STRASINGER (7TH ED. | CHAPTER 5: PHYSICAL EXAMINATION OF URINE) Flashcards
(230 cards)
1
Q
What are the (4) components included in the physical examination of urine?
A
- Color
- Clarity
- Specific gravity (SG)
- Odor
2
Q
What are the (2) components of urine where early physicians based their medical decisions?
A
- Color
- Clarity
3
Q
Observation of the color and clarity of urine provides preliminary information concerning what (4) disorders / conditions?
A
- Glomerular bleeding
- Liver dse
- Inborn errors of metabolism
- Urinary tract infection (UTI)
4
Q
Measurement of what component aids in the evaluation of renal tubular function?
A
SG
5
Q
True or False
The results of the physical examination of urinalysis (UA) also can be used to confirm or explain findings in the chemical and microscopic areas of UA
A
True
6
Q
True or False
The color of urine varies from almost colorless to black. These variations may be due to normal metabolic functions, physical activity, ingested materials, or pathological conditions
A
True
7
Q
What component of physical examination of urine is often the reason that a patient seeks medical advice?
A
Noticeable change in color
8
Q
What are the (13) more common normal and pathological colors of urine?
A
- Colorless
- Pale yellow
- Dark yellow
- Orange-yellow
- Yellow-green
- Green
- Blue-green
-
Pink
8.1. Red - Port wine
- Red-brown
-
Brown
11.1. Black
9
Q
What is the cause of colorless urine?
A
Recent fluid consumption
10
Q
What is the clinical / laboratory correlation associated with colorless urine?
A
Commonly observed with random specimens
11
Q
What are the (3) causes of pale yellow urine?
A
- Polyuria or Diabetes insipidus (DI)
- Diabetes mellitus (DM)
- Dilute random specimen
12
Q
(1) of the cause of pale yellow urine is polyuria or DI, what are the (2) clinical / laboratory correlations to these pale yellow urine?
A
- Increased 24-hour volume
- Low SG
13
Q
(1) of the cause of pale yellow urine is DM, what are the (2) clinical / laboratory correlations to these pale yellow urine?
A
- Elevated SG
- (+) GLU test result
14
Q
(1) of the causes of pale yellow urine is dilute random specimen, what is the clinical / laboratory correlations to these pale yellow urine?
A
Recent fluid consumption
15
Q
What are the (6) causes of dark yellow urine?
A
- Concentrated specimen
- B complex vitamins
- Dehydration
- Bilirubin
- Acriflavine
- Nitrofurantoin
Bilirubin = yellow
16
Q
(1) of the causes of dark yellow urine is concentrated specimen, what is the clinical / laboratory correlation to these dark yellow urine?
A
May be normal after strenuous exercise or in first morning specimen
17
Q
(1) of the causes of dark yellow urine is dehydration, what are the (2) clinical / laboratory correlations to these dark yellow urine?
A
- Fever
- Burns
18
Q
(1) of the cause of dark yellow urine is bilirubin, what are the (2) clinical / laboratory correlations to these dark yellow urine?
A
- Yellow foam when shaken
- (+) chemical test results for bilirubin
19
Q
(1) of the cause of dark yellow urine is acriflavine, what are the (2) clinical / laboratory correlations to these dark yellow urine?
A
- (-) bile test results
- Possible green fluorescence
20
Q
(1) of the cause of dark yellow urine is nitrofurantoin, what is the clinical / laboratory correlations to these dark yellow urine?
A
Antibiotic administered for UTIs
21
Q
What are the (6) causes of orange-yellow urine?
A
- Phenazopyridine
- Phenindione
- Sulfasalazine
- Azo-gantrisin compounds
- Some laxatives
- Certain chemotherapy drugs
PhePhe = Phenazopyridine | Phenindione
22
Q
What is the brand name of phenazopyridine?
A
Pyridium
23
Q
What is the other name of sulfasalazine?
A
Azulfidine
24
Q
(1) of the cause of orange-yellow urine is phenazopyridine, what is the clinical / laboratory correlations to these orange-yellow urine?
A
Drug commonly administered for UTIs
25
(1) of the cause of **orange-yellow** urine is **phenindione**, what are the (3) **clinical / laboratory correlations** to these orange-yellow urine?
1. **Anticoagulant**
2. **Orange** in **alkaline** urine
3. **Colorless** in **acid** urine
26
(1) of the cause of **orange-yellow** urine is **sulfasalazine**, what is the **clinical / laboratory correlations** to these orange-yellow urine?
**Anti-inflammatory** drug
27
What is the cause of **yellow-green** urine?
**Bilirubin** oxidized to **biliverdin**
28
(1) of the cause of **green** urine is **bilirubin oxidized to biliverdin**, what are the (2) **clinical / laboratory correlations** to these yellow-green urine?
1. **Colored foam** in **acidic** urine
2. **False-negative** chemical test results for **bilirubin**
29
What are the (2) **causes** of **green** urine?
1. **Pseudomonas** infection
2. **Asparagus**
30
(1) of the causes of **green** urine is **Pseudomonas infection**, what is the **clinical / laboratory correlations** to these green urine?
