Microscopic Examination Flashcards by Christyl Abejuela

Screening test:
Color

Significance:

Blood

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Screening test:
Clarity

Significance:

Hematuria vs hemoglobinuria/ myoglobinuria

Confirm pathogenic or non-pathogenic cause of turbidity

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Screening test:
Blood

Significance:

RBCs/RBC casts

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Screening test:
Protein

Significance:

Casts/Cells

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Screening test:
Nitrite

Significance:

Bacteria/ WBCs

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Screening test:
Leukocyte esterase

Significance:

WBCs/WBC casts/ Bacteria

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Screening test:
Glucose

Significance:

Yeast

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Person involve in Hemocytometer

Thomas Addis (1926)

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Used primarily to monitor the course of diagnosed cases of renal disease.

Hemocytometer

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Type of specimen used in Hemocytometer?

12-hour specimen

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Microscopic material observed in Hemocytometer?

RBCs, WBCs, Casts, and Epithelial cells

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Urine used in Preparation of Urine sediment

Freshly voided urine

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Type of urine specimen used in Preparation of Urine sediment

Midstream clean-catch specimen

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Urine volume needed for urine sediment

10 - 15 mL (12 mL)

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In Preparation of Urine sediment the urine is being centrifuged for…

5 mins at 400RCF

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How to get the representative of urinary sediments?

Decantation

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Volume of urine left after decantation

0.5 - 1.0 mL

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1 drop = __ mL

0.02 mL (20 micro liter)

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Size of cover slip used

22x22 mm

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In examination of urine sediment, observe minimum of how many field?

10 field (both LPO and HPO)

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Objective lense used for detection of casts and general composition

Low power objective lense (LPF) 10X

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Objective lense used for identification

High power objective lense (HPF) 40X

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Microscopy used for unstained sediment

Bright field microscopy

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T/F:

Urinary sediments are smaller than Artifacts

True

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Epithelial cells, crystals, and other elements manner of reporting

Semi-quantitative terms

Manner of reporting: Occasional Comment:

0-1, 0-3/ HPF at 10 field

Manner of reporting: Few Comment:

0-4, 2-5/ HPF at 10 fields

Manner of reporting: Some Comment:

3-5, 8-10/ HPF at 10 fields

Manner of reporting: Moderate Comment:

More than 10/HPF at 10 fields

Manner of reporting: Many Comment:

Abundant/HPF

Manner of reporting: TMTC Comment:

Too numerous to count (loaded)

Stains: Delineates structure and contrasting colors of the nucleus and cytoplasm

Sternheimer-Malbin (Crystal violet & Safranin O)

Stains: Function Identifies WBCs, epithelial cells, and casts

Sternheimer-Malbin (Crystal violet & Safranin O)

Stains: Enhances nuclear detail

Toluidine blue (metachromatic stain)

Stains: Function Differentiates WBCs and renal tubular epithelial (RTE) cell

Toluidine blue (metachromatic stain)

Stains: Lyses RBCs and enhances nuclei of WBCs

2% acetic acid

Stains: Function Distinguishes RBCs from WBCs, yeast, oil droplets, and crystals.

2% acetic acid

Stains: Stains triglycerides and neutral fats orange-red

Lipid Stains: Oil Red O and Sudan III

Stains: Function Identifies free fat droplets and lipid-containing cells and casts

Lipid Stains: Oil Red O and Sudan III

Stains: Differentiates gram-positive and gram-negative bacteria

Gram stain

Stains: Function Identifies bacterial casts

Gram stain

Stains: Methylene blue and eosin Y stains eosinophilic granules

Hansel stain

Stains: Function Identifies urinary eosinophils

Hansel stain

Stains: Stains structures containing iron

Prussian blue stain

Stains: Function Identifies yellow-brown granules of hemosiderin in cells and casts

Prussian blue stain

Expected Staining Reactions of Sediment Constituent: RBCs Neutral -

Pink to purple

Expected Staining Reactions of Sediment Constituent: RBCs Acid -

Pink (unstained)

Expected Staining Reactions of Sediment Constituent: RBCs Alkaline -

Purple

Expected Staining Reactions of Sediment Constituent: Hyaline casts

Pale pink or pale purple

Expected Staining Reactions of Sediment Constituent: Coarse granular Inclusion casts

Dark purple granules in purple matrix

Expected Staining Reactions of Sediment Constituent: Finely granular Inclusion casts

Fine dark purple granules in pale pink or pale purple matrix

Expected Staining Reactions of Sediment Constituent: WBCs (dark-staining cells) Nuclei - Cytoplasm -

Purple Purple granules

Expected Staining Reactions of Sediment Constituent: Glitter cells (sternheimer-malbin positive cells) Nuclei - Cytoplasm -

