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Warning: TT: undefined function: 32 Warning: TT: undefined function: 32 Module 3II. SEQUENCING. Assign a number to each of the following structures in order to come up with the correct sequence of A) conducting blood (from renal artery to inferior vena cava) and B) conducting urine (from afferent ar...

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Module 3 II. SEQUENCING. Assign a number to each of the following structures in order to come up with the correct sequence of A) conducting blood (from renal artery to inferior vena cava) and B) conducting urine (from afferent arteriole to urethra) in the kidneys. (20 points) 5 afferent arteriole 8 renal pelvis 7 renal pyramid 1 arcuate arteries 6 peritubular capillaries 1 glomerular tuft 2 Intellobar arteries 2 PCT 3 interlobular arteries 5 DCT 10 urinary bladder 4 efferent arteries 9 ureters 7 arcuate veins 4 Henle's ascending limb 9 Intellobar veins 3 Henle's descending limb 10 renal vein 8 interlobular veins 6 collecting duct Module 4 Give three (3) answers that meet each of the following situations: A. Types of microscopy Brightfield, DarkfieId, Phase-contrast. Interference contrast. Polarizing, Fluorescence, & Electron B. Special urine collection techniques. Urethral catheterization, Ureteral Catherization, Suprapubic aspiration, & Cvstoscqpic method C. Purposes of cytodiagnostic urinalysis. Detection of glomerular and tubular disorders, LUT disorder detection, Finding Iithiasis (kidney stones), & diagnosis of nonbacterial infections D. Purposes of performing wet urinalysis. Assessment of Diabetes, Proteinuria, Hematuria, Leucocyturia, Infections, Crystalluria, Cvlindruria among others E. Urine collection methods intended for bacterial culture. Catheterized, Midstream catch early morning, & Suprapubic aspiration F. Precautions to be observed when collecting urine samples. Chemically clean urine containers are needed, no delays in testing (analyzed within I hour receipt in the lab), appropriate collection technique for some tests, samples should be labeled and tightly sealed, external genitalia is cleaned with antiseptic prior to collection, frozen samples are for chemical testing only, among others G. Preservatives that can be used for hormones in a 24-hour urine sample. Refrigeration, Boric acid, & 6N HCl H. Substances found to exceed 3.0 grams in a 24-hour urine sample. Urea, NaCl, & Potassium I. Substances that will yield FALSE-NEGATIVE result after delayed testing. Glucose (utilized by microbes), Ketones (volatile), Bilirubin & Urobilinogen (light-sensitive), & Nitrite (convened to nitrogen) J. Urine parameters that become INCREASED in unpreserved urine Odor, pH, Nitrite, & Bacteria

Module 5 PARTS OF ROUTINE URINALYSIS Column A A A B C B A&B C A B B D D C B B

Column B

1.Assessment of phenylketonuria by detecting mousy odor of urine 2.Checking kidneys’ concentrating ability by observing urine color 3. Identifying uric acid as a blue product with phosphotungstic acid 4. Grading casts as 0-3/lpo after scanning 10 low power microscopic fields 5. Testing urine pH using a dipstick with pads varying in color from pH 1 to 14 6. Testing urine for the presence of blood without the use of a microscope 7. Finding in the urine the presence of cystine crystals 8. Deciding whether the urine is clear, hazy, turbid or cloudy 9. Protein testing of the urine using heat and acetic acid 10. Testing of urine specific gravity using reagent strip technology 11. Proper labeling of the urine samples 12. Choosing appropriate preservative for urine 13. Confirming hemosiderinuria in urine by presence of blue granules in casts 14. Testing the presence of UTI via microbial esterase and nitrate reduction 15. Testing the presence of urine iron freed from hemoglobin and myoglobin

A. Gross/Physical exam B. Chemical exam C. Microscopic exam D. Specimen evaluation

URINE PARAMETERS/COMPONENTS & ASSOCIATED CONDITIONS Column A Column B H 16.Hemosiderinuria A. urate crystals, cholesterol seen as notched plates, calcium sand B L A K E J O D F G C M B I

17. Pyuria 18. Cylindruria 19. Crystalluria 20. Bacteriuria 21. Glycosuria 22. Chyluria 23. Lipiduria 24. Alkaptonuria 25. Oliguria 26. Isosthenuria 27. Hematuria 28. Hemoglobinuria 29. Leukocyturia 30. Myoglobinuria

