AUBF (Macro, Chem, Micro) Flashcards
1
Q
Included in PHYSICAL examination of urine
A
Color
Clarity
SG - now included in rgt strip
2
Q
pigment present in urine that gives a yellow color (Thudichum)
A
Urochrome (normal pigment)
3
Q
pink pigment, most evident in spx that have been REFRIGERATED, resulting in precipitation of AMORPHOUS URATES
A
uroerythrin
4
Q
result of uroerythrin + urates in ACIDIC pH
A
pink urine sediment
5
Q
oxidation product of UROBILINOGEN (normal urinary constituent), imparts an orange-brown (amber) color to urine that is NOT FRESH (longer standing)
A
Urobilin
6
Q
pigment that may also be an indicator of hemolysis if extremely increased
checked: urobilinogen, bilirubin
A
urobilin
7
Q
urine with amorphous urates in ACID pH
A
forms PINK precipitate
8
Q
urine with amorphous phosphates in ALK pH
A
white precipitate
9
Q
urine color:
oxidation of porphobilinogen to porphyrins
A
red
portwine
10
Q
urine color:
heme biosynthesis problem —> porphyrias (enzyme deficiencies)
A
red
portwine
11
Q
urine color:
melanoma
alkaptonuria
A
black
12
Q
oxidation of melanogen (colorless pigment) to melanin (black pigment) - produced in excess
A
MELANOMA
13
Q
condition with excreted BLACK urine
A
melanoma
(not alkaptonuria - only imparts black color during standing)
14
Q
condition excreted as normal urine color and became BLACK during standing
A
alkaptonuria
15
Q
homogentisic acid (metabolite phenylalanine) - imparts black color to ALK urine from person with inborn metabolism
A
alkaptonuria
16
Q
metabolic problem in BABIES
inc pH (alk)
A
alkaptonuria
17
Q
urine color:
pseudomonas inf
A
green
(pyoverdin)
18
Q
urine color: clorets
A
blue-green
(pyocyanin)
19
Q
what must be done before assessing urine clarity
A
MIX WELL
20
Q
Reporting of urine clarity
A
Clear
Hazy
Cloudy
Turbid
Milky
21
Q
Urine clarity:
no visible particulate
transparent
A
clear
22
Q
Urine clarity:
FEW particulates,
print easily seen
A
hazy
23
Q
Urine clarity:
MANY particulates,
print blurred
A
cloudy
24
Q
Urine clarity:
print cannot be seen
A
turbid
25
Urine clarity:
may precipitate or be clotted (egg white-like) may be due to inc. lipid profile
milky
26
non-pathologic cause of urine TURBIDITY
squamous EC (contaminated collection)
mucus
amorphous phosphates, urates, carbonates
RCM
talcum powder
semen, spermatozoa
fecal contam
vaginal creams
27
pathologic cause of urine TURBIDITY
RBC
WBC
Bacteria
Yeast
Non-squamous EC (RTE cells)
Abnormal crystals
Lymph fluid (chyluria)
Lipids
28
differentiate hematuria from hemoglobinuria
hematuria: intact RBC microscopically
hemoglobinuria: hemolyzed RBC microscopically
29
eval of urine conc. (solutes present in urine)
SG
30
random urine sample SG
1.015-1.030
31
determine whether spx conc. is adequate to ensure chem test accuracy
SG
32
SG of water
1.000
33
SG of RCM
1.040
(differential to chole crystals)
34
SG: isosthenuric
1.010
35
SG: hyposthenuric
<1.010
36
SG: hypersthenuric
>1.010
37
Current urine SG measurement methods
Refractometry
Osmolality
Reagent strip
38
principle of Refractometry
refractive index (read intersection betw. blue and white portion)
39
principle of Osmolality
changes in colligative properties by particle no.
40
principle of reagent strip
pKa changes of polyelectrolyte by ions present
41
Methods for manual SG measurement
Refractometer
Urinometer
42
measurement that requires temperature adjustment
urinometer
(5/9 ; F -32)
43
measurement that requires NO temperature adjustment
refractometer
44
calibration of manual SG measurement
subtract 0.003 for every 1 g of PROTEIN
subtract 0.004 for every 1 g of GLUCOSE
45
MACROSCOPIC screening for BLOOD seen microscopically
color
46
MACROSCOPIC screening for hematuria vs hemoglobinuria/myoglobinuria and pathologic and nonpathologic cause of turbidity seen microscopically
CLARITY
47
aka myoglobinuria
rhabdomyolysis
48
Hemoglobinuria vs. Hematuria vs. Myoglobinuria
Hemoglobinura: CLEAR, red
Hematuria: TURBID, red
Myoglobinuria: coca-cola like
49
MACROSCOPIC/CHEM SCREENING TEST for RBC, RBC casts seen microscopically
Blood
50
MACROSCOPIC/CHEM SCREENING TEST for casts and cells seen microscopically
protein
51
MACROSCOPIC/CHEM SCREENING TEST for bacteria and WBCs
nitrite
52
MACROSCOPIC/CHEM SCREENING TEST for WBCs, WBC cast, bacteria
Leukocyte esterase
(has the longest reading time - 120s)
53
MACROSCOPIC/CHEM SCREENING TEST for yeast seen microscopically
glucose
54
glucose in urine
glucosuria (ex. presence of yeast)
55
INCREASED
CHANGES IN UNPRESERVED URINE
“p(a)BaON”
- pH (alk)
- bacteria
- odor (ammoniacal)
- nitrite
56
DECREASED
CHANGES IN UNPRESERVED URINE
clarity
glucose
ketones
bilirubin
urobilinogen
RBCs, WBCs, Casts
Trichomonas
57
what happen to urine COLOR during long standing (unpreserved)? reason?
