Urinalysis & Other Body Fluids (Review)
Which of the following situations suggest a traumatic tap occurred?
- More blood is in tube 1 than tubes 2, 3 or 4. - Blood clots are present.
Match the following casts with their associated conditions/descriptions.
- Mucous threads may resemble these casts Hyaline casts - Seen in renal infection or inflammation such as pyelonephritis White cell casts - Composed of plasma protein aggregates and cellular remnants Granular casts - Refractile casts with squared-off ends associated with chronic tubular injury Waxy casts
Which of the following are directly involved in the production of semen?
- Prostate - Seminal vesicles - Bulbourethral gland
Which of the following are functions of CSF?
- Supply nutrients to nervous system tissue. - Protect spinal cord from injury. - Remove waste products from cerebral metabolism.
A patient suspected of a urinary tract infection has a negative nitrite test, but bacteria is present upon microscopic examination. What may have caused this discrepant result? (Choose ALL of the correct answers)
- The bacteria that is present is not a nitrate-reducer. - The urine was in the bladder for an insufficient amount of time for nitrate to be reduced to nitrite.
Which of the following statements are TRUE regarding the reagent strip test procedure? (Choose ALL correct answers)
- Urine should be well mixed prior to dipping the reagent strip. - Prolonged immersion may wash out test reagents.
When an automated or semi-automated method is used to read urine chemical reagent strips, quality control testing must be performed at least how often?
- With each new lot of reagent strips. - Every day of patient testing.
The image is a stained smear of cerebrospinal fluid. What types of cells are present in this field?
- pia arachnoid mesothelial cells - macrophages
How many white blood cells (WBCs) would be considered normal for adult cerebrospinal fluid?
0-5 WBCs/µL
What is the lower reference limit for semen volume according to the World Health Organization, WHO Laboratory Manual for the Examination and Processing of Human Semen, 5th edition?
1.5 mL
The volume of urine recommended for centrifugation for a microscopic examination is:
10 - 15 mL
A 1:10 dilution is made on a CSF sample. Five squares on each side of the hemacytometer are counted for a total of 10 squares and a total of 150 cells are
1500 Cells/µL = 150 x 10/ 10 x 0.1 µL Cells/µL = 1500 / 1 = 1500/µL
A dilution commonly used for a routine sperm count is:
1:20
A patient who has a primarily vegetarian diet will most likely have an acid urine pH.
False
A sperm concentration of 25 x 106 spermatozoa/ mL would be considered an abnormally low concentration, according to the lower normal reference limit stated in WHO 5th edition.
False
The crystals that are seen in this image are calcium oxalate.
False
When the glucose result on a urine specimen from an infant is negative on the reagent strip, it can be assumed that the specimen is negative for other reducing substances such as galactose.
False
True or False: Lymphocyte pleocytosis refers to a decreased number of lymphocytes in a CSF when compared to a normal sample.
False The answer is false, as the presence of a greater than normal number of lymphocytes in the spinal fluid is considered lymphocyte pleocytosis.
The crystals that are seen in this image are triple phosphate crystals.
False These are cholesterol crystals.
Which of the following casts is characteristically associated with acute pyelonephritis?
white cell
A sample of cerebrospinal fluid is diluted 1:100; the standard 9 squares of a hemocytometer were counted on each side for a total of 18 large squares. Side 1- 186 cells counted Side 2- 184 cells counted total cells = 370 What is the cell count per microliter?
2.06 x 10^4 In this example, we would use the standard manual WBC count equation. Cells/µL = # of cells counted x dilution / # of large squares counted x 0.1µL (chamber depth) In this case, Cells/µL = 370 x 100 / 18 x 0.1 Cells/µL = 37000 / 1.8 Cells/µL = 20556 or 2.06 x 10^4
A spinal fluid that is slightly hazy is briefly examined microscopically. The technologist performing the count decides to make a 1:10 dilution using 30 µL of sample. What volume of diluent should be used?
270 µL
What is the optimal time to begin initial microscopic examination of a semen specimen, assuming liquefaction is complete?
30 minutes
What is the lower reference limit for progressive motility of spermatozoa when performing a semen analysis?
32% The lower reference limit for progressive motility is 32%. The lower reference limit for total motility (progressive + non-progressive) is 40 %.
A CSF glucose value is 62 mg/dL. What would you estimate the serum glucose?
93 mg/dL CSF glucose is roughly estimated to be about 2/3 of the serum glucose level in mg/dL.
