MLS Urinalysis Exam
What is the normal range of neutrophils for a synovial fluid differential?
0-25%
What is the normal range of RBCs in urine?
0-3/HPF
What is the normal range of Hyaline casts?
0-5/HPF
What is the normal range of WBCs in the urine?
0-5/HPF
What is the normal range of squamous epithelial cells?
0-5/HPF
What is the normal range of neutrophils for a CSF differential?
0-7%
What is the normal range of monocytes/macrophages for a synovial fluid differential?
0-71%
What is the normal range of lymphocytes for a synovial fluid differential?
0-78%
What is the normal range for WBCs in CSF?
0-8/uL
What is a normal urobilinogen urine result?
0.2
What rate is CSF produced?
0.35mL/min, constantly produced and reabsorbed
Which of the following specific gravity values is physiologically impossible?
1.000
In a patient with chronic renal disease in whose kidneys can no longer adjust urine concentration, the urine specific gravity would consistently read as:
1.010
What is a normal specific gravity urine result?
1.015
Given the following information, calculate the routine creatinine clearance: 24-hour urine volume = 1440 ml Serum creatinine = 2.0 mg/dl Urine creatinine = 200 mg/dl
100 ml/min
The average daily urine output is approximately:
1000- 2000 mL per day
What is the normal range of protein for a CSF?
12-60mg/dL
What is the normal range of monocytes for a CSF differential?
16-56%
The approximate renal threshold for glucose is:
160-180 mg/dL
What is the normal volume of semen and how is it reported?
2-5mL; reported as whole number with one decimal
What is the normal range of glucose for a CSF?
2/3 the blood level
A 35-year-old diabetic woman is suspected of developing renal insufficiency. Which of the following specimens should be obtained to determine the amount of creatinine being excreted in the urine?
24 hour timed collection
Which of the following will contribute to a specimen's specific gravity when measured by refractometer if it is present in a person's urine?
250mg/dL of glucose
What is the normal serum osmolality range?
275-300
What is the normal range of lymphocytes for a CSF differential?
28-95%
Blood is occult at?
2mL
What is the normal range for urine pH?
4.5 to 8.0
A urine sample is primarily acidic in nature (pH 5.0-6.0), but can vary depending on the time of day and diet. What is the overall normal range for urine pH?
4.5-8.0
What is the expected WBC range of synovial fluid in someone who has crystal induced disease?
500-200k/uL
What is a normal pH urine result?
6.5
Given the following information, calculate the creatinine clearance: 24-hour urine volume = 1000 ml Serum creatinine = 2.0 mg/dl Urine creatinine = 200 mg/dl
69 ml/minute
pH of ________ is not physiologically possible.
9
Poor specimen quality is what pH?
9.0
What is the normal range of CSF in an adult?
90-150mL
How many WBCs does CSF normally contain and what is the most common?
<10/uL (very few), lymphocytes and monocytes (mononuclear)
Smaller joints typically contain how much synovial fluid?
<1mL
What is the normal range of nucleated cells for synovial fluid?
<200/uL
What is the normal amount of WBCs in synovial fluid?
<200/uL, lymphocytes/monocytes
What WBC count for CSF usually indicates some sort of infection?
>10/uL
What is the expected range of nucleated cells of synovial fluid in someone who has septic arthrits?
>2,000/uL
What is the normal range for sperm counting?
>20million/mL
The sum of the "rapid" and "slow" progression should be greater than what percentage?
>32%
A urine specimen is tested for glucose by reagent strip and by the Clinitest method. The reagent strip result is 100 mg/dland the Clinitest result is 500 mg/dl. Which of the following statements would best account for this discrepancy?
A large amount of ascorbic acid is present in, the specimen
All of the following enhance the formation of urinary casts except:
A pH > 8.0
Glitter cells are:
A white blood cell found in hypotonic urine
What type of crystals are all found in acid/neutral urine and identified with chemical tests?
Abnormal crystals
What tablet test can detect acetoacetic acid on urine or serum and can perform serial dilutions?
Acetest
The reagent strip detects ______________ ______________ only for Ketones.
Acetoacetic acid
The presence of ketone bodies in urine specimens may be detected by the use of a reagent strip impregnated with sodium nitroprusside. This strip is sensitive to the presence of:
Acetoacetic acid and acetone
Uric acid, amorphous urates, sodium urate and calcium oxalate are the most common crystals seen in what kind of pH of urine?
Acidic
Proteinuria, WBC, WBC casts and eosinophils are urine findings for what disease?
Acute interstitial nephritis
What disease is an immune or allergic reaction, typically to medications?
Acute interstitial nephritis
What term refers to into blood flow?
Afferent
________ is the major serum protein found in urine, but most plasma ________ is not filtered by the glomerulus.
Albumin; albumin
Phosphates, ammonium biurates and calcium carbonate are what type of crystals?
Alkaline
The kidneys play an important role in which of the following?
All of the above
Which of the following conditions most likely accounts for a negative nitrite result on the reagent strip despite the presence of large amounts of bacteria?
All of the above
Which of the following is an advantages of using urinalysis stains vs unstained brightfield microscopy?
All of the above are correct
What crystals are found in unpreserved or old specs, thorny apple shaped and presence indicates poor specimen quality?
Ammonium biurates
What type of fluid is used for a lamellar body count?
Amniotic fluid
A white precipitate in a normal alkaline urine most likely is caused by:
Amorphous phosphates
What crystals are granular, white, no shape and dissolve in acetic acid?
Amorphous phosphates
White precipitate in normal alkaline urine is most likely:
Amorphous phosphates
Pink dust in the urine is most likely?
Amorphous urates
What is the most commonly found crystal in acid urine that has been refrigerated with a pH >5.5?
Amorphous urates
How do we distinguish amorphous urates from lookalikes?
Amorphous urates will dissolve in heat or NaOH, also lots of variation in size and shape
What are bacteria lookalikes in urine?
Amorphous urates, amorphous phosphates
What are the steps for post vasectomy testing?
An aliquot of sample is centrifuged and the supernatant is poured off. The sediment is then examined for the presence or absence of sperm
You receive a urine sample that was left standing at room temperature for several hours. Which of the following changes is most likely to have occured?
An increase in bacteria count
Which term is defined as a urine volume less than 50 mL excreted over a 24-hour period?
Anuria
What is the term for synovial fluid collection?
Arthrocentesis
What type of collection is usually performed under local anesthetic, needle is inserted into synovial joint and fluid is aspirate and then a portion is transferred to a sterile tube for microbiological exam and an EDTA tube for hematologic exam?
Arthrocentesis (synovial fluid collection)
Oil, starch and fibers are considered what in urine?
Artifacts
What urine component tends to be large, very retractile, seem to be less organized and symmetrical?
Artifacts
Which of the following is impermeable to water?
Ascending Loop of Henle
What interfering substances can cause a false negative of urine protein?
Ascorbic acid, protein other than albumin (tubular, Bence-Jones)
The fluid deprivation test is used to:
Assess renal concentrating ability
Plasma and urine levels of ______ are sensitive indicator of GFR and glomerular damage.
B2M
Variables that may be included in estimated creatinine clearance calculations include all of the following EXCEPT:
BUN
A positive nitrite in a urine specimen suggests the presence of which of the following?
Bacteria
The presence of what indicates contamination, UTI or improper specimen preservation?
Bacteria
What does a strong ammonia odor of urine usually mean?
Bacteria
What other result should a positive urine nitrite correlate with?
Bacteria on microscopic exam
How is bacteria distinguished from amorphous material?
Bacteria will be more uniform and may show morphology. Amorphous material dissolves in heat or acid.
What are lookalikes for amorphous urates?
Bacteria, granular casts
Microorganisms seen in urine?
Bacteria, yeast, parasites
Bacterial vaginosis = ?
Bacterial infection
Positive leukocyte esterase and nitrite chemical test strips are likely to be indicative of what?
Bacterial infection of the urinary tract
What infection consists of increased WBC count often between 100-10,000/uL and accompanied by predominance of neutrophils in CSF?
Bacterial meningitis
You receive a CSF sample for analysis and obtain the following results: Appearance = Hazy, Colorless (Clear, Colorless) WBC Count =5,000/mcL (<5/mcL) RBC Count = 0/mcL (0/mcL) Xanthochromia = Absent (Absent) Glucose = 15 mg/dL (40-70 mg/dL) Protein = 80 mg/dL (15-45 mg/dL) You perform a cytospin see the above picture in your microscope. What is most likely the cause of these findings?
Bacterial meningitis
What is the normal pH of semen and how is it reported?
