Lecture 2 Flashcards

Question

Clarity

Answer 1

Normal – clear or transparent | Cloudy/Turbid – possible bacteria or alkalinity

Answer 2

Normal – “urinoid” Fruity or sweet odor – diabetic ketoacidosis Ammoniacal odor – long standing urine Pungent odor – urinary tract infections

Answer 3

decrease in normal daily urine output. | Dehydration, burns, diarrhea, vomiting.

Answer 4

cessation of urine flow | Serious damage to the kidney

Answer 5

increase in the nocturnal excretion of urine

Answer 6

increase in the daily urine output | Diuretics, Diabetes mellitus, diabetes insipidus

Answer 7

Specific Gravity Measure of the weight of solutes in water in the urine Solutes include urea, chloride, sulfate and phosphate Specific gravity is a crude indicator of Urine Osmolality Reagent strip specific gravity Gives important insight into the patient’s hydration status

Answer 8

Water Specific Gravity: 1.000 Desirable Range: 1.010-1.025 Normal Range: 1.005 to 1.030 Hydration status 1.020 indicates relative dehydration

Answer 9

Reagent dipstick | Measures the concentration of ions and gives an indirect measure of specific gravity

Answer 10

Glycosuria or increased urine protein | Syndrome of inappropriate antidiuretic hormone

Answer 11

``` Diuretic use Diabetes insipidus (decreased ADH) Adrenal insufficiency Aldosteronism Impaired renal function ```

Answer 12

Timing First morning is most concentrated Random specimen is most common Midstream clean-catch is preferred Urine should be examined within one hour after voiding Refrigerate specimen if this cannot be done

Answer 13

``` pH Specific Gravity Protein Glucose Ketones Bilirubin Nitrites Leukocyte Esterase ```

Answer 14

Measure of the kidney’s ability to preserve normal hydrogen ion concentration in maintenance of acid-base balance Desirable Range: 6-6.5 Normal Range: 4.5-8 Affected by diet More acidic: cranberries, high protein More alkaline: citrate, vegetables, dairy products

Answer 15

Persistent alkaline urine (pH 7-8) suggests: Urinary tract infection Renal Tubular Acidosis Kidneys are unable to adequately excrete hydrogen ions Vomiting Metabolic alkalosis Vegetarian diet (pure vegans) Alkalizing drugs (antibiotics, bicarbonate) Proteus infection Converts urea to ammonia producing an ammonia odor

Answer 16

``` Acidosis Diabetes Mellitus Starvation Diarrhea Uric acid calculi Drugs (ammonium chloride) ```

Answer 17

Presence of glucose or protein

Answer 18

Diabetes insipidius | Decreased antidiuretic hormone ADH

Answer 19

Sensitive indicator of glomerular and tubular renal function Normally, 150 mg of protein daily (10-20 mg/dL)

Answer 20

Reagent on dipstick is mainly sensitive to albumin (globulins, hemoglobin, fibrinogen, Bence Jones) Normal Range: Negative or Trace ``` Abnormal Result 1+: 30 mg of protein per dL 2+: 100 mg/dL 3+: 300 mg/dL 4+: 1,000 mg/dL ```

Answer 21

Congestive heart failure, dehydration, emotional stress, exercise, fever, orthostatic (postural) proteinuria, seizures, pregnancy

Answer 22

Glomerular causes (nephropathies, DIABETES MELLITUS, infections, malignancies (Multiple myeloma: Bence-Jones protein), DRUGS (NSAIDS, penicillamine, ACE-inhibitors), sickle cell disease, tubular causes (interstitial nephritis)

Answer 23

Dilute urine | Acidic urine

Answer 24

``` Medications Penicillin, Sulfonamides Contamination Hematuria, pus, semen, vaginal secretions Alkaline urine ```

Answer 25

Glucose is normally filtered by the glomerulus, but it is reabsorbed in the proximal tubule Excreted in urine when the plasma level exceeds the kidney threshold of 180 mg/dL or when there is a defect in the reabsorption of glucose

Answer 26

``` Diabetes Mellitus Pregnancy Cushing’s syndrome Liver and pancreatic disease Impaired tubular reabsorption ```

Answer 27

Ketones are the products of fat metabolism (rather than normal glucose metabolism) Normal result: negative for ketones

Answer 28

Diabetic ketoacidosis, fasting/starvation, carbohydrate-free diets (Atkins), pregnancy

Answer 29

May be in the form of intact RBCs or hemoglobin from lysed RBCs Normal result: negative Causes Menses, vigorous exercise, anticoagulation therapy Myoglobinuria – rhabdomyolysis, myocardial infarction Hemolytic anemia, infections, calculi, tumors

Answer 30

``` Complete UA (dipstick and microscopic) Culture KUB IV Pyelogram Cystoscopy Urine cytologic exam Renal biopsy ```

Answer 31

Normal result: negative Bilirubinuria Liver disease (hepatitis, cirrhosis) **Obstructive biliary tract disease -Biliary stasis interferes with the normal excretion of conjugated bilirubin via the intestinal tract. -This causes a buildup in the bloodstream resulting bilirubinuria.

