Urinalysis & Other Body Fluids (Review)
Which of the following characteristics of cerebrospinal fluid are present if blood is due to subarachnoid hemorrhage (SAH)?
Blood is evenly distributed in all tubes. Supernatant is pink when centrifuged within one hour.
True or false? Hyaline casts are present in this slide.
True
A cystine crystal is seen in this image. True or False?
True Cystine crystals are present in acidic urine, are typically colorless, and have a characteristic hexagonal shape (also described as appearing similar to a benzene ring). These crystals are associated with cystinuria.
A reaction is in ____________ kinetics when the reaction rate depends only on enzyme concentration.
Zero order
Which of the following situations suggest a traumatic tap occurred?
- More blood is in tube 1 than tubes 2, 3 or 4 - Blood clots are present
Which of the following statements are TRUE regarding the reagent strip test procedure? (Choose ALL correct answers)
- Urine should be well mixed prior to dipping the reagent strip. - Prolonged immersion may wash out test reagents.
A patient who has a primarily vegetarian diet will most likely have an acid urine pH. True or False?
False
A sperm concentration of 25 x 106 spermatozoa/ mL would be considered an abnormally low concentration, according to the lower normal reference limit stated in WHO 5th edition.
False
The crystals that are seen in this image are calcium oxalate.
False
Urine chemical reagent strips readers can utilize any manufacturers dipsticks. True or False?
False
Sudan III will confirm the presence of:
Fat
A urine sample is cloudy pink in appearance. The microscopic examination reveals the presence of intact red blood cells. The term used to describe these findings is:
Hematuria The presence of red blood cells in the urine is termed hematuria. Hematuria is associated with various conditions associated with bleeding in the kidneys or urinary tract, amongst other causes as well.
A reagent strip test for hemoglobin has been reported positive. Microscopic examination fails to yield red blood cells. This patient's urine condition can be called:
Hemoglobinuria
The primary mechanism responsible for glomerular filtration is:
Hydrostatic differential in glomerular tufts
A low CSF glucose level is associated with all the following except:
Hyperglycemia
Which of the following methods may be employed to definitively identify Bence-Jones proteins:
Immunoelectrophoresis
Which of the following tests confirms the presence of Bence-Jones proteinuria:
Immunoelectrophoresis
In hemolytic disease, the urine bilirubin test result is negative and the urine urobilinogen test result is:
Increased
A technologist decides to make a 1:20 dilution of cerebrospinal fluid (CSF) after briefly evaluating a portion of the sample microscopically. After making the dilution and charging the chambers, the number of cells that are observed in each of the large squares of the hemocytometer is >100. What should the technologist do to obtain the most accurate count?
Make a larger dilution.
If CSF tubes numbered #1, #2 and #3 CANNOT be analyzed within one hour, the correct procedure for the microbiology sample tube is to:
Leave it at room temperature
Normal adult CSF may have 0-5 white blood cells (WBCs)/µL. Which of the following cell types account for 60-100% of these WBCs?
Lymphocytes
Which of the following white blood cells would NOT produce a positive leukocyte esterase test on the urine chemical reagent strip?
Lymphocytes
Which of the following white blood cells would NOT produce a positive leukocyte esterase test?
Lymphocytes
A technologist is having trouble differentiating between red blood cells, oil droplets, and yeast cells on a urine microscopy. Acetic acid should be added to the sediment to:
Lyse the red blood cells
Myoglobinuria is MOST likely to be noted in urine specimens from patients with which of the following disorders?
Massive muscle trauma
What is the primary functional unit of the kidney:
Nephron
CSF lymphocytosis is associated with all of the following except:
Cerebral abscess There are many causes of CSF lymphocytosis. Lymphocytosis is seen in viral, fungal, and tuberculous infections, although a predominance of neutrophils may be present in the early stages of these infections. Lumbar puncture to obtain CSF samples is often contraindicated in those with a suspected brain abscess.
Identify the urine sediment elements indicated by the arrow in the illustration:
Cholesterol crystals
Where does most cerebrospinal fluid (CSF) originate?
Choroid plexus
Where does most cerebrospinal fluid originate?
Choroid plexus
The renal threshold is best described as:
Concentration at which a substance in the blood spills into urine
Bence-Jones proteinuria is associated with all of the following conditions except:
Pernicious anemia Macroglobulinemia, Multiple Myeloma, and Amyloidosis are all associated with abnormal protein production and/or accumulation which can result in Bence-Jones proteins being excreted in the urine.
Which is the best method for examination of synovial crystals:
Polarized light
A daily urine output which is over 2000 ml/24-hours is referred to as:
Polyuria
When a patient has a bile duct obstruction, the bilirubin test portion of the reagent strip is:
Positive because conjugated bilirubin is present and is excreted by the kidneys.
Reabsorption in the kidneys primarily occurs in:
Proximal convoluted tubule
What type of cast is shown in the illustration?
