Urinalysis Chapter 6

The purpose of scanning the perimeter of urine sediment placed under a conventional glass slide is to: A. Identify types of casts B. Detect renal tubular epithelial cells C. Evaluate the overall sediment composition D. Detect the presence of casts

D

The significance of seeing bacteria in the urine sediment is increased when: A. RBCs and casts are present B. The patient has an elevated temperature C. The specimen is cloudy D. WBCs are present

D

To detect the presence of casts, the sediment is examined using: A. Increased light under high power B. Increased light under low power C. Reduced light under high power D. Reduced light under low power

D

Urinary crystals that appear yellow to reddish-brown are: A. Calcium oxalate B. Triple phosphate C. Cholesterol D. Uric acid

D

Waxy casts are most easily differentiated from hyaline casts by their: A. Color B. Size C. Granules D. Refractivity

D

Which of the following cells found in increased numbers in the urine sediment is only indicative of nephron damage? A. Erythrocytes B. WBCs C. Squamous epithelial cells D. Renal tubular cells

D

Which of the following is most likely to be found in the urine of a diabetic patient? A. Trichomonas vaginalis B. Escherichia coli C. Staphylococcus saprophyticus D. Candida albicans

D

Which of the following results should have testing repeated? A. Positive blood and protein B. pH 7.0 with uric acid crystals C. Positive bilirubin and urobilinogen D. pH 8.0, WBCs, and triple phosphate crystals

D

A medical laboratory science student consistently obtains lower RBC counts than the instructor. A possible reason for this might be: A. Failure to completely resuspend the sedimented specimen B. Reading the same cells twice C. Counting all crenated cells twice D. Using too much stain

A

A patient with severe back pain and 15 to 20 RBCs/hpf in the urine sediment may have: A. Renal calculi B. Acute glomerulonephritis C. Nephrotic syndrome D. Osteomyelitis

A

Abnormal crystals are most frequently seen in a urine that is: A. Acid B. Neutral C. Alkaline D. Collected for 24 hours

A

All of the following are reported as the quantity per high-power field except: A. Casts B. Red blood cells (RBCs) C. White blood cells (WBCs) D. Bacteria

A

Broad casts may form as a result of: A. Extreme urinary stasis B. Strenuous exercise C. Increase in loss of amino acids D. Dehydration

A

Formation of crystals due to medications is most frequently caused by: A. Inadequate hydration B. Incorrect timing of medication doses C. Medication overdoses D. Use of expired antibiotics

A

Identification of urinary crystals is based on shape and: A. Urine pH and crystal solubility B. Urine protein and crystal size C. Urine bilirubin and glucose D. Urine pH and crystal size

A

In ascending order, the location of epithelial cells in the urinary tract is: A. Squamous, transitional, renal tubular B. Transitional, renal tubular, squamous C. Renal tubular, transitional, squamous D. Squamous, renal tubular, urothelial

A

Information that aids in the identification of crystals includes all of the following except: A. Urine temperature B. Urine pH C. Crystal solubility D. Crystal birefringence

A

Nonpathogenic or "normal" crystals found in acidic urine include: A. Calcium oxalate, uric acid, amorphous urates B. Calcium oxalate, uric acid, sulfonamides C. Uric acid, amorphous urates, triple phosphate D. Uric acid, calcium carbonate, bilirubin

A

Schistosoma haematobium would most likely be found in the urine from a: A. Foreign-service employee B. Marathon runner C. Diabetic patient D. Health-care worker

A

The finding of renal tubular epithelial cells containing yellow-brown granules correlates with a positive reagent strip test for: A. Blood B. Bilirubin C. Glucose D. Nitrite

A

The most probable structures to be stained by the Prussian blue stain are: A. Renal tubular epithelial cells B. WBCs C. Transitional epithelial cells D. Urothelial cells

A

The organisms attached to a clue cell are: A. Gardnerella vaginalis B. Trichomonas vaginalis C. Escherichia coli D. Candida albicans

A

The primary factor that favors the formation of urinary casts is: A. Urinary stasis B. High pH C. Positive blood D. Low specific gravity

A

The two factors that determine relative centrifugal force are: A. Radius of rotor head and revolutions per minute (RPM) B. Radius of rotor head and time of centrifugation C. Diameter of rotor head and RPM D. RPM and time of centrifugation

