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Urinalysis and Body Fluids 4214 > Urinalysis LAB - Exam 1 > Flashcards

Urinalysis LAB - Exam 1 Flashcards

1
Q

What are the terms that could be used to describe the color of urine specimens in our lab?

A

-Straw or Colorless (str)
-Yellow (yel)
-Dark Yellow (dk. yel)
-Amber or Orange
-Red or Pink
-Brown
-Green or Blue/green

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2
Q

What are the terms that could be used to describe clarity in our lab?

A

-clear (clr)
-cloudy (cldy)
-turbid
-bloody

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3
Q

What should not be reported on in the “other clinically signif. items?

A

contaminants, such as starch granules, hair, and fibers

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4
Q

What color is associated with the presence of Bilirubin?

A

Yellow orange color

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5
Q

What color is associated with the presence of Biliverdin?

A

Green

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6
Q

What color is associated with the presence of hemoglobin?

A

Amber to red color

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7
Q

What are two reasons that could cause cloudiness in a urine specimen that is not fresh?

A

-bacteria
-leukocytes

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8
Q

Define specific gravity of urine.

A

Ratio of one substance to a standard substance of the same volume. For urine, this would be the weight of a given urine volume to the same volume of water.

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9
Q

What is the urinary odor associated with Diabetes mellitus?

A

Fruity

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10
Q

What is the urinary odor associated with maple syrup disease?

A

maple syrup

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11
Q

What is the urinary odor associated with ingestion of asparagus, garlic, or onions?

A

mercapton

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12
Q

What is the urinary odor associated with disinfectants used to clean bedpans?

A

?

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13
Q

Define the refractive index of a solution.

A

measures dissolved solids and the specific gravity of urine or serum.

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14
Q

__________ is the pigment that gives urine it’s characteristic color.

A

urochrome

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15
Q

_________ and __________ also contribute some color to urine.
Some foods and medications can contribute to urine color as well as disease states.
Color varies with urine concentration.

A

urobilin, uroerythrin

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16
Q

Normal urine is clear.
It may become cloudy due to the precipitation of…

A

amorphous crystals
-amorphous phosphates =
white crystals
-amorphous urates = pink
precipitate

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17
Q

What can give urine a hazy appearance?

A

mucus

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18
Q

Cloudy urine may contain…

Smoky or turbid urine may contain…

A

leukocytes, bacteria or epithelial cells.

RBCs

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19
Q

Milky urine contain _____ or _____.

A

fat, chyle

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20
Q

Foam can be caused by significant amounts of ________.

A

protein

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21
Q

The ratio of the weight of urine to the weight of the same volume of distilled water at a constant temperature.

A

Specific gravity

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22
Q

This is used to measure the concentrating and diluting ability of the kidney.

A

Specific gravity

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23
Q

____________ ability is one of the first functions to be lost as a result of tubular damage.

A

concentrating

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24
Q

What is the normal specific gravity range for urine?

A

1.003-1.035

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25
Q

-true measure of specific gravity
-no longer recommended for clinical measurements
-requires temperature correction

A

Urinometer

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26
Q

-ratio is the velocity of light in air to the velocity of light in solution, using a Total Solids (TS) Meter.
-The path of light is deviated when it enters a solution, and the degree of deviation or refraction is proportional to the density of the solution.

A

Refractive index

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27
Q

The refractive index varies with…

A

temperature

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28
Q

The TS meter is temperature-compensated for temperatures between ____ F and ___F and, therefore, requires no corrections in that range.

A

60-100

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29
Q

Know the reagents for each test on the urine test strips!

A

!

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30
Q

What actually measures ionic concentration?
measures pKa change of polyelectrolytes in relation to ionic concentrations

A

Specific gravity reagent strips (pKa)

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31
Q

Specific gravity reagent strips (pKa):

When urine has an increased specific gravity, the reagent pad becomes more ________.

A

acidic

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32
Q

Urine dipstick:

what is read at 30 seconds?

A

Glucose- 1st
bilirubin-2nd

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33
Q

Urine dipstick:

What is read at 40 seconds?

A

Ketone

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34
Q

Urine dipstick:

What is read at 45 seconds?

A

Specific gravity

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35
Q

Urine dipstick:

What is read at 60 seconds?

