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MTAP1: AUBF > CHAPTER 3: INTRO TO URINALYSIS > Flashcards

CHAPTER 3: INTRO TO URINALYSIS Flashcards

1
Q

References to the study of urine can be found in the drawings of

A

Cavemen and in Egyptian hieroglyphics, such
as the Edwin Smith Surgical Papyrus.

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2
Q

Although ancient physicians
lacked the sophisticated testing mechanisms now available,
they were able to obtain diagnostic information from such
basic observations as:

A
  • Color
  • Turbidity
  • Color
  • Volume
  • Viscosity
  • Sweetness (by noting that certain specimens attracted ants or tasted sweet)
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3
Q

During the ___________, physicians concentrated their efforts very
intensively on the art of uroscopy, receiving instruction in urine examination as part of their training

A

Middle Ages;

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3
Q

Wrote a book on “uroscopy” in the 5th Century

A

Hippocrates

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3
Q

In _____, Chemical testing progressed from “ant testing” and “taste testing” for glucose to __________ discovery of ___________ by boiling urine

A

1694; Frederik Dekkers’s; albuminuria

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3
Q

By _________, color charts had been developed that described the significance of 20 different colors

A

1140 CE

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3
Q

The credibility of urinalysis became compromised when
these charlatans without medical credentials began offering their predictions to the public for a healthy fee

A

Pisse Prophets

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4
Q

“Pisse Prophets,” became the subject of a book published by?

A

Thomas Bryant in 1627

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4
Q

The revelations in this book inspired the passing of the first medical licensure laws in England another contribution of urinalysis to the field of medicine

A

Thomas Bryant’s book

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5
Q

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

A

Richard Bright

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5
Q

By the _____, however, the number and complexity of the tests performed in a urinalysis had reached a point of impracticality, and urinalysis began to disappear from routine examinations.

A

1930s

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5
Q

The invention of the microscope in the _______ led to the examination of urinary sediment and the development by ______________ of methods for quantitating the microscopic
sediment

A

17th century; Thomas Addis

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6
Q

Two unique characteristics of a urine specimen account
for this continued popularity:

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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7
Q

The kidneys continuously form urine as an?

A

ultrafiltrate of plasma

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8
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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9
Q

Urine is normally 95%
_____ and 5% _______,

A

water; solutes

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10
Q

Factors that influence the variations in the concentrations of solutes in urine

A
  • Dietary intake
  • Physical activity,
  • Body metabolism, and
  • Endocrine function
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11
Q

A metabolic waste product produced in the liver from the breakdown of protein and amino acids

A

Urea

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12
Q

This accounts for nearly half of the total dissolved solids in urine

A

Urea

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12
Q

The major inorganic solid dissolved in urine is

A

Chloride

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13
Q

Inorganic components in urine (in order)

A
  1. Chloride
  2. Sodium
  3. Potassium
  4. Phosphate
  5. Ammonium
  6. Calcium
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14
Q

This greatly influences the concentrations of these inorganic compounds, making it difficult to establish normal levels

A

Dietary intake

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15
Q

Organic components in urine (in order)

A
  1. Urea
  2. Creatinine
  3. Uric Acid
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16
Q

Other substances found in urine include:

A

hormones, vitamins, and medications

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17
Q

Used to determine whether a fluid is a urine

A

The specimen can be tested for urea and creatinine content.

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18
Q

Both these substances are present in much higher concentrations in urine than in other body fluids, a fluid that is high in content of these can be identified as urine.

A

urea and creatinine

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18
Q

A decrease in urine output

A

Oliguria

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19
Q

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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20
Q

In Oliguria, how much decrease in urine output in:

  • Infants
  • Children
  • Adults
A
  • Infants: less than 1 mL/kg/hr
  • Children: less than 0.5 mL/kg/hr in children
  • Adults: less than 400 mL/day
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20
Q

This 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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20
Q

Cessation of urine flow,

A

Anuria

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21
Q

The kidneys excrete ________more urine during the day than during the night

A

two to three times

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22
Q

An increase in the nocturnal excretion of urine is termed

A

nocturia

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23
Q

An increase in daily urine volume

A

Polyuria

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24
Q

Often associated with diabetes mellitus and diabetes insipidus

A

Polyuria

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25
Q

Polyuria may be induced artificially by:

A
  • Diuretics
  • Caffeine
  • Alcohol

All of which suppress the secretion of ADH

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26
Q

In Polyuria, how much increase in urine output in:

  • Children
  • Adults
A
  • Children: 2.5 to 3 mL/kg/day
  • Adults: greater than 2.5 L/day
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27
Q

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

A

Urea

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28
Q

Product of metabolism of creatine by muscles

A

Creatinine

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29
Q

Product of breakdown of nucleic acid in food and cells

A

Uric acid

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30
Q

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

A

Chloride

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30
Q

Regulates blood and tissue fluid acidity

A

Ammonium

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30
Q

Combines with chloride, sulfate, and phosphate

A

Calcium

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31
Q

Primarily from salt, varies by intake

A

Sodium

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32
Q

Combined with chloride and other salts

A

Potassium

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32
Q

Combines with sodium to buffer the blood

A

Phosphate

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33
Q

Caused by a defect either in the pancreatic production of insulin or in the function of insulin, which results in an increased concentration of body glucose

A

Diabetes mellitus

The kidneys do not reabsorb
excess glucose, necessitating the excretion of increased amounts
of water to remove the dissolved glucose from the body

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34
Q

Results from a decrease in the production or function of ADH; thus, the water necessary for
adequate body hydration is not reabsorbed from the plasma
filtrate.

A

Diabetes insipidus

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35
Q

Polyuria accompanied by increased fluid intake is often the first symptom of either disease.

A

Diabetes mellitus or insipidus

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36
Q

________ should be used because they eliminate the chance of contamination due to improper washing

A

Disposable containers

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37
Q

Urine specimens must be collected in?

A

clean, dry, leakproof containers

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38
Q

______containers are suggested if more than 2 hours elapse between specimen collection and analysis.

A

Sterile

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38
Q

All specimens must be labeled immediately after collection
with the:

A
  1. Patient’s last and first name
  2. Identification number
  3. date and time of collection
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38
Q

The recommended capacity of urine container is _____, which
allows _____ of specimen needed for microscopic analysis,
additional specimen for repeat analysis, and enough room for
the specimen to be mixed by swirling the container

A

50 mL; 12 mL

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39
Q

Labels must be…

A

attached to the container, not to
the lid, and should not become detached if the container is
refrigerated or frozen

40
Q

Caused by oxidation or reduction of metabolites

A

Color

40
Q

These increase in unpreserved urine

A

OPeN Bacteria

Odor, pH, Nitrite, and Bacteria

40
Q

These decrease in unpreserved urine

A
  1. Clarity
  2. Glucose
  3. Ketones
  4. Bilirubin
  5. Urobilinogen
  6. Red and white blood cells and casts
  7. Bacteria
  8. Trichomonas
41
Q

Decrease in this is caused by bacterial growth and precipitation of amorphous material

A

Clarity

41
Q

Increase is caused by bacterial multiplication causing breakdown of urea to ammonia

A

Odor

42
Q

Decrease of this is caused by glycolysis and bacterial use

A

Glucose

43
Q

Decrease in this is caused by volatilization and bacterial metabolism

A

Ketones

44
Q

Decrease in this is caused by exposure to light/photo oxidation to biliverdin

A

Bilirubin

45
Q

Increase in this is caused by multiplication of nitrate-reducing bacteria

A

Nitrite

45
Q

Decrease in this is caused by oxidation to urobilin

A

Urobilinogen

46
Q

Increase in this is caused by B\breakdown of urea to ammonia by urease-producing bacteria/loss of CO2

A

pH

47
Q

Decrease in this is caused by disintegration/lyse in dilute alkaline urine

A

Red and white blood
cells and casts

48
Q

Increase in this is caused by Multiplication

A

Bacteria

49
Q

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

A

2 hours

50
Q

Decrease in this is caused by loss of motility, death

A

Trichomonas

51
Q

A specimen that cannot be
delivered and tested within 2 hours should be ______ or have an appropriate _____________ added.