(**+**) **urine culture**
31
What are the (12) **causes** of **blue-green** urine?
1. **Indican**
2. **Phenol**
3. **Familial hypercalcemia**
Causes of **green** urine:
1. **Breath deodorizers** (**Clorets**)
2. Brightly colored **food dyes**
3. **B vitamins**
4. **Asparagus**
Causes of **blue** urine:
1. **Medications**
i. **Methocarbamol** (**Robaxin**)
2. **Methylene blue**
3. **Indomethacin** (**Indocin**, **Tivorbex**)
4. **Amitriptyline** (**Elavil**)
5. **Propofol** (**Diprivan**)
32
What is the other name of **methocarbamol**?
**Robaxin**
33
What are the (2) other names of **indomethacin**?
1. **Indocin**
2. **Tivorbex**
34
(1) of the causes of **blue-green** urine is **amitriptyline**, what is the **clinical / laboratory correlations** to these blue-green urine?
**Antidepressant**
35
(1) of the causes of **blue-green** urine is **methocarbamol**, what are the (2) **clinical / laboratory correlations** to these blue-green urine?
1. **Muscle relaxant**
2. May be **green-brown**
36
(1) of the causes of **blue-green** urine is **indican**, what are the (2) **clinical / laboratory correlations** to these blue-green urine?
1. **Bacterial infections**
2. **Intestinal disorders**
37
(1) of the causes of **blue-green** urine is **methylene blue**, what is the **clinical / laboratory correlations** to these blue-green urine?
**Fistulas**
38
(1) of the causes of **blue-green** urine is **phenol**, what is the **clinical / laboratory correlations** to these blue-green urine?
When **oxidized**
39
(1) of the causes of **blue-green** urine is **propofol**, what is the **clinical / laboratory correlations** to these blue-green urine?
**Anesthetic**
40
(1) of the causes of **blue-green** urine is **familial hypercalcemia**, what is the **clinical / laboratory correlations** to these blue-green urine?
"**Blue diaper syndrome**"
41
(1) of the causes of **blue-green** urine is **indomethacin**, what is the **clinical / laboratory correlations** to these blue-green urine?
**Nonsteroidal anti-inflammatory drug** (**NSAID**)
42
What are the (9) **causes** of **pink** and/or **red** urine?
1. **RBCs**
2. **Hemoglobin**
3. **Myoglobin**
4. **Beets**
5. **Rifampin**
6. **Menstrual** contamination
**Nonpathogenic** causes of **red** urine:
1. **Menstrual** contamination
2. Ingestion of **highly pigmented foods**
3. **Medications**
i. **Rifampin**
ii. **Phenolphthalein**
iii. **Phenindione**
iv. **Phenothiazines**
43
(1) of the causes of **pink** and/or **red** urine is **RBCs**, what are the (2) **clinical / laboratory correlations** to these pink and/or red urine?
1. **Cloudy** urine w/ (**+**) chemical test results for **blood**
2. **RBCs** visible **microscopicaly**
44
(1) of the causes of **pink** and/or **red** urine is **hemoglobin**, what are the (2) **clinical / laboratory correlations** to these pink and/or red urine?
1. **Clear** urine w/ (**+**) chemical test results for **blood**
2. **Intravascular** hemolysis
45
(1) of the causes of **pink** and/or **red** urine is **myoglobin**, what are the (2) **clinical / laboratory correlations** to these pink and/or red urine?
1. **Clear** urine w/ (**+**) chemical test results for **blood**
2. **Muscle** damage
46
(1) of the causes of **pink** and/or **red** urine is **beets**, what is the **clinical / laboratory correlations** to these pink and/or red urine?
**Alkaline** urine of people who are genetically **susceptible**
47
(1) of the causes of **pink** and/or **red** urine is **rifampin**, what is the **clinical / laboratory correlations** to these pink and/or red urine?
**Tuberculosis** medication
48
(1) of the causes of **pink** and/or **red** urine is **menstrual contamination**, what is the **clinical / laboratory correlations** to these pink and/or red urine?
**Cloudy** specimen w/ **RBCs**, **mucus**, and **clots**
49
What is the **cause** of **port wine** urine?
**Pophyrins**
50
(1) of the causes of **port wine** urine is **porphyrins**, what are the (2) **clinical / laboratory correlations** to these port wine urine?
1. (**-**) test for **blood**
2. May require **additional testing**
51
What are the (2) **causes** of **red-brown** urine?
1. RBCs **oxidized** to **methemoglobin**
2. **Myoglobin**
52
(1) of the causes of **red-brown** urine is **RBCs oxidized to methemoglobin**, what are the (2) **clinical / laboratory correlations** to these red-brown urine?
1. Seen in **acidic** urine after **standing**
2. (**+**) chemical test result for **blood**
53
What are the (9) **causes** of **brown** and/or **black** urine?
