2Fill in the blank: Protocols are developed to enhance ________ whereby microscopic examination of the urine sediment is performed only on specimens meeting specific criteria.
Cost-effectiveness.
\
3Enumerate the three conditions recommended by the CLSI for performing a microscopic examination of urine.
(1) Requested by a physician, (2) When a lab-specified population is tested, (3) When abnormal physical and chemical result is obtained.
\
4Fill in the blank: For proper specimen preparation, always use fresh or adequately ________ urine specimens.
Preserved.
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5Identify the action required for a refrigerated urine specimen BEFORE it undergoes centrifugation.
Warm the specimen to 37°C.
\
6Enumerate the three formed elements that disintegrate rapidly especially in dilute alkaline urine.
RBCs, WBCs, Casts.
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7True or False: A dilute random specimen may cause a false positive reading during microscopic analysis.
False.
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8Identify the ideal specimen type that is best for the microscopic examination of urine.
First morning, mid-stream clean catch urine.
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9Fill in the blank: The standard amount of specimen volume used for urine centrifugation is ________ mL.
10-15.
\
10Identify the average volume of urine specimen recommended for standard sediment preparation.
12 mL.
\
11Identify the specific tube type where urine is ideally placed for centrifugation.
Conical tube.
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12Fill in the blank: If less than 12 mL of urine is available for testing, centrifuge ________ mL of it.
3.
\
13True or False: If less than 3 mL of urine is available, the specimen should be examined without centrifugation.
True.
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14Identify the standard duration and speed required for the centrifugation of a urine specimen.
5 minutes with 1500-2000 RPM.
\
15Fill in the blank: During centrifugation, the specimen must be ________ to prevent the formation of aerosols.
Capped.
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16Fill in the blank: Following decantation of the supernatant fluid, leave about ________ mL of urine sediment.
0.5-1.
\
17Identify the preferred manual technique for removing supernatant urine instead of pouring it off.
Aspirated or pipetted.
\
18True or False: The urine sediment should be resuspended thoroughly before putting a drop on the glass slide.
True.
\
19Identify the specific volume of urine sediment that should be placed onto the glass slide.
20 uL or 0.02 mL.
\
20Identify the standard millimeter dimensions of the glass cover slip used for covering the urine sediment.
22x22 mm.
\
21Fill in the blank: To ensure a representative examination of the urine sediment, an average of ________ fields should be evaluated.
10.
\
22Identify the magnification power associated with the Low Power Objective (LPO) used during examination.
10x.
\
23Identify the specific cell type that serves as a useful point of reference when navigating under LPO.
Squamous Epithelial Cells.
\
24Fill in the blank: Under LPO, the analyst primarily detects ________, which tend to locate near the edges of the cover slip.
Casts.
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25Identify the primary clinical objective of examining the urine sediment under LPO first.
Ascertain the general composition of the sediment.
\
26Identify the magnification power associated with the High Power Objective (HPO) used during examination.
40x.
\
27Fill in the blank: The High Power Objective (40X) is used when there are elements that require ________.
Identification.
\
28Identify the description and alternative term used for normal red blood cells in urine.
Smooth, nonnucleated biconcave discs or Discocytes.
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29Enumerate the three descriptions or terms used for red blood cells encountered in hypertonic urine.
Crenated, Burr Cell, Echinocyte.
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30Enumerate the three descriptions or terms used for red blood cells encountered in hypotonic urine.
Ghost Cells, Swell, Lysed.
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31Identify the specific term for red blood cells that show projections and fragmentation as a direct result of glomerular membrane damage.
Dysmorphic RBCs.
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32Enumerate four specific examples of dysmorphic red blood cells resulting from glomerular membrane damage.
Acanthocytes, Schistocytes, Stomatocytes, Codocytes.
\
33Identify the medical term that describes the presence of red blood cells within the urine.
Hematuria.
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34Enumerate seven clinical conditions or causes that are associated with the presentation of hematuria.
Damage to glomerular membrane, Vascular Injury within the genitourinary tract, Infection, Inflammation, Malignancy, Trauma, Coagulation Disorders.
\
35True or False: Red blood cells are considered the easiest formed elements for laboratory students to recognize under the microscope.
False.
\
36Enumerate three structural reasons why red blood cells are difficult for students to correctly recognize.
Lack characteristic structure, variation in size, has many similar looking sediments.
\
37Enumerate the three primary sources of identification error for red blood cells in urine sediment.
Yeast Cells, Oil Droplets, Air Bubbles.
\
38Fill in the blank: To differentiate yeast cells from red blood cells, add 2% ________ to safely lyse the RBCs.
Acetic Acid.
\
39Fill in the blank: The normal reference value for red blood cells in standard urine is ________ per HPF.
0-2 or 0-3.
\
40Enumerate the two standard methods used for reporting red blood cells in a microscopic report.
Average Number per 10 HPFs, None Seen if negative.
