Clinical Microscopy (Analysis Of Urine And Other Body Fluids)

A yellow-brown specimen that produces a yellow foam when shaken can be suspected of containing bilirubin. Bilirubin is a yellow pigment that is produced when red blood cells break down. It is commonly found in bile and can indicate liver or gallbladder issues if present in the specimen. The yellow foam produced when shaken could be a result of the reaction between bilirubin and other substances in the specimen.

The first-voided morning urine specimen is the most desirable specimen for routine urinalysis because it is the most concentrated specimen of the day. This means that it contains higher levels of substances such as proteins, glucose, and electrolytes, which can provide valuable information about the patient's health. In contrast, later urine specimens may be more diluted due to increased fluid intake throughout the day. This can make it more difficult to accurately assess the levels of these substances and potentially miss important diagnostic information.

Leukocyte esterase is the correct answer because it is a test that detects the presence of white blood cells in urine, indicating the possibility of a urinary tract infection. The reaction time for this test is longer because it involves the breakdown of white blood cells and the release of enzymes, which takes more time compared to other reagent strip reactions such as bilirubin, pH, and glucose.

p-Dimethylaminobenzaldehyde is used to detect urobilinogen in urine. Urobilinogen is a breakdown product of bilirubin, which is formed in the liver. p-Dimethylaminobenzaldehyde reacts with urobilinogen to produce a pink color, indicating the presence of urobilinogen in the urine sample. This reagent is commonly used in laboratory tests to assess liver function and diagnose certain liver disorders.

Polyuria is the term used to describe a urine volume in excess of 2000 mL excreted over a 24-hour period. It is characterized by the production of large amounts of urine due to various factors such as increased fluid intake, certain medications, diabetes, or kidney disorders. Polyuria can be a symptom of an underlying medical condition and may require further evaluation and treatment. Anuria refers to the absence of urine production, oliguria refers to a decreased urine volume, and hypersthenuria refers to concentrated urine.

Human chorionic gonadotropin (hCG) is a hormone that is produced during pregnancy. It is initially secreted by the developing placenta and can be detected in the blood as early as 11 days after conception. As pregnancy progresses, the concentration of hCG increases and it can also be detected in the urine. This hormone is commonly used in pregnancy tests to confirm if a woman is pregnant or not. Therefore, hCG is the hormone that is characteristically present in the blood of pregnant women and appears in the urine when its concentration reaches a certain point.

The primary chemical affected by the renin-angiotensin-aldosterone system is sodium. This system plays a crucial role in regulating blood pressure and fluid balance in the body. When blood pressure decreases, renin is released, which leads to the production of angiotensin II. Angiotensin II stimulates the release of aldosterone, which promotes the reabsorption of sodium in the kidneys. This causes an increase in sodium levels in the blood, leading to water retention and an increase in blood volume, ultimately raising blood pressure. Therefore, sodium is the primary chemical affected by this system.

Urea is the major organic substance found in urine. Urea is a waste product that is formed in the liver when proteins are broken down. It is then filtered out of the blood by the kidneys and excreted in urine. The presence of urea in urine helps to regulate the body's fluid balance and remove excess nitrogen from the body. Sodium, glucose, and chloride are also present in urine, but they are not considered the major organic substance.

The average total volume of urine produced by a normal adult every 24 hours is about 1200 mL. This is considered to be within the normal range for urine output in adults.

If the coverslip is overflowed when using the glass slide and coverslip method, casts might be missed. Casts are cylindrical structures that are formed in the renal tubules and can be found in urine samples. They can indicate various kidney conditions, such as inflammation or infection. If the coverslip is overflowed, it may cause the casts to be washed away or dislodged from the slide, resulting in them being missed during microscopic examination.

The specific gravity of a fluid indicates its concentration of solutes compared to pure water. A specific gravity of 1.010 suggests that the fluid leaving the glomerulus is slightly more concentrated than pure water. This could be due to the filtration process in the glomerulus selectively removing some solutes while allowing others to pass through.

Oliguria is the correct answer because it refers to a condition characterized by a decreased urine output, usually less than 400 milliliters per day. This abnormal decrease in urine production can be caused by various factors such as dehydration, kidney dysfunction, urinary tract obstruction, or certain medications. Oliguria is an important clinical sign that may indicate underlying health issues and should be evaluated by a healthcare professional.

A diet high in bananas, tomatoes, and pineapples can cause false positive levels of 5-HIAA. These fruits contain natural compounds that can interfere with the accurate measurement of 5-HIAA levels, leading to a false positive result. Therefore, consuming these fruits in large quantities can contribute to elevated levels of 5-HIAA, even if the actual levels of this compound in the body are normal.