1. **Homogentisic acid** (**alkaptonuria**)
2. **Malignant melanoma**
2.1 **Melanin** or **melanogen**
3. **Phenol derivatives**
4. **Argyrol**
5. **Methocarbamol**
6. **Fava beans**, **rhubarb**, or **aloe**
7. **Medications**
i. **Anti-malarial** drugs
a. **Chloroquine**
b. **Primaquine**
c. **Levodopa**
d. **Methyldopa**
e. **Phenol derivatives**
ii. **Antibiotics**
a. **Metronidazole** (**Flagyl**)
b. **Nitrofurantoin** (**Furadantin**)
8. **Laxatives** (containing **cascara** or **senna**)
**Nonpathogenic** causes of a **dark-brown** (**cola**-colored) urine:
Ingesting **large** amounts of:
1. **Fava beans**
2. **Rhubarb**
3. **Aloe**
54
What is **aygyrol**?
**Antiseptic**
55
What is the other name of **metronidazole**?
**Flagyl**
56
(1) of the causes of **brown** and/or **black** urine is **homogentisic acid (alkaptonuria)**, what are the (2) **clinical / laboratory correlations** to these brown and/or black urine?
1. Seen in **alkaline** urine after **standing**
2. **Specific** tests are available
57
(1) of the causes of **brown** and/or **black** urine is **malignant melanoma, melanin or melanogen**, what is the **clinical / laboratory correlations** to these brown and/or black urine?
Urine **darkens** on **standing** and reacts w/ **nitroprusside** and **ferric chloride**
58
(1) of the causes of **brown** and/or **black** urine is **phenol derivatives**, what is the **clinical / laboratory correlations** to these brown and/or black urine?
**Interfere** w/ **copper reduction tests**
59
(1) of the causes of **brown** and/or **black** urine is **argyrol**, what is the **clinical / laboratory correlations** to these brown and/or black urine?
Color **disappears** w/ **ferric chloride**
60
(1) of the causes of **brown** and/or **black** urine is **methyldopa or levodopa**, what is the **clinical / laboratory correlations** to these brown and/or black urine?
**Antihypertensive**
61
(1) of the causes of **brown** and/or **black** urine is **metronidazole**, what are the (3) **clinical / laboratory correlations** to these brown and/or black urine?
1. **Darkens** on **standing**
2. **Intestinal** infections
3. **Vaginal** infections
62
(1) of the causes of **brown** and/or **black** urine is **chloroquine and primaquine**, what is the **clinical / laboratory correlations** to these brown and/or black urine?
**Antimalarial** drugs
63
(1) of the causes of **brown** and/or **black** urine is **methocarbamol**, what is the **clinical / laboratory correlations** to these brown and/or black urine?
**Muscle relaxant**
64
What are the (3) common descriptions for **normal** urine **color**?
1. **Pale yellow**
2. **Yellow**
3. **Dark yellow**
65
How to properly examine the **color** of urine?
Examine the specimen under a **good light source**, looking down through the container against a **white background**
66
What is the cause of the **yellow** color of urine?
**Urochrome**
67
What is **urochrome**?
**Pigment**
68
Who named **urochrome**, and when is it named?
**Thudichum** named urochrome in **1864**
69
What is the product of **endogenous** metabolism, and under **normal** conditions, the body produces it at a **constant** rate?
**Urochrome**
70
**True or False**
The actual amount of **urochrome** produced is **dependent** on the body's **metabolic state**, with **decreased** amounts produced in patients with **thyroid conditions** and/or those in **fasting** states
**False**, the actual amount of **urochrome** produced is **dependent** on the body's **metabolic state**, with **increased** amounts produced in patients with **thyroid conditions** and/or those in **fasting** states
71
What are the (3) conditions or contexts where **urochrome** is **increased**?
1. Patients w/ **thyroid** conditions
2. Those in **fasting** states
3. Urine standing in **room temperature**
72
Can the urine **color** be used as a rough **estimate** of the urine **concentration**? Why or why not? Explain
Yes, because **urochrome** is **excreted** at a **constant** rate, the **intensity** of **yellow** color in a **fresh** urine specimen can give a rough **estimate** of urine **concentration**
73
What is the color of a **dilute** urine?
**Pale yellow**
74
What is the color of a **concentrated** urine?
**Dark yellow**
75
**True or False**
The color of urine varies depending on the body's state of hydration
**True**
76
What are the (3) **pigments** of urine?
1. **Urochrome**
2. **Uroerythrin**
3. **Urobilin**
77
What are the (2) **pigments** of urine that are also present in the urine in much **smaller** quantities, and they contribute little to the color of **normal**, **fresh** urine?
1. **Uroerythrin**
2. **Urobilin**
78
What is **uroerythrin**?
**Pink** pigment
79
Where is **uroerythrin** evident? Explain
**Uroerythrin** is most evident in specimens that have been **refrigerated**, resulting in the **precipitation** of **amorphous urates** in an **acid** urine. Uroerythrin attaches to the **urates**, giving a **pink** color to the **sediment**
**Refrigerated** urine -> **precipitation** of amorphous urates in an acid urine -> uroerythrin attaches to **urates** -> **pink** color at sediment
80
What is the **oxidation** product of the normal urinary constituent **urobilinogen**?
**Urobilin**
81
What imparts an **orange-brown** color to urine that is **not** fresh?
**Urobilin**
82
What are the (4) **abnormal** colors of urine?