modified/darkened
Reason: oxidation or reduction of metabolites (urobilinogen —> urobilin “amber”)
58
what will happen to CLARITY during long standing of unpreserved urine?
reason?
turbid (decreased)
reason: bacterial growth and precipitation of amorphous materials
59
what will happen to GLUCOSE during standing in unpreserved urine? reason?
decreased
reason: glycolysis, bacterial use
60
what will happen to KETONES during standing in unpreserved urine? reason?
decreased (highly volatile, requires freshly voided urine for accurate measurement)
reason: volatilization, bacterial metabolism
61
what will happen to BILIRUBIN during standing in unpreserved urine? reason?
decreased
Reason: light exposure, photo oxidation to biliverdin
62
what will happen to UROBILINOGEN during standing in unpreserved urine? reason?
decreased
Reason: oxidation to urobilin “amber”
63
what will happen to RBC, WBC, casts during standing in unpreserved urine? reason?
decreased
Reason: disintegration in dilute ALK urine
64
what will happen to TRICHOMONAS during standing in unpreserved urine? reason?
decreased
Reason: loss of motility, death (if disintegrated, resembles WBC)
65
loss of motility and disintegration of trichomonas resembles?
WBCs
66
what will happen to ODOR during standing in unpreserved urine? reason?
increased (ammoniacal)
Reason: bacterial multiplication (urea —> ammonia)
67
what will happen to pH during standing in unpreserved urine? reason?
increased (alk)
reason: breakdown of urea to ammonia by urease-producing bacteria or CO2 loss
ex: alkaptonuria
68
what will happen to NITRITE during standing in unpreserved urine? reason?
increased
Reason:
- multiplication of NITRATE- reducing bacteria
- bacterial contamination
69
what will happen to BACTERIA during standing in unpreserved urine? reason?
increased
Reason: multiplication
70
cause of AROMATIC urine odor
NORMAL!!
71
cause of FOUL, AMMONIA-LIKE urine odor
Bacterial decomposition
UTI
72
cause of FRUITY SWEET urine odor
Ketones (Starvation, DM, Vomiting)
73
cause of MAPLE SYRUP urine odor
MSUD (inborn error of metabolism)
74
cause of MOUSY urine odor
Phenylketonuria (PKU)
75
cause of RANCID urine odor
tyrosinemia
76
cause of SWEATY FEET urine odor
isovaleric acidemia
77
cause of CABBAGE urine odor
Methionine malabsorption
78
cause of BLEACH urine odor
Contamination
79
cause of ROTTING FISH urine odor
trimethylaminuria
“galunggong-like” odor
80
Benedict's test is only appropriate for?
