CLINICAL MICROSCOPY

Reinforcement
Glenn Philson Madronio
Where does most cerebrospinal fluid (CSF)
originate?

A. Cerebral arachnoid space

B. Choroid plexus
C. Ventricles
D. Lumbar region
B. Choroid plexus
➢ Most CSF originates here in the choroid plexus;
approximately 70%
➢ Remaining CSF, about 30%, is formed in other sites such
as the subarachnoid space and the ependymal lining of the
ventricles
When an unpreserved urine specimen
cannot be cultured immediately, which
storage method is most appropriate?

A. Stored at room temperature for up to 8 hours

B. Stored in freezer for up to 24 hours
C. Stored in the incubator for up to 8 hours
D. Stored in the refrigerator for up to 24 hours
B. Stored in ref. for up to 24 hrs.
➢ Unpreserved urine specimen that cannot be cultured
immediately may be stored in the refrigerator at 4° Celsius for up
to 24 hours
➢ After 24 hours of refrigeration, the culture results may not be
accurate as some bacteria may not survive the extended
time/temperature conditions
➢ If the urine specimen is stored at room temperature for more
than two hours without chemical preservative or placed in an
incubator, the bacteria that may be already present will start to
rapidly multiply and give falsely elevated culture results
All of the following crystals will normally be
found in a urine specimen with a pH of
8.0, EXCEPT?

A. Ammonium biurates
B. Triple phosphates
C. Calcium carbonates
D. Uric acid
D. Uric acid
➢ Uric acid crystals are most commonly found in acidic urine;
therefore, an alkaline urine with a pH of 8.0 would not have uric
acid crystals present
➢ All the other crystals listed are found in alkaline urine
Which of the following casts is
characteristically associated with acute
pyelonephritis?

A. Red cell
B. White cell
C. Fatty
D. Waxy
B. White cell
➢ Closely associated with acute pyelonephritis since white blood
cells are drawn to the infection and inflammation of the kidney
Which of the following tests included on a
urine chemical reagent strip would never be
reported as negative?

A. Urobilinogen
B. Bilirubin
C. Leukocyte esterase
D. Blood
A. Urobilinogen
➢ Note: Urobilinogen is reported as normal, not negative
Which of the following answer choices
correctly state the use of urine reagent strips
for chemical analysis?
A. Urine chemical reagent strips readers can utilize any
manufacturer's dipsticks
B. Use of a well-mixed, uncentrifuged urine sample at room
temperature is the technique for urine reagent strips
C. The urine reagent test strips method is very reliable and quick
as the timing for chemical reactions to take place is the same
D. The reagent strip can be left in the urine specimen for several
minutes without causing any problem
B. Use of a well-mixed, uncentrifuged
urine sample at room temperature is the
technique for urine reagent strips
➢ Red cells and white cells settle to the bottom of the tube when
the urine specimen is not mixed well resulting to these cells stay
undetected during analysis.
All of the following white blood cells would
produce a positive leukocyte esterase
test, EXCEPT?

A. Neutrophils
B. Eosinophils
C. Basophils
D. Lymphocytes
D. Lymphocytes
➢ Leukocyte esterase is an enzyme present in most granulocytic
white blood cells (Neutro, Eos, Baso) and monocytes -------------
but NOT found in the lymphocytes or red blood cells
Xanthochromia in CSF is characteristic of:

A. Encephalitis
B. Meningitis
C. Septicemia
D. Hemorrhage
D. Hemorrhage
➢ Xanthochromia is the pink, yellowish, or orange discoloration of
the CSF mostly due to the presence of RBC degradation
➢ Yellowish discoloration can occur within 2 to 4 hours after the
onset of subarachnoid hemorrhage
All of the statements below about synovial
fluid are true EXCEPT:

A. Arthrocentesis is performed as a means to evaluate arthritis

and other joint disorders
B. Synovial fluid is present only in movable joints
C. Joint fluid resembles plasma in viscosity
D. Joint fluid has approximately the same glucose as plasma
C. Joint fluid resembles plasma
viscosity
➢ Synovial fluid is actually quite viscous and does not have the
same consistency as plasma
➢ Thicker consistency is needed to provide a cushion and reduce
friction between the articular cartilage of synovial joints during
movement
All of the following specimen collection
methods should be used if urine cultures are
also required, EXCEPT?

