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Flashcards in 2 Deck (82):
1

What does the physical examination consist of?

1) Color and clarity
2) Clarity
3) Foam
4) Odor
5) Concentration

2

What is the definition of a "Random" type (timing of collection)?

Unspecified, can be collected at any time, most common screening purposes, can sometimes give an inaccurate view of a patient's health

3

What is the definition of a "First Morning" type (timing of collection)?

First voided the urine is generally more concentrated, contains relatively higher levels of cellular elements, or protein

4

What is the definition of "fasting-second" type (timing of collection)?

Voided after 8 hours of fasting

5

What is the definition of "postprandial-first" type, (timing of collection)?

Voided is before a meal, and to collect a specimen 2 hours after eating

6

What are the types of "Timing of Collection"?

1) Random
2) First Morning
3) Fasting - second
4) Postprandial - first

7

What is the definition of the "Timed" aka 24 hour collection?

It is a collection of urine that measures creatinine **, urine urea nitrogen, glucose, sodium, and potassium

8

What is the definition of a "Midstream Clean Catch" (timing of collection)?

Urine is the preferred type of specimen for bacteria culture* and sensitivity testing because of the reduced incidence of cellular and microbial contamination

9

For a routine urinalysis, what is needed?

a fresh (less than 1-hour old clean-catch urine sample)

10

What happens when urine stands at room temperature for a long time?

Casts and red cells undergo lysis, and the urine becomes alkalinized with precipitation of salts

11

If you are testing urine specimens within a two hour window what do you need to do?

Refrigeration or Chemical preservation should be utilized

12

What is used for chemical preservation?

- Boric Acid (MOST COMMON*)
- Chloroform
- Formalin
- Thymole
- Toluene
- Preservation Tablet

13

Preserved urine specimens can be stored at room temperature until _____

time of testing

14

What are the steps of Routine Urinalysis?

1) Physical Exam
2) Chemical Exam
3) Microscopic Exam

15

What are you looking for during the physical exam of urine?

- Color
- Transparency (clarity)
- Foam
- Odor

16

What are the 3 things that are being assessed during the physical examination of urine?

Appearance, Specific gravity, and volume

17

What is the pigment that gives urine it's characteristic yellow color?

Urochrome (urobilin)

18

What substance in urine may contribute to some pinkish or reddish color in urine?

Uroerythrin

19

What are the 4 colors that are "normal?"

Colorless, straw, yellow, amber/dark yellow

20

If urine is white and pathogenic, what will it contain?

Chyle, lipids, pyuria

21

If urine is white and NONpathogenic, what will it be the result of?

phosphates and vaginal creams

22

Define "Chyle"

A milky body fluid consisting of lymph and emulsified fats, or free fatty acids

23

Pyuria =

many WBC's

24

If you have yellow to amber/orange urine and it's pathologic, what would be the cause of this?

liver dysfunction (excessive urobilin or bilirubin), and also some Chemotherapy drugs****

25

If you have yellow to amber/orange urine and it's NON pathologic, what would you expect the reason for this color change?

- carrots
- concentrated
- urine dehydration
- food color
- vitamin B complex or C

26

What is the NON pathologic list of things associated with urine chasing to a yellow/amber/orange color?

nitrofurantoin, pygidium, quinacrine, rhubarb, senna, serotonin, sulfasalazine-acriflavine, azo ganstrisin

27

If you urine has changed to yellow/green, what would be the pathologic reason for this change?

Biliverdin and Bilirubin

28

If your urine is yellow/green and it is NON pathologic, what is the most likely cause?

Asparagus

29

If your urine is pink/red, what is the most likely pathologic reason for this?

RBCs, Hemoglobin, Myoglobin, and Porphyrin

30

If your urine is pink/red and it is NON pathologic, what is the most likely cause?

Beets (anthocyanin) and food colors: (long list)

31

If your urine is red to purple and it is pathologic what is the most likely cause?

Porphyrin

32

If your urine is red to purple, can this be non pathologic?

NO, there is definitely something wrong

33

If your urine is red to brown, what is the most likely Pathologic cause?

Methemoglobin and Myoglobin

34

If your urine is red to brown, is there any way it can be non-pathologic?

NO, this is bad

35

If your urine is brown to black, what is the most likely Pathologic cause?

- Bilirubin **
- Methemoglobin**
- Myoglobin **
- Homogentistic Acid (alkapton ***

36

If your urine is brown to black, what is the most likely cause in NON pathologic cases?

- Iron compounds*
- Fava beans*
- Aloe *

37

If your urine is Blue to Green and it is pathologic, what is the most likely cause?

- Biliverdin (green)*

- Psudomonas infection*

Indicans

38

If your urine is blue to green and it is NON pathologic, what is the most likely cause?