glucose and other reducing sugars (except SUCROSE - nonreducing)
81
Principle of benedict's test
Copper reduction
82
Benedict's test reaction
Cupric ions (Cu2+) + reducing sugar ---heat + alkali --> carboxylic acid + Cuprous oxide (Cu2O)
Cupric ions - blue solution
reducing sugar - in urine
Cuprous oxide - indicator that gives brick red ppt
83
ratio of benedict's soln to urine
1:1
84
Negative (-) Benedict's test
No color change, remains BLUE
85
Trace (+/-) Benedict's test
Green opacity
No precipitate
86
+1 Benedict's test
Green solution
Yellow precipitate
87
+2 Benedict's test
Green to yellow solution
Yellow precipitate
88
+3 Benedict's test
Muddy orange solution
Yellow precipitate
89
+4 Benedict's test
Orange to brick red precipitate
90
Urine chem test for PROTEIN
Sulfosalicylic Acid precipitation (SSA) test
91
Principle of SSA
Precipitation of urine protein by STRONG acid
92
A cold precipitation test that reacts equally with all forms of protein
SSA test
93
Explain SSA test procedure
1. 3 mL of 3% SSA reagent to 3 mL centrifuged urine (1:1)
2. Mix by inversion and observe cloudiness/turbidity
3. Grade the degree of turbidity
94
Protein measured if SSA test shows negative turbidity
<6 mg/dL
95
Protein measured if SSA test shows trace turbidity
6-30 mg/dL
96
Protein measured if SSA test shows 1+ turbidity
30-100 mg/dL
97
Protein measured if SSA test shows 2+ turbidity
100-200 mg/dL
98
Protein measured if SSA test shows 3+ turbidity
200-400 mg/dL
99
Protein measured if SSA test shows 4+ turbidity
>400 mg/dL
100
Describe turbidity in SSA test if the protein is <6 mg/dL
NEGATIVE
No increase in turbidity
101
Describe turbidity in SSA test if the protein is 6-30 mg/dL
Trace (+/-)
Noticeable turbidity
102
Describe turbidity in SSA test if the protein is 30-100 mg/dL
1+
Distinct turbidity, NO granulation
103
Describe turbidity in SSA test if the protein is 100-200 mg/dL
2+
Turbidity, granulation, NO flocculation
104
Describe turbidity in SSA test if the protein is 200-400 mg/dL
3+
Turbidity, granulation, flocculation
105
Describe turbidity in SSA test if the protein is >400 mg/dL
4+
Clumps of protein
106
Classic test for differentiating UROBILINOGEN and PORPHOBILINOGEN
Watson-Schwartz Test
107
Reagents used in Watson-Schwartz test
Chloroform
Butanol
108
location of Chloroform in Watson-Schwartz test
BOTTOM
109
location of Butanol in Watson-Schwartz test
UPPER
110
Chloroform: Soluble
Butanol: Soluble
Urobilinogen
111
Chloroform: Insoluble
Butanol: Insoluble
Porphobilinogen
112
Chloroform: Insoluble
Butanol: SOLUBLE
Other Ehrlich reacting compounds
113
Watson-Schwartz test
Color if SOLUBLE
RED
114
Watson-Schwartz test
Color if INSOLUBLE
YELLOW
115
Analyte:
Heat & Acetic Acid
Nitric Acid test
Albumin/Protein
116
End result:
Heat & Acetic Acid
Nitric Acid test
Turbidity
117
Analyte:
Benedict's test
Glucose and other reducing sugar
118
End result:
Benedict's test
Brick-red precipitate
119
Analyte:
Heat Precipitation Test
Bence Jones Protein
120
End result:
Heat Precipitation test
Turbidity
121
Analyte:
Rothera
Ketones
122
End result:
Rothera
Red purple
123
Analyte:
Gunning
Ketones
124
End result:
Gunning
Iodoform crystals (microscopic)
125
Analyte:
Gerhadt
Ketones
126
End result:
Gerhadt
Bordeaux red
127
Analyte:
Seliwanoff
Levulose
128
End result:
Seliwanoff
Orange --> red
129
Analyte:
Rubner
Lactose
130
End result:
Rubner
Brick-red precipitate
131
Analyte:
Gmelin
Bile
132
End result:
Gmelin
Play of colors (green, red, yellow)
133
Analyte:
Smith
Bile
134
End result:
Smith
Green RING
135
Analyte:
Ehrlich
Urobilinogen
136
End result:
Ehrlich
Cherry red
137
Analyte:
Schlesinger
Urobilin
138
End result:
Schlesinger
Fluorescent GREEN
139
Analyte:
Obermayer
Indican
140
End result:
Obermayer
Indigo BLUE --> Indigo RED
141
Analyte:
Guaiac
Hemoglobin
142
End result:
Guaiac
Blue junction
143
Analyte:
Ammonium Sulfate
Hemoglobin
144
End result:
Ammonium Sulfate
HGB precipitation
145
Analyte:
Thormalen
Melanin
146
End result:
Thormalen
Prussian Blue
147
Analyte:
Sulkowitch
Calcium
148
End result:
Sulkowitch
Turbidity
149
Analyte:
Fantus
Chloride
150
End-result:
Fantus
White precipitate
151
Microalbumin testing (immunologic tests)
Micral test
Immunodip
152
Micral test principle
Enzyme Immunoassay
153
Sensitivity of Micral test
0-10 mg/dL
154
Reagents used in Micral test
Gold-labeled Ab
B-galactosidase
Chlorophenol red galactoside
155
Interference in Micral and Immunodip
FALSE NEGATIVE due to DILUTED URINE
156
ImmunoDip principle
Immunochromographics
157
Sensitivity of ImmunoDip
1.2 - 8.0 mg/dL
158
Reagents used in ImmunoDip
Ab-coated BLUE LATEX particles
159
Normal protein excreted by the body
<10 mg/dL
100 mg/24 hrs
160
Albumin level of 20-200 mg/L in urine indicating kidney damage
Microalbuminuria
161
Albumin level of >200 mg/L in urine
Albuminuria
162
Urine must be delivered and tested within ___ hours
2 hours
163
Causes precipitation of amorphous urates/phosphates, and other non-pathologic crystals in urine
MOST COMMON method of urine preservation
Refrigeration
164
This may cause some crystals to dissolve
Warming at 37C
165
Recommended type of urine spx
MIDSTREAM CLEAN CATCH URINE (morning, concentrated)
166
standard amount of urine
10-15 mL
167
frequently used urine vol in laboratory
12 mL
168
urine container capacity
50 mL
169
T/F
Report if urine vol is not adequate (<10 mL) but always check the medical diagnosis
TRUE
170
Daily urine output
1200-1500 mL (600-2000 mL)/day
171
decreased urine output
what are the volumes?