\
41Enumerate the two complete urinalysis physical/chemical parameters that directly correlate with microscopic red blood cells.
Urine Color, Blood Pad.
\
42Identify the specific RBC variation seen under HPO characterized by smaller size and fragmentation in slide photo 12.
Dysmorphic RBC.
\
43Identify the RBC type seen under HPO characterized by small circles with nothing inside them in slide photo 12.
Normal RBC.
\
44Identify the RBC variations observed under LPO that are small and shrunken in slide photo 12.
Microcytic and Crenated RBCs.
\
45Identify the medical term that describes the presence of white blood cells within the urine.
Pyuria.
\
46Identify the predominant white blood cell type encountered in urine sediment samples.
Neutrophils.
\
47Identify the structural and nuclear microscopic appearance characteristic of neutrophils in urine.
Granular, Multilobed.
\
48Identify the specific name for swollen neutrophils in hypotonic urine that exhibit a distinct sparkling appearance.
Glitter Cells.
\
49Fill in the blank: The presence of neutrophils within urine sediment is primarily associated with ________ infections.
Bacterial.
\
50Identify the structural and nuclear microscopic appearance characteristic of eosinophils in urine.
Granulated, Multilobed.
\
51Identify the clinical condition that is primarily associated with an increased presence of eosinophils in urine.
Drug-Induced Interstitial Nephritis.
\
52Fill in the blank: The normal reference value for eosinophils within a urine sample is less than ________ percent.
1.
\
53True or False: The presence of eosinophils in a urine sediment sample becomes clinically significant if it is greater than 1%.
True.
\
54Enumerate four cell types that are collectively categorized as mononuclear cells in urine sediment.
Lymphocytes, Monocytes, Macrophages, Histiocytes.
\
55Describe the visual cytoplasmic features that can be seen in mononuclear cells under microscopic examination.
May appear vacuolated, abundant cytoplasm.
\
56Identify the specific mononuclear cell type that is increased during the early stages of renal transplant rejection.
Lymphocytes.
\
57Fill in the blank: The counts of monocytes and histiocytes are typically increased in cases of ________ inflammation.
Chronic.
\
58Enumerate the three primary sources of identification error for white blood cells in urine sediment.
Renal Tubular Epithelial Cells, Dead Trichomonads, Crenated RBCs.
\
59Fill in the blank: Crenated red blood cells can serve as a source of identification error because they closely look like ________.
Lymphocytes.
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60Enumerate the two agents or chemicals used to successfully differentiate renal tubular epithelial cells from white blood cells.
Supravital Stain (0.5% Toluidine Blue), 2% Acetic Acid.
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61Enumerate two distinct microscopic characteristics that allow an analyst to differentiate an RTE cell from a WBC.
RTE cells are larger, RTE cells have an eccentrically located nucleus.
\
62Fill in the blank: The normal reference value for white blood cells in a standard urine specimen is ________ per HPF.
0-5 or 0-8.
\
63Enumerate the three reporting formats or descriptions utilized for white blood cells.
Average Number Per 10 HPFs, TNTC, None seen if negative.
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64Identify what the specific laboratory reporting abbreviation TNTC stands for.
Too Numerous To Count.
\
65Enumerate the four chemical reagent strip pads or parameters that correlate with pyuria.
Leukocyte Esterase, Nitrite, Specific Gravity, pH.
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66Identify the cell type shown under HPO that displays prominent multilobed nucleoli in slide photo 17.
WBCs.
\
67Identify the specific type of neutrophils under HPO that display very noticeable internal granules in slide photo 17.
Glitter Cells.
\
68Identify the microscopic visual consequence observed when white blood cells are treated with acetic acid in slide photo 17.
Nuclear enhancement and ameboid shape.
\
69Identify the largest cells encountered during the microscopic examination of urine sediment.
Squamous Epithelial Cells.
\
70Fill in the blank: Squamous epithelial cells are estimated to be ________ times the size of a normal RBC.
5-7.
\
71Describe the irregular cytoplasmic appearance and nuclear location of a standard squamous epithelial cell.
Abundant irregular cytoplasm with a prominent centrally located nucleus; resembles a fried egg.
\
72Enumerate three anatomical locations where squamous epithelial cells line the tissue pathways.
Vagina, female urethra, male urethra.
\
73Fill in the blank: An increased number of squamous epithelial cells in a sample indicates specimen ________ due to poor collection technique.
Contamination.
\
74Identify the specific variation of squamous epithelial cells that serves as a diagnostic indicator for Bacterial Vaginosis.
Clue Cells.
\
75Identify the specific bacterial organism responsible for creating the vaginal infection marked by Clue Cells.
Gardnerella vaginalis.
\
76Describe the microscopic presentation and appearance of a diagnostic Clue Cell.
A squamous epithelial cell covered with bacteria.