RBC cast
A copper reduction method (e.g. Clinitest® or Benedict's) is performed on pediatric specimens in order to check for the presence of:
Reducing substances
Semi-automated and automated urine chemical reagent strip readers:
Remove subjectivity allowing for better reproducibility
Identify the urine sediment element shown by the arrow:
Renal tubular epithelial cast
What would best describe what you might observe after a traumatic CSF tap:
Significantly more RBCs found in tube #1 vs. tube #3
Identify the urine sediment element shown by the arrow:
Spermatozoa
The cell indicated by the arrow is a:
Squamous epithelial cell
What is the identity of the cells that are indicated by the arrow in this image?
Squamous epithelial cells (SECs)
A WBC differential count on CSF should be performed using the following technique:
Stained smear of a cytocentrifuged specimen
Identify the urine sediment elements shown by the arrow:
Starch crystals
The reaction which differentiates crystals from starch is:
Starch stains blue black with iodine
What effect may bacterial contamination have on urine pH?
The bacteria may make the pH more alkaline.
A negative glucose oxidase test and a positive test for reducing sugars in urine indicates:
The presence of a non-glucose reducing sugar such as galactose
Which of the following statements are TRUE regarding the reagent strip test procedure? (Choose ALL of the correct answers)
Urine should be well mixed prior to dipping the reagent strip. Prolonged immersion may wash out test reagents. True Statements: Urine should be well mixed prior to dipping the reagent strip. Prolonged immersion may wash out test reagents. False Statements: Urine should be centrifuged prior to dipping the reagent strip. When visually reading the reagent strip, all results can be read immediately after dipping the strip in the urine specimen.
Acetest® can be used to test for ketones in:
Urine, serum, and whole blood
Which cast is characteristically associated with acute pyelonephritis?
WBC cast
Identify the urine sediment elements shown by the arrow:
WBC casts
A test that can be used as a confirmatory test for urobilinogen is:
Watson-Schwartz Test
Identify the urine sediment elements shown by the arrow:
Waxy casts
Oliguria is usually correlated with:
Acute glomerulonephritis
Which two of the following crystalline elements are found in acid urine:
- Cystine - Tyrosine
How many white blood cells (WBCs) would be considered normal for adult cerebrospinal fluid?
0-5 WBCs/µL Children will have slightly higher counts. Up to 30 WBCs/µL is within normal limits for newborns. Lymphocytes account for 60-100% of these cells.
What is the lower reference limit for semen volume according to the World Health Organization, WHO Laboratory Manual for the Examination and Processing of Human Semen, 5th edition?
1.5 mL
A spinal fluid that is slightly hazy is briefly examined microscopically. The technologist performing the count decides to make a 1:10 dilution using 30 µL of sample. What volume of diluant should be used?
270 µL Formula = 1 / DF = Sample volume used / Total volume 1 / 10 = 30 µL / x 300 = x Volume of diluant = Total volume - Sample volume 300 - 30 = 270
What is the optimal time to begin initial microscopic examination of a semen specimen, assuming liquefaction is complete?
30 minutes
The normal range for urine pH is:
4.6 to 8.0
The sediment from a freshly collected urine specimen is examined microscopically. In addition to bacteria, what other finding from the list below would further indicate the presence of a urinary tract infection (UTI)?
> 100 white blood cells (WBCs)/ HPF
Which test is the BEST screening test for neural tube defects?
Alpha-fetoprotein Alpha-fetoprotein is produced by the fetal liver. Abnormally high levels of this substance is associated with defects in the fetal neural tube, while abnormally low levels are associated with the presence of Down' syndrome.
The urine macroscopic (urinalysis test strip) results were completely normal and within range. Upon viewing the microscopic, the technologist noticed these circular elements. What could be the identification of these elements?
Artifacts
The volume of urine recommended for centrifugation for a microscopic examination is:
10-15 mL
A 1:10 dilution is made on a CSF sample. Five squares on each side of the hemacytometer are counted for a total of 10 squares and a total of 150 cells are recorded. What is the count per microliter?
1500 Cells/µL = 150 x 10/ 10 x 0.1 µL Cells/µL = 1500 / 1 = 1500/µL
An average adult would excrete approximately what volume of urine per 24 hours:
1500 ml Normal adult urine volume is 800 to 1800 ml/24-hours for males, and 600 to 1600 ml/24-hours for females.
A dilution commonly used for a routine sperm count is:
1:20 A manual sperm count is performed in the laboratory using a Neubauer counting chamber. The diluant is usually made of sodium bicarbonate and formalin which immobilize and preserve the sperm cells for the count.
A sample of cerebrospinal fluid is diluted 1:100; the standard 9 squares of a hemocytometer were counted on each side for a total of 18 large squares. Side 1 = 186 cells counted Side 2 = 184 cells counted Total cells = 370 What is the cell count per mL?
