Deck 6: Microscopic Examination of Urine

Question 1

Substances found in the urinary sediment that can be confirmed using polarized light are:

A) WBCs
B) Casts
C) Ketone bodies
D) Lipids

Answer 1

D

Question 2

The recommended centrifugation setting for preparation of the urine sediment is:

A) 400 RPM for 10 minutes
B) 1000 RPM for 5 minutes
C) 400 RCF for 5 minutes
D) 1000 RCF for 10 minutes

Answer 2

C

Question 3

To detect the presence of casts,the sediment is examined using:

A) Increased light under high power
B) Increased light under low power
C) Reduced light under high power
D) Reduced light under low power

Answer 3

D

Question 4

The most probable structures to be stained by the Prussian blue stain are:

A) Renal tubular epithelial cells
B) WBCs
C) Transitional epithelial cells
D) Urothelial cells

Question 5

Using polarized microscopy,which of the following is/are birefringent?

A) Cholesterol
B) Triglycerides
C) Fatty acids
D) Neutral fats

Question 6

The purpose of including glucose as a significant chemical parameter by a laboratory that performs macroscopic screening is to check for the presence of:

A) WBC casts
B) Hyaline casts
C) Trichomonas vaginalis
D) Candida albicans

Question 7

10 mL of urine is centrifuged,and 9.5 mL of urine is decanted.The sediment concentration factor is:

A) 5
B) 12
C) 20
D) 24

Question 8

Identification of oval fat bodies can be verified using:

A) Bright-field microscopy
B) Phase contrast
C) Polarized light
D) Interference-contrast microscopy

Question 9

The number of fields that should be examined when quantitating urinary sediment constituents is:

A) 2
B) 5
C) 10
D) 20

Question 10

The purpose of scanning the perimeter of urine sediment placed under a conventional glass slide is to:

A) Identify types of casts
B) Detect renal tubular epithelial cells
C) Evaluate the overall sediment composition
D) Detect the presence of casts

Question 11

Calculation of the number of RBCs per milliliter of urine requires knowledge of all of the following except the:

A) Number of high-power fields per milliliter of urine
B) Speed of centrifugation
C) Number of high-power fields per viewing area
D) Area of a high-power field

Question 12

A urine specimen is referred for cytodiagnostic urine testing to detect the presence of:

A) Trichomonas vaginalis
B) Blitter cells
C) Malignant cells
D) Spermatozoa

Question 13

A medical laboratory science student consistently obtains lower RBC counts than the instructor.A possible reason for this might be:

A) Failure to completely resuspend the sedimented specimen
B) Reading the same cells twice
C) Counting all crenated cells twice
D) Using too much stain

Question 14

The two factors that determine relative centrifugal force are:

A) Radius of rotor head and revolutions per minute (RPM)
B) Radius of rotor head and time of centrifugation
C) Diameter of rotor head and RPM
D) RPM and time of centrifugation

Question 15

A lipid droplet that does not stain with Sudan III may be composed of:

A) Triglycerides
B) Cholesterol
C) Neutral fats
D) Chylomicrons

Question 16

Centrifugation of less than the recommended 12 mL of urine for the microscopic examination will:

A) Produce a false-negative sulfosalicyclic acid (SSA)
B) Produce a false-positive SSA
C) Increase the number of cellular elements
D) Decrease the number of cellular elements

Question 17

All of the following are reported as the quantity per high-power field except:

A) Casts
B) Red blood cells (RBCs)
C) White blood cells (WBCs)
D) Bacteria

Question 18

The predecessor of the standardized urine microscopic examination was the:

A) Sternheimer count
B) Addis count
C) Kova system
D) T-system

Question 19

To standardize the sediment concentration for microscopic analysis one must:

A) Centrifuge the entire urine collection
B) Use only the urine tubes and pipettes for a single commercial system
C) Interchange the urine tubes and pipettes from several commercial systems
D) Use only the parts of the commercial system that you want

