Clinmic Flashcards by Russel Bob Borromeo

Best way to break chain of infection

Hand washing

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How long to wash hands

15-20 seconds

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Most important part of handwashing

Friction

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Label of biohazard container

3 over lapping circles

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Solution to disinfect sink

1:5-1:10 NaCl solution

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How often do you disinfect sinks

Daily

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Container used for sharp wastes

Red, puncture-resistant container

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Storage of radioactive material: storage at locked room until background count is down to: _____________

10 half life

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Best first aid for chem spills

Flush area with running water for atleast 15 minutes

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Always add ______ to ______

Acid to water

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Color for health hazard

Blue

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Color for fire hazard

Red

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Color for instability/reactivity

Yellow

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Color for specific hazard

White

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Location of each hazard (quadrants)

Right: yellow
Bottom: white
Left: blue
Top: red

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Degree of hazard(hazard) index

no or minimal
Slight
Moderate
Serious
Extreme or severe

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Storage for flammable chemicals

Explosion-proof refrigerators

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Meaning of RACE

RESCUE
ALARM
CONTAIN
EXTINGUISH/EVACUTE

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What is the only type of fire water extinguisher is for

Type A

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Extinguisher for types ABC

Dry chemical

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Type of fire carbondioxide extinguishes

TYPE BC

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What type of fire metal X and Sand is used for

Type D

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Fire types

A = ORDINARY
B = LIQUIDS
C = ELECTRIC
D = METALS
E = EXPLOSIVE
K = COOKING

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Meaning of PASS

Pull
Aim
Squeeze
Sweep

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Types of fire to be handled. By trained personel only

``` Type D(metal) Type E(explosive) ```

Work related hazards and include strain due to repeated position

Ergonomic hazard

Hazard related to cold temperature

Cryogenic

Disinfection eliminates all or many pathogens except _________

Bacterial spores

Where blood enters in the kidney

Renal artery

Number of nephrons per kidney

1-1.5 million

Renal blood flow

1200ml

Renal plasma flow

600-700

Glomerules filters substances with MW of what

>70,000 dalton

Glomerular filtrate S. G.

1.010

ADH in SIADH

EXCESS

Effects of RAAS

Release of ADH and aldosterone | Vasoconstriction

Substances reabsorbed through passive transport

Water Urea Sodium

Transport involved in glucose, amino acid, salts, chloride, sodium

Active

Inability of kidneys to produce an acid urine

Renal tubular acidosis

Used to evalute glomerular filtration

Clearance

Used to assess renal transplant patients

B2-microglobulin

Measurement useful in detection of early changes in kidney function

Cystatin c

Original reference method for clearance test

Inulin clearance

Creatinine clearance formule

UV/P U=urine crea V=total/1440 ml/day P=plasma crea

Variables in cockgroft and gault

Age, sex, body weight in kg, serum crea

Variables in MDRD system

BEAC = BUN, ethnicity, albumin, crea

Recommended by the national kidney disease education program for crea clearance

MDRD-IDMS

Used to evaluate tubular reabsorption

Concentration test

Fishberg, mosenthal, specific gravity, osmolarity are tests to evaluate which parameter

Tubular reabsorption

Difference of S. G. And osmolarity

``` SG = number and density of solute OSMOLARITY = number only ```

PAH and PSP are used to test what

TUBULAR SECRETION AND RENAL BLOOD FLOW

Where does renal concentration begin

Descending and ascending loops of henle

Greatest source of error in any clearance procedure using urine

Improperly timed specimen

Discovered uroscopy

Hippocrates

Albuminuria by boiling

Frederik dekkers

Pisse prophets writing

Thomas Bryant

Person credited for Examination of urine sediments

Thomas addis

Introduced UA as routine exam

Richard Bright

Discovered urochrome

Ludwig thudichum

Person who discovered CSF

Domenico Cotugno

Phenylketonuria

Ivan folling

Discovered Alkaptonuria

Archibald garrod

Discovered cystine calculi

William Wollaston

Major organic substance in the urine

Urea

Major inorganic substance in the urine

Chloride > na > k

Ideal specimen for routine UA

First morning

Ideal specimen for pregnancy test

First morning

Specimen for evaluation of orthostatic proteinuria

First morning

Specimen for anaerobic bacterial culture and urine cytology

Suprapubic aspiration

Control for 3 glass collection

2nd glass - midstream

Time For addis count

12 hours

Time for nitrite determination

Atleast 4 hours

Timed specimen for urobilinogen

Afternoon (2-4pm)