The expected pH range of a freshly voided urine specimen is 4.5-8.0. This range is considered normal and indicates a healthy balance of acid and alkaline levels in the urine. A pH below 4.5 may indicate acidic urine, which could be caused by conditions such as metabolic acidosis or respiratory alkalosis. On the other hand, a pH above 8.0 may indicate alkaline urine, which could be caused by conditions such as urinary tract infections or kidney stones. Therefore, a pH range of 4.5-8.0 is considered optimal for a freshly voided urine specimen.

When urine is alkaline, it can cause the precipitation of amorphous phosphates, which appear as a white turbidity. Amorphous phosphates are salts of phosphoric acid that can form when urine pH is elevated. They are commonly seen in alkaline urine and are not indicative of any pathological condition. Other options like yeast cells, uroerythrin, and WBCs may cause turbidity in urine, but they are not specifically related to alkaline urine.

Trichomonas vaginalis is a parasite that causes trichomoniasis, a sexually transmitted infection. Leukocyte esterase is an enzyme produced by white blood cells, and its presence in urine indicates the presence of an infection or inflammation in the urinary tract. Trichomonas vaginalis can cause inflammation in the urinary tract, leading to the presence of leukocyte esterase. Therefore, Trichomonas vaginalis is the correct answer in this case.

A strong odor of cabbage in a urine specimen could indicate methionine malabsorption. Methionine is an essential amino acid found in protein-rich foods, including cabbage. When the body is unable to properly absorb methionine, it can lead to an accumulation of sulfur-containing compounds, which can cause the urine to have a distinct cabbage-like smell. This odor is a characteristic symptom of methionine malabsorption.

The Hansel stain is used to identify eosinophils. Eosinophils are a type of white blood cell that plays a role in the immune response, particularly in allergic reactions and parasitic infections. The Hansel stain specifically stains the granules within eosinophils, making them easier to identify and distinguish from other types of cells. This staining technique is commonly used in clinical laboratories to aid in the diagnosis and monitoring of various diseases and conditions.

A reagent test strip impregnated with an aromatic amine such as p-arsanilic acid or sulfanilamide may be used to detect nitrite. Nitrite is a common analyte that is often tested for in various applications such as water quality testing or medical diagnostics. The aromatic amine on the test strip reacts with nitrite to produce a color change, indicating the presence of nitrite in the sample being tested. This method is commonly used due to its simplicity and quick results.

A specimen with a strong ammonia odor and a heavy white precipitate indicates that the specimen may be contaminated or degraded. This could affect the accuracy and reliability of any tests performed on the specimen. Therefore, it is necessary to collect a fresh specimen to ensure accurate results.

The normal value for urinary eosinophils is less than 1%.

Blue diaper syndrome is a condition characterized by the presence of blue-colored urine and blue-stained diapers in infants. It is caused by a defect in the transport of certain amino acids, particularly tryptophan, in the kidneys and intestines. This defect is seen in Hartnup disease, a rare genetic disorder. In Hartnup disease, there is a deficiency of a specific transporter protein that is responsible for the absorption of tryptophan from the diet. As a result, tryptophan is not properly absorbed and excreted in the urine, leading to the characteristic blue color.

Casts are formed primarily in the distal convoluted tubule of the kidney. This portion of the kidney is responsible for reabsorbing water and electrolytes from the filtrate, as well as secreting waste products into the urine. Casts are formed when these substances solidify and clump together, creating a mold of the tubule. The presence of casts in the urine can indicate various kidney diseases or conditions, such as renal tubular necrosis or glomerulonephritis.

Uromodulin is the correct answer because it is the primary component of urinary mucus. Uromodulin, also known as Tamm-Horsfall protein, is a glycoprotein produced by the cells lining the thick ascending limb of the loop of Henle in the kidneys. It is secreted into the urine and forms a gel-like substance that helps to protect the urinary tract from infection and prevent the adhesion of bacteria to the urinary epithelium. Uromodulin also has other functions, such as regulating the concentration of ions in the urine.

Hurler, Hunter, and Sanfilippo syndrome are all hereditary disorders that affect the metabolism of mucopolysaccharides. Mucopolysaccharides are long chains of sugar molecules that are essential for the normal functioning of various tissues and organs in the body. In these disorders, there is a deficiency of specific enzymes that are responsible for breaking down mucopolysaccharides, leading to their accumulation in various tissues. This accumulation can cause a wide range of symptoms and complications, including developmental delays, skeletal abnormalities, organ damage, and neurological problems. Therefore, the correct answer is mucopolysaccharides.