Basic (7.2-8.0); reported as whole number with one decimal
Pale stool = ?
Bile obstruction
A reagent strip impregnated with a daizonium salt, such as 2, 4-dichloroaniline, is used to determine which analyte?
Bilirubin
Presence of _________ indicates a pathologic condition.
Bilirubin
What abnormal crystal appears clumped needles or granules and has a distinctive yellow color?
Bilirubin
What abnormal crystal may be incorporated into casts in cases of viral hepatitis?
Bilirubin
What abnormal crystal should be accompanied by positive urine bilirubin test?
Bilirubin
What urine dipstick component combines with diazonium salt in acid medium to produce an azodye, a color reaction of tan to pink (Diazo reaction)?
Bilirubin
What urine dipstick component is used to assist in the diagnosis of hepatocellular and obstructive jaundice?
Bilirubin
What urine dipstick component often gives urine a yellow, brown, or amber appearance?
Bilirubin
Which of the following substances can change the color of the urine and its foam?
Bilirubin
Yellow foam correlates with the presence of?
Bilirubin
_______ is a highly pigmented degradation product of hemoglobin and must be eliminated from the body.
Bilirubin
__________ on reagent strip shows high occurrence of false positive results, so all positives are confirmed using the __________.
Bilirubin, ictotest
High levels of _________ in blood cause the condition known as _______, characterized by a yellowing of the skin and sclera.
Bilirubin, jaundice
Upper GI bleed what color stool?
Black/tarry
The reagent test strip method for hemoglobin may yield false positive results when the urine specimen contains which of the following?
Bleach
What does a low volume of semen indicate?
Blockage
Acidic pH of semen may indicate what?
Blockage of seminal vesicles
H2O2 + chromogen ---hemoglobin/peroxidase---> oxidized chromogen + H2O What urine dipstick component?
Blood
Pseudoperoxidase activity of hemoglobin is used to catalyze reaction between hydrogen peroxide and chromogen tetramethylbenzidine to produce green color is the chemical principle of what urine dipstick component?
Blood
What urine dipstick component has a chemical principle where intact RBCs will lyse when they come in contact with the reagent pad and will create a speckled pattern?
Blood
What tests do RBCs in the urine correlate with?
Blood positive, Protein positive, hazy/cloudy, pink/red/brown color
What is an interfering substance of a urine pH result?
Bloody
Values for creatinine clearance tests on children are corrected for:
Body size
What urine component is due to extreme urinary stasis and wide due to destruction and widening of the tubule?
Broad cast
What urine component is the most common with poor renal prognosis?
Broad waxy casts
What type of fluid consists of saline being injected into the lungs, aspired and then the wash is examined?
Bronchial fluid/bronchial lavage (BAL)
Malabsorption what color stool?
Bulky/frothy
What is the clearance test calculation?
C = U x V/P (x 1.73/A for correcting)
Ketones normally do not show up in the urine, as they are usually broken down completely into _________ & __________.
CO2 & H2O
What body fluid acts as an excretory channel for metabolic products of the CNS by removing metabolic waste?
CSF
What body fluid provides nutrient medium for the central nervous system by providing a stable chemical environment?
CSF
What body fluid regulates the volume of the intracranial contents?
CSF
What body fluid serves as a mechanical buffer that prevents trauma by acting as a shock absorber for brain and spine?
CSF
What crystals are unusual to see, similar to dumbbell of CaOx and clinically insignificant?
Calcium carbonates
This crystal is typically found in acidic or neutral urine, and is commonly described as a colorless envelope.
Calcium oxalate
This crystal is usually found in acid or neutral urine, and is commonly described as a colorless envelope.
Calcium oxalate
What crystal is caused by diets with high oxalic acid (tomatoes, spinach, berries, oranges), chemical toxicity (ethylene glycol), large dose of ascorbic acid (vitamin C) or diets high in calcium?
Calcium oxalate
What crystal is found in acid urine, occasionally neutral urine and rarely in alkaline urine?
Calcium oxalate
What crystal is most commonly shaped like colorless ocathedredrals/envelopes?
Calcium oxalate
What crystal may be less commonly shaped as ovoid, rectangular or dumbbell?
Calcium oxalate
What crystal is not clinically significant, but could be associated with renal calculi?
Calcium phosphate
What crystal is shaped prism, plates or needles and soluble in acetic acid?
Calcium phosphate
What crystals are seen with pseudogout?
Calcium pyrophosphate
What crystals in synovial fluid appear rhomboid, square or rod shaped showing positive birefringence, which is blue in color when aligned with long access of filter?
Calcium pyrophosphate
Which of the following crystals would you expect to find in the synovial fluid of a patient with pseudogout?
Calcium pyrophosphate
Degenerative arthritis producing cartilage calcification and endocrine disorders producing elevated serum calcium levels are causes of what in regards to synovial fluid?
Calcium pyrophosphate/pseudogout
Degenerative arthritis producing cartilage calcification can cause what with regards to synovial fluid?
Calcium pyrophosphate/pseudogout
Endocrine disorders producing elevated serum calcium levels can cause what with regards to synovial fluid?
Calcium pyrophosphate/pseudogout
What is the most common cause of yeast infection?
Candida albicans
What urinary element forms only in DCT or collecting duct and are composed of Tamm-Horsfall mucoprotein?
Casts
When the technologist performs the microscopic examination of urine sediment, which of the following are typically enumerated using low-power magnification?
Casts
Which of the following would be quantitated on LOW power?
Casts
What are lookalikes for mucus in urine?
Casts, fibers, hair
What are increased transitional cells most indicative of?
Catheterization
What body fluid circulates in subarachnoid space over the brain and down over spinal cord?
Cerebrospinal fluid (CSF)
What testing is typically performed on tube 1 of a CSF, with all cellular elements being centrifuged out of the sample?
Chemical Exam
This crystal found in acid urine, is described as colorless rectangular plates with a notch in one or more corners.
Cholesterol
What abnormal crystal appears colorless/rectangular plates and have a distinctive notch take out?
Cholesterol
What abnormal crystal is associated with diseases producing lipiduria and usually comes from refrigerates samples?
Cholesterol
Which of the following describes a preferred collection method?
Clean catch
Regarding gross appearance, normal spinal fluid is described as:
Clear and colorless
What does a high quantity of renal tubular epithelial cells indicate?
Clinically significant, necrosis of renal tubules
What test consists of reducing substances that reduce copper sulfate to cuprous oxide in the presence of alkali and heat?
Clinitest
Based on the physical exam, which of the following urine samples would be least likely to contain blood and/or hemoglobin?
Cloudy amber urine
What is the expected appearance of synovial fluid in someone who has septic arthritis?
Cloudy, yellow
What are lookalikes for granular casts?
Clumps of small crystals, columnar RTE cells, fecal contamination
The final concentration of the urine is determined within which of the following?
Collecting duct
Which of the following is a pre-analytical component of a quality assessment program?
Collection instructions for a patient
What factors can affect the test results of semen analysis?
Collection method, time of day, transportation time and temperature, days of abstinence preceding test
What do transitional epithelial cells correlate with?
Collection type - cath
Which of the following would be part of the physical exam of urine for urinalysis?
Color and clarity
Mass screening in adults for occult blood is performed primarily to detect what?
Colorectal cancer
What is the normal CSF color and clarity?
Colorless, clear, with few cellular elements
The major function of the Loop of Henle is to:
Concentrate the urine
What does an amber color urine indicate?
Concentrated urine, low spec volume
Size and shape of RBCs in urine are largely dependent on what?
Concentration of the urine
Damage to liver allows leakage of _______ _______ into bloodstream.
Conjugated bilirubin
Obstruction of bile duct allows ________ _______ to enter bloodstream instead of intestine.
Conjugated bilirubin
What is the reasoning for seeing bacteria but no WBCs on a microscopic urine exam?
Contamination
Forms of transitional epithelial cells include all of the following EXCEPT:
Convoluted
What additional test can be used for the urine dipstick component of glucose?
Copper Reduction Test (Clinitest)
How do we distinguish RBCs from lookalikes?
Correlation of dipstick, presence of budding or pseudohyphae, highly retractile nature of oil and air, addition of acetic acid
What are the two main types of the nephron?
Cortical & Juxtamedullary
What type of nephron is primarily situated in the renal cortex, makes up 85% of all nephrons and is primarily responsible for removal of waste products and reabsorption of nutrients?
Cortical nephrons
The bilirubin reagent strip and tablet tests are based on which reaction?
Coupling of bilirubin with a diazonium salt
The concentration of which substances provides the best means of distinguishing urine from other body fluids?