A. Routinely voided
B. Clean catch
C. Catheterized
D. Suprapubic aspiration
A. Routinely voided
➢ A routinely voided urine specimen is NOT acceptable for culture.
An aseptic technique must be used to prevent contamination with
urethral or vaginal bacteria that may cause misleading positive
cultures.
Which of the following tests confirms the
presence of Bence-Jones proteinuria:

A. Protein electrophoresis
B. Sulfosalicylic acid precipitation
C. Cryoprecipitation
D. Immunoelectrophoresis
D. Immunoelectrophoresis
➢ Used to detect, diagnose, and monitor the course and treatment
of conditions associated with abnormal proteins (such as Bence-
Jones)
➢ Notably in diseases such as Multiple Myeloma and
Waldenstrom’s Macroglobulinemia
What is the identification of this crystal seen
in a urine specimen with an alkaline pH?

A. Uric acid
B. Ammonium biurate
C. Triple phosphate
D. Calcium phosphate
B. Ammonium biurate
➢ Commonly occur in the form of "thorn apples“ or in polyhedral
shapes
➢ Deeply colored from a dark-yellow to brown
What is the identity of the cells that are
indicated by the arrow in this image?

A. Yeast
B. Squamous epithelial cells
C. White blood cells
D. Red blood cells
B. Squamous epithelial cells
➢ These cells are some of the largest cells found in the urine
➢ Appear as clumps of cells and have a very large irregular-shaped
cytoplasm with a prominent centrally located nucleus
➢ Can even be seen under low-power field (LPF)
➢ Usually non-pathological
A dilution commonly used for a routine
sperm count is:

A. 1:10
B. 1:20
C. 1:100
D. 1:200
B. 1:20
➢ Most commonly used dilution for routine sperm count by using a
Neubauer counting chamber
Which of the following is characteristic of
an exudate effusion?

A. Leukocyte count greater than 1,000 WBC/µL

B. Clear appearance
C. Protein concentration less than 3.0 g/dL
D. Absence of fibrinogen
A. Leukocyte count greater than
1,000 WBC/µL
➢ Exudate effusion characteristics:
➢ Leukocyte count greater than 1,000 WBC/µL
➢ Fluid : Serum Protein ratio > 0.5
➢ Yellow or cloudy appearance
➢ Possible spontaneous clotting
A cell count is ordered on a CSF sample that
is bloody. Which of the following procedures
would improve count accuracy?

A. Dilute the sample to minimize the number of red blood cells in

the squares being counted
B. Use Spinal Diluting Fluid, a mixture of acetic acid and crystal
violet
C. Use an automated hematology cell counter
D. Use of electronic cell counter
A. Dilute the sample to minimize the
number of red blood cells in the
squares being counted
➢A total cell count could be performed initially by using saline,
mixed by inversion, and loaded into the hemocytometer
The ketone component that is measured by
the nitroprusside reaction is:

A. Acetoacetic acid
B. Beta-hydroxybutyric acid
C. Acetone
D. C-Reactive Protein
A. Acetoacetic acid
➢ A positive ketone result is demonstrated as a color change from
purple to violet
➢ Intensity of the violet color is proportional to the concentration
of ketone bodies in the urine
Nitrates in urine are reduced to nitrites by:

A. Gram-positive bacteria
B. Gram-negative bacteria
C. Acid-fast bacteria
D. Yeasts
B. Gram-negative bacteria
➢ Gram-positive bacteria, yeast, and acid fast bacteria do not
possess the enzyme reductase which aids in the reduction of
nitrates to nitrites
➢ Prolonged urinary retention in the bladder (at least 4 - 8 hours) is
necessary in order to obtain an accurate result
A patient reported to her doctor that her
stools have been ribbon-like over the last
few weeks. What is most likely the cause of
the patient's stool appearance?

