CHAPTER 2: INTRODUCTION TO URINALYSIS Flashcards
1
Q
He wrote the book on “uroscopy” in the 5th century BCE
A
Hippocrates
2
Q
He discovered protein in urine by boiling urine (1694)
A
Frederick Dekkers
3
Q
Term used to pertain to charlatans without medical credentials who offer predictions to the public in exchange for a healthy fee who became the subject of a book published by Thomas Bryant in 1627
A
Pisse prophets
4
Q
He developed methods for quantitating microscopic sediments.
A
Thomas Addis
5
Q
He introduced the concept of urinalysis as part of a doctor’s routine patient examination in 1827.
A
Richard Bright
6
Q
TRUE or FALSE:
The kidneys continuously form urine as an ultrafiltrate of plasma.
A
TRUE
7
Q
Average daily urine output
A
1200 mL – 1500 mL
8
Q
Primary organic component of urine
A
Urea
9
Q
Urine is normally composed of __% water and __% solutes.
A
95%; 5%
Note:
Concentrations may vary depending on dietary intake, physical activity, body metabolism, and endocrine functions.
10
Q
This substance is a product of protein and amino acid metabolism
A
Urea
11
Q
TRUE or FALSE:
Urea comprises majority (near half) of total dissolved solids in urine.
A
TRUE
Note:
Urea is the primary organic component of urine.
12
Q
Aside from urea, what other primary organic substance/s is/are present in urine?
A
Creatinine
Uric acid
13
Q
Major inorganic component of urine
A
Chloride
14
Q
This is a product of creatine metabolism by muscles.
A
Creatinine
15
Q
This substance is a product of nucleic acid breakdown in food and cells.
A
Uric acid
16
Q
Aside from chloride, what are other primary inorganic components found in urine?
A
Sodium
Potassium
Note:
Chloride > Sodium > Potassium
17
Q
This inorganic component combines with sodium to buffer the blood
A
Phosphate
18
Q
This inorganic component regulates blood and tissue fluid acidity
A
Ammonium
19
Q
This is used to determine whether a particular fluid is urine.
A
Testing urea and creatinine content.
Note:
Since urea and creatinine are present in high concentrations in urine as compared to other body fluids, these two substances may help identify fluid as urine.
20
Q
Inorganic components present in urine
A
Chloride
Sodium
Potassium
Phosphate
Ammonium
Calcium
21
Q
Normal daily urine output (range)
A
600 – 2000 mL
Average: 1200 – 1500 mL
22
Q
This term is used to describe a decrease in urine output
A
Oliguria
Note:
Infants: <1 mL/kg/hr
Children: <0.5 mL/kg/hr
Adults: <400 mL/day
23
Q
This term is used to describe cessation of urine flow
A
Anuria
24
Q
An increase in excretion of urine at night
A
Nocturia
25
This term is used to describe an increase in daily urine volume
Polyuria
Note:
Children: 2.5-3 mL/kg/day
Adults: >2.5 L/day
26
TRUE or FALSE:
Polyuria may be encountered in both diabetes mellitus and diabetes insipidus.
TRUE
While polyuria may be encountered in both diabetes mellitus and diabetes insipidus, the two may differ in terms of specific gravity.
27
This condition is caused by a defect either in the pancreatic production of insulin or in the function of insulin leading to increased glucose.
Diabetes mellitus
28
A patient with diabetes mellitus has a urine with (increased/decreased) specific gravity.
Increased
29
This condition results from a decrease in production or function of the antidiuretic hormone (ADH).
Diabetes insipidus
30
TRUE or FALSE:
Urine is considered a biohazardous substance.
TRUE
31
Which of the following is NOT recommended for containers for urine collection?
A. Screw-top lids
B. Flat bottom
C. Has wide mouth
D. Snap-on lids
D. Snap-on lids
NOTE:
Snap-on lids are prone to leakage.
32
The recommended capacity of a urine container.
50 mL
33
Sterile containers are suggested if more than ______ hour/s elapse between specimen collection and analysis.
2 hours
34
Generally, when attaching labels to specimens, labels must be on the (container/lid).
Container
35
This is a document that must accompany the specimens delivered to the laboratory for confirmation. It must match the information attached on the specimen label.
Requisition form
36
REJECT OR ACCEPT SPECIMEN?
Specimens in unlabeled containers
REJECT
37
REJECT OR ACCEPT SPECIMEN?
Specimens in dry and clean containers
ACCEPT
38
REJECT OR ACCEPT SPECIMEN?
Specimens contaminated with toilet paper
REJECT
39
REJECT OR ACCEPT SPECIMEN?
Labels on specimens matched the information on the accompanying requisition form
ACCEPT
40
REJECT OR ACCEPT SPECIMEN?