Colorless or light blue Pale blue or gray

Expected Staining Reactions of Sediment Constituent: Renal Tubular epithelial cells Nuclei - Cytoplasm -

Dark shade of blue-purple Light shade of blue purple

Expected Staining Reactions of Sediment Constituent: Bladder tubular epithelial cells Nuclei - Cytoplasm -

Blue-purple Light purple

Expected Staining Reactions of Sediment Constituent: Squamous epithelial cells Nuclei - Cytoplasm -

Dark shade of orange-purple Light purple or blue

Expected Staining Reactions of Sediment Constituent: Waxy casts

Pale pink or pale purple (Darker than hyaline casts; broken ends)

Expected Staining Reactions of Sediment Constituent: Fat Inclusion casts

Fat globules unstained in a pink matrix

Expected Staining Reactions of Sediment Constituent: Red cell Inclusion casts

Pink to orange-red (Intact cells can be seen in matrix)

Expected Staining Reactions of Sediment Constituent: Blood (hemoglobin) casts

Orange-red (No intact cells)

Expected Staining Reactions of Sediment Constituent: Bacteria

Motile: Do not stain Nonmotile: Stain purple

Expected Staining Reactions of Sediment Constituent: Trichomonas vaginalis

Light blue-green

Expected Staining Reactions of Sediment Constituent: Mucus

Pale pink or pale blue

Expected Staining Reactions of Sediment Constituent: Background

Pale pink or pale purple

Cytodiagnostic Urine Testing, preparation of permanent slides using...

Cytocentrifugation

Cytodiagnostic Urine Testing stain used

Papanicolaou stain

It detect the malignancies of the lower urinary tract

Cytodiagnostic Urine Testing

Cytodiagnostic Urine Testing urine specimen

First morning specimen

T/F: Cytodiagnostic Urine Testing, provides more indefinite information about RT changes associated with transplant rejection

False

Information obtained in Cytodiagnostic Urine Testing:

Viral, fungal, and parasitic infections Cellular inclusion Pathologic casts Inflammatory condition

Technique's Function: Used for routine urinalysis

Bright-field microscopy Technique

Technique's Function: Enhances visualization of elements with low refractive indices, such as hyaline casts, mixed cellular cats, mucous threads, and Trichomonas.

Phase-contrast microscopy Technique

Technique's Function: Aids in identification of cholesterol in oval fat bodies, fatty casts, and crystals

Polarizing microscopy Technique

Technique's Function: Aids in identification of Treponema pallidum

Dark-field microscopy Technique

Technique's Function: Allows visualization of naturally florescent microorganisms or those stained by a fluorescent dye.

Florescence microscopy Technique

Technique's Function: Produces a three-dimensional microscopy-image and layer-by-layer imaging of a specimen

Interference-contrast technique

Urine sediment constituents

RBCs WBCs Epithelial cells (squamous) Epithelial cells (Transitional/Urothelial) Epithelial cells (Renal tubular) Oval Fat Bodies Bacteria Yeast Parasite (Trichomonas) Spermatozoa Mucus

Urine casts

Hyaline casts RBCs casts WBCs casts Bacterial casts Epithelial cell casts Fatty casts Granular casts Waxy casts Broad casts

Normal Crystal Seen in Acidic urine

Uric acid Amorphous urates Calcium oxalate

Normal Crystal Seen in Neutral/Alkaline urine

Amorphous phosphates Calcium phosphate

Normal Crystal Seen im Alkaline urine

Triple phosphate Ammonium biurate Calcium carbonate

Abnormal crystal seen in Acid urine

Cystine Cholesterol Bilirubin Radiographic dye

Abnormal crystal seen in Acid/Neutral urine

Leucine Tyrosine Sulfonamides Ampicillin

Urinary sediment artifacts

Starch Granule Oil Droplets Air Bubbles Pollen grains Hair and fibers from clothing and diapers Fecal artifacts

RBC __________ in hypertonic urine __________ in hypotonic/hyposthenuric urine _________ with glomerular membrane damage

Crenated in hypertonic urine Ghost cells in hypotonic/hyposthenuric urine Dysmorphic with glomerular membrane damage

RBCs sources of identification error

Yeast cells Oil droplets Air bubbles

RBCs, Complete urinalysis correlation

Color Reagent strip blood reaction

Morse type: WBCs Larger than RBCs Agranulocytes Ghost cells in hypotonic urine Mononuclear cells with a abundant cytoplasm

2 correct

WBCs, sources of identification error

Renal tubular epithelial cells

WBCs, Complete urinalysis correlation

Leukocyte esterase Nitrite Specific gravity pH

Largest cells in the sediment with abundant, irregular cytoplasm and prominent nuclei