OLIGURIA
Infants: <1 mL/kg/hr
Children: <0.5 mL/kg/hr
Adult: <400 mL/day
172
cessation or failure of kidneys to produce urine
ANURIA
173
T/F
Kidneys excrete 2-3x more in day than night
T
174
Increased urine output at NIGHT
NOCTURIA
175
Increased urine output daily
What are the volumes?
POLYURIA
Children: 2.5-3.0 mL/kg/day
Adult: >2.5 L/day
176
Urine centrifugation
5 mins
400 RCF or 1,500 RPM
177
Volume of urine after removal of supernatant following centrifugation
0.5 - 1 mL
(uniform amt of urine and sediment)
178
Volume of sediment examined
20 uL (0.02 mL)
179
Purpose of examining urine sediment in LPO
view CASTS
ascertain the general composition of sediments
180
Purpose of examining urine sediments in HPO
Identification of urinary sediments
181
This method may affect casts reading wherein they have the tendency to locate near the edges of the cover slip. What is recommended to eliminate this?
Conventional Glass Slide method
Remedy: scanning of coverslip parameter
182
Point of reference in examining urine sediment
Epithelial cells (largest)
183
Reported as ave. no. per LPF
casts
184
Reported as ave. no. per 10 HPF
RBC
WBC
185
Reported as semiquantitative (rare, few, moderate, many / 1+, 2+, 3+, 4+)
EC
Crystals
Other sediments
186
Most frequently used stain in UA
Sternheimer-malbin stain
187
Components of Sternheimer-malbin stain
Crystal violet
Safranin O
188
Commercially available Sternheimer-malbin stain
Sedi stain
KOVA stain
189
Delineates structures and contrasting colors of the nucleus and cytoplasm
Sternheimer-malbin stain
190
used to confirm the presence of TAG, neutral fats, and chole
ID free fat droplets and lipid-containing cells and casts
Lipid stains (Oil red O, Sudan III) + Polarizing microscope
191
color of TAG and neutral fats using Lipids stains
orange-red
192
T/F
Oil red O and Sudan III cannot help visualize CHOLE alone. It requires polarizing microscope.
T
193
Used for ID of bacterial casts, which can be confused from granular casts
Gram stain
194
Components of Gram stain
Crystal violet (primary stain)
Iodine (mordant)
Alcohol (decolorizer)
Safranin (secondary stain)
195
Gram (+) bacteria color:
Gram (-) bacteria color:
Gram (+) bacteria color: purple/violet
Gram (-) bacteria color: pink/red
196
preferred stain for urinary EOSINOPHILS in cases of DRUG-INDUCED ALLERGIC RXN producing inflammation of the renal interstitium
Hansel stain
197
Components of Hansel stain
Methylene Blue
Eosin Y
198
Stain for Iron (hemosiderin granules: blue)
Stains positive during hemolysis and bleeding
Prussian blue stain
199
identifies YELLOW-BROWN granules of hemosiderin in cells and casts
Prussian blue stain
200
T/F
The type of microscopy used depends on the specimen type, refractive index, and ability to image unstained living cells
T
201
objects appear dark against a light BG
MOST FREQUENTLY USED in clin lab
Bright-field microscopy
202
type of microscopy that aids in Treponema pallidum ID
Dark-field microscopy
203
enhances visualization of elements with LOW refractive indices, such as:
HYALINE CASTS
MIXED CELLULAR CASTS
MUCUS THREADS
TRICHOMONAS
Phase-contrast microscopy
204
Aids in ID of cholesterol in oval fat bodies, fatty casts, and crystals
Polarizing microscopy
205
Allows visualization of naturally fluorescent microorg or those stained by a fluorescent dye including labeled Ag and Ab
Fluorescence microscopy
206
Produces a 3D microscopy image and layer by layer imaging
Interference contrast
207
Frequently performed independently of routine UA for detection of malignancies of the LOWER urinary tract
CYTODIAGNOSTIC URINE TESTING
208
Stain used in cytodiagnostic urine testing
papanicolaou stain (provides additional method for detecting and monitoring RENAL DISEASE)