A. Diarrhea
B. Constipation
C. Inflammation of the intestinal wall
D. Bowel obstruction
D. Bowel obstruction
➢ Most likely cause of ribbon-like stools
➢ Normal passage of fecal waste is restricted in some way
On a patient that has a large amount of
glucose in their urine, what would be the
expected specific gravity (SG) taken from a
refractometer in comparison to the dipstick
SG?
A. Refractometer SG would be lower than Dipstick SG
B. Refractometer SG would be higher than Dipstick SG
C. Dipstick SG would be the same as refractometer SG
D. Unable to determine
B. Refractometer SG would be
higher than Dipstick SG
➢ Reagent strip (dipstick) SG only measures ionic solutes and does
not detect organic molecules such as glucose and urea
All of the following are characteristics of
cast, EXCEPT?

A. They are cylindrical bodies

B. They are formed either in the distal convoluted tubules or the
collecting ducts of the kidney
C. They contain Tamm-Horsfall mucoprotein
D. They are formed in the urethra
D. They are formed in the urethra
➢ Casts are cylindrical bodies formed either in the distal convoluted
tubules or the collecting ducts of the kidney, not the urethra
Identify the urine sediment elements shown
by the arrow:

A. Waxy cast
B. Granular cast
C. Renal tubular epithelial cast
D. Hyaline cast
A. Waxy cast
➢ Appears smooth and homogenous, and highly refractile
➢ Present in patients with severe renal failure (and can be due to
allograft rejection)
All of the following are true in regards to
performing quality control (QC) on urine
chemical reagent strips, EXCEPT:

A. As often as required by the laboratory's procedure

B. On each new lot received in the laboratory
C. When a new bottle of reagent strips is opened
D. QC is performed only when patient results are questioned by
the health care provider
D. QC is performed only when
patient results are questioned by
the health care provider
➢ Quality control is NOT only performed when results are
questioned by the health care provider
The Clinitest reaction is based on which of
the following principles?

A. Copper reduction
B. Ortho-toluidine oxidation
C. Diazotization of sugars
D. Enzyme reaction
A. Copper reduction
➢ Based on the classic Benedict's copper reduction reaction
➢ Usually performed on pediatric specimens in order to check for
the presence of reducing substances
➢ Screening test for inborn metabolic problems (e.g. galactosemia)
Identify the urine sediment elements shown
by the arrow:

A. Cholesterol crystals
B. Uric acid crystals
C. Amorphous urate crystals
D. Cystine crystals
B. Uric acid crystals
➢ Flat diamond (four-sized), rhombic, lemon-shaped, or rarely
hexagonal shapes with a yellowish or yellowish-brown coloration
➢ Present in acid urine
➢ Show various colors when polarized
What should be added to the cytocentrifuge
chamber when preparing slides on serous
fluids to aid in the adhesion of cells to the
slide and preserve cellular morphology?

A. Hyaluronidase
B. 22% Albumin
C. 10% acetic acid
D. Sterile saline
B. 22% Albumin
➢ 10-22% albumin should be added when preparing serous fluids
and CSF
➢ This albumin concentration helps preserve cellular morphology
and improves adhesion to the slide
➢
Which of the following tests is the BEST
screening test for neural tube defects?

A. Placental lactogen
B. Bilirubin
C. Estriol
D. Alpha-fetoprotein
D. Alpha-fetoprotein
➢ Produced by the fetal liver
➢ Measured in pregnant women, using maternal blood or amniotic
fluid, as a screening test for a subset developmental abnormalities
➢ Abnormally high levels of this substance is associated with
defects in the fetal neural tube
➢If abnormally low levels, usually associated with the presence of
Down Syndrome
The reagent strip method for protein
primarily tests for which type of protein?