Required volume for drug testing And container And temperature

30-45ml 60ml 32.5-37.7

Least affected in unpreserved urine

Protein

Four glass method for prostatitis

Stamey-mears

Bacteriostic at 18g/L and used for cultural transport

Boric acid

Excellent sediment preservative

Formalin

Prevents glycolysis and good for drug analysis

Sodium flouride

Composition of saccomano fixative

50% ethanol and 2% carbowax

Used for cytology studies and how many ml of urine

Saccomano fixative | 50 ml

Average 24 hr urine volume

1200-1500ml

Excretion of more than 500ml of urine at night

Nocturia

Major pigment in urine and what colour

Urochrome - yellow

Pink pigment and may deposit in amorphous uratesans uric crystals

Uroerythrin

Black color Acidic Alkalin Air exposure

Methemoglobin Alkaptonuria(homogentisic acid) Melanin

Clarity and term

``` Clear = no particulates Hazy = few particulates, print easily seen Cloudy = many particulates, blurred print Turbid = print cannot be seen Milky = may precipitate and clot ```

Acidic urine sediments

Amorphous urates | Radiographic dye

Alkarine urine sediments

Amorphous phosphates | Carbonates

Soluble with heat

Amorphous urates | Uric acid

Soluble in ether

Lipids Lymphatic fluid Chyle

Odorless

ATN

Foul/ammoniacal

UTI

Mousy, musty odor

PKU

Rancid butter odor

Tyrosinuria

Cabbage, hops

Methionine malabsorption (oasthouse syndrome)

Sulfur odor

Cystinuria

Rotting fish

Trimethylaminuria

Tomcat urine

Multiple carboxylase deficiency

Glucose reading time, principle, positive color

30 Double sequential enzyme reaction Green to brown

Bilirubin reading time, principle, positive color

30, diazo, tan to violet

Ketone Reading time, principle, positive color

40, sodium nitropusside, purple

SG time, principle, positive color

45, pk change of a polyelectrolyte, blue (1.000) to yellow (1.030)

Reading time for protein, principle, positive color

60, protein error of indicator, blue

Ph reading time, principle, color

60, double indicator system, orange to blue (5.0-9.0)

Blood reading time, principle, color

60, pseudo peroxidase activity of hb, uniform green(hgb, mb) speckled(intact rbc)

Urobilinogen time, principle, color

60, ehrlich, red

Nitrite rt, principle, color

60, greiss, pink

Leukocyte rt, principle, color

120 secs, leukocyte esterase, purple

Principle for automate regeant strip

Reflectance photometry

Normal SG

1.003-1.035

Calibration temp for urinometer

20.0C

Temperature correction for urinometer

+0.001 for every 3C above 20 | -0.001 for every 3C below 20

3%NaCl SG

1.015

5% NaCl

1.022

9% sucrose

1.034

Urinometer is higher than refractomer by

0.002

Reagent for SG chemstrip

Bromthymol blue

Total ML for IRIS diagnostic

6ml

ML for slideless microscope

4ml

ML for IRIS mass gravity meter

2 ml

Reagents for pH strip

Methyl red | Bromthymol blue

Amount of protein secreted in the urine per day

<150mg/day

Indicator of diabetic nephropathy

Microalbuminuria

Normal Albumim excretion rate

0-20ug/min

Microalbuminuria

20-200 ug/min

Clinical albuminuria

>200 ug/min

Test for microalbuminuria

Micral test

Principl of micral test

Enzyme immunoassay

Positive and negative color for micral