2.06 x 10^4 In this example, we would use the standard manual WBC count equation. Cells/µL = # of cells counted x dilution / # of large squares counted x 0.1µL (chamber depth) In this case, Cells/µL = 370 x 100 / 18 x 0.1 Cells/µL = 37000 / 1.8 Cells/µL = 20556 or 2.06 x 10^4
According to the lower normal reference limit stated by WHO, which of the following sperm concentrations is considered abnormally low? A. 25 x 10^6 spermatozoa/mL B. 5 x 10^6 spermatozoa/mL C. 15 x 10^6 spermatozoa/mL D. 35 x 10^6 spermatozoa/mL
5 x 10^6 spermatozoa/mL According to WHO, the lower reference limit for sperm concentration is 15 x 10^6 spermatozoa per mL, so only the second option (5 x 10^6 spermatozoa/mL) goes below this lower limit.
What is generally accepted as the lower threshold value for semen pH from fertile males?
7.2
What is the approximate volume of spinal fluid in an adult?
90-150 mL
A CSF glucose value is 62 mg/dL. What would you estimate the serum glucose?
93 mg/dL CSF glucose is roughly estimated to be about 2/3 of the serum glucose level in mg/dL
What is the glomerular filtration rate for a patient with a serum creatinine of 2 mg/dL, if the urine creatinine was 124 mg/dL and the urine volume was 2.2 L/24-hrs?
95 mL/min One method of calculating a glomerular filtration rate is using creatinine and urine volume to determine creatinine clearance. The equation is as follows: Creatinine Clearance = (urine creatinine x urine flow rate) / plasma creatinine; where urine flow rate = volume in mL /24-hours x h/60 min) In this case = creatinine clearance = 124 x (2200/24 x hour/60) / 2 = 94.7 or 95 ml/min
Below is a urinalysis report on a 37-year-old woman seen in the ER with headache, hypertension, weight loss and mild edema: Color: red Clarity: cloudy Sp. Gravity: 1.010 pH: 5.0 Glucose: negative Protein: 3+ Ketones: negative Nitrite: negative Blood: moderate Urobilinogen: normal Microscopic: 25-50 RBC 2-4 WBC 2-5 granular casts 2-5 hyaline casts 0-2 RBC casts few epithelial cells Based on the urinalysis report above, the MOST probable diagnosis of this patient's condition is:
Acute glomerulonephritis
Which substance can cause a false positive result for blood on the urine chemical reagent strip?
Bleach in the collecting bottle
A urine production of less than 400 mL/day is:
Defined as oliguria
Use the following urinalysis report to answer: The patient is a female and the urinalysis is completed within two hours of collection. Color: light yellow Appearance: slightly turbid Sp. Gravity: .009 pH: 8.0 Glucose: negative Protein: 1+ Blood: negative WBC: 5/HPF RBC: 1/HPF Epithelial: 0/HPF Casts: 2 hyaline/LPF Crystals: amorphous urates Bacteria: 2+ True or false? The results are abnormal but all results correlate.
False Amorphous urates would NOT be seen in alkaline urine.
Identify the urine sediment element:
Fatty cast
Which of the following is not a standard method for measuring the specific gravity of urine:
Freezing point depression Osmolality can be measured by freezing point depression, but not specific gravity as specified in this question. The other methods are used to measure specific gravity in urine samples.
Which of the following is not a routine component of semen analysis:
Fructose level
Which of the following parameters is generally NOT considered to be a part of a seminal fluid analysis?
Glucose concentration
Nitrates in urine are reduce to nitrites by:
Gram-negative bacteria
Which one of the following statements about urea is false:
It is decreased in dehydration
On a Cytospin preparation from a pleural fluid, 50% of the cells have the following characteristics: - Uniform, regular arrangement - Some cells resemble a "fried egg" - Multiple nuclei - Smooth nuclear outline and homogeneous chromatin - When present in clumps, there are clear spaces between the cells ("windows") How should these cells be classified?
Mesothelial cells
The image is a stained smear of cerebrospinal fluid. The cell in this slide could be caused by what condition?
Metastasis
Identify the urine sediment elements shown by the arrow:
Mucus threads
A 41-year-old man is admitted to the hospital complaining of a decreased frequency of urination, a constant bloated feeling, weight gain, and mild edema of the ankles and eyes. Urinalysis results are as follows: Color: pale yellow Clarity: clear pH: 5.0 Sp. Gravity 1.010 Glucose: 2+ Ketones: negative Few oval fat bodies Protein- 3+ Blood: moderate Bilirubin: negative Bacteria: negative Urobilinogen: normal Nitrate: negative **A large amount of white foam was noted. Microscopic Results: RBCs 0-2 WBCs 0-2 Casts: 2-5 hyaline, 0 - 3 fatty casts, 0 - 2 waxy casts Few transitional epithelial cells Few oval fat bodies Based on the urinalysis report above, the MOST probable diagnosis is:
Nephrotic syndrome
Bence-Jones proteinuria can be seen in all of the following conditions except:
Nephrotic syndrome
What type of white blood cell is seen MOST frequently in urine sediment with infections of the urinary system?
