1. URINE AND HISTORY - LEC Flashcards
1
Q
References to the study of urine can be found in the drawings of cavemen and in Egyptian hieroglyphics, such as the
A
Edwin Smith Surgical Papyrus
2
Q
Although physicians from ancient Egypt
lacked the sophisticated testing mechanisms now available, they were able to obtain diagnostic information from such basic observations such as
A
color, turbidity, odor, volume, viscosity,
and even sweetness
3
Q
When did testing for glucose progress from ant testing and taste testing due to Frederik Dekkers’ discovery
A
1694
4
Q
Who discovered albuminuria by boiling urine?
A
Frederik Dekkers
5
Q
The credibility of urinalysis became compromised when __________ without medical credentials began offering their predictions to the public for a healthy fee
they are also known as ________
A
charlatans
pisse prophets
6
Q
The revelations in this book inspired
the passing of the first medical licensure laws in England
A
Pisse Prophets by Thomas Bryant in 1627
7
Q
introduced the concept of urinalysis
as part of a doctor’s routine patient examination in 1827
A
Richard Bright
8
Q
The invention of the microscope in the 17th century led to the examination of urinary sediment and to the development of methods for quantitating the microscopic sediment is led by
A
Thomas Addis
9
Q
Two unique characteristics of a urine specimen account why it is still considered for routine analysis
A
- A urine specimen is readily available and easily collected.
- Urine contains information, which can be obtained by inexpensive laboratory tests, about many of the body’s major metabolic functions
10
Q
The reasons for performing urinalysis identified by CLSI include
A
aiding in the diagnosis of disease
screening asymptomatic populations for undetected disorders,
monitoring the progress of disease and the effectiveness of therapy
11
Q
Reabsorption of water and filtered substances essential to body function converts approximately____________ of filtered plasma to the average daily urine output of _________,
depending on fluid intake
A
170,000 mL
1200 mL
12
Q
Urine is normally 95% water and 5% solutes, although considerable variations in the
concentrations of these solutes can occur due to the influence of factors such as
A
dietary intake
physical activity
body metabolism
endocrine functions
13
Q
a metabolic waste product produced in the liver from the breakdown of protein and amino acids, accounts for nearly half of the total dissolved solids in urine
A
Urea
14
Q
Other organic substances found in urine include primarily
A
creatinine and uric acid
15
Q
The major inorganic solid dissolved in urine is
A
chloride
followed by:
sodium and potassium
16
Q
Why is it difficult to establish normal levels for inorganic compounds in urine
A
Dietary intake greatly influences the concentration of inorganic compounds in urine
17
Q
Other substances found in urine besides organic and inorganic compounds include
A
hormones, vitamins, and medications
18
Q
Although not a part of the original plasma filtrate, the urine also may contain
formed elements, such as
A
cells
casts
crystals
mucus
bacteria
19
Q
Sometimes it is necessary to determine whether a fluid is urine. The best way to do so is
A
is to consider the components
of the specimen.
Creatinine, urea, sodium, and chloride are
significantly higher in urine
20
Q
A
21
Q
Urine volume depends on the
A
amount of water that the kidneys
excrete
22
Q
Factors that influence urine volume include
A
fluid intake
fluid loss from nonrenal sources
variations in the secretion of (ADH)
need to excrete increased amounts of dissolved solids, such as glucose or salts
23
Q
a decrease in urine output
A
Oliguria
24
Q
Range of clinical oliguria
A
less than 1 mL/kg/hr in infants
less than 0.5 mL/kg/hr in children,
less than 400 mL/day in adults
25
is seen commonly when the body enters a state of dehydration as a result of excessive water loss from vomiting, diarrhea, perspiration, or severe burns.
