MIDTERM-microscopic exam - urinary sediments - cast and crystals

Question 1

are the only elements found in the urinary sediment that
are unique to the kidney

Answer 1

casts

Question 2

cast are formed within the ___ and ___, providing
a microscopic view of conditions within the nephron

Answer 2

lumens of the distal convoluted tubules and collecting ducts

Question 3

Examination of the sediment for the detection of casts is
performed using what power of magnification?

Answer 3

low power

Question 4

for the analysis of mucus, When the glass
cover-slip method is used, low-power scanning should be performed along the ___ of the cover slip.

Answer 4

edges

Question 5

The major constituent of casts is ___.

Answer 5

uromodulin

Question 6

the presence of
urinary casts is termed ___.

Answer 6

cylindruria

Question 7

The most frequently seen cast is the ___

Answer 7

hyaline type

Question 8

Whereas the finding of RBCs in the urine indicates bleeding
from an area within the genitourinary tract, the presence of
RBC casts is much more specific, showing bleeding within the
____.

Answer 8

nephron

Question 9

any damage
to the nephron capillary structure can cause their formation

Answer 9

RBC casts

Question 10

RBC casts associated with glomerular damage are usually
associated with _- and ___

Answer 10

proteinuria and dysmorphic erythrocytes.

Question 11

RBC casts are easily detected under low power by their
___ color.

Answer 11

orange-red

Question 12

They are more fragile than other casts and
may exist as fragments or have a more irregular shape as the
result of tightly packed cells adhering to the protein matrix

Answer 12

rbc casts

Question 13

They are most frequently
associated with pyelonephritis and are a primary marker for
distinguishing pyelonephritis (upper UTI) from cystitis (lower
UTI).

Answer 13

WBC CASTS

Question 14

The appearance of WBC casts in the urine signifies __ or ___ within the nephron

Answer 14

infection
or inflammation

Question 15

wbc casts , they are also present in nonbacterial inflam
mations such as ___ and may accompany
RBC casts in glomerulonephritis.

Answer 15

acute interstitial nephritis

Question 16

Most frequently,
WBC casts are composed of ___; therefore, they may
appear granular, and, unless disintegration has occurred, mul
tilobed nuclei will be present

Answer 16

neutrophils

Question 17

Supravital staining
may be necessary to demonstrate the characteristic nuclei

It is particularly helpful for differentiating WBC
casts from ___.

Answer 17

RTE casts

Question 18

packed casts packed with bacteria can resemble granular casts, CONFIRMATION OF bacterial cats is best made by performing ___ on the dried or cytocentrifuged sediment

Answer 18

gram staining

Question 19

seen in conjunction with oval fat bodies and
free fat droplets in disorders causing lipiduria.

Answer 19

FATTY CASTS

Question 20

They are most frequently associated with the nephrotic syndrome, but are
also seen in toxic tubular necrosis, diabetes mellitus, and
crush injuries.

Answer 20

fatty casts

Question 21

The origin of the granules in nonpathologic conditions
appears to be from the ___ excreted by RTE cells during normal metabolism

Answer 21

lysosomes

Question 22

Increased cellular
metabolism occurring during periods of strenuous exercise accounts for the transient increase of granular casts that accompany the increased hyaline casts

TRUE OR FALSE

Answer 22

TRUE

Question 23

TYPE OF MICCROSCOPE THAT CANCONFIRM THE PRESENCE OF A GRANULA CASTS

Answer 23

SCANNING ELECTRON

Question 24

_ are representative of extreme urine stasis, indicating
chronic renal failure.

Answer 24

Waxy casts

Question 25

The brittle, highly refractive cast matrix from which these casts derive their name is believed to be caused by degeneration of the hyaline cast matrix and any cellular elements or granules contained in the matrix

Answer 25

WAXY CASTS

Question 26

Waxy casts are more easily visualized than hyaline casts because of their __

Answer 26

higher refractive index

Question 27

Often referred to as renal failure casts, broad casts like waxy casts represent extreme urine stasis.

Answer 27

BROAD CAST

Question 28

As a result of the brittle consistency of the cast matrix, they often appear fragmented with jagged ends and have notches in their sides

Answer 28

waXy casts

Question 29

As a mold of the distal convoluted tubules, the presence of broad casts indicates de struction (widening) of the ___

Answer 29

tubular walls.

Question 30

All types of casts may occur in the broad form. However, considering the accompanying urinary stasis, the most commonly seen broad casts are __ and __

Answer 30

granular and waxy

Question 31

Bile-stained broad, waxy casts are seen as the result of the tubular necrosis caused by __

Answer 31

viral hepatitis

Question 32

The primary reason for the identification of urinary crystals is to detect the presence of the relatively few abnormal types that may represent such disorders as liver disease, inborn errors of metabolism, or renal damage caused by crystallization of medication compounds within the tubules. true or false

Answer 32

true

Question 33

hwo crystals are reported but Abnormal crystals may be averaged and reported per __

Answer 33

RFMOMA per hpf; lpf

Question 34

Crystals are formed by the precipitation of ___, including inorganic salts, organic compounds, and medications (iatrogenic compounds).

Answer 34

urine solutes

Question 35

Precipitation is subject to changes in ___,___,___ which affect solubility.

Answer 35

temperature, solute concentration, and pH,

Question 36

Solutes precipitate more readily at low or high temperatures

Answer 36

low

Question 37

The presence of crystals in freshly voided urine is most frequently associated with __ (high specific gravity) specimens.

Question 38

In general, organic and iatrogenic compounds crystallize more easily in an __ pH

Answer 38

acidic

Question 39

inorganic salts are less soluble in neutral and __ solutions.

Answer 39

alkaline

Question 40

An exception is ___, which precipitates in both acidic and neutral urine.

Answer 40

calcium oxalate

Question 41

. All abnormal crystals are found in ___ urine.

Answer 41

acidic

Question 42

Additional aids in crystal identification include the use of __ microscopy and ___ of the crystals.

Answer 42

polarized; solubility characteristics

Question 43

The geometric shape of a crystal determines its __ and, therefore, its ability to polarize light

Answer 43

birefringence

Question 44

Just as changes in temperature and pH contribute to crystal formation, reversal of these changes can cause crystals to __.

Answer 44

dissolve

Question 45

___ that frequently form in refrigerated specimens and obscure sedi ments may dissolve if the specimen is warmed

Answer 45

Amorphous urates

Question 45

Amorphous phosphates require ___ to dissolve, and this is not practical, as formed elements, such as RBCs, will also be destroyed.

Answer 45

acetic acid

Question 46

The most common crystals seen in ACIDIC URINE are urates, consisting of __

Answer 46

amorphous urates uric acid acid urates sodium urates.

Question 47

uric acid ph color key feature

Answer 47

acid yellow-brown rosettes, wedges

Question 48

Amorphous urates are frequently encountered in specimens that have been refrigerated and produce a very characteristic __sediment

Answer 48

pink

Question 49

Colorless (“coffin lids”)

Answer 49

Triple phosphate

Question 50

Yellow-brown (“thorny apples”)

Answer 50

Ammonium biurate

Question 51

Colorless (envelopes, oval, dumbbell)

Answer 51

Calcium oxalate

Question 52

3 abnormal crystals for liver disease

Answer 52

leucine bilirubin tyrosine

Question 53

abnormal crystals yellow (concentric circles)

Answer 53

tyrosine