Question 20

Using a bright-field microscope,the final magnification of a high-power field is:

A) 10X
B) 40X
C) 400X
D) 1000X

Question 21

The presence of crenated RBCs in the urine sediment is associated with:

A) Rrauma
B) Hypersthenuria
C) Hyposthenuria
D) Urinary tract infection

Question 22

In ascending order,the location of epithelial cells in the urinary tract is:

A) Squamous, transitional, renal tubular
B) Transitional, renal tubular, squamous
C) Renal tubular, transitional, squamous
D) Squamous, renal tubular, urothelial

Question 23

The presence of hypochromic,irregularly shaped RBCs in the urine sediment can indicate:

A) A coagulation disorder
B) Menstrual contamination
C) Urinary tract infection
D) Glomerular bleeding

Question 24

Leukocytes that stain pale blue with Sternheimer-Malbin stain and exhibit brownian movement are:

A) Indicative of pyelonephritis
B) Basophils
C) Mononuclear leukocytes
D) Glitter cells

Question 25

Dilute alkaline urine should be examined carefully for the presence of:

A) Yeast
B) Renal tubular epithelial cells
C) Ghost RBCs
D) Fatty casts

Question 26

The organisms attached to a clue cell are:

A) Gardnerella vaginalis
B) Trichomonas vaginalis
C) Escherichia coli
D) Candida albicans

Question 27

Glitter cell is a term used to describe a specific type of:

A) Ketone body
B) Renal tubular epithelial cell
C) Neutrophil
D) Oval fat body

Question 28

An increase in urinary WBCs is called:

A) Pyelonephritis
B) Cystitis
C) Urethritis
D) Pyuria

Question 29

Eosinophils are found in the urine in cases of:

A) Nephrotic syndrome
B) Cystitis
C) Acute interstitial nephritis
D) Renal lithiasis

Question 30

A patient with severe back pain and 15 to 20 RBCs/hpf in the urine sediment may have:

A) Renal calculi
B) Acute glomerulonephritis
C) Nephrotic syndrome
D) Osteomyelitis

Question 31

To increase the probability of detecting urine sediment constituents that have a low refractive index,clinical laboratories often use:

A) Phase-contrast microscopy
B) Polarizing microscopy
C) Interference-contrast microscopy
D) Bright-field microscopy

Question 32

Urine sediments containing increased WBCs should be observed closely for the presence of:

A) Hyaline casts
B) Granular casts
C) Bacteria
D) Urothelial cells

Question 33

Optimal viewing is obtained by performing Köhler illumination adjustment to the:

A) Field diaphragm
B) Condenser
C) Operative diaphragm
D) Rheostat

Question 34

Urothelial cells routinely occur in all of the following shapes except:

A) Spherical
B) Cylindroid
C) Polyhedral
D) Caudate

Question 35

Clue cells are derived from:

A) Renal tubular epithelial cells
B) Trichomonas vaginalis
C) Histiocytes
D) Squamous epithelial cells

Question 36

Oval fat bodies are:

A) Squamous epithelial cells that contain lipids
B) Renal tubular epithelial cells that contain lipids
C) WBCs that have phagocytized lipids
D) People who fail to work out regularly

Question 37

Differentiation among RBCs,yeast,and oil droplets may be accomplished by all of the following except:

A) Observation of budding in yeast cells
B) Increased refractility of oil droplets
C) Lysis of yeast cells by acetic acid
D) Lysis of RBCs by acetic acid

Question 38

Ghost RBCs most frequently occur with a urine specimen that exhibits the following:

A) High pH, high specific gravity
B) High pH, low specific gravity
C) Low pH, high specific gravity
D) Low pH, low specific gravity

Question 39

Initial microscopic focusing on the urinary sediment is frequently performed by referencing:

A) Mucus
B) Squamous epithelial cells
C) RBCs
D) Hyaline casts

Question 40

The type of cells that line the bladder and ureters are called:

A) Squamous
B) Renal tubular
C) Transitional
D) Basal

Question 41

Which of the following elements would most likely be found in an acidic concentrated urine that contains protein?

