Chapter 6: Microscopic Examination of Urine

All of the following are true about waxy casts except they __________. a.) represent extreme urine stasis b.) may have a brittle consistency c.) require staining to be visualized d.) contain degenerated granules

c.) require staining to be visualized

Which of the following should be used to reduce light intensity in bright-field microscopy? a.) centering screws b.) aperture diaphragm c.) rheostat d.) condenser aperture diaphragm

c.) rheostat

The shape of the RTE cell associated with renal tubular epithelia casts is primarily __________. a.) elongated b.) cuboidal c.) round d.) columnar

c.) round

The primary component of urinary mucus is __________. a.) bence jones protein b.) microalbumin c.) tamm-horsefall protein d.) orthostatic protein

c.) tamm-horsefall protein

Mononuclear leukocytes are sometimes mistaken for __________. a.) yeast cells b.) squamous epithelial cells c.) pollen grains d.) renal tubular cells

d.) renal tubular cells

The predecessor of the oval fat body is the __________. a.) histiocyte b.) urothelial cell c.) monocyte d.) renal tubular cell

d.) renal tubular cell

Match the following crystals seen in ALKALINE urine with their description/identifying characteristics. Crystals in Alkaline Urine _____. Triple Phosphate _____. Amorphous Phosphate _____. Calcium Phosphate _____. Ammonium Biurate _____. Calcium Carbonate Description/Identifying Characteristics: 1. Yellow granules 2. Thin prisms 3. "Coffin lids" 4. Dumbbell shape 5. White precipitate 6. Thorny apple

3. "Coffin lids" 5. White precipitate 1. Yellow granules 6. Thorny apple 4. Dumbbell shape

Match the following types of microscopy with their descriptions. Microscope: _____. Bright-Field _____. Phase _____. Polarized _____. Dark-Field _____. Fluorescent _____. Interference Contrast Descriptions: 1. Indirect light is reflected off the object 2. Object split light into two beams 3. Low refractive index objects may be overlooked 4. Three-dimensional images 5. Forms halo of light around object 6. Detects electrons emitted from objects 7. Detects specific wavelengths of light emitted from objects

3. Low refractive index objects may be overlooked 5. Forms halo of light around object 2. Object split light into two beams 1. Indirect light is reflected off the object 7. Detects specific wavelengths of light emitted from objects 4. Three-dimensional images

Match the following abnormal crystals with their description/identifying characteristics. Abnormal Crystals: _____. Cystine _____. Tyrosine _____. Cholesterol _____. Leucine _____. Ampicillin _____. Radiographic Dye _____. Bilirubin Description/Identifying Characteristics: 1. Bundles following refrigeration 2. Highly alkaline pH 3. Bright yellow clumps 4. Hexagonal plates 5. Flat plates, high specific gravity 6. Concentric circles, radial striations 7. Notched corners 8. Fine needles seen in liver disease

4. Hexagonal plates 8. Fine needles seen in liver disease 7. Notched corners 6. Concentric circles, radial striations 1. Bundles following refrigeration 5. Flat plates, high specific gravity 3. Bright yellow clumps

Match the following crystals seen in ACIDIC urine with their description/identifying characteristics. Crystals in Acidic Urine: _____. Amorphous Urates _____. Uric Acid _____. Calcium Oxalate Monhydrate _____. Calcium Oxalate Dihydrate Description/Identifying Characteristics: 1. Envelopes 2. Thin needles 3. Yellow-brown, whetstone 4. Pink sediment 5. Ovoid

4. Pink sediment 3. Yellow-brown, whetstone 5. Ovoid 1. Envelopes

Differentiation between casts and fibers can usually be made using: a.) solubility characteristics b.) patient history c.) polarized light d.) fluorescent light

c.) polarized light

When using the glass slide and coverslip method, which of the following might be missed if the coverslip is overflowed? a.) Casts b.) RBCs c.) WBCs d.) Bacteria

a.) Casts

Which of the following lipids is/are capable of polarizing light? a.) Cholesterol b.) Neutral fats c.) Triglycerides d.) Both neutral fats and triglycerides

a.) Cholesterol

Nonpathogenic granular casts contain __________. a.) cellular lysosomes b.) degenerated cells c.) protein aggregates d.) gram-positive cocci

a.) cellular lysosomes

A structure believed to be an oval fat body produced a Maltese cross formation under polarized light but does not stain with Sudan III. The structure __________. a.) contains cholesterol b.) is not an oval fat body c.) contains neutral fats d.) is contaminated with immersion oil

a.) contains cholesterol

The finding of dysmorphic RBCs is indicative of __________. a.) glomerular bleeding b.) renal calculi c.) traumatic injury d.) coagulation disorders

a.) glomerular bleeding

The most valuable initial aid for the identification of crystals in a urine specimen is: a.) pH b.) solubility c.) staining d.) polarized microscopy

a.) pH

All of the following contribute to the formation of urinary crystals except: a.) protein concentration b.) pH c.) solute concentration d.) temperature

a.) protein concentration

WBC casts are primarily associated with __________. a.) pyelonephritis b.) cystitis c.) glomerulonephritis d.) viral infections

a.) pyelonephritis

The largest cells in the urine sediment are __________. a.) squamous epithelial cells b.) urothelial epithelial cells c.) cuboidal epithelial cells d.) columnar epithelial cells

a.) squamous epithelial cells

Initial screening of the urine sediment is performed using an objective power of __________. a.) 4X b.) 10X c.) 40X d.) 100X