Creatinine and urea
What is the name of a shrunken red cell found in highly concentrated urine?
Crenated cell
Which of the following is a post analytical component of a quality assurance program?
Critical value reporting
What disease is an inflammatory condition in which crystals form in the joints?
Crystal induced disease
Which substances found in urinary sediment are most easily distinguished by polarized microscopy?
Crystals
What test consists of sample being cultured using multiple selective and nutrient agars from CSF?
Culture/ID
What is produced by nucleated cells as a protease inhibitor?
Cystatin C
Crystals associated with severe liver disease include all of the following except:
Cystine
Cystinuria is termed when what crystals are found in urine?
Cystine
This urine crystal is seen as hexagonal plates in an acid pH.
Cystine
What abnormal crystal appears colorless/hexagonal plates and vary in size and thickness?
Cystine
What abnormal crystal is caused by metabolic reabsorption, where renal tubules can't reabsorb?
Cystine
How do we differentiate cystine crystals from uric acid crystals?
Cystine soluble in ammonia and dilute HCl
Positive LE, positive nitrite, positive RBC, positive protein, hematuria (RBCs), pyuria (WBCs), bacteria are urine findings for what disease?
Cystitis
What disease is also known as a bladder infection?
Cystitis
What disease is the infection of the urinary bladder, specifically part of the lower urinary tract?
Cystitis
A positive nitrite may indicate what?
Cystitis or pyelonephritis (Diagnosis of UTI)
What would you expect to happen to urine volume after an injection of ADH?
Decreased urine volume excreted
High SG may indicate?
Dehydration
Low SG may indicate?
Diabetes
What is the chemical principle of the nitrite reagent (Greiss reaction)?
Diazotization of nitrite followed by a reaction with quinolin compound to form a pink color
What is a pH result in urine controlled by?
Diet
Which of the following is the correct testing process for urinalysis when using reagent strips?
Dipping the reagent strip briefly into the urine specimen
Which of the following is not an acceptable disposal practice?
Discarding a used broken specimen transfer pipette with noninfectious waste
Which of the following is not considered a personal protective barrier?
Disinfectants
What type of cells in the urine vary in size, shape and hemoglobin content, often have cellular protrusions and reflect glomerular bleeding?
Dysmorphic RBCs
Why is an EDTA used for hematologic exam of synovial fluid?
EDTA prevents clot formation
What is the primary characteristic used to identify renal tubular epithelial cells?
Eccentrically located nucleus
What term refers to out of blood flow?
Efferent
The ultimate goal of a quality assessment program in urinalysis is to:
Ensure the validity of the lab results obtained
An increase in this white blood cell, typically reported as a %, may be useful in confirming a diagnosis of acute interstitial nephritis.
Eosinophil
WBC lookalikes are:
Epithelial cells, crenated RBCs
What is the expected differential of synovial hemorrhagic fluid?
Equal to PB
What interfering substances can cause a false negative of the urine urobilinogen component?
Exceeded sample stability, formalin, high concentration of nitrate
T/F: Most proteins will pass through the glomerulus and be excreted in the urine.
False
Of the following, which would be the most significant finding on a urine microscopic exam?
Fatty Casts
What urine component is often accompanied by oval fat bodies?
Fatty casts
What urine component is seen in nephrotic syndrome where fat and protein are allowed to filter through the glomerulus?
Fatty casts
What urine component requires fat stain or polarized light for a positive ID?
Fatty casts
What test is used to monitor patients undergoing treatment for malabsorption disorders of GI tract and pancreas?
Fecal Fat (Stool Fat)
What stool test is performed by staining and lactoferrin latex agglutination?
Fecal Leukocytes (Stool WBC)
What test is performed by staining for fat droplets?
Fecal fat (stool fat)
How are microorganisms quantitated in urine?
Few, moderate, many
What artifact polarizes and has morphology?
Fibers
What are lookalikes for waxy casts?
Fibers, fecal material
What is the optimal urine sample for routine urinalysis testing?
First morning sample less than two hours old
Which of the following would be the best choice urine sample if a routine urinalysis and urine culture were both ordered?
First morning, clean catch sample
Isosthenuria is a term applied to a series of urine specimens from the same patient exhibit what?
Fixed specific gravity of approximately 1.010
Prior to reporting a red blood cell cast, it is important to observe which of the following?
Free-floating RBCs
What are the two different types of osmometers?
Freezing point depression osmometers, vapor pressure osmometers
Hemorrhoid what color stool?
Fresh red blood
Nitrites are produced primarily by what type of bacteria?
GNR E. coli
Clinitest is sensitive to these non-glucose reducing substances and mainly used to detect _____________.
Galactose
What type of cells in the urine are neutrophils with granules that show brownian motion, making cells appear to sparkle?
Glitter cells
What test measures the rate at which the kidneys can remove a filterable substance from the blood?
Glomerular filtration (clearance tests)
Marked hematuria is a significant urine finding seen with what disease?
Glomerulonephritis
Oliguria, due to reduction in efficiency of nephrons is a urine finding seen in what disease?
Glomerulonephritis
Proteinuria, due to damage of glomerular basement membrane is a urine finding seen in what disease?
Glomerulonephritis
RBC casts, due to urine stasis, also see increase in hyaline and granular casts and dysmorphic RBCs are urine findings seen in what disease?
Glomerulonephritis
What disease is a post streptococcal infection?
Glomerulonephritis
What disease is a sterile inflammatory process that affects the glomerulus?
Glomerulonephritis
The structure of the nephron that functions as a non-selective filter is the:
Glomerulus
What are the 4 components that the nephron consists of?
Glomerulus, PCT, Loop of Henle, DCT
Decreased levels of what may be seen in bacterial meningitis?
Glucose
Glucose Oxidase reaction is specific for _________ only.
Glucose
Increased levels of _________ may also indicate renal tubular defects.
Glucose
What other test on synovial fluid is decreased in bacterial infection?
Glucose
What urine dipstick component has the chemical principle of glucose oxidase/peroxidase method?
Glucose
What urine dipstick component is primarily used to detect and monitor Diabetes Mellitus?
Glucose
What urine dipstick component is used to monitor diabetes?
Glucose
__________ is freely filtered by glomerulus and under normal circumstances is completely reabsorbed in the PCT.
Glucose
Which of the following statements about glucose is false?
Glucose is passively reabsorbed in the proximal convoluted tubule
Which testing method, used on reagent dip sticks, provides a specific test for glucose in urine?
Glucose oxidase
What other tests may be performed on synovial fluid?
Glucose, protein, lactate dehydrogenase, uric acid
Uric acid crystals in synovial fluid = ?
Gout
What test is performed STAT and may result in presumptive ID, allowing for faster treatment from CSF?
Gram stain
What two tests make up the microbiological exam for CSF?
Gram stain and culture/ID
What three things are considered in the routine microbiological exam of synovial fluid?
Gram stain, culture, ID of organism
What urine component contains lysosomes excreted from RTE during normal metabolism and increase during stress and exercise (non-pathogenic origins)?
Granular casts
What urine component is coarsely or finely granulated with no distinct cellular components?
Granular casts
What urine component results from degeneration of cellular casts or protein aggregates filtered by the glomerulus (pathogenic origins)?
Granular casts
Where is leukocyte esterase produced?
Granulocytes and monocytes
What four things are considered in the routine hematologic exam of synovial fluid?
Gross appearance (color, turbidity), total nucleated cell count (performed on analyzer or hemocytometer), differential (performed on wright stained cytocentrifuged sample), crystal exam
What is typically included in a hematologic exam of spinal fluid?
Gross appearance (color/turbidity), cell counts (quantify RBCs and nucleated cells), differential (morphologic evaluation of nucleated cells)
What are other bacteria that can cause septic arthritis?
Group A strep, H. influenzae, N. gonorrhoeae, E. coli and others
Which of the following substances is the indicator of choice in fecal occult blood slide tests?
Guaiac
What do squamous epithelial cells correlate with?
Hazy to cloudy, microscopic bacteria (contamination), more often in women
After verifying patient ID, whole sample is sent to where for initial gross exam?
Hematology
What clinically significant finding of the urine blood dipstick component consists of the presence of intact RBCs, commonly causing cloudy red urine?
Hematuria
What is found in disorders of the renal or genitourinary region in which bleeding occurs?
Hematuria
Pseudo-peroxidase activity of ___________ is used to produce a color reaction to test for the analyte.
Hemoglobin
What urine dipstick component is used to investigate intravascular hemolysis, UTI and glomerular nephritis?