The finding of dysmorphic RBCs is indicative of glomerular bleeding. Dysmorphic RBCs are abnormally shaped red blood cells that can be seen in the urine. They are typically associated with glomerular bleeding, which occurs when there is damage to the glomeruli in the kidneys. This damage can be caused by various conditions such as glomerulonephritis or kidney inflammation. Therefore, the presence of dysmorphic RBCs in the urine suggests that there may be bleeding occurring within the glomeruli.

A clue cell is a clinically significant epithelial cell. Clue cells are vaginal epithelial cells that are covered with bacteria, specifically Gardnerella vaginalis. The presence of clue cells is a key indicator of bacterial vaginosis, a common vaginal infection. The bacteria on clue cells disrupt the normal vaginal flora and can cause symptoms such as discharge and odor. Therefore, identifying clue cells is important in diagnosing and treating bacterial vaginosis.

High levels of ascorbate usually do not interfere with urine bilirubin tests.

A correlation exists between a specific gravity of 1.050 and radiographic dye infusion. This means that when a specific gravity of 1.050 is observed in a urine sample, it is likely that the person has undergone a radiographic dye infusion. The specific gravity of urine is a measure of its concentration, and a specific gravity of 1.050 is considered high, indicating a higher concentration of substances in the urine. Radiographic dye infusion is a medical procedure where a contrast dye is injected into the body to enhance the visibility of certain structures during radiographic imaging. Therefore, the presence of radiographic dye infusion is correlated with a specific gravity of 1.050.

Protein is the correct answer because normally, the glomerulus in the kidney filters out waste products and excess substances from the blood, such as glucose, creatinine, and urea. However, proteins are too large to pass through the filtration membrane of the glomerulus, so they are not normally filtered in significant amounts.

Ivan Folling discovered phenylketonuria from a mentally retarded child with a peculiar mousy odor to his urine. This suggests that Folling was the one who identified the condition and made the connection between the child's symptoms and the presence of phenylketonuria.

Broad and waxy casts are most likely associated with chronic renal failure. In chronic renal failure, there is a progressive and irreversible loss of kidney function. This leads to the accumulation of waste products and a decrease in the ability to concentrate urine. Broad and waxy casts are formed when there is prolonged stasis of urine in the renal tubules, causing the casts to become larger and more solid. Therefore, the presence of broad and waxy casts is indicative of chronic renal failure.

The given correct answer states that any reducing substance can give a false positive reaction with the copper reduction test for glucose. This means that substances other than glucose, which have reducing properties, can also react with the copper reagent used in the test and produce a positive result. Therefore, the copper reduction method is not specific for glucose and can lead to false positive results if other reducing substances are present in the urine.

Nephrotic syndrome is a disorder characterized by the disruption of the electrical charges that produce the tightly fitting podocyte barrier, leading to the massive loss of proteins and lipids. This disruption causes the filtration barrier in the kidneys to become permeable, allowing proteins and lipids to leak into the urine. Alport syndrome is a genetic disorder that affects the kidneys, ears, and eyes. IgA nephropathy is a condition characterized by the accumulation of the protein IgA in the kidneys. Lipid nephrosis is another term for nephrotic syndrome, so it is not the correct answer.

Cloudiness in freshly voided urine can indicate the presence of white blood cells (WBCs). WBCs in urine can be a sign of infection or inflammation in the urinary tract. When there is an infection, the body's immune response sends white blood cells to fight off the infection, and these can be present in the urine. Therefore, the presence of cloudiness in urine suggests the presence of WBCs, indicating a possible urinary tract infection or other inflammatory condition.

Polyuria is a medical term that refers to the excessive production of urine, resulting in abnormally large and frequent urination. This condition often leads to increased urine volume and frequency throughout the day and night, which can be a symptom of various underlying medical conditions, including diabetes, kidney disease, or urinary tract infections.

Uroporphyrinogen decarboxylase deficiency is associated with Porphyria cutanea tarda (PCT). PCT is a type of porphyria characterized by a deficiency of the enzyme uroporphyrinogen decarboxylase, which leads to the accumulation of porphyrins in the skin. This results in photosensitivity and the development of skin lesions, such as blisters and erosions, upon exposure to sunlight. Other types of porphyria, such as Acute intermittent porphyria (AIN), Hereditary coproporphyria (HCP), and Congenital erythropoietic porphyria (CEP), are caused by different enzyme deficiencies and have distinct clinical presentations.

A rheostat is a device used to control the amount of current flowing through a circuit by varying the resistance. In the context of bright-field microscopy, a rheostat can be used to reduce the light intensity by adjusting the resistance in the circuit that powers the light source. By increasing the resistance, less current flows through the circuit, resulting in a decrease in the light intensity. This allows for better visualization of the specimen under bright-field microscopy, especially when the light is too intense and causes glare or overexposure.

