M2: Microscopic Examination (Part 1: Macroscopic Screening) Flashcards by Geno Alinsub

Q

recommends that microscopic examination be performed
when:
- requested by a physician
- when a laboratory specified patient population is being tested
- when any abnormal physical or chemical result is obtained

A

Clinical and Laboratory Standards Institute (CLSI)

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Q

The purpose of the microscopic examination of the urinary
sediment is?

A

detect and to identify insoluble materials present in the urine

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Q

These all contribute formed elements to the urine

4

A

Blood
Kidney
Lower genitourinary tract
External contamination

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Q

Some components are of no clinical significance and are considered normal unless they are present in increased amounts, what two factors must be consdered in examination of urinary sediment?

A

Identification and quantification of elements

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Q

Abnormalities in the physical and chemical portions of the urinalysis play a primary role in the decision to perform a microscopic analysis, thus the use of the term?

A

Macroscopic screening

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Q

MACROSCOPIC SCREENING AND MICROSCOPIC CORRELATIONS

Parameters considered significant vary among laboratories?

A

Color
Clarity
Blood
Protein
Nitrite
Leukocyte esterase
Glucose (possibly)

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Q

MACROSCOPIC SCREENING AND MICROSCOPIC CORRELATIONS

Identify the screening test for the following possible microscopic findings:
RBC (blood)

A

Color (red), cloudy
or turbid

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Q

MACROSCOPIC SCREENING AND MICROSCOPIC CORRELATIONS

Identify the screening test for the following possible microscopic findings:
Squamous EC, WBC (confirm pathologic or non-patholpgic cause of turbidity)

A

Clarity: Cloudy or Turbid

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Q

MACROSCOPIC SCREENING AND MICROSCOPIC CORRELATIONS

Identify the screening test for the following possible microscopic findings:
Radiographic contrast media (X-ray dye)

A

Specific gravity >1.040

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Q

MACROSCOPIC SCREENING AND MICROSCOPIC CORRELATIONS

Identify the screening test for the following possible microscopic findings:
RBCs, RBC casts

A

Blood

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Q

MACROSCOPIC SCREENING AND MICROSCOPIC CORRELATIONS

Identify the screening test for the following possible microscopic findings:
Yeast

A

Glucose

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Q

MACROSCOPIC SCREENING AND MICROSCOPIC CORRELATIONS

Identify the screening test for the following possible microscopic findings:
WBCs intact or lysed, WBC casts (bacteria in UTI)

A

Leukocyte esterase positive

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Q

MACROSCOPIC SCREENING AND MICROSCOPIC CORRELATIONS

Identify the screening test for the following possible microscopic findings:
Bacteria (WBCs in UTI)

A

Nitrite positive

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Q

MACROSCOPIC SCREENING AND MICROSCOPIC CORRELATIONS

Identify the screening test for the following possible microscopic findings:
Increased casts and cells

A

Protein positive

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Q

SPECIMEN PREPARATION

T or F
Specimens should be examined while fresh or properly preserved.

A

T

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Q

SPECIMEN PREPARATION

These formed elements disintegrate rapidly, particularly in dilute alkaline
urine

A

RBCs, WBCs, and hyaline
casts

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Q

SPECIMEN PREPARATION

What concentration of urine does RBCs, WBCs, Hyaline casts disintegrate rapidly?

A

Dilute alkaline urine

high ph

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Q

SPECIMEN PREPARATION

You bring specimen to what temperature before centrifugation?

A

Room temperature

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Q

SPECIMEN PREPARATION

This temperature may cause precipitation of amorphous urates and phosphates and other non-pathologic crystals that can obscure other elements in the urine sediment.

A

Refrigeration

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Q

SPECIMEN PREPARATION

This temperature may dissolve some of these crystals

A

Warming specimen to 37 c

prior to centrifuging

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Q

SPECIMEN PREPARATION

This method of collection minimizes external contamination of the sediment

A

Midstream clean-catch specimen

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Q

SPECIMEN PREPARATION

Dilute random specimens cause what results?

A

False-negative

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Q

SPECIMEN PREPARATION

T or F

Shake specimen vigorously before transferring into a centrifuge tube

A

F (MIX specimen well before transferring into a centrifuge tube)

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Q

SPECIMEN VOLUME

What is the standard amount of urine that is usually centrifuged in a conical tube?