B. granulocytes, lymphocytes and plasma cells C. intact erythrocytes D. byproducts of homogentisic acid metabolism E. glucose, galactose and sucrose F. low 24-hour urine volume G. constant specific gravity H. iron deposits in epithelial cells and casts I. released red pigments from lysed skeletal muscles J. presence of fatty lymphatic fluid K. Lactobacillus acidophilus, Proteus vulgaris, Escherichia coli L. casts described as amorphous, hyaline or mixed M. released red pigment from lysed erythrocytes N. bilirubin and oxidized products O. oval fat bodies and cholesterol crystals

II.) ENUMERATION. Give three (3) examples for each of the following lettered items: (30 points) A. Normal urinary pigments Urochrome, uroerythrin, and urobilins

B. Properly labeled urine specimen should have these information Patient's full name, date of collection & time of collection among others but these three (3) should be in the label before putting other information

C. Instrumental principles used in automated urinalysis Spectrophotometry, Flow cyometry, Microscopy & Imaging

D. Types of test for genitourinary tract cancers Conventional urine cytometry, Flow cytometry, Image cytometry, & DNA analysis

E. Precautions in dipstick testing See the Table on Recommendation for Reagent Strips that contains precautions on storage and testing using reagent strips

F. Processes involved in specimen evaluation Checking for proper labels, appropriateness of sample for the tests, signs of deterioration, presence of contamination, and proper preservation

G. Materials when present in urine produce cloudiness Crystals, cells, bacteria, & lipids among others

H. Physical testing parameters Color, odor, character/clarity, volume, specific gravity, & osmolality

I.

Substances in urine that can be tested using strip technology

Glucose, Protein, Bilirubin, Ascorbic acid, Uroblinogen, Hemoglobin, Ketones, Nitrite, & Leukocyte esterase among others (pH, specific gravity. & blood are not substances)

J. Cellular components of urinary sediment RBC, RBC, epithelial cells, bacteria, and yeast cells Module 6 I. TRUE OR FALSE. Write T if the statement is correct and write F if the statement is incorrect. (15 points) T 1. The refractometer is an indirect method of measuring specific gravity. T 2. The nitrite and leucocyte reagent strip parameters are for testing bacteriuria. T 3. The clarity of urine also affects the color assessment of urine. T 4. The organic solvent ether is used to confirm the presence of chyluria. T 5. Mixing the urine sample is a must before doing clarity testing. F 6. Before dipstick testing, mixing the urine sample is not necessary. F 7. A dark background is necessary in order to observe the urine color. T 8. A white background is useful in observing urine character. F 9. The cells and crystals can be all dissolved using dilute acid. T 10. The urine color and clarity can be correlated in the wet urinalysis. T 11. The specific gravity and urine color can be correlated with each other. T 12. Distilled water serves as the reference solution in both refractometry and urinometry. F 13. pH testing is a part of the physical examination of urine. T 14. The condenser, iris diaphragm and lamp are illuminating parts of the microscope. F 15. Proteins in urine is diet-dependent unlike the urine pH and urine volume. II. MATCHING TYPE: Match column A with column B. Letters only. You are not allowed to change your answers. PARTS OF ROUTINE URINALYSIS Column A Column B Urine Appearance and their Causes C 16. Colorless A. methemoglobin, melanin F 17. Cloudy B. hemoglobin, beets, myoglobin J 18. Smoky C. very dilute urine, diabetes insipidus H 19. Milky D. bilirubin-biliverdin B 20. Red E. indicans, Pseudomonas infection A 21. Brown-black F. bacteriuria, phosphates, urates, pus cells E 22. Blue-green G. concentrated urine, urobilin in excess I 23. Yellow H. fat, emulsified paraffin, pyuria K 24. Yellow-green I. acriflavine G 25. Yellow orange J. blood in the urine (intact RBCs) K. None of the above Characteristics of Urine & Associated Conditions C 26. Sweaty feet odor A. MSUD E 27. Odor of cabbage or hops B. Filariasis, lymph node obstruction H 28. Mousy odor C. Isovaleric and glutaric acidemia F 29. Rotting fish smell D. Major long bone and pelvic bones J 30. Rancid smell E. Methionine malabsorption