A. Globulin
B. Bence-Jones protein
C. Albumin
D. Mucoprotein
C. Albumin
➢ Protein that is found in the highest concentrations in the body
➢ Reagent test strip reaction is based on the "protein error of
indicators"
➢ Phenomenon occurs because proteins act as hydrogen ion
acceptors at a constant pH
➢ Albumin is the main protein measured which contains more
amino groups to accept hydrogen ions than other groups
A negative glucose oxidase test and a
positive test for reducing sugars in urine
indicate:

A. True glycosuria
B. A false-negative glucose oxidation reaction
C. The presence of a non-glucose reducing sugar such as galactose
D. These results are normal
B. The presence of a non-glucose
reducing sugar such as galactose
➢ Negative glucose oxidase test and a positive test for reducing
sugars in urine indicate the presence of a non-glucose reducing
sugar such as galactose, fructose, glyceraldehyde, etcx
Significantly increased levels of ketones are
typically detected in the urine with all of the
following conditions, EXCEPT?

A. Diabetic acidosis
B. Excessive carbohydrate loss
C. Starvation
D. Following a low-impact exercise routine
D. Following a low-impact
exercise routine

➢ Increased levels of ketones are detected in the urine in diabetic

acidosis, excessive carbohydrate loss, and starvation
A patient suffering from typical leukemic
symptoms presents in the emergency room.
Physicians order a spinal tap after noticing
possible central nervous system
involvement. What are the cells seen in the
spinal fluid cytospin preparation?
A. Reactive mesothelial cells
B. Lymphocytes and Blasts
C. Monocytes
D. Reactive Lymphocytes
B. Lymphocytes and Blasts
➢ Predominant cell type appears as large cells with irregularly
shaped nuclei, prominent nucleoli, and scant cytoplasm
Identify the casts present in this slide.

A. Hyaline
B. Waxy
C. Granular
D. Renal tubular epithelial
A. Hyaline
➢ Colorless, homogeneous, and transparent with rounded ends
➢ Can also be seen as a result of dehydration, after diuretic
therapy, in renal disease and transiently as a result of exercise
A CSF glucose value is 62 mg/dL. What
would you estimate the serum glucose?

A. 65 mg/dL
B. 93 mg/dL
C. 120 mg/dL
D. 180 mg/dL
B. 93 mg/dL
• CSF glucose is roughly estimated to be about 2/3 of the serum
glucose level in mg/dL. Therefore:
• 62 mg/dL = 2/3 x serum glucose
• serum glucose = 62 mg/dL x 3/2
• serum glucose = 93 mg/dL
The exocrine functions of the kidneys include
which of the following?

A. Regulation of hormone production

B. Elimination of metabolic waste products
C. Maintenance of blood pressure
D. Production of red blood cells
A. Elimination of metabolic waste
products
➢ Exocrine gland removes waste products not filtered by the
glomerulus to the tubule via active transport
What is the fluid created in the abdominal
cavity named?

A. Peritoneal fluid
B. Amniotic fluid
C. Cerebrospinal fluid
D. Pleural fluid
A. Peritoneal fluid
➢ Fluid created in the abdominal cavity
"Xanthochromic" CSF means that the color
of the CSF can be any of the
following EXCEPT:

A. Pale orange
B. Pale pink
C. Yellow
D. Blue
D. Blue
➢ Pale orange or pale pink colors can be seen from 2-12 hours
after a subarachnoid hemorrhage
➢ Yellowish at about 12-24 hours after such a hemorrhage
➢ Other conditions, as well as a delay in processing can lead to
false positives
Normal crystals that can be found in urine
include:

A. Leucine
B. Tyrosine
C. Cystine
D. Triple phosphate
D. Triple Phosphate
➢ Found in highly alkaline urine
➢ Look like colorless coffin lids under the microscope
What is the element indicated by the arrow
in this image?

A. Hyaline cast
B. Waxy cast
C. Granular cast
D. Red blood cell cast
C. Granular cast
➢ Textured appearance ranging from fine to coarse
➢ Indicative of renal disease
➢ Composed of a protein matrix (e.g. tubular cells, leukocytes) with
degraded cellular material
The image is a stained smear of
cerebrospinal fluid. The cells present in this
field may indicate what condition?

