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Mercy CLS 3: Urinalysis > 4. Microscopic Exam > Flashcards

4. Microscopic Exam Flashcards

1
Q

“macroscopic screening”

A

protocols whereby microscopic examination of the urine sediment is performed only on specimens meeting specified criteria

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2
Q

centrifugation speed (RCF and RPMs)

A

400-450 RCF
1500-2000 RPMs

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3
Q

calculation for RCF

A

RCF = (1.118 x 10^-5)(radius of rotor head in cm)(RPM^2)

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4
Q

centrifuge for —- min

A

5

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5
Q

volume used for microscopic exam

A

0.5 mL - 1.0 mL

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6
Q

concentration factor =

A

concentration factor = volume of urine centrifuged/sediment volume

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7
Q

examined on low power

A

SECs
casts
mucus

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8
Q

how do stains work?

A

change the refractive index of sediment

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9
Q

most frequently used stain

A

Sternheimer-Malbin

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10
Q

crystal violet + safranin O

A

Sternheimer-Malbin

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11
Q

function of Sternheimer-Malbin

A

IDs WBCs, epithelial cells, casts

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12
Q

0.5% solution metachromatic stain

A

toluidine blue

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13
Q

function of toluidine blue

A

enhances nuclear detail
diff. WBC and renal tubular epithelial cells

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14
Q

lyses RBCs; helps differentiate

A

2% acetic acid

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15
Q

oil red O + sudan III

A

lipid stain

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16
Q

function of lipid stain

A

stain fats except cholesterol

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17
Q

methylene blue + eosin Y

A

hansel stain

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18
Q

function of hansel stain

A

IDs eosinophils
drug-induced allergic rxn

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19
Q

function of prussian blue stain

A

ID structures containing iron
IDs hemosiderin

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20
Q

preparation of permanent slides for detecting & monitoring renal disease

A

cytodiagnostic urine testing

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21
Q

function of Papanicolaou’s stain

A

cytodiagnostic urine testing

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22
Q

how does phase contrast work?

A

converting variations in refractive index to variation in contrast

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23
Q

function of polarizing microscopy

A

ID of cholesterol in oval fat bodies, fatty casts, and crystals

“maltese cross” pattern and crystals

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24
Q

Produces a 3-D microscopy image and layer-by-layer imaging of a specimen

A

Interference-contrast

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25
Q

hematuria clinical significance

A

Glomerulonephritis
Acute infections
Toxic and immunologic reactions
Malignancies
Contamination (menstruation)
Strenuous exercise

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26
Q

RBC stacking

A

rouleaux

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27
Q

messed up RBCs

A

dysmorphic forms

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28
Q

possible explanation for + blood on dipstick but = RBC on microscopic

A

myoglobin

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29
Q

clumps of WBCs associated with…

A

proteinuria

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30
Q

glitter cells are in ——- urine

A

hypertonic/dilute

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31
Q

appearance of WBCs in elderly patients or those on chemo

A

“Blebs” (vacuoles) and finger/wormlike projections (myelin forms)

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32
Q

explanation for = LE on dipstick but + WBC on microscopic

A

lymphocytes

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33
Q

abnormal epithelials clinical significance

A

Pyelonephritis
Toxic reactions
Viral infections
Transplant rejection
Secondary effects of glomerulonephritis

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34
Q

bladder cells

A

transitional/urothelial cells

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35
Q

transitional cells origin

A

lining of the renal pelvis, ureters, bladder, and upper urethra

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36
Q

syncytia

A

sheets of transitional epithelials seen after catheterization

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37
Q

renal tubular epithelial cells origin

A

linings of renal tubules

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38
Q

RTEs can indicate ——-, except in this population

A

tubular necrosis
newborns (normal)

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39
Q

renal fragments

A

3 or more collecting duct RTEs

40
Q

oval fat bodies

A

RTEs that are filled with absorbed lipids

41
Q

OFB clinical significance

A

glomerular dysfunction with renal tubular cell death and leakage of plasma components (protein and fat) into the urine

42
Q

if RTE or OFB are present…

A

protein and casts should also be present

43
Q

bacteria without WBCs can indicate…

A

poor specimen handling

44
Q

yeast are seen in ——— patients because…

A

diabetic
↑ glucose

45
Q

pseudohyphae

A

mycelial elements

46
Q

parasites in urine

A

Trichomonas vaginalis
Schistosoma haematobium ova
Enterobius vermicularis ova

47
Q

males are often asymptomatic carriers

A

trich

48
Q

parasite from bladder wall mucosa
Africa/middle East

A

S. haematobium

49
Q

parasite from fecal contamination

A

pinworm E. vermicularis

50
Q

sperm clinical significance

A
  • sex
  • male infertility
  • retrograde ejaculation
  • SA (children, nursing home etc)
51
Q

major constituent of mucus

A

uromodulin

52
Q

only elements found in sediment that are unique to the kidney

A

casts

53
Q

casts reflect ———
and are seen with —— or ——

A

status of renal tubules
urinary protein levels
urinary stasis

54
Q

normal casts

A

hyaline
granular

55
Q

casts clinical significance (general)