1. **Dark yellow** / **Amber** / **Orange**
2. **Red** / **Pink** / **Brown**
3. **Brown** / **Black**
4. **Blue** / **Green**
83
**True or False**
**Dark yellow** or **amber** urine may **always** signify a **normal concentrated** urine
**False**, **dark yellow** or **amber** urine may **not** always signify a **normal concentrated** urine
84
**Dark yellow** or **amber** urine can be caused by what?
**Bilirubin**
85
What are the (2) ways of detecting **bilirubin** in the urine?
1. It can be detected via **chemical** examination
2. The presence of bilirubin is suspected if **yellow foam** appears when the specimen is **shaken**
86
What is the way to detect **protein** in urine? Explain
**Normal** urine contains a **small** amount of **rapidly disappearing** foam when **shaken**, however, if a **large** amount of **white foam** occurs, it indicates an **increased** concentration of **protein**
87
What is the indication if the urine contains **bilirubin**?
The urine specimen may also contain **hepatitis** virus
88
What is the resulting color of urine if **photo-oxidation** of large amounts of excreted **urobilinogen** to **urobilin** is present?
**Yellow-orange**
89
**True or False**
A **yellow-orange** urine is indicative of **photo-oxidation** of **urobilinogen** to **urobilin**. However, when the urine is **shaken**, a **yellow foam** does **not** appear
**True**
90
What is the resulting color of urine if **photo-oxidation** of **bilirubin** is present? Explain
**Yellow-green**
**Bilirubin** turns into **biliverdin** (via **photo-oxidation**) -> biliverdin is the cause of **yellow-green** urine
91
**Azo-gantrisin compounds** is used to what patient population?
Patients who have **UTIs**
92
What are the (2) effects of the **thick**, **orange** pigment caused by **phenazopyridine** and/or **azo-gantrisin compounds**?
1. **Obscures** the **natural** color of the specimen
2. **Interferes** w/ **chemical** tests that are based on **color** reactions
93
What are the (2) causes of **yellow foam** when urine is **shaken**? Explain
1. **Bilirubin**
2. **Phenazopyridine**
Presence of **yellow foam** caused by **phenazopyridine** can be **mistaken** as due to bilirubin
94
What is (1) of the **most** common causes of **abnormal** urine color?
**Blood**
95
What is the **usual** color that **blood** produces in urine?
**Red**
96
**True or False**
**Red** is the **usual** color that **blood** produces in urine, but the color may range from **pink** to **brown**
**True**
97
**Red** is the usual color that **blood** produces in urine, but the color may range from **pink** to **brown**, depending on what (3) components?
1. Amount of **blood**
2. **pH** of urine
3. **Length** of **contact**
98
What is the cause of **brown** urine? Explain
**RBCs** remaining in an **acidic** urine for several hours cause the urine to turn **brown** due to the **oxidation** of **hemoglobin** to **methemoglobin**
99
A **fresh** urine containing **blood** that is **brown** also may indicate what condition / dse?
**Glomerular bleeding**
100
What are the (4) causes of **red** urine?
1. **RBCs**
2. **Hemoglobin**
3. **Myoglobin**
4. **Porphyrins** (specifically, **port wine**)
101
**True or False**
Only **RBCs** produce a (**+**) chemical test result for **blood**
**False**, because **RBCs**, **myoglobin**, and **hemoglobin** produce a (**+**) chemical test result for **blood**
102
Explain the **differentiation** of **red** urine testing chemically (**+**) for **blood**
**Red** urine -> **clear** -> **hemoglobinuria** -> **red** plasma
**Red** urine -> **clear** -> **myoglobinuria** -> **clear** plasma
**Red** urine -> **cloudy** -> **RBCs** present (**hematuria**)
103
What is the **color** and **clarity** of urine if there is **hematuria**?
**Red** and **cloudy**
104
What is the **color** and **clarity** of urine if **hemoglobin** or **myoglobin** is present?
**Red** and **clear**
105
How to **distinguish** if there is **hemoglobinuria** or **myoglobinuria** in the urine?
Hemoglobinuria (**red** plasma) vs Myoglobinuria (**clear** plasma)
106
What is the cause of **hemoglobinuria**?
It results from the **in vivo** breakdown of **RBCs**
107
What is the cause of **myoglobinuria**?
Breakdown of **skeletal muscle**
108
Explain why patients with **hemoglobinuria** has **red** plasma and why patients with **myoglobinuria** has **clear** plasma
Hemoglobinuria (**in vivo breakdown** of **RBCs** -> **hemoglobinuria** -> **red** plasma) vs Myoglobinuria (**breakdown** of **skeletal muscle** -> **myoglobinuria** -> myoglobin is **cleared** more **rapidly** from the plasma -> hence, it does **not** affect the color of the plasma)
109
Between **myoglobin** and **hemoglobin**, what is more **rapidly** cleared from the **plasma**?