K I G B D

31. Maple syrup odor 32. Sweetish or Fruity odor 33. Blackening upon long standing of urine 34. Chyluric urine due to leakage of lymph 35. Lipiduria

F. Trimethylaminuria G. Alkaptonuria H. Phenylketonuria I. Diabetes mellitus J. Tyrosinemia K. None of the above

Module 7 MULTIPLE CHOICE. Choose the lettered choice thatcorresponds to the correct answer. Letters only. 1. Which pigment causes the production of yellow foam ? C. bilirubin A. uroerythrin B. hemoglobin D. indicant 2. The presence of intact red blood cells in the urine is called A. hematuria C. hemosiderinuria B. hemoglobinuria D. hematinuria 3. Homogentisic acid forms brown-black urine upon long standing -- a condition known as A. porphyria C. melaninuria B. alkaptonuria D. urobilinuria 4. Which of these urinary constituents can be cleared through acidification? A. amorphous urates C. pus cells B. amorphous phosphates D. bacteria 5. The dye Oil Red O is used to demonstrate the presence of A. hematuria C. lipiduria B. chyluria D. pyuria 6. Excretion by an adult of more than 500 mL. of urine with a specific gravity of 1.018 at night is A. polyuria C. polydipsia B. nocturia D. nocturnal oliguria 7. Which of the following statements is not true? A. High volumes of urine result in a low specific gravity. B. The aromatic odor of freshly voided urine is of undetermined source. C. Cloudy urine is not common and not necessarily pathologic. D. Aside from urochrome, there are other pigments that give normal urine a yellow color. 8. Which parameter cannot be measured using reagent strip technology? A. specific gravity C. glucose D. osmolality B. urinary pH 9. The presence of high amounts of indican will give a urine sample a A. red-violet color C. brown-black color B. yellow-orange color D. blue-green color 10. The average adult on a normal diet produces a 24-hour urine with a pH of about A. 5.0 C. 7.0 B. 6.0 D. 7.4

11. At night, during the mild respiratory acidosis of sleep, a more acidic urine is formed. The acidity is largely due to the buildup of A. casts and crystals C. organic acids B. carbon dioxide D. ketone bodies 12. A diet high in meat and cranberries will A. lower urinary pH C. increase urinary pH B. produce neutral pH D. not affect urine pH 13. The titratable acidity of a 24-hour urine collected in ice utilizes as titrant the A. 0.1N NaHCO3 C. 0.1N NaCl B. 0.1N NaOH D. 0.1N NaNO3 14. The most accurate means of determining the pH of urine samples is the A. blue and red litmus paper method B. pH meter with a glass electrode C. titratable acidity testing using a 24-hour urine sample (in ice) D. reagent strip using bromthymol blue and methyl red 15. The protein uromucoid is secreted by the cells in the distal tubular cells and ascending loop of Henle. It is highly associated with cast formation. It is also referred to as the A. Bence Jones protein C. Retinol-binding protein B. Tamm-Horsfall glycoprotein D. Immunoglobulin light chains 16. The presence of Bence Jones protein the urine is suggestive of A. Overflow proteinuria C. Multiple myeloma B. Cylindruria D. Functional proteinuria 17. A hazy urine with high protein content collected after a heavy exercise is an example of A. Intermittent proteinuria C. Postural proteinuria D. Functional proteinuria B. Persistent proteinuria 18. To detect the kinds of protein in the urine, what is needed is C. Electrophoresis A. Multistix 10 SG B. Salting-out process D. Dye-binding tests 19. The catabolic products derived from lipids which can become potentially toxic are the C. ketone bodies A. sugar monomers B. benzene derivatives D. fatty acids 20. When lipid is lost in the urine, many granular casts, fatty casts and oval fat bodies are found in the urine sediment. Oval fat bodies are actually A. hyaline casts with lipid deposits C. droplets of cholesterol esters B. fat-laden renal tubular epithelial cells D. lipoproteins forming oval crystals 21. Tubular pattern proteinuria is seen in all of the following conditions except A. Fanconi’s syndrome C. Wilson’s disease D. Nephrotic syndrome B. Pyelonephritis 22. The tubular pattern proteinuria cannot be easily detected using reagent strip methods due to the type of protein involved – the low molecular weight proteins such as alpha-1-microglobulin, light-chain