\
77Fill in the blank: According to diagnostic criteria, bacteria must cover at least ________ percent of the cell and extend beyond its edges to be a Clue Cell.
70.
\
78Identify the primary source of identification error for squamous epithelial cells where they may mistakenly resemble casts.
Folded squamous cells.
\
79Enumerate the four qualitative reporting terms used for squamous epithelial cells per LPF.
Rare, Few, Moderate, Many.
\
80Fill in the blank: A reporting status of Rare for SECs corresponds to a range of ________ cells per LPF.
0-5.
\
81Fill in the blank: A reporting status of Few for SECs corresponds to a range of ________ cells per LPF.
5-20.
\
82Fill in the blank: A reporting status of Moderate for SECs corresponds to a range of ________ cells per LPF.
20-100.
\
83Fill in the blank: A reporting status of Many for SECs corresponds to a range of greater than ________ cells per LPF.
100.
\
84Identify the physical urinalysis parameter that must be correlated with the presence of squamous epithelial cells.
Urine Clarity.
\
85Identify the specific diagnostic cell variant indicated by the arrow in slide photo 21.
Clue Cell.
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86Identify the type of epithelial cell whose nucleus is centrally located if the cell is round, or off-center if the cell is elongated.
Transitional Epithelial Cells.
\
87Enumerate five anatomical sites where transitional epithelial cells normally originate along the urinary tract.
Renal Pelvis, Calyces, Ureter, Bladder, Upper male urethra.
\
88Enumerate two clinical pathologies where transitional epithelial cells are found in increased numbers.
UTI, renal carcinoma.
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89Enumerate two clinical procedures or interventions that lead to an increase of transitional epithelial cells in urine.
Catheterization, cystoscopy.
\
90Identify the shapes associated with transitional epithelial cells that originate from the superficial tissue layer.
Round, pear-shaped, spherical.
\
91Identify the shape and specific descriptive name given to transitional cells originating from the intermediate tissue layer.
Club-like caudate with tail, elongated.
\
92Enumerate three shapes characteristic of transitional epithelial cells originating from the basal tissue layer.
Small, rectangular, polyhedral.
\
93Identify the formed element that spherical transitional cells can look like, serving as a source of identification error.
RTE cells.
\
94Enumerate two abnormal morphological findings in transitional cells that can indicate malignancy or a viral infection.
Presence of vacuoles, irregular nuclei.
\
95Enumerate the four reporting ranges used to quantify transitional epithelial cells per HPF.
Rare, Few, Moderate, Many.
\
96Fill in the blank: A reporting status of Rare for transitional epithelial cells corresponds to a range of ________ cells per HPF.
0-5.
\
97Fill in the blank: A reporting status of Few for transitional epithelial cells corresponds to a range of ________ cells per HPF.
5-20.
\
98Fill in the blank: A reporting status of Moderate for transitional epithelial cells corresponds to a range of ________ cells per HPF.
20-100.
\
99Fill in the blank: A reporting status of Many for transitional epithelial cells corresponds to a range of greater than ________ cells per HPF.
100.
\
100Enumerate the two urinalysis parameters or pads that should be correlated with transitional epithelial cells.
Urine Clarity, Blood Pad.
\
101Identify the intermediate layer transitional cell characterized by a distinct tail projection pictured in slide photo 25.
Caudate Transitional Cell.
\
102Identify the most clinically significant type of epithelial cell found in urine sediment.
Renal Tubular Epithelial Cells.
\
103Identify the specific renal pathology or condition that directly causes the appearance of RTE cells in urine.
Tubular Necrosis.
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104Fill in the blank: In terms of tissue origin, renal tubular epithelial cells come from the ________ ONLY.
Nephron.
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105Describe the structural shape and nuclear placement characteristic of Collecting Duct RTE cells.
Polygonal or cuboidal with a large eccentric nucleus.
\
106Fill in the blank: The large eccentric nucleus of a collecting duct RTE cell can cover ________ percent of the total cell area.
60-70.
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107Enumerate three ischemic events that are associated with an increase in collecting duct RTE cells.
Shock, sepsis, trauma.
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108Identify the specific type of RTE cells that are known to be the largest among the group.
Proximal Tubular RTE Cells.
\
109Describe the unique shapes associated with proximal tubular (PCT) RTE cells.
Oblong, cigarette-shaped, columnar or rectangular.
\
110True or False: Proximal tubular RTE cells can be multinucleated with an eccentrically located nucleus.
True.
\
111Fill in the blank: Proximal tubular RTE cells are typically found increased in cases of ________.
Drug abuse.
\
112Describe the geometric shape and internal cytoplasm characteristic of Distal Tubular (DCT) RTE cells.
Ovoid to round with a grainy cytoplasm and eccentric nucleus.
\
113Enumerate four toxic events or ingestions that cause an increase in distal tubular RTE cells.
Heavy metals, hemoglobinuria, myoglobinuria, poison.