A

between 10 and 15 mL

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# SPECIMEN VOLUME A standard amount of urine, usually between 10 and 15 mL, is centrifuged in a ?

Conical tube

# SPECIMEN VOLUME This range of specimen volume provides an adequate volume from which to obtain representative sample of the elements present in the specimen.

10-15 mL of specimen volume

# SPECIMEN VOLUME This specific specimen volume is frequently used ecause multiparameter reagent strips are easily immersed in this volume and capped centrifuge tubes are often calibrated to this volume

12-mL volume

# SPECIMEN VOLUME Familiarize the reason why 12mL of specimen volume is frequently used

* multiparameter reagent strips are easily immersed in this volume * capped centrifuge tubes are often calibrated to this volume

# SPECIMEN VOLUME T or F If obtaining a 12-mL specimen is not possible, as with pediatric patients, the volume of the specimen used should be noted on just the medtech's mind

F (should be reported on **report form**) | allows the physician to correct the results, if indicated

# SPECIMEN VOLUME T or F If obtaining a 12-mL specimen is not possible, some laboratories make correction prior reporting

T

# SPECIMEN VOLUME For example, if 6-mL of urine was collected and centrifuged, the results are multiplied by what number ?

2 | para maging 12 ata

# CENTRIFUGATION Centrifugation time?

5 minutes

# CENTRIFUGATION Speed of centrifugation? | RCF

400 relative centrifugal force (RCF)

# CENTRIFUGATION Speed of centrifugation? | RPM

1,500-2,500 RPM

# CENTRIFUGATION This RCF and RPM produces an optimum amount of sediment with the least chance of damaging the elements.

RCF: 400 RCF RPM: 1,500-2,000 RPM

# CENTRIFUGATION To correct for differences in the diameter of centrifuge heads, what is the unit of centrifugation speed preferred to use?

Relatice Centrifugal Force (RCF) | than Revolutions per Minute (RPM)

# CENTRIFUGATION RPM value shown on centrifige tachometer can be converted to RCF using nomoframs available in many laboratory manuals or by using what formula?

RCF = 1.118 x 10^-5 x radius in cm x RPM ^2

# CENTRIFUGATION Using this will give a false negative result

Brake (braking)

# CENTRIFUGATION To prevent biohazardous aerosols, all speciments must be?

centrifuged in capped tubes

# SEDIMENT PREPARATION Volume of liquid that should remain in tube after decantation?

0.5-1.0 mL

# SEDIMENT PREPARATION T or F In decantation, vigorously tap repeatedly the lower part of the tube with the finger to mix the sediment

F (**gently tap** repeatedly the lower part of the tube with the finger to mix the sediment)

Concentration factor formula?

CF = V of urine centrifuged / Sediment Volume | C = V/S

# SEDIMENT PREPARATION * relates to the probability of detecting elements present in low quantities * used when quantitating the number of elements present per milliliter

Sediment concentration factor

# SEDIMENT PREPARATION To maintain a uniform sediment concentration factor, urine should be (blank) rather than poured off

aspirated off

T or F To maintain a uniform sediment concentration factor, urine should ALWAYS be aspirated off rather than poured off

F (unless otherwise specified by the commercial system in use) | Some systems provide pipettes for this purpose.

# SEDIMENT PREPARATION After decanting, sediment should be resuspened by doing what motion?

gentle agitation

# SEDIMENT PREPARATION Resuspension by gentle agitation can be perfomed by using what tool and motion?

Commercial-sytem pipette OR repeatedly tapping the tip of the tip of tube with finger

# SEDIMENT PREPARATION Calculate the concentration factor (CF) of a 10 mL urine and 0.5 sediment

10/0.5 CF = 20

# VOLUME OF SEDIMENT EXAMINED When using the conventional glass slide method, what is the recommended volume?

20 uL (0.02 mL)

# VOLUME OF SEDIMENT EXAMINED When using the conventional glass-slide method, the recommended volume is 20 µL (0.02 mL) covered by what dimensions of glass cover slip?

22 x 22 mm glass cover slip

# VOLUME OF SEDIMENT EXAMINED Allowing the specimen to flow outside of the cover slip may result in?

loss of heavier elements such as casts

# VOLUME OF SEDIMENT EXAMINED control the volume of sediment examined by providing slides with chambers capable of containing a specified volume

Commercial systems

# COMMERCIAL SYSTEM Closed system for performing fast, clean, accurate, microscopic urine analysis

Commercial system: Cen slide

These 2 commercial systems do not require manual loading of the centrifuged specimen onto a slide and are considered closed systems that minimize exposure to the specimen.