A. Allergic reaction
B. Bacterial meningitis
C. Leukemia with CNS involvement
D. Viral meningitis
C. Leukemia with CNS involvement
➢ Immature cells (Blasts) present in CSF, can be correlated with the
Peripheral Blood Smear (PBS) result
What types of cells are NOT present in this
field of a cytocentrifuged CSF sample?

A. Red cells
B. Lymphocytes
C. Neutrophils
D. Blasts
D. Blasts
➢ No blasts present in this image
➢ Mature lymphocytes are observed; chromatin pattern signifies
mature and clumped
➢ Neutrophils and RBCs are also easily observed
The kidneys perform all of the following
functions EXCEPT:

A. Acid-base balance
B. Hormone production
C. Reabsorption of waste products
D. Water and electrolyte balance
C. Reabsorption of waste products
➢ Most prominent functions of the kidneys is the removal of
unwanted substances from plasma
➢ Waste products are not reabsorbed by the kidneys
Normal fecal specimens contain all of the
following, EXCEPT:

A. Escherichia coli
B. Electrolytes
C. Urobilin
D. Shigella spp.
D. Shigella spp.
➢ True pathogens are not normally present, including Salmonella
enterica, Shigella spp., and Yersinia spp.
Homogentisic acid in urine will cause urine
to be which of the following colors?

A. Green
B. Pink
C. Port-wine
D. Brown/black
D. Black/Brown
➢ Homogentisic acid in the urine is found in Alkaptonuria, an
inherited amino acid disorder
➢ These individuals lack an enzyme that breaks down homogentisic
acid
Which of the following substances can cause
a false positive result for blood on the urine
chemical reagent strip?

A. Ascorbic acid
B. Bleach in the collecting bottle
C. High levels of nitrite
D. High specific gravity
B. Bleach in the collecting bottle
➢ Bleach can trigger the color change normally associated with the
presence of red blood cells or hemoglobin
➢ Follow up with a microscopic analysis is advised for the
confirmation of a true positive result
In a normal CSF the protein concentration as
compared to that in the plasma is generally:

A. Less than 50%

B. Less than 30%
C. Less than 10%
D. Less than 1%
A. Less than 1%
➢ Normal ratio of plasma to CSF protein is about 200:1
➢ Elevation of CSF total protein is a nonspecific finding, but usually
indicates some type of disease involving the brain or meninges
➢ Contamination of CSF with blood due to events such as
traumatic tap can elevate the CSF protein levels
Oliguria is usually correlated with:

A. Acute glomerulonephritis
B. Diabetes mellitus
C. Hepatitis
D. Tubular damage
A. Acute glomerulonephritis
➢ Closely associated with oliguria (decreased urine output), and
occasionally anuria (no urine output)
Cerebrospinal fluid (CSF) specimens are
usually collected by lumbar puncture and
placed in numbered tubes starting with the
first tube collected. If four tubes are
collected, which tube would be used for a
cell count and differential?
A. Tube No. 1
B. Tube No. 2
C. Tube No. 3
D. Tube No. 4
C. Tube No. 3
➢ Most commonly used CSF tube for hematology for cell counts
and differential. Cell counts -- particularly WBC counts -- are a
critical part of CSF testing
A semen specimen was collected three hours
before it was brought to the laboratory for
examination. What course of action should
be taken?

A. Complete macroscopic and microscopic examination as

quickly as possible
B. Report the specimen as compromised on the final report
C. Perform the macroscopic and morphology procedures only
D. Perform the wet mount only
B. Report the specimen as
compromised on the final report

➢ Recommended time limit between collection and analysis is one

hour
➢ Semen specimen is examined under a microscope to determine
the concentration, motility (movement), and morphology
The technologist in the urinalysis department
received a sample for a microscopic
examination. The image to the right shows the
microscopic urinalysis. Which of the following
conditions below would most closely match this
patient's microscopic urinalysis morphology?