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114Fill in the blank: RTE cells are considered highly significant when their count is greater than ________ cells per HPF.
2.
\
115Identify the pathological tissue condition indicated when greater than 2 RTE cells per HPF are observed.
Tubular injury.
\
116Identify the specific viral pathogen that kills the highest amounts of renal tubular epithelial cells.
Cytomegalovirus.
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117Enumerate three elements or sediments that act as common sources of identification error for RTE cells.
Spherical Transitional Cells, Granular Casts, White Blood Cells.
\
118Enumerate the two standard formats utilized for reporting renal tubular epithelial cells.
Average Number per 10 HPFs, None seen if negative.
\
119Fill in the blank: In terms of RTE correlations, a positive leukocyte esterase and nitrite indicate possible ________.
Pyelonephritis.
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120Identify the chemical parameter on a reagent strip that serves as the earliest marker for kidney damage when correlated with RTE cells.
Protein.
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121Fill in the blank: The presence of bilirubin correlated with RTE cells indicates a possible case of ________.
Hepatitis.
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122Enumerate the remaining complete urinalysis parameters to correlate with RTE cells.
Urine Color, Urine Clarity, Blood.
\
123Enumerate the three forms of RTE cells pictured from left to right in slide photo 30 based on their nephron site shape.
RTE from DCT, RTE from CD, RTE from PCT.
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124Identify the lipid-containing, highly refractile variants of renal tubular epithelial cells.
Oval Fat Bodies.
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125Enumerate two clinical conditions where lipiduria presents alongside oval fat bodies.
Nephrotic Syndrome, Diabetes Mellitus.
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126Identify the specific name for renal tubular epithelial cells that contain non-lipid vacuoles.
Bubble Cells.
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127Fill in the blank: Bubble cells are typically seen in urine sediment during cases of ________ tubular necrosis.
Acute.
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128Identify the standard microscopic metric used for reporting both oval fat bodies and bubble cells.
Average number per HPFs.
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129Enumerate the two typical geometric shapes exhibited by bacteria in urine sediment.
Bacilli, Cocci.
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130Fill in the blank: The presence of bacteria in a urine specimen is considered significant when increased bacteria is paired with increased ________.
WBC.
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131Identify the primary bacterial family that is mostly associated with urinary tract infections.
Enterobacteriaceae.
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132Enumerate two gram-positive bacterial genera that can cause a urinary tract infection.
Staphylococcus, Enterococcus.
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133Enumerate the two unorganized crystal types that act as sources of identification error for bacteria.
Amorphous Urate, Amorphous Phosphates.
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134Enumerate four complete urinalysis parameters or findings to correlate with the presence of bacteria.
Leukocyte, Nitrite, pH, Presence of WBCs.
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135Enumerate the four qualitative reporting ranges used for bacteria per HPF.
Rare, Few, Moderate, Many.
\
136Fill in the blank: A reporting status of Rare for bacteria corresponds to a range of ________ per HPF.
0-10.
\
137Fill in the blank: A reporting status of Few for bacteria corresponds to a range of ________ per HPF.
10-50.
\
138Fill in the blank: A reporting status of Moderate for bacteria corresponds to a range of ________ per HPF.
50-200.
\
139Fill in the blank: A reporting status of Many for bacteria corresponds to a range of greater than ________ per HPF.
200.
\
140Describe the shape, color, nuclear status, and budding structures of yeast cells in urine.
Ovoid, colorless, refractile cells with no nucleus and characteristic budding forms with pseudo-hyphae.
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141Identify the dual criteria that define a true yeast infection in a patient's urine specimen.
Increased Yeast + Increased WBC.
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142Identify the specific yeast species seen in cases of Diabetes Mellitus or in immunocompromised patients.
Candida albicans.
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143Enumerate three terms used to describe the vaginal infection associated with yeast cells in urine.
Vaginal moniliasis, vaginal candidiasis, genital thrush.
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144Identify the primary formed element that serves as a major source of identification error for yeast cells.
Red Blood Cells.
\
145Enumerate three chemical pads or elements to correlate with yeast cells.
Glucose, Leukocyte Esterase, Presence of WBCs.
\
146Identify the qualitative yeast reporting category described as present but hard to find.
Rare.
\
147Identify the qualitative yeast reporting category described as one or more present in almost every field of view.
Few.
\
148Identify the qualitative yeast reporting category described as easy to find, more than few, less than many.
Moderate.
\
149Identify the qualitative yeast reporting category described as prominent and present in large numbers in all fields of view.
Many.
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150Identify the structural form of yeast pictured in slide photo 36 showing elongated, interconnected hyphae components.
Mycelial form.
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151Identify the most frequently encountered parasite in a standard urine sediment sample.
Trichomonas vaginalis.
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152Identify the alternative colloquial name for the sexually transmitted infection caused by Trichomonas vaginalis.
Ping-Pong Disease.
