CLINICAL MICROSCOPY RATIO 4.

Glitter cells in hypotonic urine

Compiled by: Aaron Paul Santos and Vince Andrew a. Pus cells
Medina b. RBCs
c. Epithelial cells
1. Utilizes HPO, EXCEPT: d. Yeast cells
a. Calcium oxalate crystals  Hypotonic – Swelling of the cell
b. Pus cells  Pus cells: large granular cells; as water enter
c. Mucus threads the pus cells, the granules exhibit Brownian
d. Yeast cells movement which is seen as “sparkling
 Mucus Threads are reported as: Rare, Few, appearance”
Moderate, and Many. (Reported in LPO) Glitter Cell – degenerative WBC
 Mucus threads are sometimes mistaken as - use Sternheimer Malbin Stain (+) = Blue
hyaline casts Bubble Cell – RTE cell that absorbed non-lipid
substance
2. Glucose positive in urine chemical testing cells Ghost Cell – destroyed RBC
most likely noted in urine microscopy Clue Cell – epithelial cell with intracellular G.
a. Yeast cells vaginalis
b. RTEs – Found in renal diseases or Oval Fat Bodies – RTE cells that absorbed lipid
lipiduria substances
c. Bilirubin crystals
d. Dysmorphic RBCs 5. Fat oval bodies:
 Yeast cells are found in patients a. Squamous
with diabetes, patients with b. Urothelias
vaginal monoliasis, c. Transitional
immunocompromised d. RTEs
patients(AIDS patients)  RTE cells are capable of absorbing fats
 Yeast cells are cell types which is indicative of renal disease.
exhibiting budding  RTE cells are differentiated with oval bodies
 Yeast cells are cell types that by staining methods.
have mycelia
6. Ghost cells in hypotonic urine
What can be seen in the sediment when: a. Yeast cells
(+) Nitrite  Bacteria b. RTEs
(+) Leukocyte Esterase  WBC c. Pus cells
(+) Glucose  Yeast Cells d. RBCs
(+) Occult Blood  RBC
(+) Protein  Casts 7. Major protein constituents of mucus and casts
a. Acute phase reactant
* yeast cell seen in immunocompromised patients (DM b. Globin
patients) c. Tamm-Horsfall
d. Bence Jones
3. Organized type of urine specimen, EXCEPT:  Tamm-Horsfall is AKA uromodulin
a. Casts  Glycoprotein produced by RTE cells
b. Crystals  Protein constituent of casts
c. Epithelial Cells
d. Bacteria/Parasites 8. Benzoic acid is eliminated in this form, increases
 Organized type of urine specimen usually are with high-vegetable diet
biological elements a. Hippuric Acid
b. Creatinine
Formed Elements (organized): CREBPAYS c. Uric acid
 Casts d. Urea
 Red Cell  Benzoic Acid comes from phenolic compounds
 Epithelial cell from the food that we eat (vegetables, tea, wine,
 Bacteria fruits)
 Phenolic compounds are metabolized to form
 Pus cell
benozoic acid, benzoid acid is then
 Animal parasite metabolized/excreted in the urine in the form of
 Yeast cells hippuric acid crystals
 Sperm  Hippuric acid are sometimes colorless or
yellowish brown.
 9. Parasites possibly noted in the urine sediments in  WBCs are always associated with inflammation
microscopy, EXCEPT: and infection
a. Schistosoma japonicum  Pyelonephritis: Upper urinary tract infection
b. Trichomonas vaginalis
c. Enterobius vermicularis 23. Cast: Associated with heavy metal & chemical or
d. Schistosoma haematobium drug-induced toxicity, viral infections & allograft
 Enterobius can be found in urine through rejection:
contamination a. Waxy
 S. haematobium – seen in renal plexus b. Coarse granular
c. WBCs
10. Cast: most common 0-2/LPF is normal, low d. Epithelial Cell
refractive index  Epithelial Cell casts are always associated with
a. RBC drug induced toxicities