``` Positive = red Negative = white ```

Reagents in proteim Strip

Tetrabrom

High SG cause false _____ in protein strip

Positive

Reagent in SSA

3ml 3%SSA

SSA GRADING

``` Negative = no turbidity = <6 Trace = noticeable turbidity = 6-30 1 = turbidity = 30-100 2 = turbidity, granulation = 100-200 3 = turbidity, granulation, flocculation = 200-400 4 = clumps > 400 ```

Reagents used in glucose strip Multistix Chemstrip

Potassium iodide | Tetramethylbenzidine

Oxidizing agents such as detergents cause false ______ in glucose strip

Positive

Low temp High SG Ketone Ascorbic acids cause false ______ in glucose strip

Negative

Sensitivity of glucose strip

100 mg/dl

How many drops of urine is used in clinitest table

5 drops

How to prevent pass through phenomenon in clinitest

Apply 2 drops of urine

Also known as parent ketone

Acetoacetic acid/diacetic acid

Also known as parent ketone

Acetoacetic acid/diacetic acid

Major ketone found in the urine

Beta-hydroxybutiric acid

Legals test is also known as

Sodium nitroprusside

Reagents used in ketone strip

Sodium nitroprusside

Acetone is only measured when ____ reagent is used

Glycine

Reaction time of acetest table

30 seconds

Test to differentiate myoglobin and hemoglobin

Blondheim's test

Reagent used in blondheim's and test results

2.8 g Ammonium sulfate (80%) ``` Positive = myoglobin Negative = hemoglobin ```

Regeant used in blood strip

Tetramethylbenzidene

Comfirmatory test for bilirubin

Ictotest

Reagents used in biliribun strip

Dichloro plus benzidene

Normal value for UBG

<1mg/dl or ehrlich unit

Formaline causes false ______ in urobiniligen strip

Negative

P-aminosalycosic acid causes false ________ in urobilinogen test

Positive

Rapid screening test for porphobilinogen

Hoesch test (inverse ehrlich reaction)

Rapid screening test of UTI

Nitrite

Reagents used in nitrite

Diazonium salt and quinolin

Large quantities of bacteria converting nitrite to nitrogen causes false ______ in nitrite strip

Negative

Reagents for leukocyte

ester + diazo salt

Wbc with no esterase

Lymphocytes

Positive for LE

Neutrophils, basophils, eosinophil, monocyte, histiocyte, trichomonas

Reading time for c-stix and stix

``` C-stix = 10 Stix = 60 ```

Reading time for c-stix and stix

``` C-stix = 10 Stix = 60 ```

Reading time for c-stix and stix

``` C-stix = 10 Stix = 60 ```

Quantitative measure of formed urine elements uring hemocytomer

Addos count

Micrscop that forms halo

Phase contrast

3D microscope

Interference-contrast

Differential 3D microscope

Normaski

Modulation 3D microscope

Hoffman

Component of sternheimer-malbin stain

Crystal violet and safrarin O

Distinguishes rbc from wbc, yeast, oil droplets and crystals

2% acetic acid

Identifies urinary eosinophils

Hansel stain

Stains DNA

Phenathridine (orange)

Stains nuclear membrane, mitochondria and cell membrane

Carbocyanin (green)

Formalin causes false _____ in LE strip

False positive

High protein and medicines cause false _____ in LE

Negative

Most predominant wbc in urine

Neutrophils

NV of RBC in urine

0-2 or 0-3/hpf

NV of wbc in urine

0-5 or 0-8/hpf

In _____ urine neutrophil swell and undergo ____ movement

Hypotonic, brownian

Value of eosinophils in interstitial nephiritis

>1%

Color of glitter cell in SM stain

Pale blue

Color of leukocyte in SM stain

Pale pink

Variation of squamous epithelial cell associated with bacteria

Clue cell

Bacteria associated with clue cell

Gardnerella vaginalis

Also known as bladder cell

Transitional epithelial (uroethial)

Epithelial cell with centrally located cell

TEC

Most clinically significant epithelial cell

RTE

Origin of RTE

Nephron

Epithelial cell with eccentric nucleus

RTE

Value of RTE that signifies tubular injury

>2 rte/hpf

Lipid containing RTE found in nephrotic syndrome

Oval fat body

RTE with non lipid vacuoles

Bubble cell

Most frequently encountered parasite in urine

Trichomonas vaginalis

Most common fecal contaminant

Enterobius vermicularis

Urinary bladder cancer markers

``` NMP = nuclear matrix protein BTA = bladder tumor antigen ```

Elements read on HPF