Urinalysis is frequently performed on a patient with severe back and abdominal pain to check for hematuria, which is the presence of blood in the urine. This can indicate various conditions such as kidney stones, urinary tract infections, or kidney disease. The presence of blood in the urine can help healthcare professionals in diagnosing the underlying cause of the pain and determining the appropriate treatment plan.

The presence of renal tubular epithelial cells and casts indicates acute tubular necrosis. Acute tubular necrosis is a condition characterized by damage to the renal tubules, leading to the release of tubular epithelial cells into the urine. The presence of casts, which are cylindrical structures formed by the accumulation of cellular debris and proteins, further supports the diagnosis of acute tubular necrosis. This condition can be caused by various factors such as ischemia, toxins, or infections, and it is often associated with acute kidney injury.

Extravascular hemolytic anemia is not a cause of blood in urine. This condition occurs when red blood cells are prematurely destroyed within the body, but it does not directly affect the kidneys or urinary system. On the other hand, crush injury, malignancy of the kidney or urinary system, and renal calculi can all lead to blood in urine.

Cytotrophoblast cells are responsible for producing HCG. HCG, or human chorionic gonadotropin, is a hormone that is produced during pregnancy. It is primarily produced by the placenta and plays a crucial role in maintaining the pregnancy by supporting the production of progesterone. Cytotrophoblast cells are a type of trophoblast cell that make up the outer layer of the blastocyst, which eventually develops into the placenta. These cells are involved in implantation and the formation of the placenta, and they produce HCG to support the early stages of pregnancy.

The variables included in the Cockcroft and Gault formula for creatinine clearance are age, sex, and body weight. These factors are important in determining the rate at which creatinine is cleared from the body, as they can affect renal function. Age and sex can influence the metabolism and excretion of creatinine, while body weight is a measure of overall body mass and can also impact renal function. Therefore, including these variables in the formula allows for a more accurate estimation of creatinine clearance.

The sensitivity of a test refers to its ability to correctly identify individuals who have a particular condition or characteristic. In this case, the enzyme dipstick test for glucose has a sensitivity of 100 mg/dL. This means that the test is able to accurately detect glucose levels of 100 mg/dL or higher. It is important to note that a higher sensitivity value indicates a more accurate test in identifying individuals with the condition or characteristic being tested for.

Reagent strip specific gravity readings can be affected by various factors, including the presence of glucose, radiographic dye, and alkaline urine. These substances can influence the accuracy of specific gravity measurements obtained using reagent strips.

 

Alport syndrome is a genetic disorder characterized by the lamellated and thinning of the glomerular basement membrane. This condition affects the kidneys and can lead to progressive kidney disease. It is caused by mutations in genes that are responsible for the production of collagen, which is a major component of the basement membrane. As a result, the basement membrane becomes weakened and damaged, leading to the symptoms associated with Alport syndrome. Goodpasture syndrome, Nephrotic syndrome, and Wegener's granulomatosis are not specifically associated with lamellated and thinning of the glomerular basement membrane.

This patient is negative for orthostatic proteinuria because the protein reading remains the same (1+) in both the afternoon and first morning specimens. In orthostatic proteinuria, the protein levels typically decrease or become negative in the first morning specimen compared to the afternoon specimen due to changes in body position overnight. Since the protein reading did not change, it suggests that the proteinuria is not related to changes in body position and is likely not orthostatic proteinuria.

Visicoureteral reflux refers to the backward flow of urine from the bladder into the ureters. This condition can lead to a variety of complications, including acute pyelonephritis. Acute pyelonephritis is a bacterial infection of the kidneys, typically caused by the ascent of bacteria from the bladder through the ureters. The reflux of urine can introduce bacteria into the kidneys, increasing the risk of infection and subsequent development of acute pyelonephritis. Therefore, it is a potential consequence of visicoureteral reflux.

The correct answer is 1 and 2. This is because urinary screening tests for mucopolysaccharides can be done using Acid albumin and CTAB. The other options, Cyanide-Nitroprusside and Nitroso-naphthol, are not mentioned in relation to urinary screening tests for mucopolysaccharides.

End-stage renal disease is a condition where the kidneys are no longer able to function properly. It is characterized by electrolyte imbalance, azotemia (increased levels of nitrogenous waste products in the blood), and isosthenuria (the inability to concentrate urine). Hypersthenuria, on the other hand, refers to the ability to produce urine with a higher specific gravity, which is not a characteristic of end-stage renal disease.