What is the glomerular filtration rate for a patient with a serum creatinine of 2 mg/dL, if the urine creatinine was 124 mg/dL and the urine volume was 2.2 L/24 hrs?
95 mL/min One method of calculating a glomerular filtration rate is using creatinine and urine volume to determine creatinine clearance. The equation is as follows: Creatinine Clearance = (urine creatinine X urine flow rate) / plasma creatinine; where urine flow rate = volume in mL /24 hours x h/60 min) In this case = creatinine clearance = 124 X (2200/24 x hour/60) / 2 = 94.7 or 95 ml/min
Below is a urinalysis report on a 37-year-old woman seen in the ER with headache, hypertension, weight loss and mild edema: Color: red Clarity: cloudy Sp. Gravity 1.010 pH 5.0 Glucose: negative Protein: 3+ Ketones: negative Nitrite: negative Blood: moderate Urobilinogen: normal Microscopic: 25-50 RBC 2-4 WBC 2-5 granular casts 2-5 hyaline casts 0-2 RBC casts few epithelial cells Based on the urinalysis report above, the MOST probable diagnosis of this patient's condition is:
Acute glomerulonephritis
Oliguria is usually correlated with:
Acute glomerulonephritis
Match the following factors with the expected urine pH type:
Alkaline pH metabolic alkalosis Acidic pH meat-filled diet Alkaline pH vegetarian diet Acidic pH high urine glucose
Identify the urine sediment elements present in this acidic urine:
Amorphous urate crystals
Common crystals which can be found in ACID urine include: (Choose all that apply.)
Amorphous urates Calcium oxalate
A 3-year old girl was brought to the ER with a temperature of 103ºF, lethargy, and cervical rigidity. Three tubes of cloudy CSF were delivered to the Lab, and preliminary test results showed: WBC: 4,500/uL Differential: 88% neutrophils Glucose: 15 mg/dL 12% lymphocytes Protein: 140 mg/dL Gram stain: No organisms observed From these results, what preliminary diagnosis SHOULD the physician consider?
Bacterial meningitis
Which of the following substances can cause a false positive result for blood on the urine chemical reagent strip?
Bleach in the collecting bottle
Significantly increased levels of ketones are detected in the urine with which of the following conditions? (Choose ALL correct answers)
Diabetic acidosis Excessive carbohydrate loss Starvation
Which of the following would be the most characteristic finding in synovial fluid in a case of pseudogout:
Calcium pyrophosphate crystals
The renal threshold is best described as:
Concentration at which a substance in the blood spills into urine
The Clinitest® reaction is based on which of the following principles?
Copper reduction
Which of the following tests would be useful in the assessment of glomerular filtration:
Creatinine clearance
Which of the following best defines specific gravity:
Density of a solution compared to density of water
Sudan III will confirm the presence of:
Fat
Identify the urine sediment element:
Fatty cast
Identify the urine sediment elements present in this illustration:
Fine granular casts
Which of the following is not a routine component of semen analysis:
Fructose level
Which of the following parameters is generally NOT considered to be a part of a seminal fluid analysis?
Glucose concentration
Unconjugated bilirubin is conjugated in the liver with which of the following substances to become water soluble?
Glucuronic acid
Nitrates in urine are reduce to nitrites by:
Gram-negative bacteria
A positive leukocyte esterase test indicates the presence in a urine specimen of which of the following?
Granulocytes
An increased number of these cells, when found upon microscopic examination of urine is termed:
Hematuria
A spectrophotometric scan of amniotic fluid may be valuable in the determination of which of the following conditions:
Hemolytic disease of the newborn
True or false? The element that is indicated by the arrow is a red blood cell cast.
True
True or false? Yeast is present in this slide.
True
Which one of the following statements about urea is false:
It is decreased in dehydration
White blood cell casts are MOST likely to indicate disease of the:
Kidney
The image is a Wright-Giemsa stained smear (1000x) of cerebrospinal fluid (CSF). The arrows point to cells that may indicate which of the following conditions?
Leukemia with CNS involvement
Which of the following is characteristic of an exudates effusion?
Leukocyte count greater than 1000 WBC/uL
Substances found in urinary sediment that are more easily distinguished by use of polarized microscope are:
Lipids
Normal adult CSF may have 0-5 white blood cells (WBCs)/µL. Which of the following cell types account for 60-100% of these WBCs?