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153Describe the shape, membranes, and motility characteristic of Trichomonas vaginalis trophozoites.
Pear-shaped flagellate with an undulating membrane and jerky motility or rapid darting movement.
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154True or False: Trichomonas vaginalis infections within the male urethra or prostate are typically highly symptomatic.
False.
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155Identify the parasite egg found in urine as a contaminant resulting from fecal contamination or improper hygiene.
Enterobius vermicularis egg.
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156Fill in the blank: The egg of the pinworm Enterobius vermicularis exhibits a unique ________ shape.
D.
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157Identify the unique mode of transmission associated with Enterobius vermicularis.
Inhalation.
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158Identify the specific bladder parasite egg that is strongly associated with bladder cancer and hematuria.
Schistosoma haematobium egg.
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159Describe the shape and spine placement of a Schistosoma haematobium egg.
Blood fluke with a terminal spine, football-shaped.
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160Enumerate the two formed elements that serve as common sources of identification error for parasites.
RTE Cells, WBC.
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161Fill in the blank: Renal tubular epithelial cells can easily be mistaken for parasites especially when Trichomonas is ________.
Not moving.
\
162Enumerate the four qualitative reporting categories used for Trichomonads per HPF.
Rare, Few, Moderate, Many.
\
163Enumerate the two complete urinalysis elements to correlate with the presence of Trichomonads.
Leukocyte Esterase, WBCs.
\
164Enumerate the three specific parasites illustrated in slide photo 40 from left to right.
Trichomonas vaginalis, Schistosoma haematobium, Enterobius vermicularis.
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165Describe the structural appearance of spermatozoa heads and tails when found in urine.
Oval slightly tapered heads with long flagella-like tails.
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166Fill in the blank: Spermatozoa encountered in a urine sediment sample rarely exhibit motility because they are rapidly ________ by the urine.
Killed.
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167Identify the specific patient demographic population where laboratory protocols must be strictly followed when reporting spermatozoa.
Child's urine.
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168Identify the single source of identification error for spermatozoa in urine sediment.
None.
\
169Identify the chemical reagent pad on a standard test strip that correlates with spermatozoa.
Protein Pad.
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170Identify the terminology used to report the presence of spermatozoa according to laboratory protocol.
Present or Seen.
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171Enumerate three cellular or glandular structures responsible for producing mucus threads in urine.
Glands, epithelial cells, RTE cells.
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172Identify the major uromodulin glycoprotein constituent that makes up mucus threads.
Tamm-Horsfall Protein.
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173Describe the microscopic index and appearance of a mucus thread structure.
Threadlike with a low refractive index and irregular ends.
\
174Identify the primary urinary cast type that serves as a source of identification error for mucus threads.
Hyaline Cast.
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175Enumerate the four qualitative reporting categories used for mucus threads per LPF.
Rare, Few, Moderate, Many.
\
176Fill in the blank: A reporting status of Rare for mucus threads corresponds to a range of ________ per LPF.
0-1.
\
177Fill in the blank: A reporting status of Few for mucus threads corresponds to a range of ________ per LPF.
1-3.
\
178Fill in the blank: A reporting status of Moderate for mucus threads corresponds to a range of ________ per LPF.
3-10.
\
179Fill in the blank: A reporting status of Many for mucus threads corresponds to a range of greater than ________ per LPF.
10.
\
180Enumerate the two forms of mucus illustrated in slide photo 43.
Mucus clump, mucus thread.
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181Fill in the blank: Urinary casts are formed elements that are unique to the ________ ONLY.
Kidney.
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182Identify the clinical concept that a cast represents under microscopy, serving as a snapshot of an individual tubule.
Biopsy of an individual tubule.
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183Fill in the blank: The structural shape of any urinary cast is directly representative of the tubular ________.
Lumen.
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184Enumerate the two primary regions of the nephron where urinary casts are mainly formed.
DCT, Collecting Duct.
\
185Fill in the blank: When performing a microscopic check for casts, use LPO and focus specifically near the cover slip ________.
Edges.
\
186Identify the medical term that refers to the presence of urinary casts in a patient's specimen.
Cylinduria.
\
187Identify the standard quantitative metric used for reporting urinary casts under microscopy.
Average number per LPF.
\
188Identify the core uromodulin protein constituent that forms the primary matrix of all casts.
Tamm-Horsfall Protein.
\
189Enumerate the two specific urine specimen environments that cause a cast matrix to dissolve quickly.
Dilute, alkaline urine.
\
190Enumerate two non-pathological physiological states or periods that lead to an increased secretion of uromodulin.
Periods of stress and exercise.
\
191True or False: The presence of urinary casts can be directly detected using standard reagent strip method chemistry.
False.
\
192Fill in the blank: A standard urinary cast maintains a uniform diameter that is approximately ________ times that of an RBC.
7-8.
\
193Enumerate the three specific conditions required within the renal tubules for the formation of casts.
