Question 1

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

Accepted Answer

Casts are formed in the renal tubules and are made up of protein and other substances. They can be found in acidic urine when there is an increase in protein concentration. Ghost RBCs would be found in hematuria, which is not related to acidity or protein. Bacteria would be found in an infection, which is not related to acidity or protein. Triple phosphate crystals would be found in alkaline urine, not acidic urine.

Question 2

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

Accepted Answer

Epithelial cell casts are most closely associated with tubular damage. They are formed when renal tubular epithelial cells detach from the tubular wall and are carried into the urine, indicating damage to the tubular wall. WBC casts are associated with inflammation or infection, RBC casts with glomerular damage, and fatty casts with lipiduria.

Question 3

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

Accepted Answer

RBC casts in the urinary sediment are indicative of bleeding within the nephron, as they suggest that red blood cells have leaked into the tubular system and have been incorporated into a cast, pointing to a glomerular or tubular source of bleeding.

Question 4

The type of cell most likely to appear stained with bilirubin is:
A) Renal tubular
B) Neutrophil
C) Squamous
D) Transitional

Accepted Answer

Renal tubular cells are most likely to appear stained with bilirubin because the kidneys play a crucial role in the excretion of bilirubin. When bilirubin levels are high, it can be deposited in the kidneys, particularly in the renal tubular cells, leading to staining.

Question 5

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

Accepted Answer

A midstream clean-catch specimen is a method used to minimize contamination from the external genitalia. Squamous epithelial cells, which are common contaminants from the skin and external urethra, are significantly reduced in number with this technique. The other options (renal tubular epithelial cells, RBCs, and transitional epithelial cells) are not specifically targeted by the clean-catch method for reduction, as they can originate from within the urinary tract itself.

Question 6

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

Accepted Answer

Waxy casts are most commonly found in patients with chronic renal failure. They are thought to be formed due to stasis and degeneration of other types of casts in the distal tubules and collecting ducts.

Question 7

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

Accepted Answer

Performing a Gram stain is the best choice as it will allow the clinical laboratory scientist to differentiate between a bacterial cast (which will appear purple/blue under the microscope) and a granular cast (which may have various colors but will not show the characteristic bacterial shape and arrangement). Polarizing microscopy and the Hansel stain are not relevant to identifying casts, while adding acetic acid to the sediment may be useful for dissolving red blood cells but will not aid in identifying bacterial casts.

Question 8

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

Accepted Answer

Renal tubular cells are only found in the urine sediment when there is damage to the nephrons, which are responsible for filtering the blood and producing urine. Erythrocytes (A), WBCs (B), and squamous epithelial cells (C) can all be found in the urine sediment for various reasons and are not specific to nephron damage.

Question 9

The major constituent of urinary casts is:
A) Lipoprotein
B) Bence Jones protein
C) Uromodulin protein
D) Amino acids

Accepted Answer

The major constituent of urinary casts is uromodulin protein, also known as Tamm-Horsfall protein. It is a glycoprotein that is produced by the cells lining the thick ascending limb of the loop of Henle in the kidney.

Question 10

The primary factor that favors the formation of urinary casts is:
A) Urinary stasis
B) High pH
C) Positive blood
D) Low specific gravity

Accepted Answer

Urinary stasis is the primary factor that favors the formation of urinary casts. Casts are formed in the renal tubules and are then washed out into the urine. If urinary flow is slow or stagnant, the casts have more time to form and become more concentrated in the urine. This can occur due to various reasons such as obstruction, infection, or medications. High pH, positive blood, and low specific gravity are not factors that directly contribute to the formation of urinary casts.

Question 11

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

Accepted Answer

Yeast cells and clue cells can both be found in both a vaginal wet prep and in urine sediment.

Question 12

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

Accepted Answer

Urinary casts are formed in the distal and collecting tubules. Casts are cylindrical structures made up of various proteins like Tamm-Horsfall protein and albumin. They can take the shape of the tubules in which they are formed, and their presence in the urine can give important information about the functioning of the kidney. Casts can be diagnostic of certain kidney diseases like glomerulonephritis, pyelonephritis, and nephrotic syndrome.

Question 13

The only type of cast capable of polarization is the:
A) Waxy cast
B) Hyaline cast
C) Fatty cast
D) Granular cast

Accepted Answer

Fatty casts are capable of polarization due to the presence of lipid droplets, which can polarize light.

Question 14

Waxy casts are most easily differentiated from hyaline casts by their:
A) Color
B) Size
C) Granules
D) Refractivity

Accepted Answer

Waxy casts are most easily differentiated from hyaline casts by their refractivity. Waxy casts have a higher refractive index, making them appear more shiny or "waxy" under the microscope compared to the more transparent hyaline casts.

Question 15

Broad casts may form as a result of:
A) Extreme urinary stasis
B) Strenuous exercise
C) Increase in loss of amino acids
D) Dehydration

Accepted Answer

Broad casts are cylindrical structures that form in the kidney tubules and are made up of cells, proteins, and other materials present in the urine. They are usually associated with extreme urinary stasis, which occurs when the flow of urine is obstructed or slowed down significantly. This can happen due to various reasons, such as kidney stones, tumors, or urinary tract infections. Strenuous exercise, increased loss of amino acids, and dehydration are not commonly associated with the formation of broad casts.

Question 16

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

Accepted Answer

WBC casts are more commonly seen in lower urinary tract infections, while upper urinary tract infections are associated with minimal cellular casts or no casts at all. Therefore, the presence of WBC casts can help differentiate between upper and lower urinary tract infections.

Question 17

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

Accepted Answer

The presence of renal tubular epithelial cells containing yellow-brown granules typically indicates the presence of hemosiderin, a byproduct of hemoglobin breakdown. This finding correlates with hemolysis or bleeding within the urinary tract, which would result in a positive reagent strip test for blood.

Question 18

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

Accepted Answer

Increased hyaline and granular casts in the urine may be the result of recent strenuous exercise, as muscle breakdown products can lead to the formation of these casts. The other options are less likely to cause such an increase in casts.

Question 19

Hyaline casts may degenerate into:
A) Granular casts
B) Fatty casts
C) Broad casts
D) Waxy casts

Accepted Answer

The answer of Hyaline casts may degenerate into:
A) Granular casts
B)...

Question 20

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

Accepted Answer

Spherical transitional epithelial cells have a centrally located nucleus, while renal tubular epithelial cells have a more elongated nucleus located towards the base of the cell. The granular appearance of the cytoplasm is not a reliable characteristic for differentiation between these cell types.

Quiz 6: Microscopic Examination of Urine

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

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

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

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

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

Waxy casts can be found in the urine sediment:

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

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

The major constituent of urinary casts is:

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

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

Urinary casts are formed in the:

The only type of cast capable of polarization is the:

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

Broad casts may form as a result of:

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

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

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

Hyaline casts may degenerate into:

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