf can be found in concentrated urine without clinical concern? 2 per lpf
Besides stress and exercise, what other things can cause a nonpathological increase in the number of hyaline casts found in urine? 1. fever 2. heat exposure 3. dehydration
What pathological reasons can cause an increase in the number of hyaline casts? 1. glomerularnephritis 2. chronic renal disease 3. congestive heart failure
RBC casts found in urine are strongly indicative of ? 1. acute glomerular nephritis 2. glomerular damage (as in #1) 3. tubular necrosis
WBC casts and high bacteria may indicate ? pyelonephritis
WBC casts without bacteria may indicate ? acute interstitial nephritis
WBC casts are associate with infection and inflammation of ? the tubules
Bacterial casts may be seen in urine samples from patients with ? pyelonephritis
What are some possible reasons for RTE cells to appear in urine? 1. tubular damage 2. heavy metals 3. viral infections 4. drug toxicity 5. graft rejection 6. pyelonephritis
Fatty casts are often seen with what? oval fat bodies and fat droplets
Why might fatty casts be seen in a urine sample? 1. nephrotic syndrome 2. diabetes 3. crush trauma 4. tubular necrosis
What is the 2nd most common type of cast found in urine? granular
How many granular casts must be seen per lpf in a urine sample for it to be clinically significant? more than 5
Granular casts disintegrate to form ? waxy casts
What kind of stain helps a lab tech to ID waxy casts in urine? KOVA stain
Hyaline casts disintegrate to form ? waxy casts
Waxy casts may have what along their edges? breaks or notches
Waxy casts in urine suggest the patient may have ? extreme urine stasis/renal failure
Broad casts are also known as __ __ casts. renal failure casts
What are the most common types of broad casts? granular and waxy
What disease can cause bilirubin to appear in broad casts? viral hepatitis
Name 3 in vivo factors that can effect the chances of finding urinary crystals in a sample. 1. urine pH 2. diet 3. concentration and solubility of crystallogenic substances in specimen
Name 3 in vitro factors that can effect the chances of finding urinary crystals in a sample. 1. temperature 2. evaporation 3. urine pH
Are most urinary crystals clinically significant? no
What is indicated by abnormal urine crystals? 1. liver disease 2. inborn errors of metabolism 3. tubule damage
How is the quantity of urinary crystals reported? few, moderate, many
Crystals may form in a fresh urine specimen if the __ __ is high. specific gravity
What preservation method can cause crystals to form in urine? refrigeration
All abnormal crystals are found in what kind of urine? acidic
What kind of crystals will form in refrigerated acid urine? amorphous urates (urates=acidic)
What kind of crystals will form in refrigerated alkaline urine? amorphous phosphates (phosphates=alkaline)
Uric acid cystals may form in urine with a pH lower than ? 5.5
Uric acid cystals may be seen in patients in what 2 circumstances? 1. gout 2. chemotherapy for leukemia
Calcium oxalate crystals may form in urine that is (acidic or alkaline?) both
Dihydrate calcium oxalate crystals, the most commonly seen kind, look like ? an envelope or pyramid
Monohydrate calcium oxalate crystals have a __ appearance. dumbbell
Monohydrate calcium oxalate crystals are a sign of __ __ poisoning. radiator fluid
Ammonium biurate crystals are also called ? thorny apples
Cystine crystals come in thick and thin plates and have how many sides? 6
Cystine crystals are seen in patients with ? cystinuria
Cholesterol crystals look like sheets of ? clear glass
When seen with fatty casts and oval flat bodies, cholesterol crystals indicate what condition? nephrotic syndrome
Bilirubin crystals are also called ? liver disease crystals
Liver disease crystals have protrusions that look like ? needles
Created by: IsaacJ



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