2 Evaluation of the Urologic Patient Flashcards
1
Q
What are the common causes of colorless urine, and how can I remember them?
A
Use the mnemonic “Very Overly Dilute”:
- Very: Very dilute urine
- Overly: Overhydration
- Dilute: Very dilute urine
Common causes of colorless urine:
- Very dilute urine
- Overhydration
2
Q
What are the common causes of cloudy/milky urine, and how can I remember them?
A
Use the mnemonic “Phosphates Produce Clouds”:
- Phosphates: Phosphaturia
- Produce: Pyuria
- Clouds: Chyluria
Common causes of cloudy/milky urine:
- Phosphaturia
- Pyuria
- Chyluria
3
Q
- What is the most common cause of cloudy urine?
a. Bacterial cystitis
b. Urine overgrowth with yeast
c. Phosphaturia
d. Alkaline urine
e. Significant proteinuria
A
- c. Phosphaturia. Cloudy urine is most commonly caused by phosphates in the urine.
4
Q
- Conditions that decrease urine specific gravity include all of the following EXCEPT:
a. increased fluid intake.
b. use of diuretics.
c. decreased renal concentrating ability.
d. dehydration.
e. diabetes insipidus.
A
- d. Dehydration. Conditions that decrease specific gravity include (1) increased fluid intake, (2) diuretics, (3) decreased renal concentrating ability, and (4) diabetes insipidus.
5
Q
- Urine osmolality usually varies between:
a. 10 and 200 mOsm/L.
b. 50 and 500 mOsm/L.
c. 50 and 1200 mOsm/L.
d. 100 and 1000 mOsm/L.
e. 100 and 1500 mOsm/L.
A
- c. 50 and 1200 mOsm/L. Osmolality is a measure of the amount of solutes dissolved in the urine and usually varies between 50 and 1200 mOsm/L.
6
Q
- Elevated ascorbic acid levels in the urine may lead to false-negative results on a urine dipstick test for:
a. glucose.
b. hemoglobin.
c. myoglobin.
d. red blood cells.
e. leukocytes.
A
- a. Glucose. False-negative results for glucose and bilirubin may be seen in the presence of elevated ascorbic acid concentrations in the urine.
7
Q
- Hematuria is distinguished from hemoglobinuria or myoglobinuria by:
a. dipstick testing.
b. the simultaneous presence of significant leukocytes.
c. microscopic presence of erythrocytes.
d. examination of serum
e. evaluation of hematocrit.
A
- c. Microscopic presence of erythrocytes. Hematuria can be distinguished from hemoglobinuria and myoglobinuria by microscopic examination of the centrifuged urine; the presence of a large number of erythrocytes establishes the diagnosis of hematuria.
8
Q
- The presence of one positive dipstick reading for hematuria is associated with significant urologic pathologic findings on subsequent testing in what percentage of patients?
a. 2%
b. 10%
c. 25%
d. 50%
e. 75%
A
- c. 25%. Investigators at the University of Wisconsin found that 26% of adults who had at least one positive dipstick reading for hematuria were subsequently found to have significant urologic pathologic findings.
9
Q
- The most common cause of glomerular hematuria is:
a. transitional cell carcinoma.
b. nephritic syndrome.
c. Berger disease (immunoglobulin A nephropathy).
d. poststreptococcal glomerulonephritis.
e. Goodpasture syndrome.
A
- c. Berger disease (immunoglobulin A nephropathy). IgA nephropathy, or Berger disease, is the most common cause of glomerular hematuria, accounting for about 30% of cases.
10
Q
- The most common cause of proteinuria is:
a. Fanconi syndrome.
b. excessive glomerular permeability due to primary glomerular disease.
c. failure of adequate tubular reabsorption.
d. overflow proteinuria due to increased plasma concentration of immunoglobulins.
e. diabetes.
A
- b. Excessive glomerular permeability due to primary glomerular disease. Glomerular proteinuria is the most common type of proteinuria and results from increased glomerular capillary permeability to protein, especially albumin. Glomerular proteinuria occurs in any of the primary glomerular diseases such as IgA nephropathy or in glomerulopathy associated with systemic illness such as diabetes mellitus.
11
Q
- Transient proteinuria may be due to all of the following EXCEPT:
a. exercise.
b. fever.
c. emotional stress.
d. congestive heart failure.
e. ureteroscopy.
A
- e. Ureteroscopy. Transient proteinuria occurs commonly, especially in the pediatric population, and usually resolves spontaneously within a few days. It may result from fever, exercise, or emotional stress. In older patients, transient proteinuria may be due to congestive heart failure.
