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AUBF > 1. URINE AND HISTORY - LEC > Flashcards

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

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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

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3
Q

When did testing for glucose progress from ant testing and taste testing due to Frederik Dekkers’ discovery

A

1694

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4
Q

Who discovered albuminuria by boiling urine?

A

Frederik Dekkers

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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

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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

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7
Q

introduced the concept of urinalysis
as part of a doctor’s routine patient examination in 1827

A

Richard Bright

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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

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9
Q

Two unique characteristics of a urine specimen account why it is still considered for routine analysis

A
  1. A urine specimen is readily available and easily collected.
  2. Urine contains information, which can be obtained by inexpensive laboratory tests, about many of the body’s major metabolic functions
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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

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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

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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

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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

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14
Q

Other organic substances found in urine include primarily

A

creatinine and uric acid

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15
Q

The major inorganic solid dissolved in urine is

A

chloride

followed by:
sodium and potassium

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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

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17
Q

Other substances found in urine besides organic and inorganic compounds include

A

hormones, vitamins, and medications

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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

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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

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20
Q
A
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21
Q

Urine volume depends on the

A

amount of water that the kidneys
excrete

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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

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23
Q

a decrease in urine output

A

Oliguria

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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

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25
Q

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.

A

Oliguria

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26
Q

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

A

anuria

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27
Q

An increase in the nocturnal excretion of urine is termed

A

nocturia

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28
Q

The kidneys excrete two to three times more urine during when?

A

day compared to night

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29
Q

an increase in daily urine volume

A

Polyuria

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30
Q

Range of clinical polyuria

A

greater than 2.5 L/day in adults

greater than 2.5 to 3 mL/kg/day in children

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31
Q

Polyuria is often associated with

A

diabetes mellitus and diabetes insipidus

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32
Q

Polyuria may be induced artificially by

A

diuretics, caffeine, or alcohol

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33
Q

Primary organic component. Product of
metabolism of protein and amino acids

A

Urea

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34
Q

Product of metabolism of creatine by
muscles

A

Creatinine

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35
Q

Product of breakdown of nucleic acid in
food and cells

A

Uric acid

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36
Q

Primary inorganic component in urine . Found in combination with sodium (table salt)
and many other inorganic substances

A

Chloride

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37
Q

Primarily from salt, varies by intake

A

Sodium

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38
Q

Combined with chloride and other salts

A

Potassium

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39
Q

Combines with sodium to buffer the
blood

A

Phosphate

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40
Q

Regulates blood and tissue fluid acidity

A

Ammonium

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41
Q

Combines with chloride, sulfate, and
phosphate

A

Calcium

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42
Q

Although appearing to be dilute, a urine specimen from a patient with diabetes mellitus has a ___________________
because of the increased glucose content.

A

high specific gravity

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43
Q

is the medical definition of excessive thirst

increased ingestion of water

A

Polydipsia

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44
Q

Main difference between Diabetes mellitus and insipidus

A

Mellitus - Increased SG, Decreased production or function of insulin

Insipidus - Decreased SG, Decreased production or function of ADH

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45
Q

Main increased component in urine when person has diabetes mellitus

A

Glucose

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46
Q

Main deficiency when patient has Diabetes insipidus

A

ADH

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47
Q

Main deficiency when patient has Diabetes mellitus

A

Insulin

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48
Q

urine is a biohazardous substance
whose handling requires the observance of

A

Standard Precautions

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49
Q

Urine Specimens must be collected in

A

clean, dry, leakproof containers

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50
Q

Containers for routine urinalysis should have a wide mouth because?

A

to facilitate collections from female patients

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51
Q

Containers for routine urinalysis should have a wide flat bottom because?

A

to prevent overturning

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52
Q

Specimen containers should be made of clear material because?

A

to allow for determination of color and clarity

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53
Q

The recommended capacity of a urine specimen container is

A

50 mL

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54
Q

50 mL specimen containers for routine urinalysis is recommended because?

A

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

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55
Q

Recommended containers for urine microbiological studies

A

Individually packaged sterile containers with secure closures

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56
Q

Containers suggested if more than 2 hours elapse between specimen collection and analysis

A

Sterile containers

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57
Q

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.

A

BD Vacutainer Urine Transfer Straw

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58
Q

automated reagent strip testing

A
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59
Q

All specimens must be labeled immediately after collection with

A

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

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60
Q

Where should labels be attached?

