2. Physical exam

Question 1

4 parts of physical exam

Answer 1

• color
• clarity
• specific gravity
• odor (not reported)

Question 2

RBC presentation in fresh acidic urine

Answer 2

yellow (normal color), pink, red
as RBCs lyse, it turns brown/black

Question 3

RBC presentation in fresh alkalkine urine

Answer 3

red-brown
hemoglobin oxidation to methemoglobin is promoted by high pH

Question 4

gives normal yellow color

Answer 4

urochrome

Question 5

give increased production of urochrome

Answer 5

thyroid conditions
fasting states
urine sitting at room temp

Question 6

3 pigments in normal urine

Answer 6

• urochrome
• uroerythrin
• urobilin

Question 7

normal pink pigment

Answer 7

uroerythrin

Question 8

explain brick dust

Answer 8

amorphous urates precipitate in refrigeration and uroerythrin attaches, producing “brick dust”

Question 9

normal orange-brown pigment to non-fresh urine

Answer 9

urobilin

Question 10

urobilin is a product of…

Answer 10

oxidation of the normal urinary constituent urobilinogen

Question 11

large white foam

Answer 11

↑ protein

Question 12

dark yellow/amber + yellow foam

Answer 12

bilirubin
may contain hepatitis

Question 13

yellow-orange + white foam

Answer 13

photooxidation of large amounts of urobilinogen to urobilin

Question 14

yellow-green + colored foam

Answer 14

photooxidation of bilirubin to biliverdin (rare)

Question 15

neon orange + yellow foam

Answer 15

phenazopyridine drug (azo)
UTI pain medication

Question 16

bright yellow urine

Answer 16

vitamins (riboflavin)

Question 17

red urine + cloudy

Answer 17

hematuria
intact cells

Question 18

red urine + clear

Answer 18

hemoglobin OR myoglobin

Question 19

red urine + clear + red plasma

Answer 19

hemoglobin from in vivo RBC lysis

Question 20

red urine + clear + clear plasma

Answer 20

myoglobin from breakdown of skeletal muscle

Question 21

fresh brown urine

Answer 21

glomerular bleeding

Question 22

port wine urine

Answer 22

porphyrins
metabolic problem or lead poisoning

Question 23

nonpathogenic reasons for red/brown urine

Answer 23

menstrual contamination
beets
medication

Question 24

brown/black urine = for blood

Answer 24

melanin or homogentisic acid

Question 25

sign of melanoma

Answer 25

oxidation of melanogen --> melanin in the urine, turns black over time

Question 26

sign of alkaptonuria

Answer 26

homogentisic acid, a metabolite of phenylalanine black color to alkaline urine inborn error of metabolism

Question 27

causes of blue/green urine

Answer 27

- bacterial infections (Pseudomonas) - breath deodorizers - medications - collection bags

Question 28

print easily seen through urine

Answer 28

slightly cloudy/hazy

Question 29

print blurred through urine

Answer 29

cloudy

Question 30

print cannot be seen through urine

Answer 30

turbid

Question 31

precipitate/clotted urine

Answer 31

milky

Question 32

nonpathogenic turbidity

Answer 32

women: epithelial cells, mucus mucus semen fecal contamination radiographic contrast media talcum powder vaginal creams

Question 33

how does urine precipitate in the fridge depending on if it's acidic or alkaline?

Answer 33

**ACIDIC** pink precipitate amorphous urates soluble in NaOH, disappear upon heating **ALKALINE** white precipitate amorphous phosphates + carbonates soluble in acetic acid

Question 34

less frequent pathogenic causes of turbidity (besides RBC, WBC, bacteria)

Answer 34

- nonsquamous epithelial cells (transitional, renal) - yeast - crystals - lymph fluid - lipids/fat

Question 35

define specific gravity

Answer 35

density of a solution compared with the density of a similar volume of distilled water (SG 1.000) at a similar temperature

Question 36

specific gravity is influenced by...

Answer 36

number of particles and size of particles

Question 37

specific gravity tells us about the kidney's ability to...

Answer 37

selectively reabsorb essential chemicals and water from the glomerular filtrate

Question 38

normal specific gravity

Answer 38

1.002 - 1.035

Question 39

causes of low SG

Answer 39

diuretics (alcohol, caffeine, medications); HTN, pyelonephritis, DI, protein malnutrition

Question 40

causes of high SG

Answer 40

dehydration, proteinuria, glycosuria, eclampsia

Question 41

causes false high SG

Answer 41

radiographic contrast dye

Question 42

SG of plasma filtrate entering glomerulus

Answer 42

1.010

Question 43

SG = 1.010

Answer 43

isosthenuric

Question 44

SG < 1.010

Answer 44

hyposthenuric

Question 45

SG > 1.010

Answer 45

hypersthenuric

Question 46

measures refractive index

Answer 46

refractometer

Question 47

Each g/dL of **protein** present, the SG is increased by...

Answer 47

0.003

Question 48

Each g/dL of **glucose** present, the SG is increased by -------

Answer 48

0.002

Question 49

more representative measure of renal concentrating ability—only depends on number of particles present, not size

Answer 49

osmolality measures colligative property of sample

Question 50

used to measure osmolality 2 methods

Answer 50

osmometer freezing point depression method vapor pressure method

Question 51

SG measure on the dipstick is based on...

Answer 51

pKa, dissociation constant

Question 52

indicator on dipstick for SG

Answer 52

bromothmol blue

Question 53

how do you correct for falsely high SG results on the refractometer?

Answer 53

use the dipstick SG measure

Question 54

reagent test strip SG results are especially useful for...

Answer 54

assessing the ability of the kidneys to handle water and ionic solutes when glucose or protein is also present in the urine, or contrast media

Question 55

# odor Ammonia/strong, foul

Answer 55

bacterial infection

Question 56

# odor sweet/fruity

Answer 56

ketones

Question 57

# odor Strong, maple syrup odor

Answer 57

Maple Syrup Disease

Question 58

# odor mousy

Answer 58

Phenylketonuria

Question 59

# odor rancid

Answer 59

Tyrosinemia

Question 60

# odor sweaty feet

Answer 60

Isovaleric acidemia

Question 61

# odor cabbage

Answer 61

Methionine malabsorption

Question 62

# odor bleach

Answer 62

Contamination