**Myoglobin**
110
**True or False**
**Fresh** urine containing **hemoglobin** frequently exhibits a more **reddish-brown** color than does urine containing **myoglobin**
**False**, **fresh** urine containing **myoglobin** frequently exhibits a more **reddish-brown** color than does urine containing **hemoglobin**
111
**True or False**
The possibility of **hemoglobinuria** being produced from **in vitro** lysis of **RBCs** also must be considered
**True**
112
What is the cause of presence of **porphyrins** in the urine?
**Oxidation** of **porphobilinogen** to **porphyrins**
113
What are the (3) **nonpathogenic** causes of **red** urine?
1. **Menstrual** contamination
2. Ingestion of **highly pigmented foods**
3. **Medications**
i. **Rifampin**
ii. **Phenolphthalein**
iii. **Phenindione**
iv. **Phenothiazines**
114
What are the effects of eating **fresh beets** for patients who are **genetically susceptible**?
**Red** color in **alkaline** urine
115
What are the effects of eating **blackberries**?
**Red** color in **acidic** urine
116
What is the difference between the effects of eating **fresh beets** vs **blackberries**?
Fresh beets (**red** color in **alkaline** urine) vs Blackberries (**red** color in **acidic** urine)
117
What should be done for urine specimens that turn **brown** or **black** on **standing** and have (**-**) chemical test results for **blood**?
**Additional** testing
118
Why should urine specimens (w/ [**-**] chemical tests for **blood**) that turn **brown** or **black** on **standing** applied w/ **additional** tests?
Because they may contain **melanin** or **homogentisic acid**
119
What is **melanogen**?
**Colorless** pigment
120
What is the **oxidation** product of **melanogen**?
**Melanin**
121
What is produced in **excess** in cases of **melanoma**?
**Melanin**
122
What is the **metabolite** of **phenylalanine**?
**Homogentisic acid**
123
What is the component that imparts a **black** color to **alkaline** urine from patients w/ **inborn error of metabolism** (**alkaptonuria**)?
**Homogentisic acid**
124
What are the (3) conditions / dses that can cause **brown** or **black** urine?
1. **Liver** disorders
2. **Kidney** disorders
3. **Muscle** injury (from extreme exercise)
125
What are the (3) **nonpathogenic** causes of **dark-brown** (**cola**-colored) urine?
Ingestion of **large** amounts of:
1. **Fava beans**
2. **Rhubarb**
3. **Aloe**
126
What are the (2) **pathogenic** causes of **blue/green** urine?
1. **Bacterial** infections
i. **UTI** by **Pseudomonas** spp.
2. **Intestinal** tract infections (resulting to **increased** urinary **indican**)
127
What are the (2) characteristics of **familial benign hypercalcemia**?
1. **Rare**
2. **Inherited**
128
**Familial benign hypercalcemia** is sometimes called as what?
**Blue diaper syndrome**
129
Why is **blue diaper syndrome** called as such?
Because **children** w/ this disorder will have **blue** urine
130
What are the (4) causes of **green** urine?
1. **Breath deodorizers** (**Clorets**)
2. Brightly colored **food dyes**
3. **B vitamins**
4. **Asparagus**
131
What are the (5) causes of **blue** urine?
1. **Medications**
i. **Methocarbamol** (**Robaxin**)
2. **Methylene blue**
3. **Indomethacin** (**Indocin**, **Tivorbex**)
4. **Amitriptyline** (**Elavil**)
5. **Propofol** (**Diprivan**)
132
What should be done if **abnormally** colored urine in **specimen collection bags** from **hospitalized** patients are frequently observed? Explain
This may signify a **pathologic** condition, hence, the urine of the patient is required to **stand** for a period of time before **color** development or the presence of **medications**
133
**Phenol derivatives** found in certain **IV** medications produce what color of urine?
**Green** (due to **oxidation**)
134
What are the (2) causes of **purple** staining in **catheter bags**?
1. **Indican**
2. **Bacterial** infection
i. **Klebsiella** spp.
ii. **Providencia** spp.
135
What is the general tern that refers to the **transparency** or **turbidity** of a urine specimen?
**Clarity**
136
How to examine the **clarity** of urine in **routine UA**?
**Visually** examine the **mixed** specimen (present in a **clear** container) while holding in **front** of a **light** source
137
**True or False**
**Color** is determined first, followed by **clarity**
**False**, **color** and **clarity** are routinely determined at the **same** time
138
What are the (5) **common** terminologies used to report **clarity**?
1. **Clear**
2. **Hazy**
3. **Cloudy**
4. **Turbid**
5. **Milky**
139
What is the corresponding **term** of the given clarity
Given clarity: **Clear**
**No** visible particulates, **transparent**
140
What is the corresponding **term** of the given clarity
Given clarity: **Hazy**
**Few** particulates, print **easily** seen through urine
141
What is the corresponding **term** of the given clarity
Given clarity: **Cloudy**
**Many** particulates, print **blurred** through urine
142
What is the corresponding **term** of the given clarity
Given clarity: **Turbid**
Print **cannot** be seen through urine
143
What is the corresponding **term** of the given clarity
Given clarity: **Milky**
May **precipitate** or be **clotted**
144
What are the corresponding **terms** of the following **clarities**?