b. Waxy
c. Hyaline 24. Cast: End stage renal disease
d. Granular a. RBCs
 Hyaline casts above 0-2/LPF is indicative of b. WBCs
a. Acute glomerulonephritis c. RTE
b. Pyelonephritis d. Waxy
c. Chronic Renal Disease  End stage renal disease are referred to chronic
d. Congestive Heart Failure renal failure
 End stage renal disease may also exhibit mixed
pH: cellular elements (waxy cast + RBC cast)
A. Acidic b. Alkaline
11. Calcium oxalate A 25. Which of the tubules is impermeable to water?
12. Calcium phosphate B a. Proximal convoluted tubule
13. Triple phosphate B b. Descending loop of Henle
14. Ammonium biurate B c. Ascending loop of Henle
15. Calcium carbonate B d. Distal convoluted tubule
3 Phases of Urine formation:
Appearance: 1. Glomerular Filtration
a. Thorny apples 2. Tubular Reabsorption
b. Rossette Forms 3. Tubular Secretion
c. Dumbbells Distal convoluted tubule – where casts start to form
d. Envelope - secretion of bicarbonate
e. Coffin-lid Proximal Convoluted Tubule – reabsorption of glucose
Descending loop – reabsorption of water; urine
16. Calcium Oxalate D concentration
17. Calcium Phosphate B Ascending loop – impermeable to water
18. Triple Phosphate E
19. Ammonium biurate A 26. Cast: Its presence is ALWAYS pathologic,
20. Calcium carbonate C strongly indicative of glomerular damage
a. WBC
21. Abnormal urinary crystals noted in liver disorders, b. RBC
EXCEPT: c. Hyaline
a. Tyrosine d. Granular
b. Leucine  Blood is filtered in the glomerulus, hence if
c. Cysteine there is blood in urine it indicates glomerular
d. Bilirubin damage
 Cysteine is found in Cystinuria
 Cystinuria is an autosomal recessive disorder Hyaline Cast – mesh of Tamm-Horsfall protein
where in there is high amount of amino acid/ - Low Refractive Index
protein in the urine - can be normally seen in urine (0-2/lpf)
 Cysteine crystals are hegaonal plates. RBC Cast – Glomerulonephritis
- Glomerular damage
22. Cast: inflammation, pyelonephritis, acute allergic WBC Cast – pyelonephritis
interstitial nephritis - inflammation
a. WBCs Waxy Cast – end-stage renal disease
b. Waxy - amyloidosis
c. RBCs Bacterial Cast – sepsis/bacteremia
d. Granular RTE Cast – Chemical toxicity
- Allograft rejection; Metal poisoning
 27. Crystals: colorless, hexagonal plates 29. The following affects urine crystal solubility,
a. Tyrosine EXCEPT:
b. Uric acid a. Temperature changes
c. Cholesterol b. pH
d. Cysteine c. Solute concentration
d. Medication
28. Crystals: yellow to brown sphere, concentric and  Solubility depends on the precipitation of
radial striations crystals in urine
a. Tyrosine  Low temperature enhances precipitation
b. Leucine  Solute concentration: less concentrated; less
c. Cysteine crystals
d. Bilirubin  pH: Acidic/Alkaline
 It looks like a taenia ova (has radial strations)
30. Clear urine with positive chemical test for blood;
Normal ACID Crystals intravascular hemolysis
Amorphous URATES Brick-dust a. RBCs
Pink sediment upon ref b. Porphyrin
(Uroeythrin) c. Myogolobin
Uric Acid Most pleomorphic crystal d. Hemoglobin
Lesch-Nyhan Syndrome Hemoglobin can still be filtered in the glomerulus
– orange sands in diaper
Calcium Oxalate(Mono) Dumbbell Urine Urine Cause
Calcium Oxalate Envelope Patient
Urobilinogen Bilirubin
(dehydrate) Pre-
K (+++) Positive (-) Negative hepatic
Normal ALKALINE Crystals Jaundice
Amorphous White precipitate Hepatic
PHOSPHATE High after meals (alkaline L (++) Positive Variable
Jaundice
tide) Post-