Squamous Epithelial cell

Squamous epithelial cell, sources of identification error

Rarely encountered, folded cells may resemble casts

Squamous epithelial cell, Complete urinalysis correlation

Clarity

Spherical, polyhedral, or caudate with centrally located nucleus

Transitional (Urothelial) epithelial cell

Transitional (Urothelial) Epithelial cell, sources of identification error

Spherical forms resemble RTE cells

Transitional (Urothelial) epithelial cell, Complete urinalysis correlation

Clarity Blood, if malignancy-associated

Rectangular, columnar, round, oval or, cuboidal with an eccentric nucleus possibly bilirubin-stained or hemosiderin-laden

Renal tubular epithelial cell

Renal tubular epithelial cell, sources of identification error

Spherical transitional cells Granular casts

Renal tubular epithelial cell, Complete urinalysis correlation

Leukocyte esterase and nitrite (pyelonephritis) Color Protein Blood Clarity Bilirubin (Hepatitis)

Renal tubular epithelial cell Pyelonephritis

Leukocyte esterase and nitrite

Renal tubular epithelial cell Bilirubin

Hepatitis

Highly refractile RTE cells

Oval fat bodies

Oval fat bodies, sources of identification error

Confirm with fat stains and polarized microscopy

Oval fat bodies, Complete urinalysis correlation

Clarity Blood Protein Free fat droplets/fatty casts

Small spherical and rod-shaped structures

Bacteria

Bacteria, sources of identification error

Amorphous phosphates and urates

Bacteria, complete urinalysis correlation

pH Nitrite Leukocyte WBCs

Small, oval, refractile structures with buds and/or mycelia

Yeast

Yeast, sources of identification error

RBCs

Yeast, Complete urinalysis correlation

Glucose Leukocyte WBCs

Pear-shaped, motile, Flagellated

Parasite (Trichomonas)

Parasite, sources of identification error

WBCs Renal tubular epithelial cells

Parasites, Complete urinalysis correlation

Leukocyte WBCs

Tapered oval head with long, thin tail

Spermatozoa

Spermatozoa, sources of identification error

None

Spermatozoa, Complete urinalysis correlation

Protein

Single or clumped threads with a low refractive index

Mucus

Mucus, sources of identification error

Hyaline casts

Mucus, Complete urinalysis correlation

None

It is unique yo kidney

Urine casts

Urine casts are formed within ...

The lumen of Distal convoluted tubule and Collecting ducts

Urine casts provide microscopic view of condition within

Nephron

Detection/Scanning around cover slip edge

LPF

Low refractive index, observe in subdued light

Cast matrix

Glycoprotein excreted by the RTE cells of the CDT and upper collecting ducts

Tamm-Horsfall protein

Factors affecting the Tamm-Horsfall protein

Stress and exercise

Urine-flow stasis, acidity, Na+, Ca++

Protein gel

Formed at the junction of ALH and DCT

Tapered end

Presence of urinary cast

Cylindruria

Colorless homogenous matrix

Hyaline casts

Hyaline casts, sources of identification error

Mucus Fibers Hair Increased lighting

Hyaline casts, Complete urinalysis correlation

Protein Color (exercise) Blood (exercise

Clinical significance: Glomerulonephritis Pyelonephritis Chronic renal disease Congestive heart failure Stress and exercise

Hyaline casts

Orange-red color, cast matrix containing RBCs

RBC casts

RBC casts, sources of identification error

RBC clumps

RBC casts, complete urinalysis correlation

RBCs Blood Protein

Clinical significance: Glomerulonephritis Strenuous exercise

RBC casts

Casts matrix containing WBC

WBC casts

WBC casts, sources of identification error

WBC clumps

WBC casts, complete urinalysis correlation

WBCs Protein Leukocyte

Clinical significance: Pyelonephritis Acute interstitial nephritis

WBC casts

Bacilli bound to protein matrix

Bacterial casts

Bacterial casts, sources of identification error

Granular casts

Bacterial casts, complete urinalysis correlation

WBC cast Leukocyte Protein WBCs Nitrite Bacteria

Clinical significance: Pyelonephritis

Bacterial casts

RTE cells attached to protein matrix

Epithelial cell casts

Epithelial cell casts, sources of identification error

WBC casts

Epithelial cell cast, complete urinalysis correlation

Protein RTE cells

Clinical significance: Renal Tubular damage

Epithelial cell casts

Fat droplets and oval fat bodies attracted to protein matrix

Fatty casts

Fatty casts, sources of identification error

Fecal debris

Fatty casts, complete urinalysis correlation

Protein Free fat droplets Oval fat bodies

Clinical significance: Nephrotic syndrome Toxic tubular necrosis Diabetes mellitus - Crush injuries