A) Ghost RBCs
B) Casts
C) Bacteria
D) Triple phosphate crystals

Question 42

The type of cast most closely associated with tubular damage is the:

A) WBC cast
B) Epithelial cell cast
C) RBC cast
D) Fatty cast

Question 43

The urinary sediment constituent most closely associated with bleeding within the nephron is the:

A) RBC
B) RBC cast
C) WBC cast
D) Hyaline cast

Question 44

The type of cell most likely to appear stained with bilirubin is:

A) Renal tubular
B) Neutrophil
C) Squamous
D) Transitional

Question 45

Collection of a midstream clean-catch specimen will alleviate contamination by:

A) Renal tubular epithelial cells
B) RBCs
C) Transitional epithelial cells
D) Squamous epithelial cells

Question 46

Waxy casts can be found in the urine sediment:

A) In patients with renal failure
B) Of an alkaline urine
C) Whenever abnormal protein is present
D) When urine is not correctly preserved

Question 47

To differentiate a bacterial cast from a granular cast,a clinical laboratory scientist could:

A) Perform a Gram stain
B) Use polarizing microscopy
C) Perform a Hansel stain
D) Add acetic acid to the sediment

Question 48

Which of the following cells found in increased numbers in the urine sediment is only indicative of nephron damage?

A) Erythrocytes
B) WBCs
C) Squamous epithelial cells
D) Renal tubular cells

Question 49

The major constituent of urinary casts is:

A) Lipoprotein
B) Bence Jones protein
C) Uromodulin protein
D) Amino acids

Question 50

The primary factor that favors the formation of urinary casts is:

A) Urinary stasis
B) High pH
C) Positive blood
D) Low specific gravity

Question 51

Which of the following cells can both be found in both a vaginal wet prep and in urine sediment?

A) Yeast cell and clue cell
B) Transitional and renal epithelial cell
C) Clue cell and squamous cell
D) Renal and squamous cells

Question 52

Urinary casts are formed in the:

A) Distal and collecting tubules
B) Distal tubules and loops of Henle
C) Proximal and distal tubules
D) Proximal tubules and loops of Henle

Question 53

The only type of cast capable of polarization is the:

A) Waxy cast
B) Hyaline cast
C) Fatty cast
D) Granular cast

Question 54

Waxy casts are most easily differentiated from hyaline casts by their:

A) Color
B) Size
C) Granules
D) Refractivity

Question 55

Broad casts may form as a result of:

A) Extreme urinary stasis
B) Strenuous exercise
C) Increase in loss of amino acids
D) Dehydration

Question 56

Sediment constituents that are used to differentiate between upper and lower urinary tract infections are:

A) WBCs
B) WBC clumps
C) RBCs and WBCs
D) WBC casts

Question 57

The finding of renal tubular epithelial cells containing yellow-brown granules correlates with a positive reagent strip test for:

A) Blood
B) Bilirubin
C) Glucose
D) Nitrite

Question 58

The finding of increased hyaline and granular casts in the urine of an otherwise healthy person may be the result of:

A) Fecal contamination
B) Recent strenuous exercise
C) Early urinary tract infection
D) Analyzing an old specimen

Question 59

Hyaline casts may degenerate into:

A) Granular casts
B) Fatty casts
C) Broad casts
D) Waxy casts

Question 60

Spherical transitional epithelial cells can be differentiated from renal tubular epithelial cells by observing the:

A) Centrally located nucleus in renal tubular cells
B) Granular cytoplasm in renal tubular cells
C) Centrally located nucleus in transitional cells
D) Granular cytoplasm in transitional cells

Question 61

Granular casts present in the urine following strenuous exercise can:

A) Represent disintegration of cellular casts
B) Contain cellular lysosomes
C) Be pathogenic for renal disease
D) Represent a prerenal condition

Question 62

Which of the following differentiates a waxy cast from a fiber most effectively?