Calcium Phosphate Rosette form may be M 1.0EU (+++) Positive hepatic
confused w/ sulfonamide Jaundice
(differentiate with acetic
acid, CaPO4 dissolved) 31. Patient M is more likely suffering from what
Triple Phosphate Coffin-lid condition?
Presence of urea-splitting a. Glomerulonephritis
bacteria b. Iron Deficiency Anemia
Ammonium Biurate Thorny-Apples c. Pyelonephritis
Calcium CARBONATE Dumbbell shape d. Diabetes mellitus
(+) Effervescence with e. Cholelithiasis
acetic acid  Bilirubin increases in cases of bile
obstruction (caused by gallstones)
ABNORMAL CRYSTALS (all are found in ACIDIC Urine)  Cholecystectomy: removal of gallbladder
Tyrosine Broomstick-like
Fine needles  Pre-hepatic Jaundice – increased
Liver Disease destruction of RBCs
Leucine Round w/ striations  Hemolytic transfusion reaction
Maple Syrup Urine  Hemolytic Anemia
Disease  Severe Malaria Infection
Liver Disease  Severe Babesia infection
Bilirubin Liver Disease  Paroxysmal Nocturnal Hemoglobinuria
Cystine “Piattos-like” Hexagonal
plates Hepatic Jaundice – liver disease
(+) cyanide nitroprusside Post-Hepatic Jaundice – obstructive jaundice
test - B2 in urine
Cholesterol Notched-plates Cholelithiasis – gallbladder stones
Maltese-cross formation
Nephrotic Syndrome
 32. Chemical test result of patient K is consistent with 37. Fatty casts are seen in the following, EXCEPT:
what disorder? a. Acute tubular necrosis
a. Hemolytic Transfusion Reaction b. Nephrotic syndrome
b. Pyelonephritis c. Pyelonephritis
c. Azotemia d. NOTA
d. Hepatobillary tree obstruction  Pyelonephritis can be seen in WBC casts.
e. UTI  Fatty casts are indicative of liver damage
 Presence of Urobilinogen may indicate:
1. Liver Damage 38. WBC casts are seen in the following, EXCEPT:
2. Hemolytic disorder a. Acute allergic nephritis
b. Nephrotic Syndrome
33. Except for one, all are the possible condition of c. Pyelonephritis
patient L based on the results above d. NOTA
a. Uremia  Diseases with the suffix “itis”
b. Hepatocarcinoma
c. Hemolytic anemia 39. The following are acellular casts, EXCEPT:
d. Hepatitis A infection a. Hyaline casts
e. Serum hepatitis b. Fatty casts
c. Crystal casts
34. A negative glucose oxidase test and a positive d. NOTA
clinitest result was noted in a given urine sample,
what is the most probable reason for this 40. Epithelial cell casts are seen in the following,
reaction? EXCEPT:
a. Metal, chemical, drug intoxication
I. Urine is positive for sugar except glucose b. Acute glomerulonephritis
II. Urine may have high ascorbic acid content c. Disrupted tubular linings
III. Oxidizing agent interferes with the strip d. Viral infections
a. I,II,III are correct
b. I and II are correct A. Acidic Urine
c. Only I is correct B. Alkaline Urine
d. Only II is correct
e. All are not correct 41. Cysteine A
 Glucose oxidase: copper reduction test that is 42. Triple Phosphate B
very specific for glucose 43. Bilirubin A
 Clinitest: Test for reducing sugars/ 44. Calcium carbonate B
monosaccharides 45. Ammonium biurate B
 Increased ascorbic acid produces false positive 46. Calcium oxalate A
clinitest 47. Calcium oxalate A
 Oxidizing agent is a general term 48. Cholesterol A
Clinitest – Copper Reduction 49. Tyrosine A
50. Amorphous Bonus
 Any reducing sugar can be positive
Clinistix – Enzymatic (glucose Oxidase) 51. Tea colored urine maybe caused by:
a. Bilirubin
Ascorbic Acid always inhibits enzymatic reactions
Amber-colored urine – Bilirubin