Neutrophil Neutrophils are typically increased in urinary bacterial infections.
To screen for urinary tract infections, leukocyte esterase results should be evaluated along with the results from which of these other reagent strip tests?
Nitrite
A semen sample for semen analysis should generally be received at the testing site within what period of time?
One hour
Which of the following is not a standard method for measuring the specific gravity of urine?
Osmolality
Match urine color with substance that might have been responsible:
Phosphates > White Bilirubin > Yellow Pseudomonas > Blue to green Porphobilinogen > Red to brown
How should the production of a blue or purple color on the test pad of an Ictotest® be interpreted?
Positive for bilirubin
Which of the following macroscopic findings is MOST consistent with the microscopic finding of casts?
Positive protein
When preparing a slide for morphologic examination, what is the reason for adding a drop of albumin to the cerebrospinal fluid (CSF) sample prior to cytocentrifugation?
Preserve the integrity of the cells.
The image is a Wright-Giemsa stained smear (1000x) of cerebrospinal fluid (CSF). What is the identification of the cells that are indicated by the arrows?
Presumptive malignant cells
The arrows in the images below indicate cells that may be observed in CSF samples. Match each image to the cell's identification:
Presumptive malignant cells Image A
A urine specimen was collected at 6:00 a.m. and remained at room temperature until it was received in the laboratory at 3:30 p.m. How may the pH of the specimen be affected by the extended time at room temperature if bacteria are present in the specimen?
The pH may become more alkaline.
All the following statements about the urine specimen are true EXCEPT:
The urine specimen should always be centrifuged before performing the chemical reagent strip testing.
Which of the following tests included on a urine chemical reagent strip would never be reported out as negative?
Urobilinogen
Which of the following tests included on a urine reagent strip would never be reported out as negative?
Urobilinogen
Which of the following urine chemical reagent strip tests is based on the Ehrlich-aldehyde reaction?
Urobilinogen
Which reagent strip test is based on the Ehrlich- aldehyde reaction.
Urobilinogen
When three tubes of cerebrospinal fluid are received in the laboratory they should be distributed to the various laboratory sections as follows:
#1 Chemistry, #2 Microbiology, #3 Hematology
A patient suspected of a urinary tract infection has a negative nitrite test, but bacteria are present upon microscopic examination. What may have caused this discrepant result? (Choose ALL correct answers)
- The bacteria present are not nitrate-reducers. - The urine was not held in the bladder for a sufficient amount of time for nitrate to be reduced to nitrite.
A patient suspected of a urinary tract infection has a negative nitrite test, but bacteria is present upon microscopic examination. What may have caused this discrepant result? (Choose ALL of the correct answers)
- The bacteria that is present is not a nitrate-reducer. - The urine was in the bladder for an insufficient amount of time for nitrate to be reduced to nitrite.
Which of the following statements are TRUE for specific gravity measured by the reagent strip method? (Select ALL that apply)
- The reagent strip method is based on the relationship between ionic concentration and specific gravity. - The reagent strip method is not affected by the presence of x-ray contrast media in the urine specimen.
Which of the following statements are TRUE for specific gravity measured by the urine chemical reagent strip method? (Select ALL that apply)
- The urine chemical reagent strip method is based on the relationship between ionic concentration and specific gravity. - The urine chemical reagent strip method is not affected by the presence of x-ray contrast media in the urine specimen.
When an automated or semi-automated method is used to read urine chemical reagent strips, quality control testing must be performed at least how often?
- With each new lot of reagent strips - Every day of patient testing
What is the lower reference limit for progressive motility of spermatozoa when performing a semen analysis?
32% The lower reference limit for progressive motility is 32%. The lower reference limit for total motility (progressive + non-progressive) is 40 %.
For BEST results, a semen sample should remain at which of the following temperatures following collection?
37°C
Urine pH values can normally vary between:
5.0 to 8.0
Which of the following would be considered normal for a glucose level in cerebrospinal fluid:
60 mg/dL CSF glucose levels should be approximately 60 to 70% of plasma levels.
What is the approximate volume of spinal fluid in an adult?
Adult = 90-150 mL Neonate = 10-60mL The CSF is produced in the choroid plexuses of the lumbar ventricles and the third and fourth ventricles. Adults produce about 20 mL of CSF per hour. The fluid is reabsorbed at the same rate it is produced by the arachnoid granulations/villae back into the blood capillaries.
The reagent strip method for protein primarily tests for which type of protein?
