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Clinical Medicine LAB - Professor Sample > GU #1 > Flashcards

GU #1 Flashcards

1
Q

Reasons for obtaining urine specimens:

A

water“fluid biopsy” of the urinary tract

Quick

Economical

To diagnose renal or urinary tract disease

To monitor renal or urinary tract disease

To detect metabolic disease

**quick , noninvasive, cheap*

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2
Q

Solutes are end products of __________ and are filtered through the ________ to maintain _________ balance

A

metabolism

kidneys

acid-base - homeostasis

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3
Q

Urine collection methods?

A

Routine Void

Midstream and Clean-Catch Specimen

24-hour urine collection - big jug and collect all the urine within 24 hours

Urethral catheterization-infants

Suprapubic aspiration-surgery or prostate that is blocking urinary outlet

Pediatric collection-try not to cath them; collect it from the bag that is stuck to them in the diaper

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4
Q

What collection method is the most common?

A

Midstream and Clean-Catch Specimen

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5
Q

Indications for a UA?

A

Used as diagnosis or screening exam

screen for protein in pregnant women signifies kidney damage; looking for preeclampsia

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6
Q

UA is used to investigate?

A 
Abdominal pain / flank pain
Back pain
Dysuria - painful urinaiton
Hematuria - blood in urine 
Urinary frequency
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7
Q

Urine sampling/specimens

us only what specimens for testing for urinalysis?

A

fresh

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8
Q

Urine sampling/specimens

uses the ______ method for urinalysis?

A

Midstream clean catch

**this is the most common test - midstream clean catch *

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9
Q

For urinalysis the _______ _______ must be cleansed first with ______/_________ wipe

A

Uretheral meatus must be cleansed first with iodine/cleansing wipe

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10
Q

Urinalysis you void a small amount then ____ and then you void into ______ cup then send to lan

A

Void small amount then stop

Void into sterile specimen cup then send to lab

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11
Q

✪ best specimen for urine cultures: however they are not routinely done on everyone that you need a culture on

A

Catheterized specimen

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12
Q

Catheterized specimen

used in patients with ?

A

Dexterity issues
Bedridden
Post-op
Urinary retention

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13
Q

UA color is normally?

A

pale yellow

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14
Q

UA color: colorless means?

A

if they are very well hydrated - if kidney stone ( have them drink water until they pee clear

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15
Q

UA color: orange means?

A

pyridium

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16
Q

UA color: brown means?

A

Rhabdomyolysis

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17
Q

UA color: green means?

A

vitamins

pseudomonas

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18
Q

UA color: red means?

A

blood

hematuria

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19
Q

UA odor: fruity?

A

Diabetic (acetone)

uncontrolled Diabetes

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20
Q

UA odor: foul-smelling?

A

infections

fistulae from the intestines to the bladder

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21
Q

UA odor: fecal?

A

Enterovesicular fistula

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22
Q

UA appearance: cloudy/turbid?

A

Old specimen

Presence of pus

Ingestion of fats (large amounts)

**old or sitting around for a while it can be cloudy *

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23
Q

UA pH: alkaline causes?

A

Alkalemia
UTI
Diet high in citrus

more alkaline with infection

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24
Q

UA pH: acidic causes?

A

Acidemia
Starvation
Dehydration
Diet high in meats

**urine is normally more acidic,
more acidic if more acid in the serum, starvation, atkins diet ( ketoacidosis), paleodiet,*