35. The following are interferences for Clinitest,

52. Use of a refractometer over a urinometer is
EXCEPT:
preferred due to the fact that the refractometer
a. Lactose - monosaccharide
uses:
b. Ascorbic acid
a. Large volume of urine and compensates
c. Fructose - monosaccharide
temperature
d. Cephalosporins
b. Small volume of urine and compensates
e. Sucrose
glucose
 Sucrose is a disaccharide (not an interference)
c. Small volume of urine and
compensates temperature
36. Hyaline casts are seen in the following, EXCEPT:
d. Small volume of urine and compensates
a. Chronic renal disease
protein
b. Acute glomerulonephritis
Urinometer
c. Pyelonephritis 3C lower – substract 0.001
d. NOTA 1g glucose – subtract 0.004
1g protein – subtract 0.003
 60. Isosthenuria is used to describe urine with a
53. Which of the following tests is least affected by specific gravity of:
standing/unpreserved urine? a. Approximately 1.010
a. Glucose: Glycolysis (decreased glucose)  Hypersthernuria: above 1.010
b. pH: Increased pH (conversion of  Hyposthenuria: below 1.010
ammonia to urea)
c. Bilirubin: Decreased (exposure to light) If turbid urine specimen – caused by cellular substances
d. Protein Isosthenuria – SG urine is 1.010 (same as filtrate)
Hypostenhuria – SG <1.010
Prolonged Standing of Urine
INCREASED 61. Three glass collection method: Prostatic Infection
 Bacteria Glass 1: Collect First specimen
 Nitrite Glass 2: Midstream clean catch
 Odor Glass 3: Collect after prostatic massage
 Color Prostatitis: Presence of bacteria in the first and
 pH third glass. (Third glass 10x greater than the first)
 Presence of significant pus cells in all
54. Preferred urine sample for pregnancy testing. three glasses are indicative of Urinary
a. First Morning Urine (increased amount of Tract Infection/Contamination
HcG) 3-glass collection method – differentiate Prostatic
Pregnancy Test – best specimen is First Morning Infection
False Negative  1st vial – urine
 low SG  2nd vial – urine
 Alkaline pH  3rd vial – urine and prostatic fluid
Midstream clean-catch – for culture  if 1st and 2nd is clear and 3rd is positive it
Fasting/2nd Morning Specimen – for glucose means infection is in prostate; if 1st or 2nd is
monitoring positive it means renal/bladder infection
55. Specific gravity of triple distilled water 62. Urine with characteristic mousy odor:
a. 1.000 a. Phenylketonuria
56. Black urine with the pH of 8.0 63. Fruity odor
a. Tested for melanin a. Ketones
Homogentisic Acid and Melanin – if urine is Black test this Ammonia/Urea: Bacterial infection
Alkaptonuria – homogentisic acid is present in urine Urine with Mousy odor – Phenylketonuria
Guthrie Test – detect phenylketonuria in infants
57. A fresh urine must be requested when the
- used Bacillus subtilis (bacterial inhibition)
following result is found:
Urine with Fruity Odor – Ketonuria
a. pH = 9.0 (Old specimen)
Aromatic Urine – Normal
Fresh sample is requested
Foul Ammonia-like – Bacterial Infection; UTI
 If pH >8.0
- urease bacteria (ex. Proteus)
Cadet/Postural/Orthostatic Proteinuria – protein in
Maple Syrup – Maple Syrup urine disease
urine after exercise or standing for a long time; early
Rancid – Tyrosinemia
morning is negative
Sweaty Feet – Isovaleric academia
If early morning is positive = pathologic proteinuria
Cabbage – Methionine Malabsorption
58. College student with a +2 protein on a routine Bleach - Contamination
urinalysis. The following day, urinary protein
resulted negative. What is the most probable 64. Primary organic component of urine and is an end
cause? product of protein and amino acid metabolism
a. Orthostatic proteinuria: common to a. Urea
children and teenagers. Infections does Primary Organic Component – Urea
not change the following day Primary Inorganic Component – Chloride