Fatty casts

Coarse and line granules in a cast matrix

Granular casts

Granular casts, sources of identification error

Clumps of small crystals Columnar RTE cells

Granular casts, complete urinalysis correlation

Protein Cellular casts RBCs and WBCs

Clinical significance: Glomerulonephritis Pyelonephritis Stress and Exercise

Granular casts

Highly refractile cast with jagged ends and notches

Waxy casts

Waxy casts, sources of identification error

Fibers Fecal material

Waxy casts, complete urinalysis correlation

Protein Cellular casts Granular casts WBCs and RBCs

Clinical significance: Stasis of urine flow Chronic renal failure

Waxy casts

Wider than normal casts matrix

Broad casts

Broad cast, sources of identification error

Fecal material Fibers

Broad casts, complete urinalysis correlation

Protein WBCs and RBCs Granular casts Waxy casts

Clinical significance: Extreme urine stasis Renal failure

Broad casts

It detect the presence of the relativity few abnormal types of liver disease, inborn errors of metabolism, and renal damage

Urine crystals

Formed by the precipitation of urine solutes

Urine crystals

Urine crystals are subject to:

Changes of temperature Solute concentration pH (affect solubility)

T/F: Urine crystal, Rapid precipitation at low temperature

T/F High specific gravity - presence of crystal in fresh urine

Crystals in acidic pH

Organic and Iatrogenic compounds

Crystals in neutral and alkaline solution

Inorganic salts

CaOx present in what urine pH condition

Acidic and neutral urine

Color and shape: Yellow-brown (rhombic/4-sided/rosette) Solubility: Alkali soluble

Uric acid

Color and shape: Brick dust or yellow brown granules Solubility: Alkali and heat

Amorphous urates

Color and shape: Colorless (envelopes, oval, dumbbell, octahedral) Solubility: Dilute HCl

Calcium oxalate

Color and shape: White-colorless (granular/white ppt) Solubility: Dilute acetic acid

Amorphous phosphates

Color and shape: Colorless (flat rectangle plates/ thin prisms often in rosette formation) Solubility: Dilute acetic acid

Calcium phosphate

Color and shape: Colorless (prism shape "coffin lids) Solubility: Dilute acetic acid

Triple phosphate

Color and shape: Yellow-brown (spicule-covered spheres "thorny apples") Solubility: Acetic acid with heat

Ammonium biurate

Color and shape: Colorless (dumbbells/spherical) Solubility: Gas from acetic acid

Calcium carbonate

Color and shape: Colorless Hexagonal plates Solubility: Ammonia dilute HCl

Cystine

Cystinuria and Confirmation test

Cystine

Cystine: Confirmation test

Cyanide-nitroprusside test

Color and shape: Colorless notched plates Solubility: Chloroform

Cholesterol

Seen in refrigerated specimen (droplet form lipids) and in Nephrotic syndrome

Cholesterol

Color and shape: Yellow Clumped needles or granules Solubility: Acetic acid, HCl, NaOH, ether, Chloroform

Bilirubin

Present in hepatic disorders

Bilirubin

Color and shape: Colorless Cholesterol crystal like Solubility: 10% NaOH

Radiographic dye

Markedly high specific gravity when measured by refractometer

Radiographic dye

Color and shape: Yellow-brown Spheres (concentric circles and radial striations) Solubility: Hot alkali or alcohol

Leucine

Crystals associated with liver disorder Accompanied by tyrosine crystals

Leucine

Color and shape: Colorless-yellow Fine needle (clump or rosette form) Solubility: Alkali or heat

Tyrosine

Seen in conjunction with leucine crystals in positive chemical test results fro bilirubin

Tyrosine

Encountered in inherited disorders of amino-acid metabolism

Tyrosine

Color and shape: Varied (colorless to yellow-brown) Needles, rhombics, whetstones, sheaves of wheat, and rosettes Solubility: Acetone

Sulfonamides

Seen in inadequate patient hydration If forming in nephron may indicate tubular damage

Sulfonamides

Color and shape: Colorless Needles (form bundles following refrigeration) Solubility: Refrigeration forms bundles

Ampicillin

Seen in massive doses of this penicillin compound without adequate hydration

Ampicillin

Contaminant from improper collection

Urinary sediment artifacts

Resemble fat droplets when polarized and dimpled center

Starch Granule

From cornstarch used as glove powder and highly refractile sphere

Starch Granule

From OIO contamination

Oil droplets

Highly refractile and may resemble RBCs

Oil droplets

Occur when the specimen is placed under a cover slip

Air bubbles

Concentric circles

Pollen grains

Spheres with a cell wall and occasional concentric circles

Pollen grains

Mistaken for casts usually much linger and more refractile

Hair and fibers from clothing and diapers

Presence at a fistula between the intestinal and urinary tracts

Fecal Artifacts

Appears as plant and meat fibers or as brown amorphous material

Fecal Artifacts

Microscopic Examination Flashcards

(210 cards)