A

blood-1st
pH
protein
urobilinogen
nitrite-last

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36
Q

Urine dipstick:

What is read at 2 minutes?

A

leukocytes

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37
Q

Color intensity usually correlates with…

A

specific gravity

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38
Q

The pigmentation urochrome is excreted in _______ amounts

A

constant. Regardless of diet.

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39
Q

What substances can cause abnormal urinary pigments?

A

hemoglobin, myoglobin, bile, porphyrins, melanogens, and homogenistic acid.

also many drugs and food pigments.

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40
Q

What information does urine odor provide in diagnosis?

A

It can be used to help suggest a particular syndrome, but should never be used as the only criteria in diagnosing an illness.

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41
Q

How does the odor of urine change after standing for some time?

A

sharp ammonia pungency is formed by bacterial activity

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42
Q

What is an ammoniacal odor associated with?

A

cystitis or pyelitis, usually with obstruction in the urinary tract.

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43
Q

Maple syrup odor is associated with…

A

inherited disorder of metabolism of infants

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44
Q

The amount of turbidity present should correlate with the number of….

A

microscopic elements formed

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45
Q

What can cause small cloudy patches in normal urine?

A

mucus from the urinary and genital tracts

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46
Q

Urates cause a _______ or ________ cloud in acid urine.

leukocytes may form a _______ cloud.

Bacteria will cause a uniform _________.

A

white or pink

white

opalescence

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47
Q

What can cause a smokiness in urine?

A

Red blood cells

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48
Q

What can cause a fluffy, bulky deposit in a urine sample?

A

mucin from the urinary passage in the case of increased inflammatory states of the lower urinary or genital tracts.

49
Q

White and red blood cells, and epithelial cells present in sufficient numbers will cause __________.

A

cloudiness

50
Q

How does pus appear in alkaline urine? in acidic urine?

A

alkaline: mucoid
acidic: crumbly

51
Q

About ______ WBC/mm^2 and about ______RBC/mm^2 will produce turbidity.

A

200, 500

52
Q

What should be done if there is any cloudiness in a urine sample?

A

it should be examined microscopically to identify the elements responsible for the nebulous appearance.

53
Q

What is the specific gravity of water?

A

1.0 g/ml

54
Q

When measuring specific gravity, When should you repeat the procedure by diluting the sample with an equal volume of DI water and multiply the numbers after the decimal point?

A

When the value falls within the range of 1.025-1.030

55
Q

What conditions can cause the specific gravity to be high?

A

-fever
-diabetes mellitus
-acute nephritis

56
Q

What conditions can the specific gravity to be low?

A

-chronic nephritis
-diabetes insipidus

57
Q

Specific gravity varies inversely with….
and directly with…

A

the amount of volume

the amount of salt, urea, and protein

58
Q

specific gravity ranges:

24-hour collection-
a normal random-
normally acidic urine-

A

24-hour collection- 1.015-1.025
a normal random- 1.003-1.030
normally acidic urine- 1.010 or higher

59
Q

A low fixed urine specific gravity of 1.008-1.012 is indicative of…

A

chronic glomerulonephritis

60
Q

A specific gravity of less than _________ is significant.

A

1.003

61
Q

What may occur if a patient had a recent X-ray study such as IVP?

A

specific gravity of 1.050 with normal color

62
Q

unlike the gravimetric or refractometer methods, SG measured with the chemical reagent strip method does not need to be corrected for __________ or ___________.

A

glucose, protein

-cloudy, turbid urine does not need to be clarified before measuring

63
Q

What is the recommended method for determining SG if a urine specimen contains x-ray contrast media or plasma expanders?

A

the reagent strip method

64
Q

_________ urine can affect the indicator system and lower the SG results on the reagent pad.

A

alkaline

-it is recommended that .005 be added to the SG result when the pH is alkaline. (automatic trip readers will adjust automatically for pH)

65
Q

__________ strength is closely related to specific gravity.

A

ionic

66
Q

The pH pad on the reagent strip contains what indicator dyes?

A

methyl red and bromothymol blue

67
Q

__________protein and ___________are examples of globulin components that are sometimes present in urine, but are not distinguishable by the chemical reagent strip method for urine protein.