Hemoglobin
__________, ______________ or ___________ lysed in urine, cannot be differentiated, so other tests must be performed.
Hemoglobin, myoglobin, RBCs
What clinically significant finding of the urine blood dipstick component consists of presence of hemoglobin, commonly causing clear red urine in addition to red plasma?
Hemoglobinuria
What is found in disorders or conditions that result in massive lysing of RBCs and free hemoglobin exceeds haptoglobin?
Hemoglobinuria
What substances can interfere with the Jaffee reaction?
Hemolysis, icteremia, lipemia in serum, protein, glucose in urine
What diagnosis from a lumbar puncture is indicated by often looking for subarachnoid hemorrhage, which may be deadly if no treated early and may be from ruptured aneurysm or from head injury?
Hemorrhage
What type of synovial fluid is caused by trauma, tumor, coagulation deficiencies or anticoagulant therapy?
Hemorrhagic fluid
Fresh red blood = ?
Hemorrhoid
All of the following can result in inaccurate urine pH measurement except:
High amounts of protein in the sample
What interfering substances can cause a false positive result of urine specific gravity?
High concentration of protein
You receive sample for urinalysis and obtain the following results: MACROSCOPIC EXAM Color = Yellow Clarity = Clear Specific Gravity(dipstick) = 1.005 Specific Gravity (Refractometer) = 1.030 pH = 6.5 Protein = Negative Glucose = 500 mg/dL Ketones = Negative Blood = Negative Bilirubin = Negative Urobilinogen = 0.2 mg/dL Nitrite = Negative Leukocyte esterase = Negative What is most likely the cause of the discrepant specific gravity results? Which reading should be reported because it most accurately represents the concentrating ability of this patient's kidneys?
High glucose is causing the high refractometer reading, and measurement by dipstick should be reported
What interfering substances can cause a false negative of urine glucose?
High levels of vitamin C, improperly preserved specimens
What interfering substances can cause a false negative of the urine blood dipstick component?
High specific gravity, formalin, high nitrite, unmixed specimen
What special consideration must be taken into account with a urine pH result?
Highly alkaline indicates bacterial contamination due to improper preservation or exceeded stability
What interfering substances can cause a false negative result of urine specific gravity?
Highly alkaline urine
What interfering substances can cause a false positive of urine protein?
Highly alkaline urine, prolonged contact with urine, detergents from improper container, highly pigmented urine
What interfering substances can cause a false positive of the urine urobilinogen component?
Highly pigmented urine
What interfering substances can cause a false positive of ketones?
Highly pigmented urine, Levodopa and other sulfahydryl drugs
What interfering substances can cause a false positive of urine bilirubin results?
Highly pigmented urine, Pyrimidine and other UTI medications
What crystal is caused by diets high in fruits and veggies that contain large quantities of benzoic acid or chemical toxicity (ethylene glycol)?
Hippuric acid
What crystal is rarely found in humans, but can be found in acid urine, neutral urine, rarely alkaline urine?
Hippuric acid
What crystal is shaped colorless six sided prisms, needles or rhombic plates?
Hippuric acid
What is the normal appearance of semen?
Homogeneous, gray-opalescent
What does a black color urine indicate?
Homogentisic acid, melanin
Mucus threads are most often misidentified as which of the following?
Hyaline casts
What is the most frequently seen cast, consisting almost entirely of Tamm-Horsfall protein?
Hyaline casts
The presence of which of the following distinguishes synovial fluid from other extravascular fluids?
Hyaluronic acid
What does synovial fluid contain which is responsible for viscosity?
Hyaluronic acid
The formation of the ultra filtrate in the glomerulus is driven by which of the following?
Hydrostatic blood pressure
Crenated = ?
Hypertonic urine
What type of RBCs will shrink because of water rushing out?
Hypertonic urine
Ghost cells = ?
Hypotonic urine
What type of RBCs will swell and lyse, releasing HGB to leave an empty shell?
Hypotonic urine (low SG)
A tablet is placed on a mat and H2O is added and allowed to run off of tablet and bilirubin on mat turns blue/purple describes what test?
Ictotest
Which of the following statements regarding the microscopic examination of urine sediment is false?
If mucus is present, the chemical test for protein should be positive
What test is an immunoassay utilizing antibodies to detect hemoglobin, performing using and optical measurement method and a latex agglutination reaction and reported as positive or negative?
Immuno Fecal Occult Blood
What interfering substances can cause a false negative of ketones?
Improper preservation (acetoacetic acid broken down by bacteria)
What interfering substances can cause a false positive of urine nitrites component?
Improper preservation, exceeded stability, highly pigmented urine
Which of the following is most likely to result in a false positive nitrite results?
Improper specimen storage
What interfering substances can cause a false negative of urine bilirubin results?
Improper storage, high ascorbic acid and high nitrite
Quality control materials, used to assess the performance of reagent strips and tablet tests must:
Include constituents to assess the chemical and microscopic urine examinations
What interfering substances can cause a false negative of urine leukocyte esterase results?
Increased glucose, increased protein, increased specific gravity, some antibiotics, lymphocytes
Urine pH can be modified by all of the following EXCEPT:
Increased ingestion of water
What other results do hyaline casts correlate with?
Increased protein, blood may be present from exercise
What do renal tubular epithelial cells correlate with?
Increased protein, increased WBC & RBC, LE & nitrite positive (pyelonephritis), positive bilirubin (hepatitis)
A positive leukocyte esterase in urine often accompanies what?
Infection
Overly basic pH of semen may indicate what?
Infection
What is the presence of WBCs in the urine associated with?
Infection (most common), glomerulonephritis, lupus, transplant rejection, interstitial nephritis
What are the risks for performing a spinal tap?
Infection, bad headaches, herniation
Which of the following conditions is most likely to result in false positive bilirubin results?
Ingestion of certain medications
What is used to differentiate whether diabetes insipidus is caused by decreased ADH production or inability of tubules to respond to ADH?
Injection of ADH
What disease affects spaces between glomeruli or in other tissues of the renal system?
Interstitial diseases
What type of cells in the urine are similar in size, shape and hemoglobin content, reflect nonglomerular bleeding from lesions such as calculi or papillomas or hemorrhage from cysts in polycystic renal disease?
Isomorphic RBCs
What type of nephron extends deep into the renal medulla and is primarily responsible for concentration of urine?
Juxtamedullary nephrons
____________ can be mistaken for alcohol intoxication.
Ketoacidosis
Tablet containing sodium nitroprusside reacts with acetoacetic acid in alkaline medium to produce a purple color is the chemical principle of what component of the dipstick?
Ketone
What urine dipstick component can lead to electrolyte imbalance, dehydration and ketoacidosis?
Ketone
What urine dipstick component is clinically significant when increased, indicating increased blood levels, which can be fatal if left untreated?
Ketone
What urine dipstick component is formed in the liver from aceto acetate?
Ketone
What urine dipstick component is indicative of increased fat metabolism often seen in: Diabetes, inadequate carbohydrate intake and starvation?
Ketone
What urine dipstick component is present when the major source of energy (carbohydrates) becomes compromised?
Ketone
What urine dipstick component represents products of fat metabolism, such as: acetone, acetoacetic acid, beta-hydroxybuteric acid?
Ketone
What does a fruity odor of urine usually mean?
Ketones
What urine dipstick component is used to detect and monitor ketonuria e.g. in diabetes?
Ketones
What disorders are found in relation to hematuria?
Kidney stones, glomerular diseases, tumors, trauma, pyelonephritis, toxic chemicals, anticoagulant therapy
WBCs in the urine most often correlate with what other tests?
LE positive, nitrite positive, hazy to turbid, microscopic bacteria
What other test on synovial fluid is increased in rheumatoid arthritis, infectious arthritis and gout?
Lactate dehydrogenase
This crystal typically found in acid or neutral urine, is described as yellow-brown spheres that demonstrate concentric circles and radial striations.
Leucine
What abnormal crystal appears yellow/brown spheres, often containing concentric circles?
Leucine
What abnormal crystal is rarely seen and should be accompanied by tyrosine crystals?
Leucine
What abnormal crystals are rarely seen but may be present in cases of severe liver damage?
Leucine, tyrosine, bilirubin
What urine dipstick component can be present in inflammatory processes, such as inflammation of renal tissue, as seen in interstitial nephritis?
Leukocyte esterase
What urine dipstick component hydrolyzes inoxylcarbonic acid ester in reagent pad?
Leukocyte esterase
What urine dipstick component result can be used as a reflex test for urine culture?
Leukocyte esterase
What urine dipstick component with a positive result indicates a bacterial, fungal or parasitic infection (Diagnosis of UTI)?