Oliguria
26
cessation of urine flow
may result from any serious damage to the kidneys or from a decrease in the flow of blood to the kidneys
anuria
27
An increase in the nocturnal excretion of urine is termed
nocturia
28
The kidneys excrete two to three times more urine during when?
day compared to night
29
an increase in daily urine volume
Polyuria
30
Range of clinical polyuria
greater than 2.5 L/day in adults
greater than 2.5 to 3 mL/kg/day in children
31
Polyuria is often associated with
diabetes mellitus and diabetes insipidus
32
Polyuria may be induced artificially by
diuretics, caffeine, or alcohol
33
Primary organic component. Product of
metabolism of protein and amino acids
Urea
34
Product of metabolism of creatine by
muscles
Creatinine
35
Product of breakdown of nucleic acid in
food and cells
Uric acid
36
Primary inorganic component in urine . Found in combination with sodium (table salt)
and many other inorganic substances
Chloride
37
Primarily from salt, varies by intake
Sodium
38
Combined with chloride and other salts
Potassium
39
Combines with sodium to buffer the
blood
Phosphate
40
Regulates blood and tissue fluid acidity
Ammonium
41
Combines with chloride, sulfate, and
phosphate
Calcium
42
Although appearing to be dilute, a urine specimen from a patient with diabetes mellitus has a ___________________
because of the increased glucose content.
high specific gravity
43
is the medical definition of excessive thirst
increased ingestion of water
Polydipsia
44
Main difference between Diabetes mellitus and insipidus
Mellitus - Increased SG, Decreased production or function of insulin
Insipidus - Decreased SG, Decreased production or function of ADH
45
Main increased component in urine when person has diabetes mellitus
Glucose
46
Main deficiency when patient has Diabetes insipidus
ADH
47
Main deficiency when patient has Diabetes mellitus
Insulin
48
urine is a biohazardous substance
whose handling requires the observance of
Standard Precautions
49
Urine Specimens must be collected in
clean, dry, leakproof containers
50
Containers for routine urinalysis should have a wide mouth because?
to facilitate collections from female patients
51
Containers for routine urinalysis should have a wide flat bottom because?
to prevent overturning
52
Specimen containers should be made of clear material because?
to allow for determination of color and clarity
53
The recommended capacity of a urine specimen container is
50 mL
54
50 mL specimen containers for routine urinalysis is recommended because?
to allow 12 mL of specimen needed for microscopic analysis
additional specimen for repeat analysis
enough room for the specimen to be mixed by swirling the container
55
Recommended containers for urine microbiological studies
Individually packaged sterile containers with secure closures
56
Containers suggested if more than 2 hours elapse between specimen collection and analysis
Sterile containers
57
is a nonsterile, plastic holder device that contains a needle with a straw attachment that can be used with the collection container to fill evacuation tubes.
BD Vacutainer Urine Transfer Straw
58
automated reagent strip testing
59
All specimens must be labeled immediately after collection with
patient’s last and first name
identification number
the date and time of collection
additional information such as the
patient’s age and location
health-care provider’s name
preservative used, if any
60
Where should labels be attached?
container, not the lid
61
must accompany specimens delivered to the laboratory
requisition form
62
Additional information on the form can include
method of collection or type of specimen
possible interfering medications
patient’s clinical information
63
a must be recorded on the requisition form.
