BODY FLUIDS 2

Question 1

Evaluation of Stone Disease

Answer 1

• Routine Blood and Urine Tests
• Stone Analysis
• 24hrs urine metabolic profile

Question 2

Renal Stone Analysis yields fundamental information about:

Answer 2

• Metabolic abnormality
• Presence of infection
• possible artifacts
• drug metabolism

Question 3

Calcium Stone Characteristics: Pure Calcium Stones

Answer 3

• More acid in urine
• Low urine volume
• high oxalate excretion

Question 4

Calcium Stone Characteristics: Mixed Stone Formers

Answer 4

• pH is higher
• high calcium
• high calcium excretion
• high recurrence rate

Question 5

Calcium Stone Characteristics: Co-oxalate Monohydrate

Answer 5

• hypo-megnesuria
• acidic urine
• low urine volume
• hardness (+)

Question 6

Calcium Stone Characteristics: Ca-oxa Dihydrate

Answer 6

• hypercalciuria
• alkaline urine
• hypocitraturia
• hardness; less

Question 7

Renal Tubular Acidosis: Carbonate apattite

Answer 7

• COnsider RTA

- Increases with amount (5-39%)

Question 8

Renal Tubular Acidosis: Brushite Stones

Answer 8

consider RTA

Question 9

Characteristics:

Struvite Stone: Magnesium Ammonium Phosphate

Answer 9

• Mixed Stone: Infection
• “Proteus’
• Strains of Staphylococci, pseudomonas and klebsiella
• Rarely; E. coli
• Urine pH: <7.5

Question 10

Characteristics of Ammonium Urate

Answer 10

• Calcium oxalate- containing calculi, may start hyperuricosuria
• Elders: ass. w/ infection
• Children: may as result of hyperuricosuria, but no UTI

Question 11

Characteristics of Dahilite (Carbonic apetite)

Answer 11

• phosphate stones
• infection in body
• may not accompanying sign of disease
• RTA
• Disorder of phosphate metabolism
• rare in pure form (2-3%)

Question 12

Characteristics of Uric Acid

Answer 12

• hyperuricemia, hyperuricosuria
• low urine pH: <6.2
• Causes: gout, myeloproliferative dis., chemotherapy, radiotherapy

Question 13

Causes of Cystine:

Answer 13

• Cyateinuria
• Autosomal recessive disorder
• Occurs predominantly in pure form

Question 14

Causes of Xenthene:

Answer 14

• Xanthinuria
• Absence of xanthene oxidase
• genetic autosomal hereditary recessive enzyme disorder
• Trigger: Allopurinol treating gout

Question 15

is a fibrin degradation product (or FDP), a small protein fragment present in the blood after a blood clot is degraded through fibrinolysis, by enzyme plasmin.

Answer 15

D-dimer

Question 16

is of clinical use when there is a suspicion of deep venous thrombosis (DVT), pulmonary embolism (PE) or disseminated intravascular coagulation (DIC). It is under
investigation in the diagnosis of aortic dissection.

Answer 16

D-dimer testing

Question 17

A negative D-dimer test will virtually rule out

Answer 17

thromboembolism

Question 18

Reference Ranges for D-dimer:

• Non pregnant adult
• 1st Trimester
• 2nd Trimester
• 3rd Trimester

Answer 18

• Non pregnant adult: <0.5mg/L or ug/mL
• 1st Trimester: 0.05–.95mg/L or ug/mL
• 2nd Trimester: 0.32-1.29 mg/L or ug/mL
• 3rd Trimester: 0.13-1.7mg/L or ug/mL

Question 19

False positive readings of D-dimer can be due to various causes:

Answer 19

• liver disease,
• high rheumatoid factor,
• inflammation,
• malignancy,
• trauma,
• pregnancy,
• recent surgery
• advanced age

Question 20

False negative readings can occur if:

Answer 20

• sample is taken either too early after thrombus formation
• testing is delayed for several days
• presence of anticoagulation since it prevent thrombus extension

Question 21

is defined as excretion of albumin between 20 and 200 micrograms/min

Answer 21

Microalbuminuria

Question 22

Uses of Micral Test

Answer 22

(a) in diabetes, for early diagnosis of diabetic nephropathy;
(b) in patients with hypertension, as an indicator of end-organ damage associated with a lowered life expectancy;
(c) in pregnancy, as a possible predictor of developing preeclampsia.

