PHYSICALEXAMINATION Flashcards by Loui Mojica

OBJECTIVE observation: physical examination

Color, Volume,Clarity, Odor, and Specific Gravity

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Provides preliminary information:

glomerular bleeding
liver disease
inborn errors of metabolism
urinary tract infection

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used to confirm or to explain findings in the chemical and microscopic
areas of urinalysis

Physical examination

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◦ normal metabolic functions
◦ physical activity
◦ingested materials
◦ pathologic conditions

Colorless to black

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Normal Urine Color

pale yellow, yellow, dark yellow, and amber

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ØYellow color
Øproduct of endogenous metabolism, and
under normal conditions the body produces it
at a constant rate

Urochrome

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Øincreased amounts produced in thyroid
conditions and fasting states.
Øincreases in urine that stands at room temperature

Urochrome

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most evident in specimens that have been refrigerated ◦attaches to the urates, producing a pink color to the sediment.

Uroerythrin

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◦an oxidation product of the normal urinary constituent
urobilinogen ◦imparts an orange-brown color to urine that is not fresh.

Urobilin

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Recent fluid consumption
- Commonly observed with random specimens

Colorless

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Urine color of Polyuria or diabetes insipidus, DM and dilute random specimen

Pale yellow

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Pale yellow that Increased 24-hour volume

Polyuria or DI

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Pale yellow that Elevated specific gravity and positive glucose test result

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Pale yellow that Recent fluid consumption

Dilute random specimen

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Color of urine that Concentrated specimen

Dark yellow

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Color of urine that Dehydration from fever or burns

Amber

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Color of urine that Bilirubin oxidized to biliverdin

Yellow to green or yellow brown

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Colored foam in acidic urine and false-negative chemical test results for bilirubin

Yellow green or yellow brown

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Orange color of urine

Bilirubin
Acriflavine
Phenazopyridine (pyridium)
Nitrofurantion
Phenindione

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Orange color of urine that Yellow foam when shaken and positive chemical test results for

Bilirubin

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Orange color of urine that Negative bile test results and possible green fluorescence

Acriflavine

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Orange color of urine that Drug commonly administered for UTI and May have orange foam and thick orange pigment that can obscure or interfere with
reagent strip readings

Pyridium

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Orange color of urine that Antibiotic administered for UTI

Nitrofurantion

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Orange color of urine that Anticoagulant, orange in alkaline urine, colorless in acid urine

Phenindione

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Pink to Red color of urine

RBC Hemoglobin Myoglobin Porphyrin Beets Rifampin Mestrual contamination

Pink to Red color of urine that Cloudy urine, blood test (+) and RBCs visible microscopically

RBC

Pink to Red color of urine that Clear urine blood test (+); intravascular hemolysis

Hemoglobin

Pink to Red color of urine that Clear urine with positive chemical test results for blood; muscle damage

Myoglobin

Pink to Red color of urine that Negative chemical test results for blood and port wine

Porphyrin

Pink to Red color of urine that Detected with Watson-Schwartz screening test or fluorescence under ultraviolet light

Porphyrin

Pink to Red color of urine that drugs that affect color

Rifampin

Pink to Red color of urine that Cloudy specimen with RBCs, mucus, and clots

Menstrual contamination

Brown to Black color of urine

Homogentisic acid (alkaptonuria) Melanin Phenol derivatives Argyrol (antiseptic) Methyldopa or levodopa Metronidazole (flagyl)

Brown to Black color of urine that Seen in alkaline urine after standing; specific tests

Homogentisic acid (Alkaptonuria)

Brown to Black color of urine that Urine darkens on standing and reacts with nitroprusside and ferric chloride

Melanin

Brown to Black color of urine that Interfere with copper reduction tests

Phenol derivatives

Brown to Black color of urine that Color disappears with ferric chloride

Argyrol (antseptic)

Brown to Black color of urine that Antihypertensive

Methyldopa or levodopa

Brown to Black color of urine that Darkens on standing

Metronidazole (Flagyl)

GreeN / BLUE-green color of urine

Pseudomonas infection Phenol Methocarbamol (robaxin) Amitriptyline Clorets Indican Methylene blue

GreeN / BLUE-green color of urine that Positive urine culture

Pseudomonas infection

GreeN / BLUE-green color of urine that Muscle relaxant, may be green-brown

Methocarbamol (robaxin)