1. **Clear**
2. **Hazy**
3. **Cloudy**
4. **Turbid**
5. **Milky**
1. **No** visible particulates, **transparent**
2. **Few** particulates, print **easily** seen through urine
3. **Many** particulates, print **blurred** through urine
4. Print **cannot** be seen through urine
5. May **precipitate** or be **clotted**
145
**True or False**
**Freshly** voided, **normal** urine is usually **clear**, particularly if it is a **clean-catch midstream** specimen
**True**
146
What are the (2) causes of **white cloudiness** in an **alkaline** urine?
**Precipitation** of:
1. Amorphous **phosphates**
2. Amorphous **carbonates**
147
What are the (2) causes of **hazy** (but **normal**) urine in **women**?
1. **Squamous epithelial cells**
2. **Mucus**
148
**True or False**
Specimens that are allowed to **stand** or that are **refrigerated** also may develop **turbidity** that is **pathological**
**False**, specimens that are allowed to **stand** or that are **refrigerated** also may develop **turbidity** that is **nonpathological**
149
What is the cause of **turbidity** for **improperly** preserved urine specimens? Explain
Because **improper** preservation results in **bacterial growth** -> **increasing** specimen **turbidity**
150
What are the (3) causes of **thick** turbidity on **refrigerated** urine specimens?
**Precipitation** of:
1. Amorphous **phosphates**
2. Amorphous **carbonates**
3. Amorphous **urates**
151
**Amorphous phosphates** and **amorphous carbonates** produce what in **alkaline** urine?
**White precipitate**
152
**Amorphous urates** produce what in **acidic** urine?
**Precipitate** that resembles **pink brick dust**
153
Why is precipitate that resembles **pink brick dust** present in **acidic** urine w/ **amorphous urates**?
Due to the presence of **uroerythrin**
154
What is the difference between **amorphous phosphates** and **amorphous carbonates** vs **amorphous urates** in terms of **precipitates** that they produce?
Amorphous phosphates and amorphous carbonates (**white** precipitate in **alkaline** urine) vs Amorphous urates (precipitate resembling **pink brick dust** in **acidic** urine)
155
Where are **amorphous phosphates** and **amorphous carbonates** present?
**Alkaline** urine
156
Where are **amorphous urates** present?
**Acidic** urine
157
What is the difference between **amorphous phosphate** and **amorphous carbonates** vs **amorphous urates** in terms of the **pH** of urine where they are present?
Amorphous phosphates and amorphous carbonates (**alkaline** urine) vs Amorphous urates (**acidic** urine)
158
What are the (8) **nonpathological** causes of urine **turbidity**?
1. **Squamous epithelial cells**
2. **Mucus**
3. Amorphous **phosphates**, **carbonates**, **urates**
4. **Semen**, **spermatozoa**
5. **Fecal** contamination
6. **Radiographic contrast media**
7. **Talcum** powder
8. **Vaginal** creams
9. Normal urine **crystals**
159
How are urine **color** and **clarity** examined (/ what are the steps)?
1. Evaluate an **adequate** volume of specimen
2. Use a **well-mixed** specimen
3. View the urine through a **clear** container
4. View the urine against a **white** background using **adequate** room lighting
5. Maintain **adequate** room lighting
6. Evaluate a **consistent** volume of urine
i. Determine the urine **color**
ii. Determine the urine **clarity**
160
What are the (3) **most** common **pathological** causes of **turbidity** in a **fresh** urine specimen?
1. **RBCs**
2. **WBCs**
3. **Bacteria**
i. Caused by **infection**
ii. Caused by **systemic organ disorder**
161
What are the (6) **less** frequent **pathological** causes of **turbidity** in urine?
**Abnormal** amounts of:
1. **Nonsquamous epithelial cells**
2. **Yeast**
3. **Trichomonads**
4. Abnormal **crystals**
5. **Lymph fluid**
6. **Lipids**
162
What are the (9) pathological causes of urine turbidity?
**Most** common:
1. **RBCs**
2. **WBCs**
3. **Bacteria**
i. Caused by **infection**
ii. Caused by **systemic organ disorder**
**Less** frequent:
**Abnormal** amounts of:
1. **Nonsquamous epithelial cells**
2. **Yeast**
3. **Trichomonads**
4. Abnormal **crystals**
5. **Lymph fluid**
6. **Lipids**
163
**True or False**
The **clarity** of a urine specimen certainly provides a **key** to the **microscopic** examination results because the amount of **turbidity** should **correspond** w/ the amount of **material** observed under the **microscope**
**True**
164
**True or False**
**Clear** urine is always **normal**
**False**, **clear** urine is **not** always **normal**
165
What is (1) of the **most** important functions of **kidney**? Explain
The kidney's ability to **concentrate** the **glomerular filtrate** by selectively **reabsorbing** essential **chemicals** and **water** from the **glomerular filtrate **
166
How is the urine **concentration** measured in routine UA?
By measuring the **specific gravity** (**SG**)
167
What is the **importance** of measuring the **SG** of urine?
To determine whether the **concentration** of the specimen is **adequate** to ensure the **accuracy** of **chemical** tests
168
What is the **SG** of the **plasma** filtrate entering the **glomerulus**?