Leukocyte esterase
Which of the following statements describes the chemical principle involved on the leukocyte esterase pad of commercial reagent strips?
Leukocyte esterase hydrolyzes an acid ester on the reagent pad, then an azo coupling reaction results in a purple dye
Presence of what may help differentiate between infection with invasive vs non-invasive organisms in stool?
Leukocytes
Which component of the nephron is located exclusively in the renal medulla?
Loop of Henle
Which component of the nephron is located in the renal medulla?
Loop of Henle
What CSF collection type is usually performed under local anesthetic, needle is inserted between vertebrae into subarachnoid space, CSF drips out and is collected in sterile tubes, usually 3-4 tubes, collecting 1-2mL each?
Lumbar puncture
Which of the following blood cells will not be detected by the leukocyte esterase pad because it lacks esterase?
Lymphocytes
What does a sweet odor of urine usually mean?
MSUD
Bulky/frothy stool = ?
Malabsorption
B2M is not a reliable test in patients with?
Malignancy
What significant urine finding is seen with glomerulonephritis?
Marked hematuria
What diagnosis from a lumbar puncture is indicated by inflammation of the meninges and may be caused by a viral, bacterial, or fungal infection, as well as noninfectious causes?
Meningitis
The double indicator system used by reagent strips to determine pH uses which two indicator dyes?
Methyl red and bromthymol blue
__________ seen in early diabetic nephropathy is NOT picked up on routine dipstick.
Microalbumin
What testing is typically performed on tube 2 of CSF?
Microbiological exam
What is present in urine due to infection or contamination?
Microorganisms
The urine blood dipstick component must correlate with what other result?
Microscopic
Which of the following best aids in the differentiation of hemoglobinuria and hematuria?
Microscopic exam
Which of the following specimen collection methods usually eliminates contamination of the urine from external genitals in the distal urethra?
Midstream clean catch specimen
How do we differentiate cholesterol crystals from radiographic dye?
Missing notch is unique to cholesterol, cholesterol seen in association with fatty casts and oval fat bodies, SG of sample with radiographic dye will be increased by refractometry
What does an orange color urine indicate?
Most often Pyridium (treatment for UTI), bilirubin, energy drinks
In the examination of urinary sediment on glass slides, casts tend to appear on which area of the slide?
Mostly around the edges
Which of the following is not a distinguishing characteristic of yeast in the urine sediment?
Motility
What is a cliniclly insignificant finding in urine?
Mucus
How do we distinguish mucus in urine?
Mucus has no visible matrix, appears as strands or strings, use of polarized scope
What are lookalikes for hyaline casts?
Mucus, fibers, hair
What clinically significant finding of the urine blood dipstick component consists of the presence of myoglobin, commonly causing clear red-brown urine with normal looking plasma?
Myoglobinuria
What is found in disorders or conditions that result in destruction of muscle tissue, releasing myoglobin into circulation?
Myoglobinuria
Does amorphous urates have clinical significance?
NO
Staph, Vibrio, viruses and parasites would give what result for fecal WBC?
Negative
What is a normal bilirubin urine result?
Negative
What is a normal blood urine result?
Negative
What is a normal glucose urine result?
Negative
What is a normal ketone urine result?
Negative
What is a normal leukocyte esterase urine result?
Negative
What is a normal nitrite urine result?
Negative
What is a normal protein urine result?
Negative
Which of the following are characteristic urine findings from a patient with hemolytic jaundice?
Negative bilirubin with increased urobilinogen
What is the functional unit of the kidney which produces urine?
Nephron
Which of the following urinary tract structures does not contain transitional epithelium?
Nephron
Increased proteinuria, lipiduria, oval fat bodes, casts and RTE are urine findings seen in what disease?
Nephrotic syndrome
Presence of protein, free fat and oval fat bodies is a classic finding of what disease?
Nephrotic syndrome
What disease can progress to chronic renal failure?
Nephrotic syndrome
What disease is a circulatory disruption resulting in damage to glomerular membrane causing failure of filtration and involves hypoalbuminemia and edema?
Nephrotic syndrome
What diagnosis from a lumbar puncture is indicated by myelin basic protein measure to determine if myelin is breaking down and oligoclonal bands are tested for to see if antibodies are being produced in the spinal fluid?
Neurological disorders such as Multiple Sclerosis
What is primarily in a differential of synovial fluid in someone who has septic arthritis?
Neutrophils
What is the primarily shown in a differential of synovial fluid in someone who has crystal induced disease?
Neutrophils
What does a turbid clarity of urine mean?
Newsprint can not be seen through specimen
What does a cloudy clarity of urine mean?
Newsprint is difficult to read through sample, but you can still see that it is there
What urine dipstick component is used to assist in the diagnosis of UTI?
Nitrite and Leukocyte esterase
What urine dipstick component has the chemical principle that nitrate at acidic pH reacts with aromatic amine to form a diazonium compound that reacts with tetrahydrobenzoquinoloin compounds to produce a pink reaction (Greiss reaction)?
Nitrites
What urine dipstick component result is used for monitoring treatment and as a reflex test for urine culture?
Nitrites
___________ are produced by bacteria that are able to reduce nitrate in the urine.
Nitrites
What does a high quantity of transitional epithelial cells in urine indicate?
No clinical significance, often catheterization
The glucose reagent strip test is more sensitive and specific for glucose than the Clinitest method because it detects which of the following?
No other substances and lower concentrations of glucose
What does a clear clarity of urine mean?
No visible particulate matter when viewing print through specimen
Uric acid, creatinine, galactose, fructose, lactose, pentose, homogentisic acid, ascorbic acid chloroform and formaldehyde are what type of substances in the urine?
Non-glucose reducing
What type of semen motility consists of not moving at all?
Non-motile
What interfering substances can cause a false negative of urine nitrites component?
Non-nitrite reducing organisms, ascorbic acid, insufficient contact time in bladder, lack of urinary nitrate, conversion of nitrite to nitrogen, antibiotics
What type of semen motility consists of twitching around but not moving forward?
Non-progressive
What is the expected number of crystals seen in synovial hemorrhagic fluid?
None seen
What is the expected range of crystals of synovial fluid in someone who has septic arthritis?
None seen
What is the normal range for RBC casts?
None seen
What is the normal range for RBCs in CSF?
None seen
What is the normal range for WBC casts?
None seen
What is the normal range for bacteria in urine?
None seen
What is the normal range for granular casts?
None seen
What is the normal range for sperm counting after a vasectomy?
None seen
What is the normal range for waxy casts?
None seen
What is the normal range of renal tubular epithelial cells in urine?
None seen
What is the normal range of transitional epithelial cells?
None seen
What is the normal range of yeast in urine?
None seen
How is the appearance of semen reported?
Normal or abnormal
What does a high quanitity of squamous epithelial cells in urine indicate?
Not clinically significant, contamination
Benzidine, o-toluidine and gum guaiac are three different methods for what test?
Occult blood
What is the screening test for colorectal cancer?
Occult blood
What artifact won't dissolve in acetic acid and polarizes?
Oil
A semen sample should be completely liquefied after how many hours?
One (reported normal or abnormal)
What is the measure of osmoles of solute per kg of solution?
Osmolality
Which of the following urinary parameters are measured during the course of concentration and dilution tests to assess renal tubular function?
Osmolarity and specific gravity
What urine cells are RTEs that have absorbed lipids?
Oval fat bodies
What urine cells are most often associated with glomerular damage caused by the nephrotic syndrome?
Oval fat bodies
What urine cells is confirmed most often by polarized microscopy?
Oval fat bodies
On the reagent strip test for blood, the presence of hemoglobin in the urine catalyzes what?
Oxidation of the chromagen to a blue-green color with a pseudo-peroxidase reaction
What interfering substances can cause a false positive of the urine blood dipstick component?
Oxidizing agents (detergents, bleach), bacterial peroxidases (E. coli peroxidase), menstrual contamination
What is the most common WBC seen in the urine?
PMNs
Bile obstruction what color stool?
Pale
What are lookalikes for Leucine crystals?
Parasite ova, WBCs, renal cells
What serous fluid is around the heart?
Pericardial
What serous fluid is in the belly?
Peritoneal (ascites)
What are the three effusion/serous fluids?
Peritoneal, pleural, pericardial
Which microscopic method can be used to detect more easily the presence of casts in urine sediment?
Phase contrast microscopy
Triple phosphate, amorphous phosphate and calcium phosphate are what type of crystals?
Phosphates
What part of a urinalysis includes color, clarity and specific gravity?