Time specimen is received in the laboratory
64
The laboratory should reject specimens that are
improperly labeled and/or collected
65
Situations leading to specimens that should be rejected can include:
1. Specimens in containers that are unlabeled or improperly labeled
2. Labels and requisition forms that do not match
3. Specimens contaminated with feces or toilet paper
4. Containers with contaminated exteriors
5. Specimens of insufficient quantity
6. Specimens that have been transported improperly
7. Specimens that have not been preserved correctly during a time delay
8. Specimens for urine culture collected in a nonsterile container
9. Inappropriate collection for the type of testing needed (for example, midstream clean-catch specimen for bacterial culture)
66
After collection, specimens should be delivered to the laboratory promptly and tested within
2 hours
67
A specimen that cannot be delivered and tested within 2 hours should be
refrigerated or have an appropriate chemical preservative added
68
changes in unpreserved urine in terms of
Color
Modified/darkened
Oxidation or reduction of metabolites
69
changes in unpreserved urine in terms of
Clarity
Decreased
Bacterial growth and precipitation of amorphous material
70
changes in unpreserved urine in terms of
Odor
Increased ammonia smell
Bacterial multiplication causing breakdown of urea to ammonia
71
changes in unpreserved urine in terms of
pH
Increased
Breakdown of urea to ammonia by urease-producing bacteria/loss of CO2
72
changes in unpreserved urine in terms of
Glucose
Decreased
Glycolysis and bacterial use
73
changes in unpreserved urine in terms of
Ketones
Decreased
Volatilization and bacterial metabolism
74
changes in unpreserved urine in terms of
Bilirubin
Decreased
Exposure to light/photo oxidation to biliverdin
75
changes in unpreserved urine in terms of
Urobilinogen
Decreased
Oxidation to urobilin
76
changes in unpreserved urine in terms of
Nitrite
Increased
Multiplication of nitrate-reducing bacteria
77
changes in unpreserved urine in terms of
Red and white blood cells and casts
Decreased
Disintegration/lyse in dilute alkaline urine
78
changes in unpreserved urine in terms of
Bacteria
Increased
Multiplication
79
changes in unpreserved urine in terms of
Trichomonas
Decreased
Loss of motility, death
80
The method of preservation used most routinely is _____________ which decreases bacterial growth and metabolism
refrigeration at 2°C to 8°C
81
If the urine is to be cultured, it should be (preservation)
refrigerated during transit and kept refrigerated until cultured, up to 24 hours
82
Refrigerated samples should return to room temperature when
before chemical testing by reagent strips
83
Refrigeration of urine samples also can cause
precipitation of amorphous urate and phosphate crystals
84
What should be done when a specimen must be transported over a long distance and refrigeration is impossible
chemical preservatives may be added
85
Commercially prepared transport tubes with a ___________ are available that allow for the transport, testing, and storage of the urine specimens
lyophilized preservative
86
The ideal preservative for urine should be
bactericidal, inhibit urease, and preserve formed elements in the sediment
should not interfere with chemical tests
87
To obtain a specimen that is representative of a patient’s metabolic state, regulation of certain aspects of specimen collection is often necessary. These special conditions may include
time
length
method of collection
patient’s dietary and medicinal intake
88
This is the specimen received most commonly because of its ease of collection and convenience for the patient.
Random Specimen
89
useful for routine screening tests to detect obvious abnormalities. However, it also may show erroneous results resulting from dietary intake or physical activity just before collection. Then the patient will be requested to collect an additional specimen under more controlled conditions.
Random Specimen
90
is the ideal screening specimen
First Morning Specimen
91
Specimens must be returned to room temperature before chemical testing by reagent strips because
the enzyme reactions on the strips perform best at room temperature.
92
First Morning Specimen is also essential for preventing _____________ and evaluating _____________
false-negative pregnancy tests
orthostatic proteinuria
93
Why is First morning specimen essential?
it is a concentrated specimen thereby assuring detection of chemicals and formed elements
94
Measuring the exact amount of a urine chemical is often necessary instead of just reporting its presence or absence. A carefully _____________ must be used to produce accurate quantitative results
timed specimen
also known as 24 hour specimen
95
Many solutes exhibit diurnal variations such as
catecholamines
17-hydroxysteroids
electrolytes
96
When the concentration of the substance to be measured changes with diurnal variations and with daily activities, such as exercise, meals, and body metabolism, collection of this specimen is required
24 hour
97
To obtain an accurate timed specimen, the patient must begin and end the collection period with
an empty bladder.
98
The concentration of a substance in a particular period must be calculated from the
urine volume produced during that time.
99
On its arrival in the laboratory, a 24-hour specimen must be
mixed thoroughly and the volume accurately measured and recorded
100
For 24 hour urine, adding urine formed before the start of the collection period will
and failure to include the urine produced at the end of the collection period will
falsely elevate the results
falsely decrease the results
101
This specimen is collected under sterile conditions by passing a hollow tube (catheter) through the urethra into the bladder.