**1.010**
169
What is the term used to describe a urine w/ a **SG** of **1.010**?
**Isosthenuric**
170
What is the term used to describe a urine w/ a **SG** of **< 1.010**?
**Hyposthenuric**
171
What is the term used to describe a urine w/ a **SG** of **> 1.010**?
**Hypersthenuric**
172
What is the range of **SG** of **normal random** specimens (depending on the patient's **hydration**)?
**~ 1.002 - 1.035**
173
What are specimens w/ a **SG** of **< 1.002**?
These are **not** probably urine
174
What is the range of **SG** of **most** **random** specimens?
**1.015 - 1.030**
175
What is the density of a **solution** compared w/ the density of a **similar** volume of **distilled water** at a **similar** temperature?
**SG**
176
What is the **SG** of **distilled water**?
**1.000**
177
**True or False**
Since **urine** is actually **water** that contains **dissolved chemicals**, the **SG** of urine is a measure of the **density** of the **dissolved chemicals** in the specimen
**True**
178
What is influenced by **number** and **size** of particles present in the urine?
**SG**
179
**True or False**
Since **SG** is influenced by **number** and **size** of particles in the urine, **large** molecules contribute **more** to the reading than do **small** molecules
**True**
180
Currently, what is the **only** method used in routine **UA** that requires **correcting**?
**Refractometer**
181
What are the (3) **current** methods of urine **SG** measurements?
1. **Refractometry**
2. **Osmolality**
3. **Reagent strip**
182
What is the **principle** of **refractometry** (in terms of measuring SG)?
**Refractive index**
183
What is the **principle** of **osmolality** (in terms of measuring SG)?
Changes in **colligative** properties by particle number
184
What is the **principle** of **reagent strip** (in terms of measuring SG)?
**pKa** changes of a **polyelectrolyte** by ions present
185
What determines the **concentration** of **dissolved** particles in a specimen by measuring **refractive index**?
**Refractometry**
186
What is the **comparison** of the velocity of **light** in the **air** w/ the velocity of **light** in a **solution**?
**Refractive index**
187
What is the mechanism of **refractometers**?
Clinical refractometers make use of these principles of light by using a **prism** to direct a specific (**monochromatic**) wavelength of daylight against a **manufacturer-calibrated scale** of SG. The **concentration** of the specimen determines the **angle** at which the **light** beam **enters** the prism. Therefore, the **SG scale** is **calibrated** in terms of the **angles** at which light **passes** through the specimen
188
What is the **advantage** of using **refractometry** in determining the **SG**?
It uses a **small** volume of specimen (**1 or 2 drops**)
189
Are temperature corrections necessary in refractometry? Why or why not?
**No**, because the **light** beam passes through a **temperature-compensating liquid** before being directed at the **SG scale**
190
In **refractometry**, temperature is **compensated** between what range?
Between **15 °C - 38 °C**
191
How are **corrections** for **GLU** and **protein** done when **refractometry** is used?
Subtract **0.003** for each gram of **protein** present and **0.004** for each gram of **GLU** present
The amount of **protein** or **GLU** present can be determined from the chemical **reagent strip** tests
192
How is **refractometer** used (/ what are the steps)?
1. Put **1** or **2** drops of sample on the prism
2. Close the **daylight plate** gently
3. The sample must be **spread** all over the **prism surface**
4. Look at the scale through the **eyepiece**
5. Read the scale where the **boundary line** intercepts it
6. **Wipe** the sample from the prism clean w/ a tissue paper and water
193
How to **calibrate** a **refractometer**?
Use **distilled water** -> reading should be **1.000**
If necessary, the instrument contains a **zero setscrew** to **adjust** the **reading** for distilled water
The calibration is further checked using either **5% NaCl** which should read **1.022 ± 0.001**, or **9% sucrose**, which should read **1.034 ± 0.001**
194
When should urine **control** specimens representing **low**, **medium**, and **high** concentrations be run?
At the **beginning** of each shift
195
What should be done **after** running the urine controls?
**Calibration** and **control** results are always **recorded** in the appropriate QC **records**
196
What is the SG of patients who have recently undergone an **IV pyelogram**?
Abnormally high (**> 1.040**)
197
What is the cause of **abnormally high** SG of patients who have recently undergone **IV pyelogram**?
It is due to the **excretion** of the injected **radiographic contrast media**
198
What is the SG of patients who are receiving **dextran** or other **high MW IV fluds** (**plasma expanders**)?
Abnormally **high** SG
199
When will the SG of patients who are receiving **dextran** or other **high MW fluids** (**plasma expanders**) return to normal?
Once the foreign substance has been **cleared** from the body
200
What are the (2) ways to measure the **urine concentration** of patients who are receiving **dextran** or other **high MW fluids** (**plasma expanders**)? Why can these be used to measure the urine concentration?
1. **Reagent strip** chemical test
2. **Osmometry**
Because these are **not** affected by the high MW substances
201
What are the (2) conditions / dses of patients that manifests abnormally **high** urine **SG**?
Patients who:
1. Have recently undergone **IV pyelogram**
2. Are receiving **dextran** or other **high MW fluids** (**plasma expanders**)
202
What is the difference between **SG** vs **osmolality**?