Answer 32

Conjugated bilirubin in the intestinal tract is converted by bacterial action to urobilinogen Small amount is normally excreted in the urine (up to 4 mg/d), but the major excretion is in the feces Normal result: normal or trace

Answer 33

Increased Any condition that causes an increase in the production in bilirubin Hemolytic anemias, malaria Any disease that prevents the liver from normally removing the reabsorbed urobilinogen from the portal circulation Infectious or toxic hepatitis, congestive heart failure

Answer 34

Decreased Any process that decreases bilirubin in the stool Diminishing liver function Obstruction of the bile ducts (cholelithiasis) Antibiotic therapy Suppression of normal intestinal flora

Answer 35

Rapid screen for the detection of bacteria that are capable of reducing nitrates to nitrites. -Escherichia coli (most common), Enterobacter, Proteus, Klebsiella, Pseudomonas, Citrobacter. Positive test indicates that these organisms are present in significant numbers > 10,000 per mL

Answer 36

Test is highly specific but not highly sensitive Positive result is helpful, but a negative result does not rule out Urinary Tract Infection Normal result: negative False Positives -Vaginal contaminant, strips exposed to air False Negatives -Low nitrate diet, urine not in the bladder for at least 4 hours, bacteria that lack nitrate reductase enzyme

Answer 37

Test that indicates whether white blood cells are present in the urine Cystitis, Pyelonephritis, Urethritis (STI) Normal result: negative False Positives Vaginal cellular contamination or trichomonads

Answer 38

Ictotest – bilirubin (purple) Clinitest – glucose Sulfosalicylic acid – protein (hazy) Acetest – Ketones (purple)

Answer 39

Required Reading: How to use a Microscope Powerpoint on Moodle ``` Summary Total magnification is the ocular lens (10x) x objective lens -Scanning lens 10x X 4x = 40x -Low power 10x X 10x = 100x -High power 10x X 40x = 400x ```

Answer 40

Fresh sample of 10-15 mL of urine is centrifuged at 1,500-3,000 rpm for 5 minutes The supernatant is decanted and the sediment resuspended in the remaining liquid A single drop is transferred to a clean glass slide, and a cover slip is applied

Answer 41

Hemosiderin (iron)

Answer 42

Squamous epithelial cells covered with bacteria Gardenerella vaginalis Bacterial Vaginosis Fishy odor

Answer 43

Sexually transmitted urogenital parasite 1-2 times bigger than WBC Rapid erratic movement

Answer 44

Vaginal candidiasis

Answer 45

Commonly found in urine sediment Rarely clinically significant Reported as few, moderate, many, or too numerous to count (TNTC) under microscopic high power

Answer 46

Flat colorless hexagonal plates Favor acidic urine Result of an inherited metabolic defects that prevents the reabsorption of cystine

Answer 47

Retangular plates with a notch in one or more of the corners May be seen in those with nephrotic syndrome

Answer 48

Yellow spheres with concentric and radial strias Polarized light – “maltese cross” Seen in liver failure

Answer 49

Fine brownish needles May be seen with liver disease

Answer 50

Yellow spheres with spicules Conjugated bilirubin Liver disease

Answer 51

Formed in distal and collecting tubules Only a few hyaline or granular casts are normal

Answer 52

Casts contain Tamm-Horsfall protein, which is a mucoprotein secreted only by renal tubular cells, and forms the matrix of casts

Answer 53

Hard to visualize as they have no inclusions

Answer 54

Degenerated cellular casts or protein aggregation | Classified as finely granular or coarsely granular

Answer 55

Cellular casts -Red blood cell casts -Signify glomerular disease White blood cell casts -Associated with pyelonephritis and infection Renal tubular epithelial cell casts -Tubular diseases like tubular necrosis or drug toxicity Acellular cast *Waxy cast – seen in severe renal failure

Answer 56

Protein that stores iron Normal result: negative Appears as a dark yellow-brown pigment Positive Hemochromatosis Chronic hemolytic anemia Paroxysmal nocturnal hemoglobinemia

Answer 57

- Human chorionic gonadotropin (hCG) is produced by the syncytiotrophoblast cells of the placenta after implantation (a few days after conception). - hCG should double every 2-3 days for the first 6 weeks. - Most chemical tests for pregnancy look for the presence of the beta subunit of hCG in blood or urine.

Answer 58

Normal results | Negative: 25 IU/L

Answer 59

Testing done too early Test has too high hCG detection threshold Medications: diuretics and promethazine

Answer 60

Medications containing the hCG molecule Non-pregnant production of the hCG moledule Medications (chlorpromazine, phenothiazines, methadone) Tests read after the suggested reaction time

Answer 61

hCG injections as part of infertility treatment will test positive on pregnancy tests regardless of her actual pregnancy status Some infertility drugs (clomid) do not contain hCG hormone

Answer 62

Testicular tumors Ovarian germ cell tumors Choricocarcinoma Gestational trophoblastic disease

Answer 63

Quantitative blood tests | Can detect hCG levels as low as 1 IU/L

Lecture 2 Flashcards

(87 cards)