A

container, not the lid

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61
Q

must accompany specimens delivered to the laboratory

A

requisition form

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62
Q

Additional information on the form can include

A

method of collection or type of specimen

possible interfering medications

patient’s clinical information

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63
Q

a must be recorded on the requisition form.

A

Time specimen is received in the laboratory

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64
Q

The laboratory should reject specimens that are

A

improperly labeled and/or collected

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65
Q

Situations leading to specimens that should be rejected can include:

A
  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)
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66
Q

After collection, specimens should be delivered to the laboratory promptly and tested within

A

2 hours

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67
Q

A specimen that cannot be delivered and tested within 2 hours should be

A

refrigerated or have an appropriate chemical preservative added

68
Q

changes in unpreserved urine in terms of

Color

A

Modified/darkened

Oxidation or reduction of metabolites

69
Q

changes in unpreserved urine in terms of

Clarity

A

Decreased

Bacterial growth and precipitation of amorphous material

70
Q

changes in unpreserved urine in terms of

Odor

A

Increased ammonia smell

Bacterial multiplication causing breakdown of urea to ammonia

71
Q

changes in unpreserved urine in terms of

pH

A

Increased

Breakdown of urea to ammonia by urease-producing bacteria/loss of CO2

72
Q

changes in unpreserved urine in terms of

Glucose

A

Decreased

Glycolysis and bacterial use

73
Q

changes in unpreserved urine in terms of

Ketones

A

Decreased

Volatilization and bacterial metabolism

74
Q

changes in unpreserved urine in terms of

Bilirubin

A

Decreased

Exposure to light/photo oxidation to biliverdin

75
Q

changes in unpreserved urine in terms of

Urobilinogen

A

Decreased

Oxidation to urobilin

76
Q

changes in unpreserved urine in terms of

Nitrite

A

Increased

Multiplication of nitrate-reducing bacteria

77
Q

changes in unpreserved urine in terms of

Red and white blood cells and casts

A

Decreased

Disintegration/lyse in dilute alkaline urine

78
Q

changes in unpreserved urine in terms of

Bacteria

A

Increased

Multiplication

79
Q

changes in unpreserved urine in terms of

Trichomonas

A

Decreased

Loss of motility, death

80
Q

The method of preservation used most routinely is _____________ which decreases bacterial growth and metabolism

A

refrigeration at 2°C to 8°C

81
Q

If the urine is to be cultured, it should be (preservation)

A

refrigerated during transit and kept refrigerated until cultured, up to 24 hours

82
Q

Refrigerated samples should return to room temperature when

A

before chemical testing by reagent strips

83
Q

Refrigeration of urine samples also can cause

A

precipitation of amorphous urate and phosphate crystals

84
Q

What should be done when a specimen must be transported over a long distance and refrigeration is impossible

A

chemical preservatives may be added

85
Q

Commercially prepared transport tubes with a ___________ are available that allow for the transport, testing, and storage of the urine specimens

A

lyophilized preservative

86
Q

The ideal preservative for urine should be

A

bactericidal, inhibit urease, and preserve formed elements in the sediment

should not interfere with chemical tests

87
Q

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

A

time
length
method of collection
patient’s dietary and medicinal intake

88
Q

This is the specimen received most commonly because of its ease of collection and convenience for the patient.

A

Random Specimen

89
Q

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.

A

Random Specimen

90
Q

is the ideal screening specimen

A

First Morning Specimen

91
Q

Specimens must be returned to room temperature before chemical testing by reagent strips because

A

the enzyme reactions on the strips perform best at room temperature.

92
Q

First Morning Specimen is also essential for preventing _____________ and evaluating _____________

A

false-negative pregnancy tests

orthostatic proteinuria

93
Q

Why is First morning specimen essential?

A

it is a concentrated specimen thereby assuring detection of chemicals and formed elements

94
Q

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

A

timed specimen

also known as 24 hour specimen

95
Q

Many solutes exhibit diurnal variations such as

A

catecholamines
17-hydroxysteroids
electrolytes

96
Q

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

A

24 hour

97
Q

To obtain an accurate timed specimen, the patient must begin and end the collection period with

A

an empty bladder.

98
Q

The concentration of a substance in a particular period must be calculated from the

A

urine volume produced during that time.