Urine-flow stasis, Acidity, Increased sodium and calcium.
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194Enumerate the six sequential steps involved in the physiological formation and eventual excretion of a urinary cast.
1. Aggregation of uromodulin protein into individual protein fibrils attached to RTE cells, 2. Interweaving of protein fibrils to form a loose fibrillar network, 3. Further protein fibril interweaving to form a solid structure, 4. Possible attachment of urinary constituents to solid matrix, 5. Detachment of protein fibrils from the epithelial cells, 6. Excretion of the cast.
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195Enumerate the five sequential stages of cast degeneration from its initial cellular form to its final stage.
(1) Hyaline Cast, (2) Cellular Cast, (3) Coarsely Granular, (4) Finely Granular, (5) Waxy Cast.
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196Fill in the blank: The normal reference value for hyaline casts in a healthy individual is ________ per LPF.
0-2.
\
197Describe the visual matrix, refraction index, sides, and ends characteristic of a hyaline cast.
Colorless, homogenous matrix with a low refractive index, parallel sides, and rounded ends.
\
198Identify the most commonly observed urinary cast that acts as the prototype cast beginning for all other types.
Hyaline cast.
\
199Enumerate three microscopic elements or settings that serve as sources of error when identifying hyaline casts.
Mucus Threads, Fibers, Increased Lighting.
\
200Enumerate four clinical conditions or diseases that demonstrate a clinical significance linked with hyaline casts.
Chronic Renal Disease, Congestive Heart Failure, Glomerulonephritis, Pyelonephritis.
\
201Identify the color and internal matrix contents characteristic of an RBC cast.
Orange-red color with a cast matrix containing RBCs.
\
202Identify the specific cellular cast type that is recognized as the most fragile cast.
RBC cast.
\
203Identify the primary source of identification error for RBC casts.
RBC clumps.
\
204Enumerate three clinical conditions or activities associated with the presentation of RBC casts.
Glomerulonephritis, Lupus (SLE), Strenuous Exercise.
\
205Identify the specific components found contained within the protein matrix of a WBC or pus cast.
Intact WBCs.
\
206Identify the clinical condition for which the finding of a WBC cast is diagnostic, safely distinguishing it from cystitis.
Pyelonephritis.
\
207Enumerate the two primary sources of error when identifying WBC casts under microscopy.
WBC clumps, RTE cells.
\
208Enumerate three clinical conditions associated with the finding of WBC/Pus casts.
Pyelonephritis & other infections, Acute Interstitial Necrosis, SLE.
\
209Describe the composition and visual shapes of the cells attached within an RTE cell cast.
RTE cells attached to a protein matrix appearing as smaller, round, and oval cells.
\
210Identify the primary source of identification error for RTE cell casts.
WBC cast.
\
211Enumerate three clinical conditions associated with the observation of RTE cell casts.
Renal Tubular Damage, Drug Toxicity, Acute Tubular Necrosis.
\
212Describe the size, color, and density features of a coarsely granular cast.
Large coarse granules within a matrix that tend to be darker in color.
\
213Enumerate three internal structural sources or byproducts from which coarsely granular cast granules originate.
Degenerating cells, trapped cellular debris, metabolic byproducts.
\
214True or False: Coarsely granular casts are directly associated with one specific, unique renal disease.
False.
\
215Enumerate the two sources of identification error for coarsely granular casts.
Clumps of small crystals, columnar RTE Cells.
\
216Describe the granule distribution, size, and appearance texture characteristic of a finely granular cast.
Small granules dispersed throughout the matrix giving a sandpaper appearance.
\
217Identify the cellular metabolic structures or organelles from which finely granular cast granules originate.
Lysosomes of RTE cells.
\
218Enumerate four benign or physiological conditions that can be accompanied by finely granular casts.
Strenuous exercise, stress, dehydration, fever.
\
219Enumerate the two sources of identification error for finely granular casts.
Clumps of small crystals, columnar RTE cells.
\
220Describe the refraction, ends, cracks, matrix, and appearance characteristic of a waxy cast.
Highly refractile cast with jagged ends and notches (cracks), a brittle ground-glass appearance, and a homogenous matrix.
\
221Identify the specific laboratory embedding material that waxy casts visually resemble.
Paraffin shavings.
\
222Identify the stage of degeneration represented by the finding of a waxy cast.
Final degenerative form of all types of casts.
\
223Enumerate the two elements that serve as sources of identification error for waxy casts.
Fibers, Fecal Material.
\
224Identify the critical renal condition indicated by the persistent presence of waxy casts.
Chronic Renal Failure leading to End-Stage Renal Disease.
\
225Enumerate three additional clinical states associated with the presence of waxy casts.
Stasis of Urine Flow, Nephrotic Syndrome, Transplant Rejection.
\
226Fill in the blank: A broad cast is characterized by a matrix that is ________ times wider than a normal cast.