A

Bence Jones protein and mucoprotein

68
Q

is based on the phenomenon called the blank (ability of protein to alter the color of some acid-base indicators without altering the pH)

A

“Protein Error of Indicators”

69
Q

What is the confirmatory test for urine protein?

A

sulfosalicylic acid (SSA) precipitation test

70
Q

The presence of an increased amount of ________ in a urine specimen is often the first indicator of renal disease.

A

protein

71
Q

The amount of protein present in urine samples from patients with glomerular damage usually ranges from _________ mg/dL. If the urinary protein is due to a disorder that affects tubular reabsorption, the urine protein quantities will be much greater.

A

1-40

72
Q

What are the two reactions that occur for glucose detection on reagent pad strips?

A

-glucose oxidase catalyzes the oxidation of glucose to gluconic acid and hydrogen peroxide

-Then, the peroxidase in the glucose pad catalyzes the oxidation of a chromogen by the hydrogen peroxide to form a colored product.

73
Q

Reagent pad strip testing:

What temp. must glucose be analysed at?

Does glucose react with any other reducing substances? (lactose, fructose)

A

room temp

no

74
Q

A specific gravity higher than ______ may lower glucose reagent sensitivity, especially in the presence of a high (alkaline) urine pH.

A

1.020

75
Q

The test for ketone bodies is based on a nitroprusside reaction. ___________ acid reacts with ________________ and glycine in an alkaline medium to produce a violet-to-purple colored complex.

A

Acetoacetic, sodium nitroferricyanide

76
Q

What can cause false-positive ketone reagent strip results?

A

-captopril (an antihypertensive drug)
-D-penicillamine (an antibiotic)
-Highly pigmented urine

77
Q

What can cause false-negative ketone reagent strip results?

A

-prolonged storage at room temp (over 2 hours)

78
Q

In diabetes mellitus patients, the presence of ketones in the urine (ketonuria) indicates that what should be done?

A

insulin dose needs to be increased

79
Q

The term ___________ is used to describe the presence of intact red blood cells in the urine.

A

hematuria

80
Q

Term used when RBCs have been destroyed, causing hemoglobin will be present in the urine

A

hemoglobinuria

81
Q

The presence of only _____ RBCs per microliter of urine is considered to be clinically significant. For this reason, a chemical test is needed to detect quantities of blood too small to change the color of the urine.

A

five

82
Q

What is used to differentiate between hematuria and hemoglobinuria when the chemical reagent strip is positive for blood?

A

Microscopic examination

83
Q

What is the reagent test strip for blood based on?

A

he peroxidase-like activity of hemoglobin, which catalyzes the reaction of cumene hydroperoxide and 3, 3’, 5, 5’ tetramethylbenzidine.

84
Q

What all is the reagent test strip for blood sensitive to?

A

free hemoglobin, myoglobin, and a minimum of 5 intact RBCs per microliter of urine.

85
Q

What can cause a false positive for blood on the urine reagent strip?

A

-oxidizing agents, like bleach
- contaminated with povidone-iodine
-Microbial peroxide (from UTIs)
-myoglobin (ex: muscle wasting disease, trauma, coma)

86
Q

What can cause a falsely-decreased test result for blood on reagent strip?

A

Captopril

87
Q

What can cause a false negative for blood on reagent test strip?

A

not mixing urine specimen

88
Q

Hemoglobinuria may be associated with:

A

-Hemolytic anemia
-Severe burns
-Transfusion reaction
-Infection
-Strenuous exercise

89
Q

The nitrite test on the urine reagent strip detects the presence of…

A

nitrate-reducing bacteria (ie, gram-negative bacteria). Bladder infections are usually caused by gram-negative bacteria. These bacteria reduce nitrate to nitrite when urine remains in the bladder at least three hours.

90
Q

Is nitrite present in urine in normal circumstances?

A

no

91
Q

When present, nitrite react with __________________ in the reagent pad to produce a diazonium compound.

A

p-arsanilic acid

92
Q

In nitrate detection on the reagent strip, is the color development proportional to the number of bacteria present?

A

NO

93
Q

What other substances can nitrate react with in urine?

A

nitrite does not react with any other substances normally found in urine

94
Q

Dose a negative nitrite test rule out bacterial UTI?

A

no. UTIs can be cause by bacteria that do not reduce nitrate.