Albumin
Match the following factors with the expected urine pH type:
Alkaline pH > Metabolic alkalosis Acidic pH > Meat-filled diet Alkaline pH > Vegetarian diet Acidic pH > High urine glucose
Which ketone is NOT detected in the Acetest® tablet method?
Beta-hydroxybutyric acid
An increased number of these cells, when found upon microscopic examination of urine is termed:
Hematuria
Match the following positive urine blood results with the possible conditions which cause them to occur.
Hemoglobinuria > Hemolytic anemia Hematuria > Glomerulonephritis Hemoglobinuria > Severe burns Hematuria > Renal calculi Hematuria > Pyelonephritis
Sulfosalicylic acid can be used to confirm the result of which of the following tests included on a urine chemical reagent strip?
Protein
Excessive carbohydrate loss that may occur due to vomiting, or rapid weight loss may result in the presence of which of following substances not normally contained in the urine?
Ketones
White blood cell casts are MOST likely to indicate disease of the:
Kidney
Which of the following may cause a false positive bilirubin result on a urine chemical reagent strip?
Large doses of chloropromazine
Which one of the following crystals is NOT found in normal urine?
Leucine
Identify the urine sediment elements shown by the arrow:
Leucine crystals
The image is a Wright-Giemsa stained smear (1000x) of cerebrospinal fluid (CSF). The arrows point to cells that may indicate which of the following conditions?
Leukemia with CNS involvement
The image is a stained smear of cerebrospinal fluid. The cells present in this field may indicate what condition?
Leukemia with CNS involvement
Which of the following is characteristic of an exudates effusion?
Leukocyte count greater than 1000 WBC/uL
Substances found in urinary sediment that are more easily distinguished by use of polarized microscope are:
Lipids
Parasites which can be found in urinary sediment include all of the following EXCEPT:
Plasmodium malariae Plasmodium malariae is the only parasite that is listed that could NOT potentially be seen in urine sediment. Plasmodium is a blood parasite. Both Enterobius vermicularis and Trichomonas vaginalis could potentially arrive in the urine as contaminants from other sources; Enterobius from fecal contamination and Trichomonas from vaginal secretions. Of the parasites that are listed, only Schistosoma haematobium is a true urinary tract parasite.
Which of the following is true about Bence-Jones protein when performing the heat precipitation test?
Precipitates between 40°C and 60°C but redissolves at 100°C
Identify the urine sediment elements present in this illustration:
Tyrosine crystals
The nephron includes all of the following except:
Urethra
Which crystals will NOT normally be found in a urine specimen with a pH of 8.0?
Uric acid
Identify the urine sediment elements shown by the arrow:
Uric acid crystals
What is the MOST probable condition when a clean catch urine gave these results: Appearance: cloudy, amber pH: 5.0 Specific Gravity: 1.015 Protein: 1+ Glucose: negative Occult Blood: trace Nitrite: positive Microscopic Results: Many bacteria 30-40 WBC/HPF
Urinary tract infection
Upon centrifugation, a cerebrospinal fluid (CSF) sample supernatant exhibited xanthochromia. The image is a Wright-Giemsa stained smear that was made from that CSF sample. What condition is probably related to these macroscopic and microscopic findings?
Previous subarachnoid hemorrhage
In a patient with acute glomerulonephritis you would expect to find all of the following in the urine except:
Yeast
Cells seen in the microscopic examination of the urine of a 30 year old female which are smaller than RBC's but much the same shape are probably:
Yeast cells
Which of the following best defines specific gravity:
Density of a solution compared to density of water
A test for microalbuminuria is used most often to monitor patients with which of the following diseases or conditions?
Diabetes
The elements indicated by the arrows are more likely to be seen in patients with which condition:
Diabetes
The technologist in the urinalysis department received a sample for a microscopic examination. The image to the right shows the microscopic urinalysis. Which of the following conditions below would most closely match this patient's microscopic urinalysis morphology?
Glomerulonephritis
Unconjugated bilirubin is conjugated in the liver with which of the following substances to become water soluble?
Glucuronic acid
What is the element indicated by the arrow in this image?
Granular cast
A positive leukocyte esterase test indicates the presence in a urine specimen of which of the following?
Granulocytes
True or false? The cells shown in the image to the right are transitional epithelial cells.
True
True or false? The element that is indicated by the arrow is a red blood cell cast.
True
True or false? Yeast is present in this slide.
True
Urine should be at room temperature prior to testing with the reagent strip method.
True
Xanthochromia in a premature infant may be due to an immature blood-brain barrier.
True
The ketone component that is measured by the nitroprusside reaction is:
Acetoacetic acid
What is the identification of this crystal seen in a urine with an alkaline pH?