Lymphocytes
Urine should be at room temperature prior to testing with the reagent strip method.
True
Identify the urine sediment elements shown by the arrow:
Mucus threads
To screen for urinary tract infections, leukocyte esterase results should be evaluated along with the results from which of these other reagent strip tests?
Nitrite
A semen sample for semen analysis should generally be received at the testing site within what period of time?
One hour
Bence-Jones proteinuria is associated with all of the following conditions except:
Pernicious anemia Macroglobulinemia, Multiple Myeloma, and Amyloidosis are all associated with abnormal protein production and/or accumulation which can result in Bence-Jones proteins being excreted in the urine.
Match urine color with substance that might have been responsible:
Phosphates White Bilirubin Yellow Pseudomonas Blue to green Porphobilinogen Red to brown
How should the production of a blue or purple color on the test pad of an Ictotest® be interpreted?
Positive for bilirubin
Which of the following macroscopic findings is MOST consistent with the microscopic finding of casts?
Positive protein
The arrows in the images below indicate cells that may be observed in CSF samples. Match each image to the cell's identification.
Presumptive malignant cells Image A
Upon centrifugation, a cerebrospinal fluid (CSF) sample supernatant exhibited xanthochromia. The image is a Wright-Giemsa stained smear that was made from that CSF sample. What condition is probably related to these macroscopic and microscopic findings?
Previous subarachnoid hemorrhage
The primary site of reabsorption of glomerular filtrate is the:
Proximal convoluted tubule
What type of cast is shown in the illustration?
RBC cast
Xanthochromia in a premature infant may be due to an immature blood-brain barrier.
True
Which of the following cells when found upon microscopic examination of the urine would be most indicative of kidney disease:
Tubular epithelial cells
The presence of increased levels of protein in the urine may be an early indicator of which of the following conditions?
Renal disease
Which of the following specimen collection methods should NOT be used if urine cultures are also required?
Routinely voided
Which of the following would best describe what you might observe after a traumatic CSF tap:
Significantly more RBCs found in tube #1 vs. tube #3
How does ion concentration in the urine relate to specific gravity?
Specific gravity increases as ionic concentration increases.
What is the identity of the cells that are indicated by the arrow in this image?
Squamous epithelial cells (SECs)
Identify the urine sediment elements shown by the arrow:
Starch crystals
The reaction which differentiates crystals from starch is:
Starch stains blue black with iodine
Which of the following would be the most appropriate method to confirm a positive protein from a urine dipstick:
Sulfosalicylic acid precipitation
The nephron includes all of the following except:
Urethra
A negative glucose oxidase test and a positive test for reducing sugars in urine indicates:
The presence of a non-glucose reducing sugar such as galactose
What is the identification of these crystals seen in urine with an alkaline pH?
Triple phosphate
Identify the urine sediment elements indicated by the arrow in the illustration:
Triple phosphate crystals
Cytocentrifugation is the recommended method for preparing a cerebrospinal fluid (CSF) sample for examination of cellular morphology.
True
Quality control procedures should be performed with each new lot of chemical reagent strips, and as often as required by the laboratory's procedure.
True
The gold-orange needle-like crystals that are indicated by the arrows are bilirubin crystals.
True
The patient is a female and the urinalysis is completed within two hours of collection. True or false? The presence of bacteria correlates with the slight turbidity and WBC result.
True
True or false? The cells shown in the image to the right are transitional epithelial cells.
True
A test that can be used as a confirmatory test for urobilinogen is:
Watson-Schwartz Test
Identify the urine sediment elements shown by the arrow:
Waxy casts
Cell counts on CSF specimens should be performed within what time frame following collection of the CSF sample?
Within one hour
Two CSF specimens were sent to the Lab with the following results: Tube #1 = 11,200 rbc/µL Tube #2 = 300 rbc/µL The results on these CSF specimens are indicative of:
a traumatic tap
Fecal urobilinogen level may be markedly decreased because of:
biliary obstruction
Charcot-Leyden crystals in stool may be associated with an immune response and are thought to be the breakdown products of:
eosinophils
If CSF tubes numbered #1, #2 and #3 CANNOT be analyzed within one hour, the correct procedure for the microbiology sample tube is to:
leave it at room temperature
The image is a stained smear of cerebrospinal fluid. The cell in this slide could be caused by what condition?
metastasis
Semi-automated and automated urine chemical reagent strip readers:
remove subjectivity allowing for better reproducibility