99
Q

On its arrival in the laboratory, a 24-hour specimen must be

A

mixed thoroughly and the volume accurately measured and recorded

100
Q

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

A

falsely elevate the results

falsely decrease the results

101
Q

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

A

Catheterized Specimen

102
Q

The test requested most commonly on a catheterized specimen is a

A

bacterial culture

103
Q

As an alternative to the catheterized specimen, the _____________ provides a safer, less traumatic method for obtaining urine for bacterial culture and routine urinalysis

A

midstream clean-catch specimen

104
Q

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

A

Midstream Clean-Catch Specimen

105
Q

Strong bacterial agents, such as
_______________, should not be used as cleansing agents for mid stream clean catch specimen

A

hexachlorophene or povidone-iodine

106
Q

provides a specimen for bacterial culture that is completely free of extraneous contamination, particularly in infants or children

A

suprapubic aspiration

107
Q

urine may be collected by external introduction of a needle through the abdomen into the bladder, a process called

A

suprapubic aspiration

108
Q

Suprapubic aspiration specimen can also be used for

A

cytological examination

109
Q

Several methods are available to detect the presence of prostatitis.

A

Three-Glass Collection
Pre- and Postmassage Test
Stamey-Meares Test for Prostatitis

110
Q

What procedure is used to cleanse the area before a Three-Glass Collection?

A

The male midstream clean-catch procedure.

111
Q

What is collected in the first container during the Three-Glass Collection?

A

The first urine passed

112
Q

What is collected in the second container during the Three-Glass Collection?

A

midstream portion of the urine

113
Q

How is the third specimen in the Three-Glass Collection obtained?

A

After a prostate massage to release prostate fluid, the remaining urine is collected in a third sterile container.

114
Q

What is the significance of the first and third specimens in the Three-Glass Collection?

A

The first and third specimens are examined microscopically to detect prostatic infection.

115
Q

In prostatic infection, how do the white blood cell and bacterial counts in the third specimen compare to the first?

A

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
Q

What additional cells may be present in the third specimen in cases of prostatic infection?

A

Macrophages containing lipids.

117
Q

What is the purpose of the second specimen in the Three-Glass Collection?

A

control for bladder and kidney infection.

118
Q

For a three glass collection, Why would a positive result in the second specimen invalidate the third specimen’s results?

A

indicates bladder or kidney infection, contaminating the third specimen and making its results invalid.

119
Q

What indicates a positive result in the Pre- and Postmassage Test (PPMT)?

A

Significant bacteriuria in the postmassage specimen with a bacterial count greater than 10 times the premassage count.

120
Q

What is the first urine specimen collected in the Stamey-Meares Test for Prostatitis called?

A

Voided Bladder 1 (VB1), the first 10 mL of urine, representing the urethral specimen

121
Q

What is the second urine specimen collected in the Stamey-Meares Test for Prostatitis?

A

Voided Bladder 2 (VB2), another 10 mL of urine representing the bladder specimen.

122
Q

What do you call the third specimen collected in the Stamey-Meares test for Prostatitis

A

Expressed Prostatic Specimen (EPS) collected during a prostatic massage

123
Q

What is the fourth urine specimen collected in the Stamey-Meares Test for Prostatitis called

A

Voided Bladder 3 (VB3), the first 10 mL of urine after the prostatic massage (EPS).

124
Q

What are the four specimens in the Stamey-Meares Test tested for

A

sent for culture.

125
Q

What is examined in the sediment of the three urine specimens in the Stamey-Meares Test?

A

White blood cells/aggregates
macrophages
oval fat bodies
bacteria
fungal hypha

126
Q

What is considered abnormal in the examination of prostatic secretions in the Stamey-Meares Test?

A

Having more than 10 to 20 white blood cells per high-power field.

127
Q

What do VB1 and VB2 specimens test for in the Stamey-Meares Test?

A

VB1 tests for urethral infection or inflammation, and VB2 tests for urinary bladder infection.

128
Q

What is the first step in the Clean-Catch Specimen Collection procedure for females?

A

The patient should wash her hands.

129
Q

How should the labia be cleansed before collecting a clean-catch urine sample in females?

A

Cleanse from front to back on either side of the urinary opening using a clean antiseptic towelette for each side.

130
Q

What is important about the handling of the urine container during collection in females?

A

The container should not touch the genital area, and the inside of the container and lid should not be touched.

131
Q

How should the penis be cleansed before collecting a clean-catch urine sample in males?

