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ClinChem Ch6
Practice test for microscopic urinalysis class exam in ClinChem1 DelTech Owens
| Question | Answer |
|---|---|
| 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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