Urine passes from the bladder through the catheter into a plastic bag, where it accumulates. Urine specimens then can be collected from this urine bag
Catheterized Specimen
102
The test requested most commonly on a catheterized specimen is a
bacterial culture
103
As an alternative to the catheterized specimen, the _____________ provides a safer, less traumatic method for obtaining urine for bacterial culture and routine urinalysis
midstream clean-catch specimen
104
It provides a specimen that is less contaminated by epithelial cells and bacteria and therefore is more representative of the actual urine than the routinely voided specimen
Midstream Clean-Catch Specimen
105
Strong bacterial agents, such as
_______________, should not be used as cleansing agents for mid stream clean catch specimen
hexachlorophene or povidone-iodine
106
provides a specimen for bacterial culture that is completely free of extraneous contamination, particularly in infants or children
suprapubic aspiration
107
urine may be collected by external introduction of a needle through the abdomen into the bladder, a process called
suprapubic aspiration
108
Suprapubic aspiration specimen can also be used for
cytological examination
109
Several methods are available to detect the presence of prostatitis.
Three-Glass Collection
Pre- and Postmassage Test
Stamey-Meares Test for Prostatitis
110
What procedure is used to cleanse the area before a Three-Glass Collection?
The male midstream clean-catch procedure.
111
What is collected in the first container during the Three-Glass Collection?
The first urine passed
112
What is collected in the second container during the Three-Glass Collection?
midstream portion of the urine
113
How is the third specimen in the Three-Glass Collection obtained?
After a prostate massage to release prostate fluid, the remaining urine is collected in a third sterile container.
114
What is the significance of the first and third specimens in the Three-Glass Collection?
The first and third specimens are examined microscopically to detect prostatic infection.
115
In prostatic infection, how do the white blood cell and bacterial counts in the third specimen compare to the first?
The third specimen will have a white blood cell/high-power field count and a bacterial count 10 times that of the first specimen.
116
What additional cells may be present in the third specimen in cases of prostatic infection?
Macrophages containing lipids.
117
What is the purpose of the second specimen in the Three-Glass Collection?
control for bladder and kidney infection.
118
For a three glass collection, Why would a positive result in the second specimen invalidate the third specimen's results?
indicates bladder or kidney infection, contaminating the third specimen and making its results invalid.
119
What indicates a positive result in the Pre- and Postmassage Test (PPMT)?
Significant bacteriuria in the postmassage specimen with a bacterial count greater than 10 times the premassage count.
120
What is the first urine specimen collected in the Stamey-Meares Test for Prostatitis called?
Voided Bladder 1 (VB1), the first 10 mL of urine, representing the urethral specimen
121
What is the second urine specimen collected in the Stamey-Meares Test for Prostatitis?
Voided Bladder 2 (VB2), another 10 mL of urine representing the bladder specimen.
122
What do you call the third specimen collected in the Stamey-Meares test for Prostatitis
Expressed Prostatic Specimen (EPS) collected during a prostatic massage
123
What is the fourth urine specimen collected in the Stamey-Meares Test for Prostatitis called
Voided Bladder 3 (VB3), the first 10 mL of urine after the prostatic massage (EPS).
124
What are the four specimens in the Stamey-Meares Test tested for
sent for culture.
125
What is examined in the sediment of the three urine specimens in the Stamey-Meares Test?
White blood cells/aggregates
macrophages
oval fat bodies
bacteria
fungal hypha
126
What is considered abnormal in the examination of prostatic secretions in the Stamey-Meares Test?
Having more than 10 to 20 white blood cells per high-power field.
127
What do VB1 and VB2 specimens test for in the Stamey-Meares Test?
VB1 tests for urethral infection or inflammation, and VB2 tests for urinary bladder infection.
128
What is the first step in the Clean-Catch Specimen Collection procedure for females?
The patient should wash her hands.
129
How should the labia be cleansed before collecting a clean-catch urine sample in females?
Cleanse from front to back on either side of the urinary opening using a clean antiseptic towelette for each side.
130
What is important about the handling of the urine container during collection in females?