SG (depends on the **number** of particles present in a solution and the **density** of these particles) vs Osmolality (affected only by the **number** of particles present)
SG (**number** and **density**) vs Osmolality (**number**)
203
What is defined as **1 g** MW of a substance divided by the **number** of particles into which it dissociates?
**Osmole**
204
How to determine the **osmolarity** of a solution?
By **measuring** a property that is mathematically related to the number of **particles** in the solution (**colligative property**) and comparing this value w/ the value obtained from the **pure solvent**
205
What are the (4) colligative properties?
"(2) **points** + (2) **pressure**" | "**FP**, **BP**, **VP**, **OP**"
1. Freezing point
2. Boiling point
3. Vapor pressure
4. Osmotic pressure
206
Solute **dissolved** in solvent causes the following what (4) changes in colligative properties?
1. **Lower freezing point**
2. **Higher boiling point**
3. **Increased osmotic pressure**
4. **Lower vapor pressure**
207
What is the **normal pure water point** of the given colligative property?
Given colligative property: **Freezing point**
**0 °C**
208
What is the **normal pure water point** of the given colligative property?
Given colligative property: **Boiling point**
**100 °C**
209
What is the **normal pure water point** of the given colligative property?
Given colligative property: **Vapor pressure**
**2.38 mmHg at 25 °C**
210
What is the **normal pure water point** of the given colligative property?
Given colligative property: **Osmotic pressure**
**0 mmHg**
211
What is the **effect of 1 mole of solute** to the given colligative property?
Given colligative property: **Freezing point**
**Lowered 1.86 °C**
212
What is the **effect of 1 mole of solute** to the given colligative property?
Given colligative property: **Boiling point**
**Raised 0.52 °C**
213
What is the **effect of 1 mole of solute** to the given colligative property?
Given colligative property: **Vapor pressure**
**Lowered 0.3 mmHg at 25 °C**
214
What is the **effect of 1 mole of solute** to the given colligative property?
Given colligative property: **Osmotic pressure**
**Increased 1.7 X 10^9 mmHg**
215
What is the **solvent** in **urine**?
**Water**
216
Since **water** is the **solvent** in urine, how to determine the **number** of particles **present** in a sample?
It can be determined by **comparing** a **colligative property** value of the sample w/ that of **pure water**
217
What is the **instrument** used to measure **osmolality**?
**Osmometer**
218
How does the **A2O Advanced Automated Osmometer** measure **osmolality**?
**Freezing-point depression**, providing a more **automated** method for measuring both **urine** and **serum osmolality**
219
What term is used most commonly because both the **solute** and the **solvent** are expressed in the same units of measure?
**Molality**
220
What is the principle of **reagent strip** for **SG**?
Change in **pKa** (dissociation constant) of a **polyelectrolyte** in an **alkaline** medium. The polyelectrolyte ionizes, releasing **hydrogen ions** in proportion to the number of **ions** in the solution. The **higher** the **concentration** of urine, the **more hydrogen ions** are released, thereby **lowering** the **pH**. Incorporation of the indicator **bromthymol blue** on the **reagent pad** measures the change in **pH**. As the SG **increases**, the indicator changes from **blue** (**1.000** [**alkaline**]), through shades of **green**, to **yellow** (**1.030** [**acid**])
221
Readings of **SG** is made in what **intervals** by careful comparison w/ the **color chart**?
**0.005**
222
**True or False**
Urine **odor** is a **noticeable** physical property
**True**
223
What is the **odor** of a **freshly** voided urine?
**Faint aromatic odor**
224
What happens to the **odor** of the urine as the specimen **stands**? Explain why this happens in the odor of the specimen
The odor of **ammonia** becomes more **prominent**
The **breakdown** of **urea** is the cause of the **ammonia** odor
Breakdown of **urea** -> **ammonia** odor
225
What is the **odor** of urine if caused by **bacterial** infections?
**Strong**, **unpleasant** odor similar to **ammonia**
226
What is the **odor** of urine if caused by **diabetic ketones**?
**Sweet** or **fruity**
227
What is the **odor** of urine if caused by **maple syrup urine disease (MSUD)**?
Strong odor of **maple syrup**
228
What is the **odor** of urine if caused by ingestion of certain foods such as **onions**, **garlic**, and **asparagus**?
**Unusual** or **pungent**
229
Who are the people that can **smell** the **odor** of urine if caused by ingestion of **asparagus**?
Those who are **genetically predisposed**
230
What are the (9) **odors** of urine and their corresponding possible common **causes**?
1. **Aromatic** = **Normal**
2. **Foul**, **ammonia-like** = **bacterial decomposition**, **UTI**
3. **Fruity**, **sweet** = **ketones** (**DM**, **starvation**, **vomiting**)
4. **Maple syrup** = **MSUD**
5. **Mousy** = **phenylketonuria** (**PKU**)
6. **Rancid** = **tyrosinemia**
7. **Sweaty feet** = **isovaleric acidemia**
8. **Cabbage** = **methionine malabsorption**
9. **Bleach** = **contamination**