A

Cleanse the tip of the penis with an antiseptic towelette and let it dry; retract the foreskin if uncircumcised.

132
Q

What is a common tool used for collecting routine pediatric urine specimens?

A

Soft, clear plastic bags with hypoallergenic skin adhesive.

133
Q

How are sterile pediatric specimens obtained?

A

By catheterization or suprapubic aspiration.

134
Q

What should be avoided when attaching the collection bag to the patient’s skin?

A

Do not touch the inside of the bag.

135
Q

What should be done to ensure the collection area is free of contamination for routine specimen analysis for pediatric patients

A

Clean the genital area and attach the bag firmly, avoiding the anus.

136
Q

How should the collection bag be secured during the specimen collection process for pediatric patients?

A

A diaper is placed over the collection bag.

137
Q

What is the next step after collecting enough urine in the pediatric collection bag?

A

Remove the bag and either label it or pour the specimen into a container, then label the container.

138
Q

How should the area be prepared for collecting a microbiology specimen from a pediatric patient?

A

Clean the area with soap and water, then dry it sterilely, removing any residual soap.

139
Q

What is the most vulnerable part of a drug-testing program?

A

Urine specimen collection.

140
Q

What ensures proper specimen identification from collection to lab results in drug testing?

A

The Chain of Custody (COC).

141
Q

A standardized form that documents and accompanies every step of drug testing, from collector to courier to laboratory to medical review officer to employer.

A

Chain of Custody (COC)

142
Q

Why must urine specimens be handled securely in drug testing?

A

To prove no tampering (substitution, adulteration, or dilution) occurred.

143
Q

What are acceptable forms of identification for the individual submitting a urine specimen?

A

Photo identification or positive identification by an employer representative with a photo ID

144
Q

When is a witnessed urine specimen collection required

A

When it is suspected the donor may alter or substitute the specimen, or when client policy requires it.

145
Q

What is the role of a same-gender collector in a witnessed urine collection?

A

They observe the collection of 30 to 45 mL of urine.

146
Q

How long after collection should the urine temperature be taken, and what is the acceptable temperature range?

A

Within 4 minutes, with a temperature range of 32.5°C to 37.7°C.

147
Q

What happens if the urine specimen temperature is outside the acceptable range? for drug test urine specimen

A

The temperature is recorded, and the supervisor or employer is contacted immediately, with a re-collection of the specimen required.

148
Q

What are signs that a urine specimen may have been adulterated?

A

A pH greater than 9 or a specific gravity of less than 1.005.

149
Q

What is indicated by a specific gravity of less than 1.005 in a urine specimen?

A

Possible dilution of the specimen, requiring re-collection.

150
Q

What happens if a urine specimen shows signs of contamination?

A

The color is inspected, and if contamination is suspected, pH and specific gravity may be tested, potentially leading to re-collection.

151
Q

How should the specimen be handled after collection in drug testing?

A

The specimen is labeled, packaged, and transported following laboratory-specific instructions.

152
Q

Types of urine specimens

A

Random
First morning
24-hour (or timed)
Catheterized
Midstream clean-catch
Suprapubic aspiration
Three-glass collection
Four-glass collection

153
Q

Purpose of Random specimen

A

Routine screening

154
Q

Purpose of first morning specimen

A

Routine screening
Pregnancy tests
Orthostatic protein

155
Q

Purpose of 24-hour (or timed) specimen

A

Quantitative chemical tests

156
Q

Purpose of Catheterized

A

Bacterial culture

157
Q

Purpose of Midstream clean-catch

A

Routine screening
Bacterial culture

158
Q

Purpose of Suprapubic aspiration

A

Bladder urine for bacterial culture
Cytology

159
Q

Purpose of Three-glass collection

A

Prostatic infection

160
Q

Purpose of Four-glass collection

A

Prostatic infection

161
Q

Positive glucose in this type of sample suggests renal problems

A

Fasting/ second morning sample

162
Q

A specimen that is collected after fasting and 2 hours after eating breakfast

A

2 hour post prandial

163
Q

specimen used to define the ability of the body to dispose glucose load

A

Glucose tolerance specimen

164
Q

Specimen used for urobilinogen

A

Early afternoon specimen

165
Q

specimen used for ADDIS count

A

12 hour specimen

166
Q

preservative for 12 hour specimen

A

39-40% formalin 10 ml

AUBF (12 decks)

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