``` WBC RBC normal Crystals bacteria OFB TEC RTE ```

Reporting of abnormal crystals

Average number/LPF

Reporting of RTE

Average number/hpf

``` Number of crystals in reporting Rare Few Moderate Many ```

0-2 2-5 5-20 >20

Number of bacteria in rare

0-10

Number of bacteria in few

10-50

Number of bacteria in moderate

50-200

Number of bacteria in many

>200

Reporting of TEC

Rare, few, moderate/HPF

Reporting of abnormal crystals/casts

Average number/LPF

Casts are formed primarily in the _______

DCT, CD

Prototype cast

Hyaline

Normal value of hyaline cast

0-2/LPF

Finaly degenerative form of all types of cast

Waxy cast

Cast that signifies chronic renal failure

Waxy cast

Most common type of broad cast

Granular and waxy

Factors contributing to crystal formation

Temperature Solute concentrarion PH

First consideration when identifying crystals

Urine PH

Normal crystals

Armp

Most pleomorphic crystal

Uric acid

Brick dust, yellow brown granules soluble in heat and alkali

Amorphous urates

Crystal found in ethylene glycol poisoning(antifreeze)

Monohydrate CaOx (whewelite)

"Cigarette butt" appearance

Calcium sulfate

Yellow brown/colorless prism soluble in water and ether

Hippuric acid

Thorny apple appearance and found in what ph

Amorphous biurate | Alkaline

Prism shaped, coffin-lid, fern-leaf, feathery appearance

Triple phosphate (struvite)

Differentiate cystine from uric acid

Cystine = soluble in dilute HCL, positive in Cyanide Uric = insoluble in diluted HCl, birefringent

Rectangular plate with in 1 or more corners (staircase pattern)

Cholesterol | Radiographic dye

Fine colorless to yellow needles in clumps or Rossette, soluble in heat and alkali

Tyrosine

Yellow-brown spheres with concentric circles and radial striations

Leucine

Precipitated with tyrosine after adding alcohol

Leucine

Precipitated with tyrosine after adding alcohol

Leucine

Clumped granules or needles with bright yellow color

Bilirubin

Crystal positive in lignin test and diazo reaction

Sulfonamide

Colorless needles that tend to form following refrigeration

Ampicillin

Crystal increased in massive doses of penicillin

Ampicillin

Spheres with dimpled center

Starch granules

Maltese cross formers

OFB FATTY CAST FAT DROPLETS STARCH GRANULES

Optical surfaces of the microscope should be cleaned with a _________

Lens paper

Clean any contaminated lens immediately with a _____________

Commercial lens paper

Optical surfaces of the microscope should be cleaned with a ________

Lens paper

Optical surfaces of the microscope coated with dust should be clean with a ________

Camel's hair

The presence of crystals in freshly voided urine is most frequently associated with _______

High SG (concentrated specimen)

Testing for many substance in IEM/newborn screening

MS/MS

Phenylalanine is known as

Tyrosine disorder

Most well known aminoacidurias in the world

Phenylketonuria

Gene missing in PKU

Phenyl analine hydroxylase

Guthrie bacterial inhibition test positive result

Growth

Bacteria used in guthrie test

Bacillus subtilis

Guthrie test used for detecting

PKU

Confirmatory test for PKU

Ion exchange HPLC

Gene absent in Alkaptonuria

Homogentisic acid

Most common IEM in the PH

MSUD

Genes absent in coding for enzymes in MSUD

Leucine Isoleucine Valine

Hartnup disease is what disorder

Indicanuria

Blue diaper syndrome

Hartnup disease

Cells that produce serotonin

Argentaffin/entochromaffin

Cystinuria is the defective reabsoprtion of

cystine Ornithine Lysine Argenine

Defect in the metabolism of methionine

Homocystinuria

Colorless urine of porphyria in _______

Lead poisoning

Specimens in screening test of porphyria

Stool, urine, bile, blood

CDC Recommended test for lead poisoning

Free erythrocyte protoporphyrin (FEP)

MPS affecting eyes, skeletal, brain

Hurler

MPS affecting Skeletal and mental, sexlinked

Hunter

MPS disease affecting mental only

Sanflippo

Screening test for MPS and positive colors

Albumin - white turbidity CTAB - white turbidity MPS paper test - blue

Gene absent in lesch-nyhan disease

Hypoxanthine guanine phosphoribsyltransferase

Carbohydrate disorder associated with infant liver failure, cataract and mental disorder

Galactosemia

Glomerular disorders are of what common origin

Immune complex

Depositition of immune complex formed in conjuction of group A strep

Acute post-streptococcal glomerulonephritis

Disease findings: ``` Macroscopic hematuria Proteinuria Dysmorphic rbc Rbc Granular cast (+) aso titer ```

Acute post-streptococcal glomerulonephritis

Deposition of immune complexes from systemic immume disorders (sle)

Rapidly progressive (cresentic) glomerulonephritis

Deposition of antiglomerular basement membrane antibody

Goodpasture syndrome

Presence of ANCA against neutrophil

Wegener's granulomatosis

Decrease in platelets disrupt vascular integrity

Henoch schonlein purpura

Thickening of glomerular membrane following IgG immune complex deposition

Membranous glomerulonephritis

Cellular proliferation affecting capillary walls Presence tram truck

Membranoproliferative glomerulonephritis

Presence of waxy and broad cast

Chronic glomerulonephritis

Deposition of IgA on the glomerular membrane

IgA nephropathy (berger's)

Disruption of podocytes and little cellular changes

Minimal change disease (nil disease, lipid nephrosis)

Most common cause of ESRD Microalbuminuria (+) micral test

Diabetic nephropathy (kimmelstiel-wilson disease)

Genetic disorder showing lamellated and thinning of glomerular basement membrame

Alport syndrome

Disruption of electric charges Massive loss of lipid and protein OFB

Nephrotic syndrome

Damaged to renal tubular cells caused by ischemia or toxic agents Presents of rte cells, rte casts, hyaline, grnaular, waxy and broadcasts

Acute tubular necrosis

Crystals generally associated with uromodilin-associated kidney disease (UKD)

Uric acid

Inhereted defect in the production of normal uromodulin, increases uric acid causing gout.

UKD

Generalised failurenof tubular reabsoprtion in the pct

Fanconi's syndrome

What crystals are possibly formed in fanconi's syndrome

Cystine

Findings: low specific gravity Polyuria Failures of hypothalamus to produce ADH

Neurogenic DI

Failure of renal tubules to respond to ADH

Nephrogenic DI

Findings: Wbc, bacteria, NO CAST, microscopic hematuria, mild Proteinuria, increased PH

Cystitis (lower uti)

Findings: Wbc casts, bacterial casts, microscopic hematuria, protenuria Vesicoureteral reflux, untreated cystitis)

Acute pyelonephritis (upper UTI)

Findings: Broad cast, waxy cast, wbc, bacteria, wbc cast, bacterial cast, granular cast, hematuria, protenuria Due to recurrent infection

Chronic pyelonephritis