A. Diabetes mellitus
B. Glomerulonephritis
C. Yeast infection
D. Pyuria
B. Glomerulonephritis
➢ Kidney disease in which the glomerulus (filters waste and fluids
from the blood) is damaged
➢ Causes blood and protein to be lost in the urine
Which one of the following statements
about urea is false?

A. It accounts for 75% of nonprotein nitrogen excreted

B. It is elevated in a variety of glomerular, tubular, interstitial, and
vascular renal diseases
C. It is decreased in dehydration
D. The serum reference range for normal individuals is 6 to 20 mg/dL
when expressed as blood urea nitrogen
C. It is decreased in dehydration
➢ Urea is actually increased, not decreased, during bouts of
dehydration
➢ Urea accounts for 75% of nonprotein nitrogen excreted by an
individual, it is elevated in a variety of glomerular, tubular,
interstitial, and vascular renal diseases
➢ Serum reference range for normal individuals is 6 to 20 mg/dL
when expressed as blood urea nitrogen
Urine pH values can normally vary between:

A. 4.5 to 8.0
B. 5.0 to 7.0
C. 6.0 to 8.0
D. 5.5 to 7.0
A. 4.5 to 8.0
➢ Normal range is from pH 4.5 to 8.0
➢ Additional Notes:
➢ After meals, urine becomes more alkaline due to gastric acid secretion
(alkaline tide)
➢ At night due to shallow breathing, it becomes more acid
➢ A high meat diet results in more acid urine than a vegetarian diet, due to
the excretion of phosphates and sulfates
Identify the urine sediment elements shown
by the arrow:

A. Yeast
B. WBCs
C. Fat
D. Starch crystals
D. Starch Crystals
➢ Round to oval, are highly refractile, with an irregular indentation
in the center
➢ May exhibit the "Maltese cross" appearance under polarized
light
➢ Possible contaminants in normal urine are due body powders or
from protective gloves
What is the approximate volume of spinal
fluid in an adult?

A. 10-60 mL
B. 50-70 mL
C. 90-150 mL
D. 200-500 mL
C. 90-150 mL
➢ Approximate volume of CSF in an adult is 90-150 mL
➢ CSF is produced in the choroid plexuses of the lumbar ventricles
and the third and fourth ventricles
➢ Adults produce about 20 mL of CSF per hour
What is the urinary system composed of?

A. Kidney, ureter, urinary bladder, and urethra

B. Two kidneys, two urethras, one urinary bladder, and one ureter
C. Two kidneys, two ureters, one urinary bladder, and one urethra
D. Two kidneys, one ureter, one bladder, and one urethra
C. Two kidneys, two ureters, one
urinary bladder, and one urethra.
Identify the urine sediment elements
indicated by the arrow in the illustration:

A. Cholesterol crystals
B. Triple phosphate crystals
C. Amorphous urate crystals
D. Ammonium biurate crystals
B. Triple phosphate crystals
➢ Colorless prisms with 3 to 6 sides and oblique ends or "feathery
sleeves“, also described as “coffin lid shaped”
➢ Can normally occur in alkaline urine (but may also indicate
presence of infection)
Which two of the following crystalline
elements are found in acid urine:

A. Cystine and calcium carbonate

B. Triple phosphate and calcium carbonate
C. Calcium phosphate and uric acid
D. Tyrosine and cystine
D. Tyrosine and cystine
The cells shown in the image below are:

A. Transitional epithelial cells

B. Renal tubular epithelial cells
C. Yeast cells
D. Squamous epithelial cells
A. Transitional epithelial cells
➢ Originated from renal pelvis, ureters, bladder, and urethra
➢ Polygonal in shape; smaller and smoother in outline than
Squamous epithelial but larger than WBC
Which of the following tests would be useful
in the assessment of glomerular filtration:

A. 24 hour urine protein

B. Creatinine clearance
C. PSP test
D. Urea clearance
A
➢ Utilized to estimate the glomerular function of the kidney
➢ Creatinine clearance calculation is defined as the volume of
plasma that is cleared of creatinine by the kidney per unit of time
and uses the following formula:
➢ Creatinine clearance = (Urine creatinine conc x Urine Volume) / Plasma
creatinine conc.
➢ Creatinine clearance measurements have a recommended specimen
requirement = 24-hour urine collection
Identify the crystals in the image.