- Vitamin B12*
- Thymole*
- Diuretic Therapy* (blue urine color)

39

Why would urine become cloudy?

Due to precipitation of amorphous crystals

40

Amourphous phosphates precipitate =

WHITE

41

Amorphous urate precipitate =

PINK (uroerythrin)

42

Cloudy urine may contain ____

Salts/crystals**

43

Hazy urine may contain _____

Mucus**

44

Smoky urine may contain _____

RBCs ***

45

Turbid urine may contain _____

leukocytes, bacteria, pus, proteins, and epithelial cells ****

46

Milky urine may contain ____

Fat or chyle ****

47

Various non-urinary substances can cause _____

urine specimens to appear hazy or cloudy

48

If your urine is clear, what is the most likely cause it would be a Pathologic problem?

Very dilute or Polyuria (DM, or DI)

49

If your urine is clear, what is the most likely cause it would be a NON pathologic problem?

Over hydrated

50

If urine is cloudy to turbid, what is the most likely pathologic cause of this?

Varying degrees of:

- Casts
- Cells
- Crystals and Calculi
- Fat (lipid, chyle)
- Microorganisms
- Fecal Contamination

51

If urine is cloudy to turbid, what is the most likely NON-pathologic cause of this?

- Creams, lotions
- Crystals
- Mucus
- Radiographic dyes
- Powders
- Fecal Contamination

52

What is the tell all sign that foamy urine is pathologic?

It is PERSISTENTLY* foamy urine and becomes more noticeable over time

53

What is the tell all sign that foamy urine is NON pathologic?

It SOMETIMES develops (the foam)

54

What are the main causes of foamy urine in regards to Pathologic problems?

- Significant amounts of protein (kidney disease)
- UTI (pus)
- Fistula from colon to bladder

55

What are the main causes Urine would be foamy under Non-pathologic circumstances?

- Rapid urination
- Foam increased with urine concentration (dehydration)
- Toilet cleaner

56

Sweet or fruity urine is associated with:

Ketones (e.g. DM)

57

Pungent urine is associated with:

Bacteria (ammonia) (e.g. UTI)

58

Maple syrup smelling urine is associated with:

Amino acids (maple syrup urine disease)

59

Musty or mousy urine odor of an infant is associated with:

Phenylketonuria

60

Rancid butter or fishy urine odor is associated with:

Hypermethioninemia

61

Stronger ammonia smelling urine is associated with:

Dehydration

62

What does a urine concentration test actually test?

specific gravity, refractive index, pKa, osmolarity

63

What is Urine Specific Gravity (USG)?

Ratio of the weight of a volume of urine to the weight of the same volume of distilled water at a constant temperature

64

What is Urine Specific Gravity used to measure (USG)?

Measures the concentrating and diluting ability in the kidney

65

What is one of the first functions to be lost as a result of tubular damage?**

Concentrating ability**

66

What is the normal range in regards to Urine Specific Gravity (USG)?

1.003-1.035

67

Urine Specific Gravity simple definition:

Simply the ratio of the density of a substance to the density of water. It is one of the few unites quantities in chemistry

68

What is the definition of "Refractive Index?"

Ratio of the velocity of light in air to the velocity of light in solution, using a Total Solids (TS) Meter (refractometer)

69

What is actually occurring when checking the Refractive Index?

The path of light is deviated when it enters a solution, and the degree of deviation or refraction is proportional to the density of the solution

70

What does Refractive index vary with?

With temperature, but the TS meter is temperature-compensated for temperatures between 60-100 degrees, and requires no corrections in that range

71

What are you testing with a refractometer?

Testing specific gravity of urine

72

What is a schematic representation of the refractometer?

Schematic Refractometer TS scale

73

What does Specific Gravity Reagent Strips (pka) measure?

Measures pKa change of polyelectrolytes in relation to ionic concentration; actually measures ionic concentration

74

What does specific gravity reagent strips (pka) relate to?

Urine specific gravity

75

When more ions are present during the specific gravity reagent test strips, what happens?

When more ions are present, more acid groups become disassociated, releasing hydrogen ions and causing pH to change

76

What would we use to measure the change in pH of urine?

Specific Gravity Reagent Strips (pKa)

77

In regards to Specific Gravity Reagent Strips (pKa), when urine has an increased specific gravity, what will the reagent pad become?

more Acidic

78

What does urine osmolality measure?

It measures total solute concentration

79

What does Urine osmolality depend on?

The number of particles in the solution**

80

What does specific gravity depend on?

The number and weight of the solutes**

81

What is a better indicator of the concentrating and diluting abilities of the kidney?

Osmolality because it is unaffected by the density of solutes

82

What should be used in pathological urines?***

Direct measurement of urine osmolality should be used (uncontrolled diabetes mellitus, nephrotic syndrome and in assessing hydration status)