immunoglobulins and lysozymes. On the other hand, glomerular pattern proteinuria is detected because the protein involved is mainly A. albumin C. medium-chain immunoglobulins B. Bence Jones protein D. Tamm Horsfall protein 23. Which substance may largely affect urinary pH testing? A. protein C. glucose B. ketone bodies D. bilirubin 24. Which statement regarding protein testing is not true? A. Reagent strips are not sensitive in measuring globulins but sensitive to albumin. B. Both albumin and globulins can be precipitated using SSA and TCA. C. Reagent strips can be used in assessing the degree of proteinuria. D. Both reagent strips, SSA and TCA methods are for urine protein screening. 25. Which blood glucose level exceeds the renal threshold for glucose leading to glucosuria? A. 100 mg/dL C. 130 mg/dL D. 220 mg/dL B. 157 mg/dL 26. Urine glucose testing serves to check endocrine function to diagnose the disease A. Diabetes insipids C. Diabetes mellitus B. Hyperglycemia D. Glucosuria 27. The copper reduction tablet test for glucose is the A. Clinistix C. Clinitest B. Bilitest D. Chemstrip G 28. What enzyme will oxidize glucose into gluconic acid and hydrogen peroxide? A. hexokinase C. glucokinase B. glucose oxidase D. glucose peroxidase 29. O-toluidine is the chromogen used in which reagent strip for glucose? A. Clinistix C. Multistix B. Chemstrip-G D. Clinitest 30. All of the following are reducing sugars except A. glucose C. galactose B. fructose D. sucrose 31. What compound of copper is colored red? A. CuOH C. CuSO4 B. Cu2O D. CuO 32. What organic substances are products of incomplete lipid metabolism? A. free fatty acids C. bile pigments B. ketone bodies D. porphyrins 33. The most abundant among these organic substances in the urine is A. beta-hydroxybutyric acid C. diacetic acid D. urea B. acetone

34. The most abundant among these inorganic urine constituents is A. sodium C. bicarbonate B. chloride D. potassium 35. Ketonuria may be seen in all of the following conditions except A. fasting C. excessive exercise B. type I diabetes mellitus D. carbohydrate-rich diet 36. Sodium nitroferricyanide reaction (Acetest) is specific for urinary A. urobilinogen C. bilirubin B. diacetate D. sucrose 37. Rothera’s wet method can detect all of the following except A. acetoacetic acid C. acetone B. beta-hydroxybutyrate D. ketone bodies 38. Which of the following substances is an oxidizing agent? C. hydrogen peroxide A. ascorbic acid B. glutathione D. uric acid 39. If delay in testing for ketone bodies cannot be prevented, the urine sample should be A. kept capped at room temperature C. discarded and replaced by a new one B. added with preservative D. refrigerated at 2-10 degrees Celsius 40. Which of the following is not a breakdown product of hemoglobin? A. bilirubin C. hemosiderin B. amino acids D. haptoglobin 41. The Diazo (p-nitrobenzenediazonium p-toluene sulfonate) tablet test is for the detection of urine A. hemoglobin C. urobilinogen B. bilirubin D. myoglobin 42. Ehrlich’s aldehyde reaction is the formation of reddish-brown color due to A. urobilinogen C. bilirubin B. nitrite D. leukocyte esterase 43. Bilirubin can be detected using all of the following methods except A. Ictotest C. Diazo reagent strip D. Blondheim method B. Yellow foam test 44. Schwartz-Watson test differentiates between the presence of urobilinogen and A. hemoglobin C. bilirubin B. porphyrins D. porphobilinogen 45. Inverse Ehrlich’s reaction is also known as C. Hoesch’s test A. Hecht’s test B. Nitrite test D. Leukocyte esterase test A positive nitrite test indicates ___A_(46)____ while a positive leukocyte esterase test indicates ___ _C__(47)____ . A. bacteriuria C. pyuria B. cylindruria D. crystalluria

48. C-Stix reagent strips are impregnated with buffered phosphomolybdates to detect A. ascorbic acid C. citric acid B. 5-hydroxyindoleacetic acid D. melanin 49. The 5-hydroxyindole acetic acid (5-HIAA) is a byproduct of metabolism of C. serotonin A. porphyrins B. indicant D. ascorbic acid 50. The most abundant among the ketone bodies which accounts 78% of the total in urine is A. acetone C. acetoacetic acid B. beta-hydroxybutyric acid D. urea

Module 8 I.