2-6.
\
227Identify the common clinical designation or nickname given to a broad cast.
Renal Failure Cast.
\
228Identify the structural change in the kidney tubules indicated by the appearance of a broad cast.
Destruction or widening of tubular walls.
\
229True or False: Any type of urinary cast has the potential to progress and become a broad cast.
True.
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230Enumerate the two sources of identification error for broad casts.
Fecal Material, Fibers.
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231Enumerate the two clinical conditions or states associated with the presence of broad casts.
Extreme urine stasis, Renal failure.
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232Identify the internal structures attached to the protein matrix that comprise a fatty cast.
Fat droplets, oval fat bodies.
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233Identify the optical refraction status and distinct color sheen exhibited by fat droplets in a fatty cast.
Highly refractile fat droplets with a yellowish-green sheen.
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234Identify the primary source of identification error for fatty casts.
Fecal debris.
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235Enumerate four clinical diseases or traumas associated with the finding of fatty casts.
Nephrotic Syndrome, Toxic Tubular Necrosis, Diabetes Mellitus, Crush Injuries.
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236Identify the structural definition of a pigmented cast.
Hyaline matrix with coloration due to pigment incorporation.
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237Identify the pigment that imparts a distinct gold-brown color to a pigmented cast matrix.
Bilirubin.
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238Enumerate two pigments that impart a yellow to red-brown color to a pigmented cast matrix.
Hemoglobin, Myoglobin.
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239Identify the common name for a hemoglobin-incorporated cast that describes its muddy visual color.
Blood cast.
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240Identify the cast type characterized by bacilli bound to a protein matrix, serving as a distinct sign of pyelonephritis.
Bacterial cast.
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241Identify the specific pigmented cast type illustrated in slide photo 59.
Muddy Brown Cast.
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242Enumerate two clinical scenarios or conditions associated with the formation of crystal casts.
Renal calculi, drug precipitation.
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243Identify the specific clinical kidney infection marked by the observation of fungal casts.
Fungal pyelonephritis.
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244Identify the cast variant that contains multiple distinct cell types within a single matrix, associated with multiple conditions.
Mixed cellular cast.
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245Identify the specific drug crystal type embedded within the cast matrix shown in slide photo 60.
Sulfamethoxazole Crystals.
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246Describe the visual ribbon folds and end characteristics of mucus threads when acting as a cast look-alike.
Ribbon-like with twists and folds and serrated or irregular ends.
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247Identify the structures with tapered ends that share the exact same clinical significance as standard casts.
Cylindroids.
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248Identify the specific structural junction in the nephron where cylindroid casts are formed.
Junction of Ascending Loop of Henle and DCT.
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249Identify the cast look-alike element pictured in slide photo 61.
Cylindroid.
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250True or False: Most unorganized urinary crystals found routinely in urine samples are highly clinically significant.
False.
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251Identify the physical process that leads to the formation of unorganized crystals from urinary solutes.
Precipitation.
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252Identify the single most valuable analytical aid or parameter used in the identification of urinary crystals.
Urine pH.
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253Enumerate three core physical and chemical factors that contribute directly to crystal formation.
pH, Solute Concentration, Temperature.
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254Identify the specific metabolic compound or breakdown category that leads to uric acid crystals when increased.
Purines.
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255Enumerate three color hues that can be displayed by uric acid crystals under microscopy.
Colorless, yellow-brown, yellow to golden-brown.
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256Enumerate seven pleomorphic shapes or forms that uric acid crystals can characteristically exhibit.
Rhombic (Diamond), Four-sided Flat Plates (Whetstones), Flat forms, Cubic forms, Barrel forms, Wedge, Rosettes, Lemon-shaped.
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257Identify the atypical hexagonal shape variant of uric acid crystal that can be easily mistaken for a cystine crystal.
Hexagon.
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258Enumerate five clinical statuses, diseases, or therapies associated with the finding of uric acid crystals.
Receiving Chemotherapy, Lesch-Nyhan Syndrome, Gouty Arthritis, Chronic Nephritis, Renal Calculi.
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259Describe the precipitate color and common nickname given to amorphous urates in urine.
Orange-pink precipitate with a "Brick Dust" appearance.
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260Describe the sand texture, color, and cast mimicking arrangement of amorphous urates.
Sand-like appearance, yellow-brown in color, and can form clumps resembling granular casts.
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261Identify the specific urine pigment that accumulates to form a pink sediment when amorphous urates are refrigerated.
Uroerythrin.
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262Identify the laboratory remedy used to successfully clear turbidity caused by amorphous urates before chemical testing.
Warm urine specimen to 37°C.
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263Identify the most frequently observed urinary crystal found across general urinalysis testing.
Calcium Oxalate.
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264Enumerate three specific foods or vitamins high in oxalic acid that promote calcium oxalate crystal formation.
Tomatoes, asparagus, Vitamin C.