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25
UA: stones related to alkaline conditions?
Calcium carbonate, | Calcium phosphate, Magnesium phosphate
26
UA: stone related to acidic conditions?
Xanthine cystine uric acid calcium oxalate
27
UA protein normal?
normally no protein present **runner or you work out aggressively causing micro trauma to the kidney you can spill proteins * ** think inflammation, damage or infections if there is protein in the urnine*
28
if there is protein in the urine, then it is an indication of what ?
✪ indicator of renal disease **glomerular capillary pores are to small to let protein through and if there is damage or inflammation then protein, mostly albumin, leaks through ( glomerular membrane is injured), when albumin leaks through you can decrease the oncotic pressure in the vascular system and cause interstitial edema edema and proteinuria are conditions for nephrotic syndrome **
29
UA increased protein causes?
Glomerulonephritis SLE Kidney trauma Multiple myeloma- Bence joyce Preeclampsia Polycystic kidney dz Malignant HTN Pyelonephritis Goodpasture syndrome - AI condition where body attacks the kidneys and the fail
30
UA increased protein causes cont...?
``` CHF Orthostatic proteinuria Bladder tumors Urethritis Amyloidosis ```
31
Glucose is ___ normally found in the urine?
NOT
32
What is the number one cause of glucose in the urine?
diabetes
33
Other causes of glucose in the urine?
Renal glycosuria - lower threshold for secretion of glucose Fanconi syndrome - transport defect in the proximal renal tubule Nephrotoxic chemicals
34
If there is glucose in the urine then it indicates an ________ serum glucose , > ___.
elevated >180
35
Specific Gravity range?
1.005-1.030
36
Specific Gravity is a measurement of _____________.
concentration
37
SG compares with ?
water **usually more solutes in urine than in water ( SG of urine is really close to the SG of water)*
38
SG is used to evaluate the _____________ and __________ power of the kidneys
concentrating and excretory power **SG - how well our kidney can concentrate the urine *
39
Low specific gravity causes?
decreased conc. over hydration - peeing clear Diabetes insipidus Renal failure - cause more water secretion Diuretics
40
High specific gravity causes?
dehydration SIADH renal ischemia fever glycosuria proteinuria
41
UA: leukocyte esterase normal ?
Normal: none but we do see it with UTI so its positive
42
Leukocyte esterase is a screening test to detect what?
leukocytes
43
Leukocyte esterase positive with ?
Pyuria UTI
44
Leukocyte esterase falsely increased with ?
WBC normal not in urine and it is false increase if sample has external inflammation or vaginal discharge ( got a special with external WBCs)
45
UA: nitrites normal urine level?
none
46
UA nitrites is an ________ test for detecting ________.
indirect bacteria **nitrites are made by bacteria so we can assume we having infection*
47
bacteria reduce ________ to _________ by producing _________
nitrates nitrites reductase
48
+nitrites and +leuks = ?
UTI
49
UA normal ketone level?
none
50
Causes of ketonuria?
Metabolic conditions Dietary conditions Increased metabolic states anything that causes ketoacidosis **what ever raises ketone is the serum with raise it in the urine *
51
conjugated bilirubin is ____________.
water soluble
52
Bilirubin in the urine suggests process affecting ____________________
excretion of bilirubin ** excreted through the kidney system into the urine so anything that raises conjugated bili it will raise urine bili*
53
Urobilinogen: means conjugated bilirubin is broken down in the bowel into ___________
Urobilinogen
54
Bilirubin has to be __________ to be in the kidneys so .....?
Infectious hepatocellular disease Obstructive process
55
Urobilinogen is increased with ?
Hemolysis Hemorrhage Hepatic damage
56
Urobilinogen is decreased with ?
Obstructive disease **obstructive process - high bilirubin but low urobilinogen ( cause it is not going though the bile duct and small intestine - it is going start to the vascular system), Galls tone - high bili but uronbilinogen is not elevated cause there is obstruction elevated bilirubin and a decreased to NL urobili = obstructive process*
57