GreeN / BLUE-green color of urine that Antidepressant

Amitriptyline

GreeN / BLUE-green color of urine that Bacterial infection (Klebsiella, Providencia)

Indican

GreeN / BLUE-green color of urine that Fistulas

Methylene blue

GreeN / BLUE-green color of urine that When oxidized

Phenol

Urine foam that URINE WITH LARGE AMOUNT OF PROTEIN

Albumin

cause a stable white foam to be produced when urine is poured or agitated

Albumin

FOAM IF PRESENT WILL BE CHARACTERISTICALLY YELLOW

Bilirubin

transparency/turbidity of a urine specimen Clear container

Urine transparency

Urine transparency Visually examine

Mixed well , view in clear container and maintain light

No visible particulates, transparent.

Clear

Few particulates, print easly seen through urine.

Hazy

Many particulates, print blurred through urine.

Cloudy

Print cannot be seen through urine.

Turbid

May precipitate or be clotted.

Milky

Collected urine for normal Clarity

Midstream or clean catch

Pathologic Causes of Urine Turbidity

RBCS WBCs Bacteria Yeast Nonsquamous epithelial cells Abnomal crystals Lymph fluid Lipids

Nonpathologic Causes of Urine Turbidity

Squamous epithelial cells Mucus Amorphous phosphates, carbonates, urates Semen, spermatozoa Fecal contamination Radiographic contrast media Talcum powder Vaginal creams

Laboratory Correlations in Urine Turbidity: Acidic Urine

Amorphous urates Radiographic contrast media

Laboratory Correlations in Urine Turbidity: Alkaline Urine

Amorphous phosphates carbonates

Laboratory Correlations in Urine Turbidity: Soluble With Heat

Amorphous urates, uric acid crystals

Laboratory Correlations in Urine Turbidity: Soluble in Dilute Acetic Acid

RBCs Amorphous phosphates carbonates

Laboratory Correlations in Urine Turbidity: Insoluble in Dilute Acetic Acid

WBCs Bacteria yeast Spermatozoa

Laboratory Correlations in Urine Turbidity: Soluble in Ether

Lipids Lymphatic fluid chyle

The ability of the kidneys to selectively reabsorb essential chemicals and water from the glomerular filtrate

Specific gravity

detects possible dehydration or abnormalities in antidiuretic hormone

Specific gravity

of a solution compared with the density of a similar volume of distilled water at a similar temperature

Density

Direct method: SG

Urinometer

Indirect method: SG

Refractometer

direct method: urinometer used in

harmonic oscillation densitometry

Indirect method: refractometer used in

REAGENT STRIP

Urinometer (hydrometer) principle

Density

weighted float attached to a scale ◦sink to a level of 1.000 in distilled water ◦less accurate than the other methods

Urinometer

Major disadvantage of urinometer

◦ Requires large volume (10-15ml) ◦ Spinning motion ◦ Read at lower meniscus

Urinometer (hydrometer) Tempt. Sensitive

20 degree celsius

Refractometer Principle:

refractive index

The concentration of dissolved particles present in the solution determines the velocity and angle at which light passes through a solution.

Refractometer

Refractometer Advantage:

Small amount (1 to 2 drop) Temperature compensated bet. 15-38°C

is a comparison of the velocity of light in air with the velocity of light in a solution.

Refractive index

Harmonic oscillation densitometry Principle

Density

The frequency of a sound wave entering a solution changes in proportion to the density of the solution

Harmonic oscillation densitometry

Harmonic oscillation debate Results are linear up to a specific gravity of

1.080

Reagent strip Method Principle:

pKa changes of a polyelectrolyte

Isosthenuric SG

1.010 SG OF URINE

Hyposthenuric SG

< 1.010 SG OF URINE

Hypersthenuric SG

> 1.010 SG OF URINE

ABNORMALLY HIGH S.G RESULTS ARE SEEN:

> 1.035

S.G OF RANDOM SPECIMEN FALLS BETWEEN

1.015-1.025

SPECIMEN WITH S.G OF ________ PROBABLY ARE NOT URINE.

1.003

Freshly voided urine

Aromatic odor

Prolonged standing of specimen and Breakdown of urea

Ammoniacal

PHYSICALEXAMINATION Flashcards

(92 cards)