Ammonium biurate
Identify the crystal indicated by the arrow in this alkaline urine:
Ammonium biurate crystal
A microscopic examination of a normal urine pH 8.0 shows 2+ yellow-brown thorny spheres which are MOST probably:
Ammonium biurate crystals
Identify the urine sediment elements present in this acidic urine:
Amorphous urate crystals
What are the microscopic elements that are indicated by arrows in this image?
Bacteria
A 3-year old girl was brought to the ER with a temperature of 103ºF, lethargy, and cervical rigidity. Three tubes of cloudy CSF were delivered to the Lab, and preliminary test results showed: WBC: 4,500/uL Differential: 88% neutrophils Glucose: 15 mg/dL 12% lymphocytes Protein: 140 mg/dL Gram stain: No organisms observed From these results, what preliminary diagnosis SHOULD the physician consider?
Bacterial meningitis Due to the elevated WBC count, along with a strong percentage of neutrophils, a bacterial infection should be suspected. Though there are no organisms seen on the gram stain, a bacterial infection is still very possible as the bacterial count in the spinal fluid may be low.
Identify the urine sediment elements indicated by the arrows in this microscopic field.
Calcium oxalate crystals
Which of the following would be the most characteristic finding in synovial fluid in a case of pseudogout:
Calcium pyrophosphate crystals
The Clinitest® reaction is based on which of the following principles?
Copper reduction
Which of the following tests would be used in the assessment of glomerular filtration:
Creatinine clearance
Which test would be useful in the assessment of glomerular filtration:
Creatinine clearance
An India Ink preparation is used to identify:
Cryptococcus neoformans in CSF India ink preparation performed on spinal fluid is used to demonstrate the polysaccharide capsule of Cryptococcus neoformans by negative staining. Direct detection of capsular antigen by agglutination or immunoassay techniques is much more sensitive, and has largely replaced the India Ink stain for clinical specimens.
Identify the urine sediment elements shown by the arrow:
Cystine crystals
Charcot-Leyden crystals in stool may be associated with an immune response and are thought to be the breakdown products of:
Eosinophils The Charcot-Leyden crystals are thought to be created by damaged eosinophil byproducts. These crystals have a strong association, although rare, with parasitic infections or allergic reactions.
A 62-year-old man drank an unknown liquid in a suicide attempt, and his urine contained crystals similar in shape to those shown in this image. This man MOST likely ingested:
Ethylene glycol
When the glucose result on a urine specimen from an infant is negative on the reagent strip, it can be assumed that the specimen is negative for other reducing substances such as galactose.
False
True or False: Lymphocyte pleocytosis refers to a decreased number of lymphocytes in a CSF when compared to a normal sample.
False The answer is false, as the presence of a greater than normal number of lymphocytes in the spinal fluid is considered lymphocyte pleocytosis.
True or false? The cells that are indicated by the arrows in this urine sediment (using phase contrast microscopy) are red blood cells (RBCs).
False The cells are white blood cells (WBCs).
When the glucose result on a urine specimen from an infant is negative on the urine chemical reagent strip, it can be assumed that the specimen is negative for other reducing substances such as galactose.
False The method used on the urine chemical reagent strip is specific for glucose. An additional test, such as Clinitest®, should be used to check for other reducing substances.
Lymphocyte pleocytosis refers to a decreased number of lymphocytes in a CSF when compared to a normal sample.
False The presence of a greater than normal number of lymphocytes in the spinal fluid is considered lymphocyte pleocytosis.
The crystals that are seen in this image are triple phosphate crystals. True or False?
False These are cholesterol crystals.
True or false? Cystine crystals are present on this slide.
False These are tyrosine crystals
The microscopic finding illustrated in this image is a hyaline cast.
False This is a fiber artifact.
Which of the following artifacts may be mistaken for casts?
Fibers
Identify the urine sediment elements present in this illustration:
Fine granular casts
A spectrophotometric scan of amniotic fluid may be valuable in the determination of which of the following conditions:
Hemolytic disease of the newborn Amniotic fluid bilirubin is elevated in hemolytic disease of the newborn. It is determined by using the absorbance spectrum of amniotic fluid to determine the increase of absorbance at 450 nm, which is the absorbance peak for bilirubin. This value, along with the gestational age, are used in Liley's three zone chart to determine the risk of severe fetal hemolysis.
Identify the urine sediment element indicated by the arrow in the illustration:
Hyaline cast
Which of the following cells when found upon microscopic examination of the urine would be most indicative of kidney disease:
Tubular epithelial cells
Sulfosalicylic acid can be used to confirm the result of which of the following tests included on a urine reagent strip?
Protein The SSA reaction is used to detect protein in the urine. Unlike the protein test on the dipstick, the SSA reaction will detect albumin and globulins, and Bence-Jones proteins. This principle is based on the acidification of proteins which causes turbidity and can be measured based on protein concentration present.
The primary site of reabsorption of glomerular filtrate is the:
Proximal convoluted tubule
The presence of increased levels of protein in the urine may be an early indicator of which of the following conditions?