* Cen-slide * R/S Workstations

# COMMERCIAL SYSTEM Provides a specially designed tube that permits direct reading of the urine sediment

Commercial system: Cen slide

# COMMERCIAL SYSTEM T or F decanting, re-suspending, pipetting, sediment transfer, microscope slides and coverslips are the requirements for cen-slide

F (**NO decanting**)

# COMMERCIAL SYSTEM Familiarizie the options provided by the commercials systems: cen slide

* Capped calibrated centrifuge tubes * Decanting pipettes (to control sediment volume) * Slides (control amount of sediment examined) * Produce a consistent monolayer sediment for examination * Provide calibrated grids (more consistent quantitation)

# COMMERCIAL SYSTEM control sediment volume | options/advantages of using commercial systems

Decanting pipettes

# COMMERCIAL SYSTEM control amount of sediment examined | options/advantages of using commercial systems

Slides

# COMMERCIAL SYSTEM more consistent quantitation | options/advantages of using commercial systems

calibrated grids

# EXAMINING THE SEDIMENT Sediments should be examined for how many fields under LPO and HPO?

10-20 fields

# EXAMINING THE SEDIMENT T or F One should examine the sediment under LPO and HPO

T

# EXAMINING THE SEDIMENT AT what objective should the sediment be examined first to **detect casts** and **ascertain the general composition of the sediment**?

LPO (10x)

# EXAMINING THE SEDIMENT When elements such as **casts that require identification** are encountered, the setting is changed to?

HPO (40x)

# EXAMINING THE SEDIMENT HPO a. Detection of casts b. Identificationof casts c. BOTH d. NEITHER

b. Identification of casts

# EXAMINING THE SEDIMENT In what area of the slide are casts observed when using conventional glass-slide ?

near edges of the cover slip

# EXAMINING THE SEDIMENT T or F If the conventional glass-slide method is being used, casts have a tendency to locate near the edges of the cover slip; therefore, high-power scanning of the cover-slip perimeter is recommended

F (**lOW-POWER SCANNING** of perimeter is recommended)

# EXAMINING THE SEDIMENT When using bright-field microscopy, examine the sediment under | level of light

reduced or subdued light

# EXAMINING THE SEDIMENT T or F Initial focusing can be difficult with a fluid specimen

T

# EXAMINING THE SEDIMENT T or F Care must be taken to ensure that the examination is being performed in the correct plane

T

# EXAMINING THE SEDIMENT What urine sediment should be used as reference?

Epithelial cell (squamous ec yum)

# EXAMINING THE SEDIMENT T or F Once the epithelial cell is located as point of reference, only the coarse adjustment should now be adjusted

T (**DO NOT move the coarse adjustment knob** anymore) | move mo lang coarse kapag finofocus yung squamous ec ## Footnote ok? ok

# EXAMINING THE SEDIMENT T or F Focusing on artifacts should be done

F (should be **AVOIDED**)

# EXAMINING THE SEDIMENT often larger than the regular sediment elements and cause the microscopist to examine objects in the wrong plane

Artifacts

# EXAMINING THE SEDIMENT This action aids in obtaining a complete representation of the sediment constituents

Continuous focusing with the fine adjustment

# REPORTING THE MICROSCOPIC EXAMINATION Familiarize the steps in reporting microscopic examination

1. Count the number microscopic elements in 10 field 2. Get average 3. Report according to following standard of reporting

# REPORTING THE MICROSCOPIC EXAMINATION One should count the number of microscopic elements in what number of fields?

10 fields

# REPORTING THE MICROSCOPIC EXAMINATION RBCs, WBCs, crystals, renal tubular cells, yeast, and bacteria are reported per?

reported per HPF (high power field)

# REPORTING THE MICROSCOPIC EXAMINATION Squamous epithelial cells, transitional epithelial cells and casts are reported per

reported per LPO (low power field)

# REPORTING THE MICROSCOPIC EXAMINATION Memorize the elements reported per HPF

* RBCs * WBCs * RTE cells * Yeast * Bacteria | CYB ## Footnote Cells, yeast, bacteria

# REPORTING THE MICROSCOPIC EXAMINATION Memorize the elements reported per LPF

* Squamous EC * Transitional EC * Casts | Epthelial cells and casts

# REPORTING THE MICROSCOPIC EXAMINATION Memorize the elements reported quantitatively | Reported quantitatively (0-2, 2-5,5-10...)