Physical exam
A complete urinalysis consists of what 3 parts?
Physical exam, chemical exam, microscopic exam
What serous fluid is around the lungs?
Pleural
Which term is defined as a urine volume in excess of 2000 mLs excreted over a 24-hour period?
Polyuria
What does a pH of 9.0 indicate?
Poor specimen quality, ammonium biurates
Salmonella, Shigella, Campy, Yersinia, Ecoli would give what result for fecal WBC?
Positive
What other results does the presence of Trichomonas vaginalis correlate with?
Positive LE
What dipstick results do yeast correlate with in urine?
Positive LE, positive glucose, low pH
What urine findings are seen with cystitis?
Positive LE, positive nitrite, positive RBC, positive protein, hematuria, pyuria, bacteria
A positive urine leukocyte esterase result is often accompanied by what?
Positive nitrite and bacteria on microscopic exam (also found in presence of yeast and trichomonas infection)
What dipstick results do bacteria correlate with in urine?
Positive nitrite, positive LE
What other results do waxy casts correlate with?
Positive protein, cellular casts, granular casts, presence of WBCs under microscope, presence of RBCs under microscope
What other results do granular casts correlate with?
Positive protein, cellular casts, presence of WBCs under microscope, presence of RBCs under microscope
What other results do WBC casts correlate with?
Positive protein, positive LE, presence of WBCs under microscope
What other results do RBC casts correlate with?
Positive protein, positive RBC dipstick, presence of RBCs under microscope
How is Trichomonas vaginalis in urine reported?
Presence
Spinal fluid that is red, pink or yellow usually is caused by?
Presence of RBCs in the spinal fluid
How do we distinguish Trichomonas vaginalis from WBCs in urine?
Presence of motility, presence of flagella
How are crystals reported?
Present only if seen
How is mucus in urine reported?
Present or absent
A urine that produces a large amount of white foam should be suspected to contain increased amounts of which substance?
Protein
Decreased levels of what are seen in cases of CSF leakage?
Protein
Increased _______ is caused by underlying renal disease.
Protein
Increased levels of what are seen in cases of meningitis, hemorrhage, and multiple sclerosis for CSF?
Protein
What other test on synovial fluid is increased in bacterial infection?
Protein
What urine dipstick component consists of tetrabromphenol blue going from yellow to green as albumin levels increase?
Protein
What urine dipstick component is an indicator of renal disease?
Protein
What urine dipstick component is the most important and valuable part of a routine urinalysis?
Protein
What urine dipstick component is used to help in diagnosis and monitoring of proteinuria e.g. in pregnancy or UTI, nephritis or nephrotic syndrome?
Protein
What urine dipstick component primarily detects albumin in the urine?
Protein
What two tests consist of the chemical exam for CSF?
Protein and glucose
White/clear foam correlates with large amounts of?
Protein, especially albumin
What are the urine findings for acute interstitial nephritis?
Proteinuria, WBC, WBC casts, eosinophils
How is bilirubin produced?
Protoporphyrin is converted to bilirubin by cells of reticuloendothelial system and unconjugated bilirubin binds to albumin and is transported to the liver where it becomes conjugated and ends up in the intestine
In a normal patient, 100% of the glucose is reabsorbed in the nephron. Where does this reabsorption take place?
Proximal Convoluted Tubule
More than 66% of the filtered water, sodium, and chloride, and 100% of filtered glucose, amino acids, and proteins are reabsorbed in which part of the nephron?
Proximal convoluted tubule
Calcium pyrophosphate = ?
Pseudogout
What does a green color urine indicate?
Pseudomonas infection
The cell wall of a dead sperm will allow stain in, so those semen stain what color?
Purple
Rapid onset, urinary frequency and lower back/flank pain due to involvement of the kidney are clinical findings for what disease?
Pyelonephritis
What disease has the same urine findings as a bladder infection but also has WBC casts?
Pyelonephritis
What disease is an infectious process of the kidney, typically due to ascending infection of the lower urinary tract (untreated UTI)?
Pyelonephritis
You perform a urinalysis and obtain the following results: MACROSCOPIC EXAM Color = Yellow Clarity = Turbid Specific Gravity = 1.017 pH = 6.5 Protein = Negative Glucose = Negative Ketones = Negative Blood = 2+ Urobilinogen = Negative Nitrite = Positive Leutocyte Esterase = Positive MICROSCOPIC EXAM WBCs = 26-100/HPF RBCs = 6-10/HPF WBC Casts = 11-26/LPF Bacteria = Many What is most likely the cause of these findings?
Pyelonephritis
Presence of WBCs in the urine is called?
Pyuria
What does a CSF cell count consist of?
RBC and WBC counts may be performed by an automated analyzer or manually using a hemacytometer
Acute glomerulonephritis = ?
RBC cast
What urine component is caused by bleeding within the nephron from glomerulonephritis or strenuous exercise?
RBC cast
What urine components usually enter through damaged glomerulus, but any damage to the nephron may allow formation?
RBC cast
What are lookalikes for RBC casts?
RBC clumps, coarsely granular casts
What are lookalikes for yeast in urine?
RBCs
What urinary cells appear as smooth, non-granular, non-nucleated, bi-concave disks, often with a hard-looking edge?
RBCs
Yeast, oil droplets, air bubbles, CaOx crystals and talcum powder are often mistaken with what cell in the urine?
RBCs
What does a brown color urine indicate?
RBCs oxidized to methemoglobin
How do we distinguish yeast from RBCs?
RBCs will lyse with addition of acetic acid, presence of budding, presence of pseudohyphae
What does a red/pink color urine indicate?
RBCs, Hemoglobin, Myoglobin
Blood may be present in urine as intact _________ or may be detected as _________.
RBCs, hemoglobin
What are lookalikes for cholesterol crystals?
Radiographic dye
What clinical findings can be found with pyelonephritis?
Rapid onset, urinary frequency, lower back/flank pain due to involvement of the kidney
What type of semen motility consists of swimming quickly across a field?
Rapid progressive
What are the 4 types of classified motility?
Rapid progressive, slow progressive, non-progressive, non-motile
The findings of increased hyaline and granular casts in the urine of an otherwise healthy individual is most often seen in which of the following?
Recent strenuous exercise
What is the expected appearance of synovial hemorrhagic fluid?
Red, bloody (may see erythrophagocytosis)
What abnomal color is caused by the presence of RBCs in the spinal fluid?
Red, pink or yellow
Traumatic tap that may indicate subarachnoid hemorrhage results in what abnormal colors of spinal fluid?
Red, pink, yellow
Urobilinogen is formed by which of the following?
Reduction of bilirubin by intestinal bacteria
Urobilinogen is formed from which of the following?
Reduction of conjucated bilirubin by intestinal bacteria
A birefringent substance is one that:
Refracts light in two different dimensions at 90 degrees to each other
Which of the following is the most common form of urine preservation, providing the least amount of interference?
Refrigeration
Which of the following is not a function of the kidney?
Removal of excess protein from the blood
What disease affects the glomerulus, tubules, intestitium and vasculature?
Renal disease
Which of the following urinary casts are diagnostic of advanced tubular destruction, producing urinary stasis?
Renal tubular cell casts
Which of the following statements regarding renal epithelial cells is a true?
Renal tubular cells have a large nuclear to cytoplasmic ratio
What is the smallest epithelial cell in the urine that originates from the tubules of the nephron?
Renal tubular epithelial cells
What urinary cells vary in size and shape, but usually have an eccentric nucleus?
Renal tubular epithelial cells
What acid-base disorder is seen with acidic urine?
Respiratory or metabolic acidosis
What acid-base disorder is seen with alkaline urine?
Respiratory or metabolic alkalosis
Which of the following is a post-analytical component of a quality assessment program?
Results reporting
What disorders are found in relation to myoglobinuria?
Rhabdomyolosis, trauma, crush syndromes, prolonged coma, convulsion, muscle-wasting diseases, alcoholism, heroin use, extensive exercise
What is the main bacteria to cause septic arthritis?
S. aureus
What are the urine findings of pyelonephritis?
Same as bladder infection but with WBC casts
What does a CSF differential consist of?
Sample is concentrated on slide using cytocentrifugation, is stained with Wright's stain and a differential is performed
What is the normal viscosity of semen and how is it reported?
Sample should drop freely form a plastic pipette with no stringy tail; normal or increased
What type of analysis is usually performed in addition to other testing to investigate infertility or inability to conceive and may also be performed to evaluate effectiveness of a vasectomy or vasectomy reversal?
Semen analysis
What test consists of one drop of semen mixed with Eosin-Y and Nigrosin and a wedge prep of sample is made?