The container should not touch the genital area, and the inside of the container and lid should not be touched.
131
How should the penis be cleansed before collecting a clean-catch urine sample in males?
Cleanse the tip of the penis with an antiseptic towelette and let it dry; retract the foreskin if uncircumcised.
132
What is a common tool used for collecting routine pediatric urine specimens?
Soft, clear plastic bags with hypoallergenic skin adhesive.
133
How are sterile pediatric specimens obtained?
By catheterization or suprapubic aspiration.
134
What should be avoided when attaching the collection bag to the patient's skin?
Do not touch the inside of the bag.
135
What should be done to ensure the collection area is free of contamination for routine specimen analysis for pediatric patients
Clean the genital area and attach the bag firmly, avoiding the anus.
136
How should the collection bag be secured during the specimen collection process for pediatric patients?
A diaper is placed over the collection bag.
137
What is the next step after collecting enough urine in the pediatric collection bag?
Remove the bag and either label it or pour the specimen into a container, then label the container.
138
How should the area be prepared for collecting a microbiology specimen from a pediatric patient?
Clean the area with soap and water, then dry it sterilely, removing any residual soap.
139
What is the most vulnerable part of a drug-testing program?
Urine specimen collection.
140
What ensures proper specimen identification from collection to lab results in drug testing?
The Chain of Custody (COC).
141
A standardized form that documents and accompanies every step of drug testing, from collector to courier to laboratory to medical review officer to employer.
Chain of Custody (COC)
142
Why must urine specimens be handled securely in drug testing?
To prove no tampering (substitution, adulteration, or dilution) occurred.
143
What are acceptable forms of identification for the individual submitting a urine specimen?
Photo identification or positive identification by an employer representative with a photo ID
144
When is a witnessed urine specimen collection required
When it is suspected the donor may alter or substitute the specimen, or when client policy requires it.
145
What is the role of a same-gender collector in a witnessed urine collection?
They observe the collection of 30 to 45 mL of urine.
146
How long after collection should the urine temperature be taken, and what is the acceptable temperature range?
Within 4 minutes, with a temperature range of 32.5°C to 37.7°C.
147
What happens if the urine specimen temperature is outside the acceptable range? for drug test urine specimen
The temperature is recorded, and the supervisor or employer is contacted immediately, with a re-collection of the specimen required.
148
What are signs that a urine specimen may have been adulterated?
A pH greater than 9 or a specific gravity of less than 1.005.
149
What is indicated by a specific gravity of less than 1.005 in a urine specimen?
Possible dilution of the specimen, requiring re-collection.
150
What happens if a urine specimen shows signs of contamination?
The color is inspected, and if contamination is suspected, pH and specific gravity may be tested, potentially leading to re-collection.
151
How should the specimen be handled after collection in drug testing?
The specimen is labeled, packaged, and transported following laboratory-specific instructions.
152
Types of urine specimens
Random
First morning
24-hour (or timed)
Catheterized
Midstream clean-catch
Suprapubic aspiration
Three-glass collection
Four-glass collection
153
Purpose of Random specimen
Routine screening
154
Purpose of first morning specimen
Routine screening
Pregnancy tests
Orthostatic protein
155
Purpose of 24-hour (or timed) specimen
Quantitative chemical tests
156
Purpose of Catheterized
Bacterial culture
157
Purpose of Midstream clean-catch
Routine screening
Bacterial culture
158
Purpose of Suprapubic aspiration
Bladder urine for bacterial culture
Cytology
159
Purpose of Three-glass collection
Prostatic infection
160
Purpose of Four-glass collection
Prostatic infection
161
Positive glucose in this type of sample suggests renal problems
Fasting/ second morning sample
162
A specimen that is collected after fasting and 2 hours after eating breakfast
2 hour post prandial
163
specimen used to define the ability of the body to dispose glucose load
Glucose tolerance specimen
164
Specimen used for urobilinogen
Early afternoon specimen
165
specimen used for ADDIS count
12 hour specimen
166
preservative for 12 hour specimen
39-40% formalin 10 ml