A. Leucine crystal
B. Cholesterol crystal
C. Bilirubin crystal
D. Cystine crystal
B. Cholesterol crystals
➢ Appear in acid urine as large, flat, transparent plates with
notched corners
The viscosity of the synovial fluid is due to
synoviocyte secretion of
mucopolysaccharide, which contains:

A. Acid phosphatase
B. Phosphatidyl glycerol
C. Hyaluronic acid
D. Lecithin
C. Hyaluronic acid
➢ Normal viscosity of synovial fluid comes from the polymerization
of hyaluronic acid
➢ Provides proper joint lubrication
A urine specimen produced yellow foam
when shaken. What is the cause of the
yellow foam?

A. Phosphates
B. Bilirubin
C. Normal
D. Red blood cells
B. Bilirubin
What is the purpose of the sweat chloride
test?

A. Is a noninvasive way to collect and test for DNA

B. To aid in the diagnosis of streptococcal infections
C. To help diagnose peptic ulcers due to Helicobacter pylori
D. To help diagnose cystic fibrosis
D. To help diagnose cystic fibrosis
➢ Gold Standard for the diagnosis of cystic fibrosis
➢ Collected sweat from the patient is tested for chloride
concentration; can be up to 5x higher for cystic fibrosis patients
compared to normal value
Each of the cells below can be found in all
types of body fluids EXCEPT:

A. Neutrophils
B. Macrophage/monocytes
C. Lymphocytes
D. Mesothelial cells
D. Mesothelial cells
➢ Mesothelial cells are found only in serous body fluids including
pleural fluid, peritoneal fluid, and pericardial fluid.
Which of the following sites is used most
often for CSF collection?

A. Ventricles
B. L1-L2
C. Suboccipital
D. L3-L4
D. L3-L4
➢ Most common to avoid damage to the spinal cord in adults
because the spinal cord does not extend that far down
➢ In children and infants, the spinal cord may extend this far,
therefore the intervertebral space between L4 and L5 can be used
Identify the urine sediments present in this
image observed using brightfield microscopy.

A. White blood cells

B. Squamous epithelial cells
C. Red blood cells
D. Yeast
C. Red blood cells
➢ are slightly smaller than WBCs and have a smooth, non-
nucleated appearance
The image is a Wright-Giemsa stained smear
(1000x) of cerebrospinal fluid (CSF). What is
the identification of the cells that are
indicated by the arrows?

A. Ependymal cells
B. Atypical lymphocytes
C. Presumptive malignant cells
D. Immature white blood cells
C. Presumptive malignant cells
➢ characteristics that help to identify these, and the surrounding
cells, as a malignant cells include: giant cells, cellular crowding,
high nuclear to cytoplasm (N/C) ratio, non-uniform nuclei,
irregular nuclear membranes, multinucleation, and vacuolation
The volume of urine recommended for
centrifugation for a microscopic examination
is:

A. 1-3 mL
B. 10-15 mL
C. 15-20 mL
D. Volume is not important
B. 10-15 mL
➢ Optimal sample for microscopic evaluation
➢ Supernatant is discarded; remaining 0.5-1.0 mL of sediment is
used for the microscopic examination
Which of the following casts might be found
in the urine of a healthy individual after
strenuous exercise?

A. Epithelial cell casts and granular casts

B. Hyaline casts and granular casts
C. Granular casts waxy casts
D. Waxy casts and hyaline casts
B. Hyaline and granular cast
➢ May be seen in healthy individuals for a short time period after
strenuous exercise
➢ Even the mildest cases of renal disease and are not particularly
associated with any specific disease
➢ Granular casts, however almost always indicate significant renal
disease except after strenuous exercise
THANK YOU!