12
Q
- Glucose will be detected in the urine when the serum level is above:
a. 75 mg/dL.
b. 100 mg/dL.
c. 150 mg/dL.
d. 180 mg/dL.
e. 225 mg/dL.
A
- d. 180 mg/dL. This so-called renal threshold corresponds to a serum glucose level of about 180 mg/dL; above this level, glucose will be detected in the urine.
13
Q
- The specificity of dipstick nitrite testing for bacteriuria is:
a. 20%.
b. 40%.
c. 60%.
d. 80%.
e. >90%.
A
- e. >90%. The specificity of the nitrite dipstick test for detecting bacteriuria is greater than 90%.
14
Q
- All of the following are microscopic features of squamous epithelial cells EXCEPT:
a. large size.
b. small central nucleus.
c. irregular cytoplasm.
d. presence in clumps.
e. fine granularity in the cytoplasm.
A
- d. Presence in clumps. Squamous epithelial cells are large, have a central small nucleus about the size of an erythrocyte, and have an irregular cytoplasm with fine granularity.
15
Q
- The number of bacteria per high-power microscopic field that corresponds to colony counts of 100,000/mL is:
a. 1.
b. 3.
c. 5.
d. 10.
e. 20.
A
- c. 5. Therefore 5 bacteria per high-power field in a spun specimen reflect colony counts of about 100,000/mL.
16
Q
- All of following is true of uroflowmetry EXCEPT:
a. Qmax >20 mL/s is not consistent with obstruction.
b. Qmax, mean flow rate, and voided volume are parameters obtained from this study.
c. 80 mL voided volume is adequate for uroflowmetry.
d. the study can be performed in sitting and standing positions.
e. uroflowmetry cannot diagnose the location of obstruction.
A
- c. 80 mL voided volume is adequate for uroflowmetry. The minimum voided volume that is accepted as a requirement for considering an adequate assessment is at least 100 mL.
17
Q
- The following should be given to uncomplicated patients undergoing simple flexible diagnostic cystourethroscopy:
a. single-dose oral antibiotic following procedure
b. 3 days of oral antibiotics following procedure
c. 3 days of oral antibiotics starting the day prior to procedure
d. nothing
e. single intramuscular injection of ceftriaxone following procedure
A
- d. Nothing. For patients undergoing simple diagnostic flexible cystoscopy no antibiotic prophylaxis is recommended unless there are extenuating risk factors for infection or recent orthopedic implantation of artificial joints. Refer to American Urological Association (AUA) recommendations on antibiotic prophylaxis for urological procedures.
18
Q
- What is the most appropriate initial workup for asymptomatic microscopic hematuria (AMH)?
a. Flexible cystoscopy, urinary cytology, CT urogram, and UroVysion FISH
b. Flexible cystoscopy and CT urogram
c. CT urogram and NMP22
d. Flexible cystoscopy, urinary cytology, and CT urogram
e. Flexible cystoscopy, renal ultrasound, and urinary cytology
A
- b. Flexible cystoscopy and CT urogram. For the initial work-up of AMH, routine urine cytology is not necessary. Cytology is generally utilized in patients with a history of bladder cancer undergoing surveillance or the index of suspicion of a high-grade lesion is present.
19
Q
What are the common causes of red urine, and how can I remember them?
A
Use the mnemonic “Hearty Hemoglobin Anomalies Cause Phenomenal Phenomenon Rarely”:
- Hearty: Hematuria
- Hemoglobin: Hemoglobinuria/myoglobinuria
- Anomalies: Anthocyanin in beets and blackberries
- Cause: Chronic lead and mercury poisoning
- Phenomenal: Phenolphthalein (in bowel evacuants)
- Phenomenon: Phenothiazines (e.g., Compazine)
- Rarely: Rifampin
Common causes of red urine:
- Hematuria
- Hemoglobinuria/myoglobinuria
- Anthocyanin in beets and blackberries
- Chronic lead and mercury poisoning
- Phenolphthalein (in bowel evacuants)
- Phenothiazines (e.g., Compazine)
- Rifampin
20
Q
What are the common causes of orange urine, and how can I remember them?
A
Use the mnemonic “Dye Pee Solution”:
- Dye: Dehydration
- Pee: Phenazopyridine (Pyridium)
- Solution: Sulfasalazine (Azulfidine)
Common causes of orange urine:
- Dehydration
- Phenazopyridine (Pyridium)
- Sulfasalazine (Azulfidine)