NORMAL OR ABNORMAL FINDINGS. Tell whether the following laboratory situations or microscopic findings are normal or abnormal. Write N if normal and A if abnormal. N 1) 0-2 erythrocytes per high power field N 2) bacterial count of 1,000/mL of urine N 3) 10 PMN per high power field of standardized slide A 4) presence of cystine crystals N 5) occasional amorphous urates A 6) presence of numerous dysmorphic RBCs A 7) moderate amount of waxy casts A 8) presence of structures seen as Maltese crosses A 9) passage of brown urine positive for melanin A 10) bacteriuria (100,000/mL urine) A 11) presence of fragmented urothelial cells A 12) 5 renal cells per hpf A 13) turbid uriine due to fecal contamination A 14) albuminuria after heavy exercise A 15) 0-2 hyaline casts per 1pf A 16) 0-1 fatty cast per 1pf A 17) Tumor cells found in mine sediment A 18) Abundant mucus threads in urine N 19) Rare appearance of renal tubular cells N 20) 0-4 leukocytes per hpf

II. TYPES OF SEDIMENT. Identify the specific type of cell, cast, contaminant or crystal that are referred to by each of the following: NOTE: For crystals, give chemical name. 11) PMN- WBC 1) refractile “Maltese cross”- Fat Globules 2) Lacy phosphate precipitates- Amorphous PO 12) G1 cells- dysmorphic RBC 3) Ghost cells- RBC 13) “Corkscrew” casts- waxy cast 4) Oval fat bodies- Renal cells 14) “Coffin lid” crystals- triple phosphate 5) Lemon-shaped “Whetstone”- Uric acid 15) Hexagonal laminated crystals- cystine 6) Crenated or dysmorphic structure- RBC 16) “Thorn apple” crystals- ammonium biurate

7) Refractile “budding” forms- yeast cells 17) Renal failure casts- waxy cast 8) Glitter cells- WBC 18) Cells with endo-ecto cytoplasmic rim- Urothelial/transitional epth 9) Sheaves of wheat with eccentric binding- sulfa crystal 19) Shadow cells- RBC 10) “Envelope” crystals- Calcium oxalate 20) Brick dust- ammorphous urates

III. ENUMERATION. Enumerate the following: 1 – 4………………. Requisites for Cast Formation High salt conc, increased acidity, high protein conc, stasis and stagnation of urine 5 – 8………………. Parameters Used in Cast Classification Matrix, inclusion, pigments and cells 9 – 12…………….. Contaminants in Urine Microscopy Muscle fiber, vegetable cels, spermatozoa, pollen grains, cotton fibers, wood fibers, starch granules, oil droplets, spermatozoa, fecal materials like eggs and detritus, diaper materials 13 – 15 ………….. Stains used in Studying Urine Sediments Pap stain, Gram, Giemsa, Wrights, Sternheimer-Malbin, Safranin, Crystal Violet, Toluidine Blue, Lactophenol cotton blue, Hansel, Oil Red O, Sudan III, Prussian blue 16 – 20…………… Methods of Examining Urine Sediment Brightfield microscopy, Darkfield microscopy, PCM, EM, Polarizing microscopy, Interference microscopy, Cytodiagnostic method, Quantitative and differential counts, Image cytometry & DNA analysis and Flow cytometry (Automated Urinalysis) 21 – 25 …………..Conditions Affecting the Genitourinary Tract Characterized by Passage of Casts in the Urine Chronic glomerulonephritis (CGN), Acute glomerulonephritis (AGN), chronic pyelonephritis, acute pyelonephritis, Nephrotic syndrome, Acute tubular necrosis (ATN), and Acute renal allograft rejection IV.

TYPES OF CRYSTALS. Identify each of the following crystals whether they are found in normal acid urine (write AC), normal alkali...