A

The type of cell most likely to appear stained with bilirubin is: A. Renal tubular B. Neutrophil C. Squamous D. Transitional

A

To differentiate a bacterial cast from a granular cast, a clinical laboratory scientist could: A. Perform a Gram stain B. Use polarizing microscopy C. Perform a Hansel stain D. Add acetic acid to the sediment

A

To dissolve amorphous urates, you could: A. Warm the specimen to body temperature B. Add concentrated sodium hydroxide C. Add dilute hydrochloric acid D. Add dilute acetic acid

A

To increase the probability of detecting urine sediment constituents that have a low refractive index, clinical laboratories often use: A. Phase-contrast microscopy B. Polarizing microscopy C. Interference-contrast microscopy D. Bright-field microscopy

A

Urinary casts are formed in the: A. Distal and collecting tubules B. Distal tubules and loops of Henle C. Proximal and distal tubules D. Proximal tubules and loops of Henle

A

Using polarized microscopy, which of the following is/are birefringent? A. Cholesterol B. Triglycerides C. Fatty acids D. Neutral fats

A

Waxy casts can be found in the urine sediment: A. In patients with renal failure B. Of an alkaline urine C. Whenever abnormal protein is present D. When urine is not correctly preserved

A

Which of the following cells can both be found in both a vaginal wet prep and in urine sediment? A. Yeast cell and clue cell B. Transitional and renal epithelial cell C. Clue cell and squamous cell D. Renal and squamous cells

A

Which of the following differentiates a waxy cast from a fiber most effectively? A. Waxy casts do not polarize light, and fibers do. B. Waxy casts are more refractile than fibers. C. Waxy casts have rounded ends, and fibers do not. D. Waxy casts are thicker on the edge, and fibers are thicker in the center.

A

To standardize the sediment concentration for microscopic analysis one must: A. Centrifuge the entire urine collection B. Use only the urine tubes and pipettes for a single commercial system C. Interchange the urine tubes and pipettes from several commercial systems D. Use only the parts of the commercial system that you want

B

Urothelial cells routinely occur in all of the following shapes except: A. Spherical B. Cylindroid C. Polyhedral D. Caudate

B

Which of the following crystals is associated with ethylene glycol ingestion? A. Uric acid B. Calcium oxalate monohydrate C. Triple phosphate D. Calcium oxalate dihydrate

B

Which of the following crystals occurs in two very distinct forms? A. Ammonium biurate B. Calcium oxalate C. Leucine D. Cholesterol

B

Which of the following elements would most likely be found in an acidic concentrated urine that contains protein? A. Ghost RBCs B. Casts C. Bacteria D. Triple phosphate crystals

B

Yeast may appear in the urine sediment in all of the following forms except: A. Mycelial B. Biconcave C. Oval D. Budding ovals

B

10 mL of urine is centrifuged, and 9.5 mL of urine is decanted. The sediment concentration factor is: A. 5 B. 12 C. 20 D. 24

C

A urine specimen is referred for cytodiagnostic urine testing to detect the presence of: A. Trichomonas vaginalis B. Blitter cells C. Malignant cells D. Spermatozoa

C

All of the following affect the formation of crystals except: A. Urine specific gravity B. Urine pH C. Urinary casts D. Urine temperature

C

All of the following are associated with severe urinary stasis except: A. Granular casts B. Waxy casts C. WBC casts D. Broad casts

C

Cystine crystals are often confused with: A. Cholesterol crystals B. Leucine crystals C. Uric acid crystals D. Triple phosphate crystals

C

Differentiation among RBCs, yeast, and oil droplets may be accomplished by all of the following except: A. Observation of budding in yeast cells B. Increased refractility of oil droplets C. Lysis of yeast cells by acetic acid D. Lysis of RBCs by acetic acid

C

Dilute alkaline urine should be examined carefully for the presence of: A. Yeast B. Renal tubular epithelial cells C. Ghost RBCs D. Fatty casts

C

Eosinophils are found in the urine in cases of: A. Nephrotic syndrome B. Cystitis C. Acute interstitial nephritis D. Renal lithiasis