``` Findings: Eosinophilia (>1%) Wbc casts Hematuria Proteinuria NO bacteria ```

Acute interstitial nephritis

Simultaneous appearance of the elements of acute/chronic GN & nephrotic syndrome (cells, casts, lipid droplets, ofb)

Telescoped urine

GFR in renal failure

<25ml/min

Specific gravity in Renal failure

Consistently 1.010

``` Findings: Telescoped urine Azotemia GFR: <25/ml Isothenuria Protenuria, glycosuria (+) telescoped urine ```

Renal failure

Primary UA finding in renal lithiais

Microscopic hematuria

Conditions favouring the formation of renal calculi

PH Solute concentration Urinary stasis

Calculi: very hard, dark in color, rough surfaces

Calcium oxalate

Calculi: yellowish to brownish red, moderately hard

Uric acid/urate calculi

Calculi: Yellow-brown, greasy, resembles old soap (least common)

Cystine

Calculi: pale and friable

Phosphate

Calculi: accompanied by urea splitting bacteria, branching/staghorn calculi

Triple phosphate

Insoluble diuretic, mustard colored stones

Triamterene calculi

Calculi: associated with inherited enzyme deficiency and hyperuricemia

Adenine calculi

If neutrophils are fixed in ethanol ANCA forms a _______ pattern called _____

Perinuclear, p-anca

If neutrophils are fixed with formalin the pattern is ______ through out the ______ called the ______

Granular, cytoplasm, c-anca

The rate of proteinuria in nephrotic syndrome

>3.5g/day

Antigen associated with minimal change disease

HLA-B12

Uses high energy shockwaves to break kidney stones

Lithotripsy

Uses high energy shockwaves to break kidney stones

Lithotripsy

Stones often found in renal calculi

Caox, calcium phosphate

High SG causes false ______ in glucose

Decrease

Effect of a >6.5 pH to SG

False decrease

Clinmic Flashcards

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