Renal disease
A semen specimen was collected three hours before it was brought to the laboratory for examination. What course of action should be taken?
Report the specimen as compromised on the final report.
When a urine specimen cannot be cultured immediately it may be:
Stored at 4°C for up to 24 hours
Which of the following methods is not a quantitative method for the determination of albumin?
Sulfosalicyclic acid precipitation
Which acid is most frequently used to precipitate protein for confirmatory urinalysis tests?
Sulfosalicylic
Which of the following would be the most appropriate method to confirm a positive protein from a urine dipstick:
Sulfosalicylic acid precipitation
The estimation of hyaluronic acid concentration by measurement of viscosity is useful in evaluating which type of fluid?
Synovial
The estimation of Hyaluronic Acid concentration by measurement of viscosity is useful in evaluating which type of fluid?
Synovial fluid This allows for the thicker consistency of the fluid for cushioning and protection from friction during movement.
The gold-orange needle-like crystals that are indicated by the arrows are bilirubin crystals.
True
A voided urine specimen is delivered from the women's clinic to the laboratory six hours after collection. The following results are reported: Color: yellow Protein: negative Bilirubin: negative Clarity: cloudy Glucose: negative Urobilinogen: 0.2 mg/dL Sp. Gravity: 1.020 Ketone: negative Nitrite: positive pH: 9.0 Blood: negative Leukocyte esterase: negative What might these results indicate?
The urine may have remained too long at room temperature and bacterial contaminants have affected the nitrite and pH results.
The image is a stained smear of cerebrospinal fluid. Which of the following statements is true about the cells shown at the right?
They line the arachnoid space.
The patient is a female and the urinalysis is completed within two hours of collection. True or false? The presence of bacteria correlates with the slight turbidity and WBC result.
True
To determine if xanthochromia is present in a cerebrospinal fluid sample, the sample must be centrifuged within one hour. True or False?
True
These tubes of cerebrospinal fluid (CSF) arrive in the laboratory for evaluation. The tubes were numbered in the order in which they were obtained, with #1 being the first tube collected and #3 being the last tube collected. What may be indicated by the macroscopic appearance of the CSF?
Traumatic tap
Two CSF specimens were sent to the Lab with the following results: Tube #1 = 11,200 rbc/µL Tube #2 = 300 rbc/µL The results on these CSF specimens are indicative of:
Traumatic tap
Identify the urine sediment element shown by the arrow:
Trichomonas Trichomonas is the most common parasite found in urine. It is often the result of vaginal contamination. Characteristic motility will help in its identification.
What is the identification of these crystals seen in urine with an alkaline pH?
Triple phosphate
Identify the urine sediment elements indicated by the arrow in the illustration:
Triple phosphate crystals
What element is indicated by the arrow on this slide?
Waxy cast
Cell counts on CSF specimens should be performed within what time frame following collection of the CSF sample?
Within one hour
What term is used to describe the color in these tubes of cerebrospinal fluid (CSF)?
Xanthochromia
The nitrite portion of the test strip can be used to: (Choose ALL correct answers)
- Monitor antibiotic therapy - Detect a bladder infection in an early stage in pregnant women - Screen individuals with recurrent infections - Detect presence of cystitis
To ensure precision and accuracy of the reagent strip tests used for chemical analysis of urine, it is necessary that:
- Positive and negative controls be run on a daily basis - Positive and negative controls be run when a new bottle of test strips is opened
Which of the following statements are true for the reagent strip procedure? (Choose ALL correct answers)
- Prolonged immersion may wash out reagents. - Some tests require specified reading times.
What types of cells are present in this field of a cytocentrifuged CSF sample?
- Red cells - Lymphocytes - Neutrophils
Detection of a fruity odor in a fresh urine sample may be indicative of which of the following:
- Starvation - Diabetes mellitus
Which of the following statements are true regarding the storage and handling of urinalysis chemical reagent strips? (Choose ALL correct answers)
- Store reagent strips at the temperature recommended by the manufacturer. - Remove only enough strips for immediate use.
Which of the following are characteristics of casts? (Choose all that apply.)
- They are cylindrical bodies. - They contain Tamm-Horsfall mucoprotein.
Which of the following characteristics of cerebrospinal fluid are considered abnormal?
- Turbidity - Bloody appearance - Xanthochromia - Fibrin clot
Match the urine sediment or crystal to the correct description.
- Amorphous Phosphates, Triple Phosphate,Ammonium biurate, Calcium Carbonate Alkaline urine - Bilirubin, Cholesterol,Calcium Oxalates, Amorphous Urates Acidic urine
Common crystals which can be found in ACID urine include: (Choose all that apply.)