C

Glitter cell is a term used to describe a specific type of: A. Ketone body B. Renal tubular epithelial cell C. Neutrophil D. Oval fat body

C

Identification of oval fat bodies can be verified using: A. Bright-field microscopy B. Phase contrast C. Polarized light D. Interference-contrast microscopy

C

In an unpreserved and old urine specimen, there could be difficulty differentiating between bacteria and: A. Yeast B. Mucus C. Amorphous phosphates D. Pollen grains

C

Motility by which of the following is most noticeable during the urine sediment examination? A. Spermatozoa B. Candida albicans C. Trichomonas vaginalis D. Escherichia coli

C

Specimens containing mucus may be erroneously reported as containing: A. Bacteria B. Yeast C. Hyaline casts D. Oval fat bodies

C

Spherical transitional epithelial cells can be differentiated from renal tubular epithelial cells by observing the: A. Centrally located nucleus in renal tubular cells B. Granular cytoplasm in renal tubular cells C. Centrally located nucleus in transitional cells D. Granular cytoplasm in transitional cells

C

The major constituent of urinary casts is: A. Lipoprotein B. Bence Jones protein C. Uromodulin protein D. Amino acids

C

The number of fields that should be examined when quantitating urinary sediment constituents is: A. 2 B. 5 C. 10 D. 20

C

The only type of cast capable of polarization is the: A. Waxy cast B. Hyaline cast C. Fatty cast D. Granular cast

C

The recommended centrifugation setting for preparation of the urine sediment is: A. 400 RPM for 10 minutes B. 1000 RPM for 5 minutes C. 400 RCF for 5 minutes D. 1000 RCF for 10 minutes

C

The type of cells that line the bladder and ureters are called: A. Squamous B. Renal tubular C. Transitional D. Basal

C

Under polarized light, all of the following will exhibit the Maltese cross formation except: A. Starch granules B. Oval fat bodies C. Pollen grains D. Fatty casts

C

Urine sediment artifacts frequently differ from true sediment constituents by their: A. Location in the specimen B. Appearance C. Refractility D. Number present

C

Urine sediments containing increased WBCs should be observed closely for the presence of: A. Hyaline casts B. Granular casts C. Bacteria D. Urothelial cells

C

Using a bright-field microscope, the final magnification of a high-power field is: A. 10X B. 40X C. 400X D. 1000X

C

All of the following crystals can be found in acid urine except: A. Cholesterol B. Tyrosine C. Cystine D. Ammonium biurate

D

An increase in urinary WBCs is called: A. Pyelonephritis B. Cystitis C. Urethritis D. Pyuria

D

Calcium carbonate crystals can be distinguished from bacteria by: A. Warming the sediment B. Refrigerating the specimen C. Checking the pH of the specimen D. Adding acetic acid

D

Centrifugation of less than the recommended 12 mL of urine for the microscopic examination will: A. Produce a false-negative sulfosalicyclic acid (SSA) B. Produce a false-positive SSA C. Increase the number of cellular elements D. Decrease the number of cellular elements

D

Clue cells are derived from: A. Renal tubular epithelial cells B. Trichomonas vaginalis C. Histiocytes D. Squamous epithelial cells

D

Collection of a midstream clean-catch specimen will alleviate contamination by: A. Renal tubular epithelial cells B. RBCs C. Transitional epithelial cells D. Squamous epithelial cells

D

Hyaline casts may degenerate into: A. Granular casts B. Fatty casts C. Broad casts D. Waxy casts

D

Leukocytes that stain pale blue with Sternheimer-Malbin stain and exhibit brownian movement are: A. Indicative of pyelonephritis B. Basophils C. Mononuclear leukocytes D. Glitter cells

D

Nonpathogenic or "normal" crystals found in alkaline urine include: A. Calcium oxalate, uric acid, amorphous urates B. Calcium oxalate, uric acid, sulfonamides C. Uric acid, amorphous urates, calcium carbonate D. Triple phosphate, calcium carbonate, ammonium biurate

D

Sediment constituents that are used to differentiate between upper and lower urinary tract infections are: A. WBCs B. WBC clumps C. RBCs and WBCs D. WBC casts