59. Cloudiness in a freshly voided urine could 65. Preservative for urine culture
indicate the presence of: a. Boric Acid
a. Protein Formalin: preservative of sediments
b. Glucose Sodium Fluoride: preservative for drug
c. WBC analysis
d. Metabolites of vitamins Tablet preservatives: may affect urine
culture
Urine preservatives  Patient deprived with Water; Serum osmolality
 Boric Acid – for Culture and SG is measured after. SG and Osmolality
 Formalin – Formed elements should be increased.
 Sodium Fluoride – Drug analysis; Quantitative
glucose measurement 71. The patient underwent a procedure wherein an x-
ray contrast dye was administered which may
affect specific gravity. What should be the method
66. A patient has a need to submit a 24 hr urine of choice to avoid the interference?
specimen and as a medical technologist, which of a. Reagent strip testing
the instruction is important to be conveyed to the b. Urinometer
patient? c. Refractometer
a. Discard the first urine specimen, discard d. Densitometer
the last specimen  Principle of Reagent Strip
 Including the first specimen: Falsely testing: Release of Hydrogen
elevated Ions
 Including the last specimen: Falsely
decreased 72. Which of the following tests can assess renal
tubular function?
24-hour urine collection a. Osmolality and Specific Gravity
 Void 1st urine output – cause false-elevated
73. Brown-black urine is associated with:
67. Which type of urine specimen is used for a. Melanin
cytological exam? Methemoglobin – Dark brown urine in ACIDIC Condition
a. Suprapubic aspiration Homogentisic acid – Dark brown to black in ALKALINE
Catheterized: Urine Culture condition
Suprapubic Aspiration
 Cytological exam 74. The yellow of color of urine is due to what
 Anaerobic Culture pigment?
Critical Quantitative bacteriology a. Urochrome
Pigments that gives urine its color
68. Urine specimen collection for drug testing follow  Urochrome
these procedures except:  Urobilin
a. Reagent strip testing  Uroerythrin
b. Addition of bluing agent
c. Check for color and amount 75. Urine color that develops a port wine color after
d. Fill out a COC form standing may contain:
a. Porphyrin
69. Urine specific gravity is directly proportional to its: Porphyrin – Port-wine color
a. Dissolved solids  Lead Poisoning
 Specific gravity is more or less equal  Problem in Hemoglobin sysnthesis
to density
 SG = Density of substance/density of 76. Non-pathogenic causes of red urine except
water a. Rifampin
 Density = mass/volume hence more b. Vitamin B complex
mass is more density c. Blueberries
 Greater mass, greater specific d. Beets
gravity Cloudy Red Color – RBC
Clear Red Color – Hemoglobin (intravascular hemolysis)
70. ADH is associated with: - Myoglobin (muscle destruction)
a. Low specific gravity Chromaturia – Vit. B complex problem
 Low ADH, High urine volume - bright yellow color
which produces less
concentrated urine
ADH deficiency = Diabetes Insipidus 77. Ammonia like odor:
 High Volume ; Low SG a. Proteus infection (Bacterial Infection)
Diabetes Mellitus
 High Volume; High SG 78. Clarity of urine sample must be determined using
Fishberg and Mosenthal Test – assess renal tubular a. glass tubes
function
79. Patients with uncontrolled diabetes mellitus most
likely have:
a. High specific gravity, pale urine
 Three P’s  Fluid loss from non-renal sources
Polyuria, Polyphagia, Polydypsia  Sugar

80. Physical examination of urine shows the 91. Pathologic causes of Urine turbidity
following:
Increased 24hr volume
Low SG
Pale Yellow color
These results are clinically correlated with?
a. Diabetes Insipidus
 Low SG

81. Which of the following medication does not affect

urine color?
a. Methyldopa/Metronidazole - Black
b. Nitrofurantoin – Yellow Orange
c. Vitamin C

82. Urine specimen comes to the laboratory four

hours after it is obtained. It is acceptable for urine 92. Physical Examination of Urine
culture only if a. Color
a. Refrigerated b. Clarity
 Freezing can kill bacteria c. SG
 Some additives can alter urine
tests 93. Presence of bilirubin in a urine specimen causes:
a. Yellow foam when shaken
83. Which of the following will be affected by allowing Bilirubin – Yellow foam when shaken
the urine specimen to remain at RT for 3hrs Protein – white foam when shaken
before analysis
a. pH (increased) 94. Recommend specimen container for urine must
be:
84. Routine urinalysis is done first, and after 3 hours a. Screw-capped
the specimen is sent to the microbiology section b. 50 mL
for urine culture. The specimen should be: c. Disposal
a. Rejected due to time delay
95. Reasons for specimen rejection:
85. Urine samples should be examined within one a. Unlabeled containers
hour after voiding because: b. QNS
a. There will be bacterial contamination (will
increase the pH of urine) 96. General screening
a. Random specimen

97. Including the first portion in a 24 hr urine

86. For a patient suspected to have prostatitis, what specimen will
is the method of collection? a. Falsely increase the results
a. Three-glass method
b. Pre and post massage collection 98. What is increased in unpreserved urine?
a. pH
87. Blue green color of urine is associated with b. Bacteria
patients: c. Nitrite
a. Taking anti-depressants like amitriptyline
99. What is decreased in unpreserved urine?
88. The following are causes of non-pathologic urine a. Blood Cells
turbidity except: b. Glucose
a. Yeast
100. Specific Gravity of 1.001 is most likely:
89. Preservative for drug analysis: a. Not urine
a. Sodium Fluoride Normal SG cannot be <1.002 or >1.035
90. Factors that influence urine volume: Legend:
 Fluid intake BLACK: Ms. Porto’s Ratio (4GMT)
 Variations in the secretion ADH RED: Mr. Manahan’s Ratio (4DMT)