Question 23

is a test strip now available that makes a semiquantitative assessment of the albumin concentration in the urine at various levels (0, 10, 20, 50, 100 mg/L).

Answer 23

Micral-Test

Question 24

For screening, a concentration of 20-200 mg/L of____ in the first morning urine has been proven to be a suitable indicator in Micral TEST.

Answer 24

albumin

Question 25

Advantage of Micral Test

Answer 25

no influence on the measurement from interfering factors such as glucose concentration, pH value, ketonuria, storage of the sample, or bacterial contamination in the urine

Question 26

This utilizes monoclonal antibodies tagged with fluorochromes which bind specifically to ‘GPI-AP’ on peripheral blood cells or FLAER [bacterial aerolysin tagged with fluorescent antibody] which binds directly to GPI anchor itself.

Answer 26

Multicolour Flow Cytometry Test

Question 27

Gold standard test for diagnosis of PNH.

Answer 27

Multicolour Flow Cytometry Test

Question 28

The name lupus was derived from the Latin for ”wolf”. Autoantibodies are a characteristic feature of systemic lupus erythematosus (SLE).

Answer 28

LE cell

Question 29

Abortive nucleus in the process of being extruded, undergoes ‘nucleophagocytosis’ by Neutrophils is seen in:

Answer 29

- LE cells - bone marrow, peripheral blood, synovial fluid, cerebrospinal fluid and pericardial and pleural effusions from patients with SLE.

Question 30

The detection of this in serum facilitates the diagnosis of patients with systemic lupus erythematosus (SLE) and related autoimmune diseases.

Answer 30

antinuclear antibodies (ANA)

Question 31

ANA titers higher than 1/500 are usually very significant clinically, often found in:

Answer 31

spontaneous or drug-induced SLE and few other Auto-immune diseases.

Question 32

is an immunologic marker in the body, found in low titer in a number of diseases, including infectious mononucleosis and other viral diseases, chronic bacterial infections, and other acute and chronic conditions.

Answer 32

RHEUMATOID FACTOR (RH FACTOR TEST)

Question 33

The highest levels of rheumatoid factor are usually found in

Answer 33

rheumatoid arthritis

Question 34

higher titers of RH factor tend to correlate with

Answer 34

- more severe and sustained disease, - joint deformities, - rheumatoid nodules, - other extra-articular features of the disease.

Question 35

present in an estimated 60 to 80% of people with RA, according to the Arthritis Foundation.

Answer 35

ANTI-CYCLIC CITRULLINATED PEPTIDE (ANTI-CCP) TEST

Question 36

Interpret anti-CCP >20 units per milliliter (u/ml)

Answer 36

increased risk of RA

Question 37

detects the presence of CRP, which the liver produces in response to inflammation in the body.

Answer 37

C-reactive protein (CRP) Test

Question 38

The presence of CRP can indicate

Answer 38

- inflammation anywhere in the body, just like RA | - obesity and infecton, increase CRP in blood

Question 39

evaluates the risk that a seriously ill person is developing a systemic bacterial infection, (including chronic bacterial diseases such as tuberculosis)

Answer 39

PROCALCITONIN TEST

Question 40

Uses of PROCALCITONIN TEST

Answer 40

a) It helps detect or rule out sepsis (it is best used during the first day of presentation.) b) distinguish between viral and bacterial meningitis, c) detect/rule out bacterial pneumonia in those who are seriously ill and in fever of unknown origin. d) in post- trauma or post-operative patient with viral pneumonia in order to detect the development of a secondary bacterial infection. e) may be used to monitor the effectiveness of antimicrobial treatment.

Question 41

Low levels of procalcitonin indicates

Answer 41

= low risk of sepsis but do not exclude it. = indicate a localized infection that has not yet become systemic = or a systemic infection that is less than six hours old. = the person's symptoms are likely due to another cause

Question 42

High levels of procalcitonin indicate:

Answer 42

high probability of sepsis

Question 43

Reference Range of procalcitonin in Adult

Answer 43

<0.10 ng/mL

Question 44

``` Neonate reference ranges of procalcitonin: Ages in hours:         At birth -  18-20 hours  - 48 hours  - ```

Answer 44

Ages in hours:         At birth -  <2.00 18-20 hours  - <20.00 48 hours  - <5.00