A) Waxy casts do not polarize light, and fibers do.
B) Waxy casts are more refractile than fibers.
C) Waxy casts have rounded ends, and fibers do not.
D) Waxy casts are thicker on the edge, and fibers are thicker in the center.

Question 63

Which of the following crystals is associated with ethylene glycol ingestion?

A) Uric acid
B) Calcium oxalate monohydrate
C) Triple phosphate
D) Calcium oxalate dihydrate

Question 64

A urine specimen refrigerated overnight is cloudy and has a pH of 6.The turbidity is probably due to:

A) Amorphous phosphates
B) Amorphous urates
C) Triple phosphate crystals
D) Calcium oxalate crystals

Question 65

All of the following are associated with severe urinary stasis except:

A) Granular casts
B) Waxy casts
C) WBC casts
D) Broad casts

Question 66

Cystine crystals are often confused with:

A) Cholesterol crystals
B) Leucine crystals
C) Uric acid crystals
D) Triple phosphate crystals

Question 67

All of the following crystals can be found in acid urine except:

A) Cholesterol
B) Tyrosine
C) Cystine
D) Ammonium biurate

Question 68

Formation of crystals due to medications is most frequently caused by:

A) Inadequate hydration
B) Incorrect timing of medication doses
C) Medication overdoses
D) Use of expired antibiotics

Question 69

All of the following affect the formation of crystals except:

A) Urine specific gravity
B) Urine pH
C) Urinary casts
D) Urine temperature

Question 70

Which of the following crystals occurs in two very distinct forms?

A) Ammonium biurate
B) Calcium oxalate
C) Leucine
D) Cholesterol

Question 71

To dissolve amorphous urates,you could:

A) Warm the specimen to body temperature
B) Add concentrated sodium hydroxide
C) Add dilute hydrochloric acid
D) Add dilute acetic acid

Question 72

Crystals found in the urine that are associated with pathogenic disease include:

A) Calcium oxalate and uric acid
B) Leucine and tyrosine
C) Heavy amorphous phosphates
D) Triple phosphate and ammonium biurate

Question 73

Identification of urinary crystals is based on shape and:

A) Urine pH and crystal solubility
B) Urine protein and crystal size
C) Urine bilirubin and glucose
D) Urine pH and crystal size

Question 74

Abnormal crystals are most frequently seen in a urine that is:

A) Acid
B) Neutral
C) Alkaline
D) Collected for 24 hours

Question 75

Information that aids in the identification of crystals includes all of the following except:

A) Urine temperature
B) Urine pH
C) Crystal solubility
D) Crystal birefringence

Question 76

All of the following may be seen in the urine following strenuous exercise except:

A) Protein
B) Glucose
C) Hyaline casts
D) Granular casts

Question 77

Nonpathogenic or "normal" crystals found in acidic urine include:

A) Calcium oxalate, uric acid, amorphous urates
B) Calcium oxalate, uric acid, sulfonamides
C) Uric acid, amorphous urates, triple phosphate
D) Uric acid, calcium carbonate, bilirubin

Question 78

Nonpathogenic or "normal" crystals found in alkaline urine include:

A) Calcium oxalate, uric acid, amorphous urates
B) Calcium oxalate, uric acid, sulfonamides
C) Uric acid, amorphous urates, calcium carbonate
D) Triple phosphate, calcium carbonate, ammonium biurate

Question 79

To distinguish a cellular cast from a clump of cells,the clinical laboratory scientist should:

A) Check for dysmorphic cells
B) Look carefully for a cast matrix
C) Determine if free-standing cells are present
D) Examine the sediment using polarizing microscopy

Question 80

Urinary crystals that appear yellow to reddish-brown are:

A) Calcium oxalate
B) Triple phosphate
C) Cholesterol
D) Uric acid