D

Substances found in the urinary sediment that can be confirmed using polarized light are: A. WBCs B. Casts C. Ketone bodies D. Lipids

D

The presence of hypochromic, irregularly shaped RBCs in the urine sediment can indicate: A. A coagulation disorder B. Menstrual contamination C. Urinary tract infection D. Glomerular bleeding

D

The purpose of including glucose as a significant chemical parameter by a laboratory that performs macroscopic screening is to check for the presence of: A. WBC casts B. Hyaline casts C. Trichomonas vaginalis D. Candida albicans

D

A lipid droplet that does not stain with Sudan III may be composed of: A. Triglycerides B. Cholesterol C. Neutral fats D. Chylomicrons

B

A urine specimen refrigerated overnight is cloudy and has a pH of 6. The turbidity is probably due to: A. Amorphous phosphates B. Amorphous urates C. Triple phosphate crystals D. Calcium oxalate crystals

B

All of the following may be seen in the urine following strenuous exercise except: A. Protein B. Glucose C. Hyaline casts D. Granular casts

B

Calculation of the number of RBCs per milliliter of urine requires knowledge of all of the following except the: A. Number of high-power fields per milliliter of urine B. Speed of centrifugation C. Number of high-power fields per viewing area D. Area of a high-power field

B

Crystals found in the urine that are associated with pathogenic disease include: A. Calcium oxalate and uric acid B. Leucine and tyrosine C. Heavy amorphous phosphates D. Triple phosphate and ammonium biurate

B

Ghost RBCs most frequently occur with a urine specimen that exhibits the following: A. High pH, high specific gravity B. High pH, low specific gravity C. Low pH, high specific gravity D. Low pH, low specific gravity

B

Granular casts present in the urine following strenuous exercise can: A. Represent disintegration of cellular casts B. Contain cellular lysosomes C. Be pathogenic for renal disease D. Represent a prerenal condition

B

Initial microscopic focusing on the urinary sediment is frequently performed by referencing: A. Mucus B. Squamous epithelial cells C. RBCs D. Hyaline casts

B

Optimal viewing is obtained by performing Köhler illumination adjustment to the: A. Field diaphragm B. Condenser C. Operative diaphragm D. Rheostat

B

Oval fat bodies are: A. Squamous epithelial cells that contain lipids B. Renal tubular epithelial cells that contain lipids C. WBCs that have phagocytized lipids D. People who fail to work out regularly

B

The finding of increased hyaline and granular casts in the urine of an otherwise healthy person may be the result of: A. Fecal contamination B. Recent strenuous exercise C. Early urinary tract infection D. Analyzing an old specimen

B

The predecessor of the standardized urine microscopic examination was the: A. Sternheimer count B. Addis count C. Kova system D. T-system

B

The presence of crenated RBCs in the urine sediment is associated with: A. Rrauma B. Hypersthenuria C. Hyposthenuria D. Urinary tract infection

B

The type of cast most closely associated with tubular damage is the: A. WBC cast B. Epithelial cell cast C. RBC cast D. Fatty cast

B

The urinary sediment constituent most closely associated with bleeding within the nephron is the: A. RBC B. RBC cast C. WBC cast D. Hyaline cast

B

To distinguish a cellular cast from a clump of cells, the clinical laboratory scientist should: A. Check for dysmorphic cells B. Look carefully for a cast matrix C. Determine if free-standing cells are present D. Examine the sediment using polarizing microscopy

B

True or False: A structure resembling a cast but having a tapered end should not be reported as a cast.

False

True or False: The finding of increased urinary WBCs is not significant unless increased bacteria are also present.

False

True or False: To adjust the intensity of light in a bright-field microscope, the condenser should be raised or lowered.

False

True or False: Trichomonas vaginalis is not found in urine from male patients.

False

True or False: WBC casts should always be accompanied by significant bacteriuria.

False

True or False: When changing magnification using a parfocal microscope, focusing is performed using the coarse adjustment knob.

False

True or False: In the urinalysis laboratory, a bright-field microscope can be converted to a polarizing microscope.

True

True or False: Renal tubular epithelial cells from the distal convoluted tubule are smaller than those from the proximal convoluted tubule.

True

True or False: To be considered significant, yeast cells in the urine sediment should be accompanied by leukocytes.

True