Semen viability
What infection is a medical emergency and may lead to destruction of the synovial joint in a period of days?
Septic arthritis
What infection is most often a result of dissemination of bacteria through the bloodstream from another infected site, such as abscess, wound, throat, genitals, in synovial fluid?
Septic arthritis
What infection may also enter directly through penetration of joint through trauma or surgery or for unknown reasons in synovial fluid?
Septic arthritis
What is the term for infection of the joints?
Septic arthritis
Effusion fluids aka =?
Serous fluids
How are crystals identified in synovial fluid?
Shape and birefringence via polarized microscopy (very painful)
How do we distinguish WBCs from lookalikes?
Size, correlation of dipstick, addition of acetic acid
How do we distinguish transitional epithelial cells from lookalikes?
Size, nuclear location
How do we distinguish renal tubular epithelial cells from lookalikes?
Size, nucleus
What type of semen motility consists of moving foreword slowly, often not in a straight line?
Slow progressive
The ketone reagent strip and tablet tests are based on the reactivity of ketone with which of the following?
Sodium nitroprusside
What does a hazy clarity of urine mean?
Some visible particulate matter when viewing print through specimen, but you can still read print
What does the density of a solution compared with the density of a similar volume of DI water at the same temperature refer to?
Specific gravity
What is used to assess the ability of kidneys to concentrate urine?
Specific gravity
What urine dipstick component is used to evaluate the concentrating ability of the kidney?
Specific gravity
What urine dipstick component is used to investigate the concentrating and diluting power of the kidney?
Specific gravity
Of the following, which would not be an analytic component in quality assurance?
Specimen preservation
Which of the following is considered to be a pre-analytic component in quality assurance?
Specimen preservation
What test consists of semen being incubated in a 56C water bath, performed on 40x using a special slide and special eyepiece with a grid and reported in millions/mL?
Sperm count
Size and shape of head, neck, midpiece and tail are evaluated and reported as % normal forms for what?
Sperm morphology
What is a significant finding only if found in urine of a female child?
Spermatozoa
What significant finding must be confirmed by a second tech?
Spermatozoa in a young girl
What urinary cell originates from the linings of the vagina and female urethra and lower portion of the male urethra?
Squamous Epithelial cells
What are largest cells typically found in the urine sediment?
Squamous epithelial cells
What is the largest and most common epithelial cell found in urine?
Squamous epithelial cells
What urinary cell contains abundant, irregular cytoplasm and a small nucleus in urine?
Squamous epithelial cells
What urine cells are rarely misidentified?
Squamous epithelial cells
What artifact is highly retractile and polarizes?
Starch
Presence of excess fat is termed?
Steatorrhea
What is oxidized to urobilin and is excreted in the feces?
Stercobilinogen
What is the most common sediment urine stain used that contains crystal violet and safranin O?
Sternheimer-Malbin stain
Bacteria, roughage, GI secretions, bile, electrolytes and water are components of what?
Stool
To preserve the integrity of reagent strips, it is necessary that they are:
Stored in a tightly capped container
Excretion of casts is increased when?
Stress and exercise
Increased number of hyaline casts can be seen in association with?
Stress and exercise, glomerulonephritis, pyelonephritis, chronic renal disease, CHF
What interfering substances can cause a false positive of urine glucose?
Strong oxidizing agents (peroxide/bleach)
What interfering substances can cause a false positive of urine leukocyte esterase results?
Strong oxidizing agents, formalin, highly pigmented urine
The presence of RBCs does NOT decrease significantly in subsequent collection tubes indicates what from spinal fluid?
Subarachnoid hemorrhage
Xanthochromia is most often associated with which condition?
Subarachnoid hemorrhage
Which of the following best describes renal tubular secretion?
Substances pass from the plasma to the urine ultra filtrate
What are the three stains for fecal fat/stool fat test?
Sudan III, Sudan IV, Oil red O
What is the cold precipitation test used to confirm presence of protein?
Sulfosalicyclic acid testing (SSA)
What diagnosis from a lumbar puncture is indicated by cancer spreading from primary site to subarachnoid space and may lead to neurologic symptoms and death?
Suspected malignancy
What body fluid acts as a shock absorber for joints?
Synovial fluid
What body fluid is contained in the joints, such as knee, shoulder, hip, wrist, elbow, fingers, toes, etc.?
Synovial fluid
What body fluid lubricates joints during movement?
Synovial fluid
What body fluid transports nutrients to and waste from cartilage?
Synovial fluid
The matrix of casts consists primarily of what?
Tamm-Horsfall protein
This cell type may be seen as spherical, polyhedral or caudate forms.
Tansitional epithelial cells
Analytical components of a quality assurance program or procedures are policies that affect the:
Technical testing of the specimen
You have a urine that contains 20-25 wbc/HPF and many bacteria, but is negative for nitrites. Which statement best describes this finding?
The bacteria present are most likely gram positive
You receive a sample for a Urinalysis and obtain the following results: MACROSCOPIC EXAM Color = Yellow Clarity = Hazy Specific Gravity = 1.020 pH = 7.5 Protein = Negative Blood = Negative Glucose = Negative Ketones = Negative Bilirubin = Negative Urobilinogen = Negative Nitirite = Negative Leukocyte esterase = Moderate MICROSCOPIC EXAM WBC = 11-25/HPF Bacteria = Many Which statement best explains the discrepancy between the chemical and microscopic exam?
The bacteria present are most likely gram positive
A routine urinalysis is performed on a young child suffering from diarrhea. The reagent test strip is negative for glucose but positive for ketones. These results may be explained by which of the following statements?
The child has increased catabolism of fat because of decreased intestinal absorption
The bilirubin reagent strip test and tablet tests are based on which reaction?
The coupling of bilirubin with a diazonium salt
Which of the following is not a feature of the renal counter current multiplier mechanism?
The descending limb of the loop of Henle is impermeable to water
Which of the following has the least affect on the formation of crystals in the nephron?
The diameter of the tubular lumen
You have a physician on the phone questioning a negative urine bilirubin result that was reported on a patient in the ER. Her patient is jaundiced, so she believes the result is incorrect. Which of the following is not a possible explanation of the negative test result?
The patient has a bile duct obstruction
Which of the following statements best describes the chemical principle of the protein reagent strip test?
The protein accept hydrogen ions from the indicator dye which results in a color change
Which of the following statements best describes the protein reagent test strip?
The protein accepts hydrogen ions from an indicator dye without a change in pH, which results in a color change
Which statement regarding lymphocytes found in urine sediment is correct?
Their number is often increased in patients experiencing kidney transplant rejection
Why are procedure manuals neccessary in a clinical laboratory?
To ensure that all individuals perform the same task consistently
Why are procedure manuals necessary in a clinical laboratory?
To ensure that all individuals perform the same task consistently
Why is hematologic examination of a lumbar puncture typically performed on tube 3 or 4?
To limit contamination of RBCs and WBCs from procedure
What is the primary purpose of a universal precautions policy in the laboratory?
To prevent the exposure and transmission of potentially infectious agents to personnel
Directly after collection, what should be done to a synovial fluid to prepare it for hematologic analysis?
Transfer a portion to an EDTA tube
What disorders are found in relation to hemoglobinuria?
Transfusion reaction, hemolytic anemia, severe burns, infection
What urinary cells are smaller than squamous cells?
Transitional epithelial cells
What urinary cells contain distinct, centrally located nucleus that comes in many shapes: spherical, polyhedral, caudate?
Transitional epithelial cells
What urinary cells originate from the renal pelvis, bladder and upper urethra?
Transitional epithelial cells
The presence of RBCs decreases significantly in subsequent collection tubes indicates what from spinal fluid?
Traumatic tap
Tube 4 may be clear and colorless, while tube 1 may be red or pink, this indicates what from spinal fluid?
Traumatic tap
Spinal fluid that is red, pink or yellow is usually due to what and may indicate what?
Traumatic tap; subarachnoid hemorrhage
Trichomoniasis = ?
Trichomonas infection
The most frequently encountered parasite in urine is:
Trichomonas vaginalis
What sexually transmitted parasite is usually associated with vaginal inflammation and discharge?
Trichomonas vaginalis
This crystal is found in alkaline urine, and is typically described as a colorless coffin lid.
Triple phosphate
What crystal is not clinically significant, shaped colorless prisms/coffin lids and associated with UTI?
Triple phosphate
What are the three phosphate alkaline crystals?
Triple phosphate, amorphous phosphate, calcium phosphate
Each tube from a lumbar puncture is designated for what testing?