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265Identify the scientific name given to the more common, dihydrate form of calcium oxalate.
Weddellite.
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266Enumerate four shapes or geometric symmetry forms displayed by dihydrate calcium oxalate crystals.
Octahedral envelope, two pyramids joined at their bases, bi-pyramidal prisms, dodecahedral.
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267Identify the scientific name given to the less common, monohydrate form of calcium oxalate.
Whewellite.
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268Enumerate the two primary shapes displayed by monohydrate calcium oxalate crystals.
Oval, Dumbbell shaped.
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269Fill in the blank: Oval shapes of monohydrate calcium oxalate crystals can easily resemble normal ________.
RBCs.
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270Identify the atypical shape of monohydrate calcium oxalate and the specific chemical poisoning case it signifies.
Diamond/Rhomboid shape; Ethylene Glycol Poisoning.
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271Enumerate the two common populations where ethylene glycol poisoning usually occurs.
Children, pets.
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272Describe the shape and prism structure characteristic of normal sodium urate crystals.
Needle-shaped, slender pencil-like prisms.
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273Identify the game that a cluster of sodium urate crystals closely resembles visually.
Pick-up sticks.
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274Enumerate two rare spherical structural forms that sodium urates can occasionally take.
Spherulite, Beachball appearance.
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275Describe the color, elongated shapes, and noodle-like thickness characteristic of hippuric acid crystals.
Yellow brown or colorless, elongated prisms or hexagons, thin resembling noodles.
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276Describe the needles, cigarette nickname, and identical look-alike crystal associated with calcium sulfate.
Long colorless needles or prisms, "cigarette-butt" shape; identical to Calcium Phosphate.
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277Identify the most common chemical cause of turbidity encountered in alkaline urine specimens.
Amorphous Phosphates.
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278Describe the color, texture, and sand presentation characteristic of amorphous phosphates.
White-colorless or beige, granular, sand-like appearance.
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279True or False: Turbidity caused by amorphous phosphates in refrigerated urine will disappear when the specimen is warmed.
False.
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280Identify the alternative mineral name given to calcium phosphate crystals.
Apatite.
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281Identify the more common chemical form of calcium phosphate crystals found in urine.
Dibasic form.
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282Enumerate three structural shapes or star arrangements characteristic of dibasic calcium phosphate crystals.
Thin slat-like prisms in rosette, Stars Arrangement (Stellar Form), flat rectangular plates.
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283Identify the drug crystal class that the rosette form of dibasic calcium phosphate can be easily confused with.
Sulfonamide crystals.
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284Identify the pathological renal structure of which calcium phosphate is a common chemical constituent.
Renal calculi.
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285Identify the less common chemical form of calcium phosphate crystals found in urine.
Monobasic form.
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286Describe the sheets, plates, and unique floating behavior characteristic of monobasic calcium phosphate.
Large, thin, irregular, granular-appearing sheets or plates; tend to float on the surface of urine.
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287Enumerate two alternative chemical or mineral names used for triple phosphate crystals.
Struvite, Ammonium Magnesium Phosphate.
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288Identify the iconic prism shape that triple phosphate crystals characteristically resemble.
Coffin lid.
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289Identify the feathery or botanical appearance that triple phosphate crystals take as they begin to disintegrate.
Fern-leaf like.
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290Enumerate two atypical structural shapes that triple phosphate crystals can display.
Flat, X-shaped.
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291Enumerate four clinical conditions or urinary tract issues where triple phosphate crystals are found.
Calculi, Enlarged Prostate, Cystitis, Urine Stasis.
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292Identify the specimen condition and age where ammonium biurate crystals are characteristically encountered.
Old specimen.
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293Identify the color and iconic spicule fruit nickname associated with ammonium biurate crystals.
Yellow brown; "Thorny apples" appearance / spicule-covered spheres.
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294Describe the color and shapes characteristic of normal calcium carbonate crystals.
Colorless, dumbbell or spherical shapes.
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295Enumerate two microscopic elements that clumps of calcium carbonate can closely resemble.
Amorphous material, bacteria.
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296Identify the specific chemical reaction phenomenon that occurs when acetic acid is added to calcium carbonate crystals.
Gas Formation (Effervescence).
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297Describe the color, refraction, structure, and plate geometry characteristic of cystine crystals.
Colorless, refractile, laminated appearance, hexagonal plates.
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298Identify the normal acid urinary crystal that cystine crystals can most easily be mistaken for.
Uric acid.
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299Describe the stop-sign side counts and birefringence differences that allow an analyst to separate cystine from uric acid.
Cystine: six-sided stop sign, NOT birefringent; Uric acid: four-sided stop sign, VERY birefringent.
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300Describe the flat plates, corner notches, and pattern name characteristic of cholesterol crystals.
Colorless, flat, notched plates forming a "staircase pattern" with a rectangular plate notched in one or more corners.
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