b.) 10X

When pyuria is detected in a sediment, the slide should be carefully checked for the presence of __________. a.) RBCs b.) bacteria c.) hyaline casts d.) mucous

b.) bacteria

A clinically significant squamous epithelial cell is the __________. a.) cuboidal cell b.) clue cell c.) caudate cell d.) columnar cell

b.) clue cell

The finding of yeast cells in the urine is commonly associated with__________. a.) cystitis b.) diabetes mellitus c.) pyelonephritis d.) liver disorders

b.) diabetes mellitus

Following an episode of hemoglobinuria, RTE cells may contain __________. a.) bilirubin b.) hemosiderin granules c.) porphobilinogen d.) myoglobin

b.) hemosiderin granules

Crenated RBCs are seen in urine that is __________. a.) hyposthenuric b.) hypersthenuric c.) highly acidic d.) highly alkaline

b.) hypersthenuric

Prior to identifying a RBC cast, all of the following should be observed except: a.) free-floating RBCs b.) intact RBCs in the cast c.) presence of a cast matrix d.) a positive reagent strip blood reaction

b.) intact RBCs in the cast

Macroscopic screening of urine specimens is used to __________. a.) provide results as soon as possible. b.) predict the type of urinary casts present. c.) increase cost-effectiveness of urinalysis. d.) decrease the need for polarized microscopy.

c.) increase cost-effectiveness of urinalysis.

The Sternheimer-Malbin stain is added to urine sediments to do all of the following except: a.) Increase visibility of sentiment constituents. b.) Change the constituents refractive index. c.) Decrease precipitation of crystals. d.) Delineate constituent structures.

c.) Decrease precipitation of crystals.

The purpose of the Hansel stain is to identify __________. a.) Neutrophils b.) Renal tubular cells c.) Eosinophils d.) Monocytes

c.) Eosinophils

Differentiation among RBCs, yeast, and oil droplets may be accomplished by all of the following except: a.) Observation of budding in yeast cells. b.) Increase refractivity of oil droplets. c.) Lysis of yeast cells by acetic acid. d.) Lysis of RBCs by acetic acid.

c.) Lysis of yeast cells by acetic acid.

When observing RTE casts, the cells are primarily __________. a.) embedded in a clear matrix b.) embedded in a granular matrix c.) attached to the surface of a matrix d.) stained by components of the urine filtrate

c.) attached to the surface of a matrix

Transitional epithelial cells are slough from the __________. a.) collecting duct b.) vagina c.) bladder d.) proximal convoluted tubule

c.) bladder

Forms of transitional epithelial cells include all of the following except: a.) spherical b.) caudate c.) convoluted d.) polyhedral

c.) convoluted

Crystals associated with sever liver disease include all of the following except: a.) bilirubin b.) leucine c.) cystine d.) tyrosine

c.) cystine

The two factors that determine relative centrifugal force are __________ and __________. a.) radius of rotor head; RPM b.) radius of rotor head; time of centrifugation c.) diameter of rotor head; RPM d.) RPM; time of centrifugation

c.) diameter of rotor head; rpm.

The majority of casts are formed in the __________. a.) proximal convoluted tubules b.) ascending loop of henle c.) distal convoluted tubules d.) collecting duct

c.) distal convoluted tubules

Which of the following lipids is/are stained by Sudan III? a.) Cholesterol b.) Neutral fats c.) Triglycerides d.) Both neutral fats and triglycerides

d.) Both neutral fats and triglycerides

Which of the following are reported as number per LPF? a.) RBCs b.) WBCs c.) Crystals d.) Casts

d.) Casts

Variations in the microscope analysis of urine include all of the following except: a.) Preparation of the urine sediment. b.) Amount of sediment analyzed. c.) Method of reporting. d.) Identification of formed elements.

d.) Identification of formed elements.

All of the following can cause false-negative microscope results except: a.) Braking the centrifuge. b.) Failing to mix the specimen. c.) Dilue alkaline urine. d.) Using midstream clean-catch specimens.

d.) Using midstream clean-catch specimens.

A person submitting a urine specimen following a strenuous exercise routine can normally have all of the following in the sediment except: a.) hyaline casts b.) granular casts c.) RBC casts d.) WBC casts

d.) WBC casts

The presence of fatty casts is associated with __________. a.) nephrotic syndrome b.) crush injuries c.) diabetes mellitus d.) all of the above

d.) all of the above

Cylindroiduria refers to the presence of__________. a.) cylindrical renal tubular cells b.) mucous resembling casts c.) hyaline and waxy casts d.) all types of casts

d.) all types of casts

Increased transitional cells are indicative of __________. a.) catheterization b.) malignancy c.) pyelonephritis d.) both catheterization and malignancy

d.) both catheterization and malignancy

The observation of broad casts represents __________. a.) destruction of tubular walls b.) dehydration and high fever c.) formation in the collecting ducts d.) both destruction of tubular walls and formation in the collecting duct

d.) both destruction of tubular walls and formation in the collecting duct

Nuclear detail can be enhanced by __________. a.) prussian blue b.) toluidine blue c.) acetic acid d.) both toluidine and acetic acid

d.) both toluidine and acetic acid

All of the following crystals routinely polarize except: a.) uric acid b.) cholesterol c.) radiographic dye d.) cystine

d.) cystine

A primary characteristic used to identify renal tubular epithelial cells is __________. a.) elongated structure b.) centrally located nucleus c.) spherical appearance d.) eccentrically located nucleus

d.) eccentrically located nucleus

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.) glitter cells