- Amorphous urates - Calcium oxalate
False-positive tests for protein on a urine reagent strip may be caused by: (Choose ALL of the correct answers)
- Bacterial contamination - Urine that has remained at room temperature for an extended period of time - Alkaline medication
Which of the following cells are considered abnormal and clinically significant on a CSF differential?
- Blast cells - Malignant cells
Match the following descriptions of casts with their appropriate name:
- Casts with highly refractive particles > Granular casts - "Renal failure" cast > Broad casts - Low refractive index > Hyaline casts
Which of the following statements are TRUE regarding storing and handling of chemical reagent strips if you are using a manual method (visually reading the reagent strip)?
- Compare strip to color chart to check for correlating color. - Handle strips at end away from test area.
Examples of conditions resulting in benign proteinuria include: (Choose ALL correct answers)
- Dehydration - Orthostatic proteinuria
Which of the following conditions produce glycosuria? (Choose ALL correct answers)
- Diabetes mellitus - Impaired tubular reabsorption/advanced kidney failure
Which cast(s) might be found in the urine of a healthy individual after strenuous exercise:
- Hyaline casts - Granular casts
Nephrotic syndrome is associated with which of the following clinical findings? Note: more than one answer choice is correct.
- Increased proteinuria - Decreased serum albumin - Edema
Which of the following can cause a false positive result for ketones? (Choose ALL correct answers)
- L-Dopa metabolites - Highly pigmented urine
Abnormal crystals that can be found in urine include:
- Leucine - Tyrosine - Cystine If the crystals are from solutes that are not normally in the urine, they are considered "abnormal." Abnormal crystals may indicate an abnormal metabolic process. Some of these include: Cystine, tyrosine, and leucine.
The indicator(s) used in the pH test region of the chemical reagent strips for urine is/are:
- Methyl red - Bromothymol blue
Which of the following substances are detected with Clinitest® tablets?
All reducing substances
Bacterial contamination of a urine specimen from a normal healthy individual could originate from all of the following except:
Bladder
What is the identification of these crystals seen in a urine with an acid pH?
Calcium oxalate
Match the following reagent strip tests to the disease or disorder that would most likely cause a positive test result.
Diabetes mellitus > Ketones Renal calculi > Blood Hepatitis/cirrhosis > Bilirubin Urinary tract infection > Nitrites
Match the following urine chemical reagent strip test pads to the disease or disorder that would most likely cause a positive test result.
Diabetes mellitus > Ketones Renal calculi > Blood Hepatitis/cirrhosis > Bilirubin Urinary tract infection > Nitrites
Many white blood cells (WBCs) are present in this image of urine sediment that is observed using brightfield microscopy.
False This slide shows many red blood cells (RBCs.)
All of the statements below about synovial fluid are true EXCEPT:
Joint fluid resembles plasma in viscosity Synovial fluid is actually quite viscous and does not have the same consistency as plasma. The reason for its thicker consistency is to provide cushion and reduce friction between the articular cartilage of synovial joints during movement.
A yellow coloration found in fresh cerebrospinal fluid supernatant is termed:
Xanthochromia - It may indicate that a subarachnoid hemorrhage (SAH) has occurred.
The constituents that are indicated by the arrows in this image of a stained urine sediment are:
Yeast
Quality control procedures should be performed with each new lot of chemical reagent strips, and as often as required by the laboratory's procedure. True or False?
True
Fecal urobilinogen level may be markedly decreased because of:
Biliary obstruction In the intestines, bilirubin is converted to urobilinogen. Most urobilinogen, which gives feces their dark color, is excreted in the feces. An absence of bilirubin in the intestine, which occurs with bile duct obstruction, blocks the conversion of bilirubin to urobilinogen, which causes clay-colored stools and a decreased fecal urobilinogen level.
Which of the following specimen collection methods should NOT be used if urine cultures are also required?
Routinely voided
How does ion concentration in the urine relate to specific gravity?
Specific gravity increases as ionic concentration increases.
Cytocentrifugation is the recommended method for preparing a cerebrospinal fluid (CSF) sample for examination of cellular morphology.
True
Significantly increased levels of ketones are detected in the urine with which of the following conditions? (Choose ALL correct answers)
- Diabetic acidosis - Excessive carbohydrate loss - Starvation
Match the following casts with their associated conditions/descriptions.
- Mucous threads may resemble these casts Hyaline casts - Seen in renal infection or inflammation such as pyelonephritis White cell casts - Composed of plasma protein aggregates and cellular remnants Granular casts - Refractile casts with squared-off ends associated with chronic tubular injury Waxy casts
The image is a stained smear of cerebrospinal fluid. What types of cells are present in this field?
- Pia arachnoid mesothelial cells - Macrophages
Which of the following are directly involved in the production of semen?
- Prostate - Seminal vesicles - Bulbourethral gland
Which of the following are functions of CSF?
- Supply nutrients to nervous system tissue. - Protect spinal cord from injury. - Remove waste products from cerebral metabolism.