* RBCs * WBCs * RTE * Casts

# REPORTING THE MICROSCOPIC EXAMINATION Memorize the elements reported semi-quantitatively | Reported semi-quantitatively (Rare, Few..1+,2+…)

* Squamous EC * Crystals * Yeast * Bacteria

# REPORTING THE MICROSCOPIC EXAMINATION Squamous EC is reported as ? (2) | give reported per and reported quanti or semi-quanti

reported per LPF reported semi-quantitatively

# REPORTING THE MICROSCOPIC EXAMINATION Cast is reported as ? (2) | give reported per and reported quanti or semi-quanti

reported per LPF reported quantitatively

# REPORTING THE MICROSCOPIC EXAMINATION RBCs and WBCs are reported as ? (2) | give reported per and reported quanti or semi-quanti

reported per HPF reported quantitatively

# REPORTING THE MICROSCOPIC EXAMINATION Crystals are reported as ? (2) | give reported per and reported quanti or semi-quanti

reported per HPF reported semi-quantitatively

# REPORTING THE MICROSCOPIC EXAMINATION Bacteria is reported as ? (2) | give reported per and reported quanti or semi-quanti

reporter per HPF reported semi-quantitatively

# REPORTING THE MICROSCOPIC EXAMINATION Budding yeast, mycelial elements, Trichomonas, and sperm are reported as what?

rarely reported

# REPORTING THE MICROSCOPIC EXAMINATION **Squamous EC/LPF** None - Rare - Few Moderate - Many - | give the values correspondent to the following report

None - 0 Rare - 0-5 Few - 5-20 Moderate - 20-100 Many - >100 | 5, 20, 100

# REPORTING THE MICROSCOPIC EXAMINATION **Casts/LPF** give the values for reporting

None 0-2 2-5 5-10 >10

# REPORTING THE MICROSCOPIC EXAMINATION **RBC & WBC/HPF** give the values for reporting

None 0-2 2-5 5-10 10-25 25-50 50-100 >100 (Too numerous to count)

# REPORTING THE MICROSCOPIC EXAMINATION **Crystals/HPF** None - Rare - Few- Moderate - Many -

None - 0 Rare - 0-2 Few- 2-5 Moderate - 5-20 Many - >20

# REPORTING THE MICROSCOPIC EXAMINATION **Bacteria/HPF** None - Rare - Few - Moderate - Many -

None - 0 Rare - 0-10 Few- 10-50 Moderate - 50-200 Many - >200

# REPORTING THE MICROSCOPIC EXAMINATION How are abnormal crystals reported?

Abnormal crystals ave/ lpf

I fyou see this card, pakiaral how to convert LPF/HPF to mL

PLLLLSSS

# CORRELATING RESULTS T or F Microscopic results should be correlated with the physical and chemical findings to ensure the accuracy of the report

T

# CORRELATING RESULTS Specimens in which the results do not correlate must be rechecked for both?

technical and clerical errors

# Routine Urinalysis Correlations Identify what microscopic element: Physical - turbidity Physical - (+) blood Exceptions - number

RBC

# Routine Urinalysis Correlations Identify what microscopic element: Physical - Red color Chemical - (+) protein Exceptions - Hemolysis

RBC

# Routine Urinalysis Correlations Identify what microscopic element: Physical - Turbidity Chemical - (+) protein Exceptions - Number

WBC

# Routine Urinalysis Correlations Identify what microscopic element: Physical - Turbidity Chemical - Exceptions - Number

EC

# Routine Urinalysis Correlations Identify what microscopic element: Physical - Chemical - (+) protein Exceptions - Number

Casts

Identify what microscopic element: Physical - Turbidity Chemical - (+) Nitrite, (+) Leukocytes Exceptions - Number and Type

Bacteria

Identify what microscopic element: Physical - Turbidity Chemical - pH Exceptions - Number and Type

Crystals

Identify what microscopic element: Physical - Color Chemical - (+) bilirubin Exceptions -

Crystals