Tube 1 - Chemical testing Tube 2 - Microbiological testing Tube 3 - Hematologic examination Tube 4 - Immunologic examination
What test is used to determine the ability of kidney to concentrate urine?
Tubular
Substances bound to plasma proteins in the blood can be eliminated in the urine by which mechanism?
Tubular secretion
What abnormal crystal is rarely seen and should be accompanied by Leucine crystals and positive urine bilirubin?
Tyrosine
What abnormal crystal may be found in disorders of amino-acid metabolism?
Tyrosine
What abnormal crystals appear fine, colorless to yellow needles and frequently form clumps or sheaths?
Tyrosine
Black/tarry stool = ?
Upper GI bleed (very bad)
Uric acid, amorphous urates and sodium urate are what type of acidic crystal?
Urates
What are the most common crystals seen in acidic pH urine?
Urates, calcium oxalate
Which of the following are present in the largest amounts in urine?
Urea, creatinine and sodium
This crystal found in acidic urine, may be seen as four-sided flat plates, wedges, or rosettes.
Uric acid
What crystal is highly birefringent under polarized light which aids in indentification?
Uric acid
What crystal is usually seen in a person with a high purine diet?
Uric acid
What crystal usually precipitates due to poor dilution of urine or over production?
Uric acid
What crystals appear to be rhomboid, wedges and needle, yellow/brownish red or can be clear, also described as almond shaped?
Uric acid
What is the most commonly found crystal in acid urine with a pH usually <5.5?
Uric acid
What other test on synovial fluid is increased in gout?
Uric acid
What are lookalikes for cystine crystals?
Uric acid crystals
What crystals in synovial fluid appear as long needles showing negative birefringence and yellow in color when aligned with long access of filter?
Uric acid crystals
Chemotherapy for leukemia can cause what with regards to synovial fluid?
Uric acid crystals/gout
Decreased renal excretion of uric acid can cause what with regards to synovial fluid?
Uric acid crystals/gout
Diets high in meats, alcohol and fructose can cause what with regards to synovial fluid?
Uric acid crystals/gout
Impaired metabolism of purines can cause what with regards to synovial fluid?
Uric acid crystals/gout
Impaired metabolism of purines, decreased renal excretion of uric acid, diets high in meats, alcohol, fructose and chemotherapy for leukemia can all cause what with regards to synovial fluid?
Uric acid crystals/gout
What are the three common urates in urine?
Uric acid, amorphous urates, sodium urate
Which of the following would be most likely to encourage urinary cast formation?
Urinary stasis
Gel formation of casts is encouraged by:
Urinary stasis, acidic urine, increased urine concentration, increased urine protein
What component in urine comes from the precipitation of urine salts?
Urine crystals
What urine component is affected by pH, temperature and concentration of urine?
Urine crystals
What are the three common methods of measuring specific gravity?
Urinometer, reagent strip, refractometer
Decreased levels of ________ are seen in obstruction of the bile duct.
Urobilinogen
Impaired liver (liver disease) is unable to adequately process recirculated _______ and it is lost in urine.
Urobilinogen
In hemolytic disorders, an excess of ________ is reabsorbed to the blood stream, causing excess to be lost via kidney.
Urobilinogen
Increased levels are seen when the liver is unable to process or there is an overabundance of ________.
Urobilinogen
What is a breakdown product of hemoglobin, produced by the conversion of bilirubin?
Urobilinogen
What urine dipstick component is reabsorbed, recirculates to the liver and is excreted back to the intestines?
Urobilinogen
What urine dipstick component is used to investigate jaundice?
Urobilinogen
What urine dipstick component reacts with diazonium salt in acid to produce a pink color (Diazo reaction)?
Urobilinogen
What urine dipstick component reacts with p-dimethylaminobenzaldehyde in acid to produce a pink color (Ehrlich's aldehyde reaction)?
Urobilinogen
The yellow color of normal urine is due to which pigment?
Urochrome
Unstained sample is added to urinalysis slide or slide with coverslip and examined for the presence of clue cells, yeast and trichomonas for what test?
Vaginal wet mount
What test consists of the sample being collected on a sterile swab and placed in 1mL of saline?
Vaginal wet mount
What test is performed to aid in the diagnosis of vaginitis?
Vaginal wet mount
Bacterial infection, yeast infection, and trichomonas infection are common causes of what?
Vaginitis
What is the condition characterized by vaginal discharge, odor, pruritus (itching), irritation, painful, urination and painful intercourse?
Vaginitis
What stain is performed if the sum of rapid and slow progression is not >32%?
Viability stain
What infection consists of increased WBC count often between 10-100/uL and typically accompanied by predominance of lymphocytes in CSF?
Viral meningitis
What is the normal consistency and color of synovial fluid?
Viscous; pale yellow
Which of the following would be considered a CLIA waived test?
Visual inspection of a urine dipstick
What should the patient avoid when collecting their sample for occult blood?
Vitamin C, iron, anti-inflammatory agents
Pyelonephritis = ?
WBC casts
What urine component always represents infection in the nephron seen in glomerulonephritis and pyelonephritis?
WBC casts
What urine component is made when certain cells present during cast formation are trapped in the matrix?
WBC casts
What are lookalikes for WBC casts?
WBC clumps
What are lookalikes for Trichomonas vaginalis in urine?
WBCs
What type of cells in the urine appear granulated and a nucleus may be visible?
WBCs
A positive urine leukocyte esterase result should correlate with what other result?
WBCs on microscopic exam
What are the lookalikes for renal tubular epithelial cells?
WBCs, granular/fatty casts, transitional epithelial cells
What are the lookalikes for transitional epithelial cells?
WBCs, squamous epithelial cells, renal tubular epithelial cells
Antidiuretic hormone regulates the reabsorption of which of the following?
Water in the collecting tubules
This cast most frequently appears to have a brittle consistency.
Waxy
What urine component is brittle and highly refractive?
Waxy casts
What urine component is caused by degeneration of hyaline cast matrix and anything contained in the matrix?
Waxy casts
What urine component often fractures while moving through tubules and appear cracked with jagged ends?
Waxy casts
What urine component represent extreme urine stasis seen in chronic renal failure or end stage renal disease (ESRD)?
Waxy casts
The cell wall of a live sperm will not allow stain through, so those semen stain what color?
White
This cell type are often found in the presence of a positive chemical LE and nitrite.
White blood cells
The leukocyte esterase test is negative, but leukocytes are present in the urine. What is the most likely cause of this discrepancy?
White blood cells present are lymphocytes
What is the expected appearance of synovial fluid in someone who has crystal induced disease?
White, turbid
Fat can be found in urine sediment in all of the following forms except:
Within hemosiderin granules
What is defined as the yellowing of CSF from conversion of hemoglobin to bilirubin from broken down RBCs?
Xanthochromia
What may also be present in spinal fluid if bleed is greater that 1-4 hours old?
Xanthochromia
The presence of what indicates diabetes mellitus, vaginal contamination, antibiotic therapy or immunocompromised individuals?
Yeast
Which urinary sediment component when observed microscopically is most likely to resemble red blood cells?
Yeast
Volvovaginal candidiasis = ?
Yeast infection
High bilirubin is often accompanied by ______ ______.
Yellow foam
What is the normal appearance of synovial fluid?
Yellow, clear
Increased bilirubin = ?
icteric
Pads are also sensitive to __________, a heme containing protein found in muscle tissue.
myoglobin
The higher the number of ions in the sample, the more hydrogen ions are released, lowering the _______, resulting in the indicator changing from blue to green to yellow
pH
What is the most important property for crystal ID?
pH
What is the single most important piece of information used in identification of urinary crystals?
pH
What urine dipstick component has a double indicator of methyl red and bromthymol blue as its chemical principal?
pH
What urine dipstick component is an indicator of acid-base balance in the body?
pH
What urine dipstick component is used to help characterize types of crystals or amorphous?
pH
What urine dipstick component is used to monitor treatment of a UTI?
pH
Which dipstick method uses a double-indicator system of methyl red and bromthymol blue?
pH
_______________ must ALWAYS be consulted when identifying urine crystals.
pH
Which of the following may cause a false positive urine protein reading when using biochemical reagent test strips?
pH is greater than 8.0
A fresh urine specimen should be requested when which of the the following results is found?
pH of 9.0 with ammonium biurate crystals
What are the 10 biochemical tests of a dipstick?
pH, protein, glucose, ketones, blood, bilirubin, urobilinogen, nitrite, leukocyte esterase, specific gravity
Large joints (knee, ankle, hip) typically contain how much synovial fluid?
~1mL
