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Mercy CLS 3: Urinalysis > 3. Chemical Exam > Flashcards

3. Chemical Exam Flashcards

1
Q

QC of reagent test strips happens when?

A

every 24 hours
new bottle opened
questionable results
concern about integrity

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2
Q

Why can’t the = control for reagent test strips be DI?

A

Needs to have a similar ionic concentration to urine.

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3
Q

confirmatory testing

A

use of different reagents or methodologies to detec the same subtances with the same or greater sensitivity or specificity

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4
Q

importance of pH on test srip

A

determining existence of systemic acid-base disorders
management of urinary conditions that require urine to be monitored at specific pH

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5
Q

2 major regulators of body pH

A

lungs
kidneys

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6
Q

how do the kidneys help regulate pH?

A

secrete H+ and ammonium ions
reabsorbing bicaronate ions

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7
Q

typical pH of first morning specimen

normal random sample pH range

A

5.0-6.0

4.5-8.0
(pH outside this range is physiologically impossible)

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8
Q

physiological causes of acidic urine (9)

A
  • respiratory acidosis (emphysema)
  • DM
  • starvation
  • dehydration
  • diarrhea (base out the bottom)
  • acid-producing bacteria
  • high-protein diet
  • cranberry juice
  • medications
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9
Q

physiological causes of alkaline urine (6)

A
  • respiratory alkalosis (hyperventilation)
  • vomiting
  • renal tubular acidosis
  • vegetarian diet
  • urease-producing bacteria
  • old specimen
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10
Q

principle of pH reaction

A
  • double indicator system
  • methyl red + bromthymol blue
  • yellow—acid; blue—alkaline
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11
Q

protein is most indicative of…

A

early renal disease

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12
Q

normal urine protein

A

< 10 mg/dL
100 mg/24 hours

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13
Q

proteinuria indicated at —- mg/dL

A

30

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14
Q

categories of proteinuria causes

A
  • prerenal
  • renal
  • postrenal
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15
Q

proteins found in prerenal proteinuria

A

hemoglobins
myoglobins
acute phase proteins (infection, inflammation)

usually not detected by routine urinalysis, which detect primarily albumin

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16
Q

Bence Jones proteins are free ——-, and indicates….

A

monoclonal Ig light chains
multiple myeloma

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17
Q

method used to dx Bence Jones proteins

A

serum electrophoresis + immunoelectrophoresis

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18
Q

2 types of proteinuria of renal origin

A
  • glomerular damage
  • tubular dysfunction
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19
Q

most serious and most common type of proteinuria

A

glomerular damage

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20
Q

tubular dysfuntion leading to proteinuria is caused by less (filtration/reabsorption/secretion) of low MW proteins

A

reabsorption

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21
Q

examples of tubular proteinuria

A

Fanconi’s syndrome
heavy metal poisoning
severe viral infections

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22
Q

explain microalbuminuria

A

development of diabetic nephropathy leading to reduced glomerular filtration and eventual renal failure

type 1 and 2 DM

first predicts onset of renal DM complications

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23
Q

explain orthostatic proteinuria

A

increased pressure on the renal vein when in the vertical position causes proteinuria that goes away when you lay down

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24
Q

prinicple of protein reaction

A
  • principle of protein error of indicators
  • reagent pad is at pH 3, and proteins cause release of H+
  • H+ turn indicator blue-green
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25
Q

confirmatory test for protein

A

sulfosalicylic acid precipitation test (SSA)

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26
Q

principle of SSA

A
  • acid will precipitate proteins out of a solution, making the solution cloudy
  • reacts equally with all forms of protein
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27
Q

most frequently performed chemical analysis on urine

A

glucose

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28
Q

renal threshold for glucose

A

160-180 mg/dL

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29
Q

2 types of causes of glycosuria

A
  • hyperglycemia-associated
  • renal-associated
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30
Q

examples of hyperglycemia-associated glycosuria

A

Diabetes mellitus
Pancreatitis
Pancreatic Cancer
Acromegaly
Cushing Syndrome
Hyperthyroidism
Pheochromocytoma
Central nervous system damage
Stress
Gestational diabetes

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31
Q

examples of renal-associated glycosuria

A

Fanconi Syndrome
Advanced renal disease
Osteomalacia
Pregnancy

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32
Q

failure to thrive

A

galactose in urine
lack galactose-1-phosphate uridyl transferase

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33
Q

principle of glucose reaction

A
  • double sequential enzyme reaction
  • includes glucose oxidase, peroxidase, chromogen, and buffer
  • detects only glucose
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34
Q

vitamin C causes false —- glucose, blood, and bilirubin

A

negative

35
Q

confirmatory test for glucose

A

copper reduction test
clinitest
benedict’s test

36
Q

clinitest principle

A
  • detects all reducing substances/sugars
  • sugars reduce copper sulfate to cuprous oxide, colored green/red
37
Q

pass through phenomenon

A

clinitest
high glucose levels

38
Q

why don’t ketones normally show up in urine?

A

all the metabolized fat is completely broken down into carbon dioxide and water

39
Q

3 ketones and percentages

A
  • Beta-hydroxybutyrate (78%)
  • Acetoacetic Acid (20%)
  • Acetone (2%)
40
Q

why does DM lead to ketoacidosis even when blood glucose is high?