Specimens of insufficient quantity
REJECT
41
REJECT OR ACCEPT SPECIMEN?
Specimens that have been improperly transported but came from a long way
REJECT
42
REJECT OR ACCEPT SPECIMEN?
Specimens with contaminated exteriors
REJECT
43
TRUE or FALSE:
There is only one and a standard protocol that must be followed by all laboratories in terms of specimen rejection.
FALSE
Note: Laboratories may have their own conditions for specimen rejection provided it is included in their own written policy.
44
Following collection, urine specimen should be delivered to the laboratory promptly and tested within _____ hour/s.
2
45
Identify whether the following are INCREASED or DECREASED in unpreserved urine:
Clarity
DECREASED
Note:
Due to bacterial growth and precipitation of amorphous material
46
Identify whether the following analytes are INCREASED or DECREASED in unpreserved urine:
Odor
INCREASED
Note:
Due to bacterial multiplication causing breakdown of urea to ammonia
47
Identify where the following analytes are INCREASED or DECREASED in unpreserved urine:
pH
INCREASED
Note:
Breakdown of urea to ammonia by urease-producing bacteria/loss
of CO2
48
Identify whether the following analytes are INCREASED or DECREASED in unpreserved urine:
Glucose
DECREASED
Note:
Glycolysis and bacterial use
49
Identify whether the following analytes are INCREASED or DECREASED in unpreserved urine:
Ketones
DECREASED
Note:
Volatilization and bacterial metabolism
50
Identify whether the following analytes are INCREASED or DECREASED in unpreserved urine:
Bilirubin
DECREASED
Note:
Exposure to light/photo oxidation to biliverdin
51
Identify whether the following analytes are INCREASED or DECREASED in unpreserved urine:
Urobilinogen
DECREASED
Note:
Oxidation to urobilin
52
Identify whether the following analytes are INCREASED or DECREASED in unpreserved urine:
Nitrite
INCREASED
Note:
Multiplication of nitrate-reducing bacteria
53
Identify whether the following analytes are INCREASED or DECREASED in unpreserved urine:
Red and white blood cells and casts
DECREASED
Note:
Disintegration in dilute alkaline urine
54
Identify where the following analytes are INCREASED or DECREASED in unpreserved urine:
Bacteria
INCREASED
Note:
Multiplication
55
Identify where the following analytes are INCREASED or DECREASED in unpreserved urine:
Trichomonas
DECREASED
Note:
Loss of motility, death
56
Identify where the following analytes are INCREASED or DECREASED in unpreserved urine:
Color
INCREASED (DARKENED)
Note:
Oxidation or reduction of metabolites
57
The most routinely used method of preservation is refrigeration at what temperature?
2°C to 8°C
Note:
This decreases bacterial growth and metabolism
58
TRUE or FALSE.
If the urine is to be cultured, it should be refrigerated during transit and kept refrigerated until cultured up to 24 hours.
TRUE
59
TRUE or FALSE.
Urine samples which are preserved via refrigeration may immediately be chemically tested (use of reagent strips).
FALSE
Note: The specimen must first return to room temperature before chemical testing by reagent strips because enzyme reactions on the strips perform best at RT.
60
Identify the URINE PRESERVATIVE described:
This does not interfere with chemical tests but precipitates amorphous phosphates and urates.
This prevents bacterial growth for 24 hours.
Refrigeration
61
Identify the URINE PRESERVATIVE described:
This prevents bacterial growth and metabolism but interferes with drug and hormone analyses.
This keeps pH at about 6.0 and can be used for urine culture transport.
Boric acid
62
Identify the URINE PRESERVATIVE described:
This is an excellent sediment preservative but acts as a reducing agent and therefore interferes with chemical tests for glucose blood, leukocyte esterase, and copper reduction
Formalin (Formaldehyde)
63
Identify the URINE PRESERVATIVE described:
This is a good preservative for drug analyses but it can inhibit reagent strip tests for glucose, blood, and leucocytes
Sodium fluoride
64
Identify the URINE PRESERVATIVE described:
This is convenient when refrigeration is not possible. It also has controlled concentration to minimize interference.
Commercial preservative tablets
65
Identify the URINE PRESERVATIVE described:
Contains collection cup, transfer straw, culture and sensitivity (C&S) preservative tube, or UA tube
Urine Collection Kits (Becton, Dickinson, Rutherford, NJ)
66
Identify the URINE PRESERVATIVE described:
Sample stable at room temperature (RT) for 48 hours; prevents bacterial growth and metabolism; keeps pH at 6.0
This is not recommended if urine is below minimum fill line.
Light gray and gray C&S tube
67
What are the preservatives present in the light gray and gray C&S tube?