Blood in the urine indicates some type of damage in the __ tract
GU
58
Hematuria causes?
``` UTI/Cystitis Stones Cancer Trauma (MVC, athletes) Blood thinners Menstruation - female Traumatic catheterization ``` Myoglobin- gives cherry red appearance without blood! muscle damage - skeletal muscle **kidney sensitive to an inflammation in the body or micro trauma so they will leak protein and blood in small amount - this is NL only larger amount we are worried about *
59
UA micro: WBCs: >5 per LPF = ?
infection
60
UA micro: epithelial cells in urine means?
Cells lining the hollow organs and the skin. If present, can indicate contamination. **microscopic analysis - looks for WBC and gives you a count, more then 5 per low power field - infection!, if there are many squamous epithelial cells then it means the sample is contaminated *
61
What frequently causes kidney stones?
Ca oxalate
62
Casts are what?
mold or renal tubules - slugging off of the inside of the renal tubule - different casts mean different things
63
RBC casts indicate?
infection
64
Hyaline casts indicate?
can be normal they are just hyaline cells ** not everyone makes casts - *
65
Hyaline casts indicate?
can be normal they are just hyaline cells ** not everyone makes casts*
66
Urine C & S indications?
+ dipstick or micro results
67
Urine C & S normal ?
no growth
68
Urine C & S abnormal?
single organism multiple organism
69
Urine C & S >100,000 bacteria/ mL = ?
infection ( Klebsiella or E.coli)
70
Urine C&S 10,000-100,000 = ?
consider clinical presentation
71
Urine C&S <10,000 bacteria / mL = ?
no infection | (maybe if they are immunocompromised or something then yeah we want to treat this number)
72
Urine C&S: multiple organisms?
Probably contaminated
73
Urine stone analysis?
Strain urine of patient with stone
74
Urinary stone analysis: calcium oxalate / phosphate stones = ?
80%
75
Urinary stone analysis: Ammonium phosphate stones = ?
10%
76
Urinary stone analysis: Urice acid stones = ?
9%
77
Urinary stone analysis: Cystine stones = ?
1%
78
Urine cytology indications?
Gross or microscopic hematuria
79
Urine cytology is the initial screening test for?
✪ initial screening test for bladder cancer **sometimes they will have negative cytology*
80
Urine cytology is a good test for screening for but a __ is diagnostic?
CA CT is dx
81
Urine Microalbumin (MA) refers to protein not __________ by routine protein testing from __?
detectable UA **protein that is smaller ( smaller amount) then what we test for with UA*
82
Urine Microalbumin (MA) can ID _____________ 5 years prior to routine testing.
diabetic nephropathy **why we looking for minute amount of protein? it is a good indication or early kidney disease or damage in DM patients before they start spilling over bigger proteins * ** order a UA and MA*
83
MA: Annual screening test for diabetics?
3 tests: If 2 or more are positive than 24-hour urine for microalbumin should be completed
84
Urine Microalbumin (MA) is a early indicators of what?
✪ early indicator of damage to renal system from diabetes ( so we can start duo do things to save them - like pt them on an ACE )
85
42 yo female with left flank pain radiating into the LLQ of the abdomen since this morning. Waxes and wanes. Rates it 10/10. VS: HR 108 BP 165/76 T 37.0C SPO2 96% UCG: negative
glucose, protein(idk), nitrite if pilo - we will have WBC run a serum glucose test, CT scan of kidneys maybe some kidney inflammation ( looks a little larger) stone down in the LLQ right pic - level of the hips UVJ is the most common place for a stone to get stuck ( uretevesticular junction) HURTS LIKE THE DICKENS
86
21 yr old female presents with dysuria, frequency, and urgency x 2 days. VS: all WNL UCG: negative UA: +leuks, +blood, +nitrites, Micro: many epithelials, >25 WBC Next test?
UTI! epithelial - we should get another specimen treat her empirically and send specimen for culture 3 days of bactrim or cipro for uncomplicated UTI for healthy immune system 1 tab BID x 3 days most common for UTI ( same ABS for pilo but we treat for 7 days ) but if they are pregnant then marcobid ( bacteriostatic) or nitrofurantoin

Clinical Medicine LAB - Professor Sample (36 decks)

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