A
  • renal disease
  • diuretic therapy
  • athletic pseudonephritis
56
Q

major constituent of casts

A

uromodulin/Tamm-Horsfall protein

57
Q

uromodulin production ↑ during…

A

exercise
stress

58
Q

broad casts indicate…

A

tubular distension

59
Q

factors that enhance cast formation

A
  • ↓ pH
  • ↑ in solute concentration
  • ↓ in rate of urine flow (urinary stasis)
  • Proteinuria (particularly albumin)
60
Q

cylindruria

A

casts in urine

61
Q

hyaline cast composition

A

uromodulin

62
Q

hyaline cast clinical significance

A

Strenuous exercise
Dehydration
Emotional stress
Glomerulonephritis
Pyelonephritis
Chronic renal disease
Congestive heart failure

63
Q

RBC cast clinical significance

A

Acute glomerulonephritis (Strep sequelae)
Tubular damage
Strenuous exercise
Incompatible blood transfusions

64
Q

WBC cast clinical significance

A

Pyelonephritis (upper UTI)—bacteria +
Acute interstitial nephritis—bacteria =

65
Q

bacterial cast clinical significance

A

pyelonephritis

66
Q

RTE cast clinical significance

A

renal tubular damage

67
Q

granular cast composition

A

disintegrated cell casts

68
Q

granular cast clinical significance

A

Normal
Exercise
Renal disease

69
Q

waxy casts indicate…

A

extreme urine stasis, indicating chronic renal failure

70
Q

formation of waxy cast

A

degeneration of the hyaline cast matrix and any cellular elements or granules contained in the matrix

71
Q

casts that do not polarize

A

waxy

72
Q

waxy cast clinical significance

A

Chronic renal failure
Tubular obstruction
Acute renal disease (Glomerulonephritis, Nephrotic syndrome)
Malignant HTN
Renal allograft rejection

73
Q

fatty casts are seen with…

A

OFBs and free fat droplets

74
Q

fatty casts clinical significance

A

Nephrotic syndrome
Toxic tubular necrosis
DM
Crushing injuries

75
Q

broad casts are mostly either —– or —– casts and indicate…

A

granular or waxy
extreme urinary stasis

76
Q

pathologic crystals (organic + iatrogenic) are formed in —– urine

A

acidic

77
Q

factors that enhance crystal formation

A

↑ concentration of solute in urine
pH of urine
Urinary stasis allowing time for formation
↓ Temperature

78
Q

normal crystals seen in acidic urine

A
  • amorphous urates
  • uric acid
  • acid urates
  • sodium urates
  • calcium oxalate
79
Q

normal crystals seen in alkaline urine

A
  • amorphous phosphates
  • triple phosphate
  • calcium phosphate
  • calcium carbonate
  • ammonium biurate
80
Q

abnormal crystals

A
  • cystine
  • cholesterol
  • leucine
  • tyrosine
  • bilirubin
  • radiographic dye
  • sulfa
  • ampicillin
  • hemosiderin
  • hippuric acid
81
Q

uric acid crystals abnormal numbers

A

Increased levels of purines and nucleic acids (diet)
Gout
Chemotherapy
Kidney stones

82
Q

acid urates + sodium urates abnormal numbers

A

gout

83
Q

calcium oxalate abnormal numbers

A

foods (tomatos, asparagus, vit C)
kidney stones
ethylene glycol poisoning

84
Q

ethylene glycol antidote

A

🥂

85
Q

triple phosphate abnormal numbers

A

UTI from urease + bacteria

86
Q

calcium phosphate/carbonate abnormal numbers

A

renal calculi

87
Q

ammonium biurate abnormal numbers

A

iatrogenically induced
improperly handled urine

88
Q

cystine crystals clinical significance

A

Metabolic disorder that prevents reabsorption of cystine by the renal tubules (cystinuria)
Renal tubular damage
Renal calculi

89
Q

cholesterol clinical significance

A

Lipiduria
Nephrotic Syndrome

90
Q

leucine clinical significance

A

IEM
severe liver disease

seen with tyrosine

91
Q

tyrosine clinical significance

A

IEM
severe liver disease

seen with leucine and + bilirubin

92
Q

bilirubin clinical significance

A

hepatic disorders
viral hepatitis

93
Q

usually makes iatrogenic crystals go away

A

adequate patient hydration

94
Q

hemosiderin seen when?

A

2-3 days after severe hemolytic episode

95
Q

hippuric acid clinical significance

A

ethylene glycol poisoning

96
Q

starch seen in…

A

contamination from gloves, talcum powder

Mercy CLS 3: Urinalysis (10 decks)

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