A

without functioning insulin, the body cannot use the glucose that is available

41
Q

clinical significance of ketonuria

A

Diabetic acidosis
Insulin dosage monitoring
Malabsorption/pancreatic disorders
Strenuous exercise
Vomiting
Eating disorders
Inborn errors of amino acid metabolism

42
Q

principle of ketone reaction

A
  • at an alkaline pH, acetoacetate reacts with sodium nitroprusside to produce a purple color
  • only detects acetoacetic acid unless glycine is included, and then detects acetone also
43
Q

confirmatory test for ketones

A

acetest

44
Q

acetest principle

A
  • tablet includes sodium nitroprusside and glycine
  • turns purple with ketones
45
Q

Reabsorption of filtered hemoglobin also results in the appearance of large yellow-brown granules of denatured —– called —— in the renal tubular epithelial cells and in the urine sediment.

A

ferritin
hemosiderin

46
Q

brown recluse spider bites

A

hemoglobinuria

47
Q

muscle destruction

A

rhabdomyolysis

48
Q

statin medications

A

rhabdo
myoglobinuria

49
Q

blood reaction principle

A
  • pseudoperoxidase activity of hemoglobin to oxidize chromogen
  • green-blue color
  • reacts with RBCs, hemoglobin and myoglobin
50
Q

—— cells can give false negative blood

A

crenated

51
Q

2 types of bilirubin

A
  • unconjugated/indirect: water insoluble, bound to albumin in blood stream - NOT in urine
  • conjugated/direct: water soluble, can be found in urine
52
Q

In the liver, bilirubin is conjugated with ——– by ———– to form ————-, commonly called conjugated bilirubin.

A

glucuronic acid
glucuronyl transferase
bilirubin diglucuronide

53
Q

Bacteria in the intestines reduces the conjugated bilirubin to ———– and ————-.

A

urobilinogen
stercobilinogen

54
Q

—-bilinogen can be reabsorbed or excreted in urine, and —-bilinogen cannot be reabsorbed and remain in intestine

A

urobilinogen
stercobilinogen

55
Q

give stool its color

A

urobilin and stercobilin

56
Q

clinical significance of bilirubinuria

A

Hepatitis
Cirrhosis
Other liver disorders
Biliary obstruction (gallstones, carcinoma)

57
Q

bilirubin reaction principle

A
  • diazo reaction
  • conjugated bilirubin combines with diazonium salt to form azodyte
58
Q

confirmatory test for bilirubin

A

ictotest

59
Q
A

ictotest for bilirubin

60
Q

—-% of urobilinogen is reabsorbed

A

2-5%

61
Q

urobilinogen is quickly converted to —— on standing

A

urobilin

62
Q

peak levels of urobilinogen

A

2-4 PM

63
Q

normal urobilinogen

A

< 1 mg/dL

64
Q

clinical significance of urobilinogen

A

Early detection of liver disease
Liver disorders, hepatitis, cirrhosis, carcinoma
Hemolytic disorders
Constipation

65
Q

urobilinogen reaction principle

A
  1. MULTISTIX - Ehrlich’s aldehyde reaction - pink
  2. CHEMSTRIP - diazo reaction - red
66
Q

limitation of urobilinogen test

A

cannot determine absence of urobilinogen

67
Q

preservative that interferes with urobilinogen

A

formalin

68
Q

Pre-Hepatic

unconjugated bilirubin
conjugated bilirubin
urine bilirubin
urine UBG
fecal UBG

A

unconjugated bilirubin ↑
conjugated bilirubin normal
urine bilirubin =
urine UBG ↑
fecal UBG ↑

69
Q

Post-Hepatic

unconjugated bilirubin
conjugated bilirubin
urine bilirubin
urine UBG
fecal UBG

A

unconjugated bilirubin normal
conjugated bilirubin ↑
urine bilirubin +
urine UBG =
fecal UBG =, white color

70
Q

why is the nitrite test important?

A

detecting initial bladder infection, because patients are often asymptomatic or have vague symptoms

71
Q

nitrite reaction principle

A
  • Greiss reaction
  • nitrite + aromatic amine –> diazonium salt
  • diazonium salt + tetrahydrobenzoquinolin –> pink azo dye
72
Q

how to provide sufficient contact time for nitrite test

A

take first morning specimen

73
Q

lack leukocyte esterase

A

lymphocytes

74
Q

LE reaction principle

A
  • acid ester + LE –> indoxyl aromatic compound
  • aromatic compound + diazonium salt –> purple azo dye
75
Q

trace amounts of LE are insignificant in ——

A

women
vaginal contamination

76
Q

LE false positives with esterases found in…

A

histiocytes
trichomonas

77
Q

helps us determine unsatisfactory specimens

A

SG

78
Q

↑ SG = — pH change
↓SG = —- pH change

A

↓ pH
↑pH

79
Q

reagent strip SG only detects…

A

ionic solutes

80
Q

principle metabolite of ascorbic acid

A

oxalate

81
Q

ascorbic acid is a strong —– because of its ene-diol group

A

reducing substance
(H+ donator)

82
Q

reagent tests that use ——— or ——- are subject to vitamin C interference

A

H2O2
diazonium salt

83
Q

4 test interfered with by vitamin C

A
  • blood (H2O2)
  • bilirubin (diazonium)
  • nitrite (diazonium)
  • glucose (H2O2)
84
Q

ascorbic acid reaction principle

A
  • action of ascorbic acid to reduce a dye
  • blue to orange

Mercy CLS 3: Urinalysis (10 decks)

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