Boric acid
Sodium borate
Sodium formate
68
Identify the URINE PRESERVATIVE described:
This can be used on automated instruments, require refrigeration within 2 hours, has round or conical bottom, and has no preservatives
Yellow UA Plus tube
69
Identify the URINE PRESERVATIVE described:
Stable for 72 hours at RT; instrument-compatible.
Urine must reach minimum fill line; preservatives include sodium propionate, ethyl paraben, and chlorhexidine
Cherry red/yellow Preservative Plus tube
70
Preservatives included in a Cherry red/yellow Preservative Plus tube
Sodium propionate
Ethyl paraben
Chlorhexidine
71
The most commonly received type of urine specimen because of its ease of collection and convenience for the patient.
Random Specimen
72
The ideal type of urine specimen for screening.
First Morning Specimen
73
This type of urine specimen is highly concentrated, thereby assuring detection of chemicals and formed elements that may not be present in a dilute random specimen.
First Morning Specimen
74
Type of urine specimen used for quantitative tests
24-hour (Timed) Specimen
75
TRUE or FALSE.
In collecting accurate timed specimen, the patient must begin and end the collection period with an empty bladder.
TRUE
76
In collection of timed specimens, why must be the first collected urine voided?
Addition of urine formed before the start of collection period will falsely elevate results.
77
This type of urine specimen is collected under sterile conditions by passing a hollow tube (catheter) through the urethra into the bladder.
Catheterized specimen
78
This is considered an alternative to catheterized specimen and provides a safer, less traumatic method for obtaining urine for bacterial culture and urine analysis.
Midstream Clean-Catch
79
This type of urine specimen is collected by external introduction of a needle through the abdomen into the bladder.
Suprapubic Aspiration
80
Urine specimen that is easiest to collect and is used for routine screening.
Random Specimen
81
Urine specimen used for routine screening, pregnancy tests, and for evaluation of orthostatic proteinuria
First morning specimen
82
Type of urine specimen/s that may be used for bacterial culture
Catheterized
Midstream clean-catch
Suprapubic aspiration
83
Type of urine specimen which may be used for cytologic examination
Suprapubic aspiration
84
Type of urine specimen collected to determine presence of prostatic infection
Three-glass collection
85
TRUE or FALSE
Similar to the midstream clean-catch specimen, the first urine passed is also discarded in three glass collection.
FALSE.
The first urine passed is collected in a sterile container and is examined microscopically.
86
In three glass collection, what is the use of the second container?
This contains the midstream portion and is used as control for bladder and kidney infection.
Note:
If this turns out to be positive, the results from the third specimen are invalid because infected urine has contaminated the specimen.
87
In three-glass collection, if the third specimen has white blood cell/high power field count and a bacterial count _____ times that of the first specimen, prostatic infection is diagnosed.
10
88
The Stamey-Mears Test for Prostatitis involves the four-glass method. What are collected in each of the four containers?
1: Initial voided urine
2: Midstream urine
3: Expressed prostatic secretions (EPS)
4: post-prostatic massage urine specimen
89
In testing for prostatitis via four-glass method, which part/container tests urethral infection or inflammation.
First container (Initial voided urine)
90
In testing for prostatitis via four-glass method, which part/container tests for urinary bladder infection
Second container (Midstream)
91
In Stamey-Mears test for prostatitis, how many white blood cells per high-power field present in cultured prostatic secretions are considered abnormal?
>10-20
92
This is used for collection of pediatric urine specimens.
Soft, clear plastic bags (hypoallergenic)/Wee bags
93
In collecting pediatric urine specimens, applied bags must be checked every ______ minutes until the needed amount of sample has been collected.
15 minutes
94
This is the most vulnerable part of drug testing program
Urine specimen collection
Note:
This requires correct collection procedures and documentations
95
The process that provides this documentation of proper sample identification from the time of collection to the receipt of laboratory results.
Chain of Custody (COC)
96
A standardized form that must document and accompany every step of drug testing, from collector to courier to laboratory to medical review officer to employer
Chain of Custody (COC)
97
TRUE or FALSE.
In drug testing, urine specimen collections may be "witnessed" or "unwitnessed."
TRUE
98
In urine collection for drug testing, the urine temperature must be taken within _____ minutes from the time of collection.
4 minutes
99
In urine collection for drug testing, the specimen temperature must be within the range of ____________.
32.5°C to 37.7°C
100
Identify whether the Timed Specimen Collection is CORRECT or INCORRECT:
Day 1: At 9 AM, the patient voids and discards this specimen; collects all urine for the next 24 hours.
Day 2: At 9 AM, the patient voids and adds this specimen to the previously collected urine.
CORRECT