95
Q

What can cause false-positve nitrite results?

A

-prolonged room temp storage
-medications that cause urine to become red or orange (from incorrect reading)

96
Q

What can cause false-negative result? For nitrite

A

-urine not remaining in the bladder long enough for bacteria to reduce nitrate
-severe bacterial infection that causes the bacteria to further reduce nitrite to nitrogen

97
Q

What is the basis of the leukocyte test on the reagent strip?

A

-detection of esterase (granulocytic white blood cells (ie, neutrophils, basophils and eosinophils) contain) contain this)
-esterase from leukocytes react with indoxy ester derivative and diazonium salt

98
Q

Is the intensity of the purple color produced on the leukocyte test proportional to the amount of leukocyte esterase present?

A

yes

99
Q

What is the granulocyte most often detected in urine? What does it indicate?

A

probable urinary tract infection

100
Q

_______________ do not contain leukocyte esterase and would not produce a positive leukocytes test on the reagent strip.

A

Lymphocytes

101
Q

What should be done if leukocytes are positive on the reagent test strip?

A

confirm by performing a microscopic examination of the sediment

102
Q

What could be a cause of a false-positive or falsely elevated leukocyte result?

A

vaginal contamination of the urine specimen or a highly-colored specimen.

103
Q

What can cause falsely decreased results for leukocytes?

A

-presence of significantly elevated protein, glucose, or specific gravity (significantly elevated specific gravity can crenate the white blood cells, leaving them unable to release esterases).
-The drugs cephalexin and gentamicin

104
Q

A positive leukocytes test is often accompanied by a positive __________ test. Together, they confirm the presence of a bacterial urinary tract infection.

A

nitrite

105
Q

The presence of bilirubin in urine in detectable amounts is always…

A

abnormal

Even a slight change in color should be considered significant since bilirubin is never present in normal urine.

106
Q

Bilirubin, a product of ____________ catabolism, is characterized by its distinctive yellow pigment

A

hemoglobin

107
Q

Only ____________ bilirubin is excreted in urine.

A

conjugated

If bilirubin is elevated and is conjugated, it will be detected by the urine reagent strip.

108
Q

The test for bilirubin on the urine chemical reagent strip is based on the formation of an azobilirubin compound resulting from a reaction of bilirubin in an acid medium with _______________.

A

diazotized 2, 4 dichloroaniline

109
Q

Since other pigments in the urine may influence the test results, this test is more difficult to interpret than other urine reagent strip tests

A

Bilirubin

110
Q

What can cause bilirubin false-positive results?

A

-large doses of chlorpromazine
-presence of metabolites of phenazopyridine
-Metabolites of etodolac

111
Q

What can cause false negative bilirubin results?

A

-specimen that is not fresh
-Indoxyl sulfate (indican)
-positive nitrites

112
Q

The ________ is used by some laboratories to rule out a false-positive bilirubin dipstick result that is caused by urine color interference.

A

Ictotest®

113
Q

Bilirubin:

The Ictotest® employs the same _________ reaction as the reagent strip, but should not give a false-positive result with colored urines.

A

diazotization

114
Q

Why will bilirubin not show on a urine test if jaundice is due to red cell destruction?

A

it causes unconjugated bilirubin, which the kidneys cannot excrete.

115
Q

a byproduct of hemoglobin breakdown. It is produced in the intestinal tract as a result of the action of bacteria on bilirubin.

A

Urobilinogen

As the urobilinogen circulates in the blood to the liver, a portion of it is diverted to the kidneys and appears as urinary urobilinogen.

116
Q

Which test is it impossible to get a negative result?

A

urobilinogen test cannot determine absences of urobilinogen

117
Q

How does the test for urobilinogen work chemically?

A

based on the Ehrlich Aldehyde Reaction. P-dimethylaminobenzaldehyde in an acid medium with a color enhancer reacts with urobilinogen to form a pink-red color.

118
Q

What can cause false positive urobilinogen test?

A

-porphobilinogen*
-sulfonamides
-p-aminosalicylic acid
-dugs that contain azo dyes

119
Q

What can cause false-neative urobilinogen test?

A

-sample that remains at room temp for too long
-too much light exposure
-presence of formalin

Urinalysis and Body Fluids 4214 (14 decks)

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