A

refrigerated; chemical preservative

52
Q

The method of preservation used most routinely is refrigeration
at

A

2°C to 8°C

53
Q

If the urine is to be cultured, it should be refrigerated during transit and kept refrigerated until cultured, up to _______.

A

24 hours

54
Q

Specimens must be returned to
____________ before chemical testing by reagent strips because the enzyme reactions on the strips perform best at room temperature

A

room temperature

55
Q

Can cause precipitation of amorphous urate and phosphate crystals.

A

Refrigeration

55
Q

Does not interfere with
chemical tests however, this precipitates amorphous phosphates and urates

A

Refrigeration

56
Q

The ideal preservative should be:

A

bactericidal, inhibit urease, and preserve formed elements in the sediment, does not interfere with chemical tests

56
Q

Prevents bacterial growth
for 24 hours

A

Refrigeration

57
Q

Keeps pH at about 6.0
Can be used for transport
of urine cultures

A

Acids (boric acid, HCL, acetic acid, tartaric acid)

58
Q

Prevents bacterial growth
and metabolism

A

Acids (boric acid, HCL, acetic acid, tartaric acid)

59
Q

interferes with analysis of
drugs and hormones

A

Acids (boric acid, HCL, acetic acid, tartaric acid)

60
Q

Excellent sediment
preservative

A

Formalin (formaldehyde)

60
Q

Acts as a reducing agent,
interfering with chemical
tests for glucose, blood,
leukocyte esterase, and
copper reduction

A

Formalin (formaldehyde)

61
Q

Rinse specimen container
with formalin to preserve cells and casts

A

Formalin (formaldehyde)

62
Q

Good preservative for drug
analyses

A

Sodium fluoride

63
Q

Inhibits reagent strip tests
for glucose, blood, and
leukocytes

A

Sodium fluoride

64
Q

Convenient when refrigeration is not possible. Have controlled concentration to minimize interference

A

Commercial preservative
tablets

65
Q

Check tablet composition to
determine possible effects
on desired tests

A

Commercial preservative
tablets

66
Q

It contains collection cup,
transfer straw, culture and
sensitivity (C&S) preservative tube, or UA tube

A

Urine Collection Kits4
(Becton, Dickinson,
Rutherford, NJ)

67
Q

Do not use if urine is below
minimum fill line

A

Light gray and gray
C&S tube or Cherry red/yellow
Preservative Plus tube

68
Q

Specimen stable at room
temperature (RT) for 48 hours; prevents bacterial growth and
metabolism

A

Light gray and gray
C&S tube

69
Q

Preservatives in Light gray and gray C&S tube

A
  • Boric acid
  • Sodium borate
  • Sodium formate
70
Q

Keeps pH at about 6.0

A

Acids (boric acid, HCL, acetic acid, tartaric acid) or Light gray and gray C&S tube

71
Q

Has round or conical bottom,

A

Yellow UA Plus tube or Cherry red/yellow Preservative Plus tube

72
Q

Use on automated
instruments

A

Yellow UA Plus tube

73
Q

Must refrigerate within 2 hours

A

Yellow UA Plus tube

74
Q

Specimen stable for
72 hours at RT;
instrument-compatible

A

Cherry red/yellow
Preservative Plus tube

74
Q

Bilirubin and urobilinogen
may be decreased if specimen is exposed to light and left at RT

A

Cherry red/yellow
Preservative Plus tube

75
Q

This has no preservative

A

Yellow UA Plus tube

76
Q

Preservatives in Cherry red/yellow Preservative Plus tube

A

Sodium propionate, ethyl paraben, and chlorhexidine

77
Q

The specimen received most commonly because of
its ease of collection and convenience for the patient

A

Random specimen

78
Q

This specimen is essential for preventing false-negative pregnancy tests and for evaluating orthostatic proteinuria

A

First Morning Specimen

79
Q

______ must be used to produce an accurate quantitative result

A

24-Hour (or Timed) Specimen

80
Q

Solutes that exhibit diurnal variations. They lowest concentration is in the early morning and the highest concentration occurs in the afternoon.

A

catecholamines, 17-hydroxysteroids, and electrolytes

81
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, __________ is required.

If the concentration of a particular substance remains constant, the specimen may be collected over a ________ period.

A

24-hour collection; shorter

82
Q

Common Errors Associated with Timed Urine Collections

A
  • Loss of urine specimen
  • Inclusion of two first morning specimens
  • Inaccurate measurement of total urine volume
  • Inadequate urine preservation
  • Transcription error
82
Q

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

A

an empty bladder

83
Q

In collecting 24-hour urine spx, it should be _______ or kept on _______ during the collection period and may require addition of a ___________

A

refrigerated; ice; chemical preservative

83
Q

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

A

midstream clean-catch

84
Q

Adding urine formed before the start of the collection period (24-hour collection) will falsely _______ the results, and failure to include the urine produced at the end of the collection period will falsely _______ the results

A

elevate; decrease

85
Q

This specimen is collected under sterile conditions by passing
a hollow tube through the urethra into the bladder.

A

Catheterized Specimen

86
Q

What should not be used as cleansing agents for midstream clean-catch?

A

Strong bacterial agents, such as
hexachlorophene or povidone-iodine

87
Q

Cleansing agent used for midstream clean-catch

A

Mild antiseptic towelettes

88
Q

This urine collection method may be collected by external introduction of a needle through the abdomen into the bladder

A

Suprapubic Aspiration

89
Q

T/F: The bladder is sterile under normal conditions

A

True

90
Q

This method is used for used for cytological examination and/or bacterial culture

A

Suprapubic Aspiration

91
Q

This method is used for used for routine screening and/or bacterial culture

A

Midstream Clean-Catch Specimen

92
Q

Methods used to detect the presence of prostatitis

A

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

93
Q

The test requested most commonly on a catheterized specimen is?

A

bacterial culture

94
Q

The first urine passed for three-glass collection is collected in a?

A

sterile container

95
Q

The first and third specimens for three-glass collection are?

A

examined microscopically

95
Q

The midstream portion for three-glass collection is collected in?

A

another sterile container

96
Q

In prostatic infection, the third specimen will have a ___________ and a ________ 10 times that of the first specimen

A

white blood cell/high power field count; bacterial count

97
Q

The second specimen for three-glass collection is used as a control for __________. If it is positive, the results from the ________ are invalid because infected urine has contaminated the specimen.

A

bladder and kidney infection; third specimen

97
Q

When both a routine urinalysis
and a culture are requested on a catheterized or midstream collection, what should be performed first?

A

The culture should be performed first to prevent contamination of the specimen.

98
Q

A clean-catch midstream urine specimen is collected. A second urine sample is collected after the prostate is massaged

A

Pre- and Postmassage Test

99
Q

Positive result for Pre- and Postmassage Test

A

Postmassage specimen of greater than 10 times the premassage count (bacteriuria).

100
Q

What is used for collecting urine of pediatric patients?

A

Clear plastic bags, hypoallergenic skin adhesive to attach to the
cleaned genital area of both boys and girls

101
Q

They describe the traditional four-glass urine collection technique

A

Meares and Stamey

102
Q

In Stamey-Meares Test for Prostatitis, this represents the urethral spx

A

The first urine specimen, voided bladder (VB1), the first 10 mL of urine

102
Q

In Stamey-Meares Test for Prostatitis, this represents the bladder spx

A

The second specimen, voided bladder 2 (VB2), another 10 mL of urine (after the px voids 100-150 mL of urine after the first 100 mL)

102
Q

In Stamey-Meares Test for Prostatitis, this consists
of the first 10 mL of urine collected after EPS; it contains
any EPS trapped in the prostatic urethra

A

The fourth specimen

103
Q

In Stamey-Meares Test for Prostatitis, this expressed prostatic specimen
(EPS), which is the fluid collected during prostatic massage

A

Third specimen

104
Q

In Stamey-Meares Test for Prostatitis, Urethral infection or inflammation is tested for by the?

A

VB1

105
Q

In Stamey-Meares Test for Prostatitis, The VB2 tests for?

A

urinary bladder infection

106
Q

These are cultured and examined for white blood cells. Having more than 10 to 20 white blood cells per high-power field is considered abnormal

A

Prostatic secretions in Stamey-Meares Test for Prostatitis

MTAP1: AUBF (17 decks)

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