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Phlebotomy > Chapter 5 Exam > Flashcards

Chapter 5 Exam Flashcards

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1
Q

How much protein indicates clinical proteinuria?

A

30 mg/dL; 300 mg/24 hours

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2
Q

What is another name for uromodulin?

A

Tamm-Horsfall

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3
Q

What temperture should the specimen be tested at?

A

Room temperature - Enzymatic reactions on the strip are temperature dependent.

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4
Q

What foods produce alkaline urine?

A

A vegetarian diet

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5
Q

What foods produce and acidic urine?

A

High protein diet; cranberry juice

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6
Q

What is the normal pH range of normal urine

A

4.5 to 8; first morning specimen is slightly acidic 5 -6

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7
Q

Can you test a urine with a pH of 9.0?

A

No, this indicates an improperly stored/aged specimen - a fresh specimen should be obtained

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8
Q

What should be done if a urine pH is 9.0?

A

Obtain a fresh specimen

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9
Q

What is orthostatic proteinuria?

A

Little to no protein production when supine - increased protein when standing

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10
Q

What age group is orthostatic proteinuria most commonly found?

A

Children and young adults

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11
Q

What causes orthostatic proteinuria?

A

Increased pressure on the renal vein when in the vertical postion

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12
Q

Is orthostatic proteinuria due to disease?

A

No, it is due to increased pressure on the renal vein - the kidneys are otherwise healthy

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13
Q

Is orthostatic proteinuria transitory or permanent?

A

Transitory - orthostatic proteinuria usually goes away by adulthood

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14
Q

What are Bence Jones proteins an indication of?

A

Multiple myleoma

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15
Q

What is unique about Bence Jones proteins’ solubility?

A

Bence Jones proteins coagulate at 40 - 60 C and dissolve when the temperature reaches 100 C

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16
Q

What protein does the the test pad detect?

A

Albumin

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17
Q

What are the causes of prerenal proteinuria?

A

Intravascular emolysis, muscle injury, acute phase reactants, multiple myeloma

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18
Q

What are the causes of renal proteinuria?

A

Glomerular disorders, immune complex disorders, amyloidosis, toxic agents, diabetic nephropathy, strenuous exercise, dehydration, hypertension, pre-eclampsia, orthostatic proteinuria

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19
Q

What are the causes of postrenal proteinuria

A

Lower UTI/inflammation, injury/trauma, prostatic fluid/spermatozoa, vaginal secretions

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20
Q

Which has the higher hydrogen ion concentration, acidic urine or alkaline urine?

A

Acidic urine

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21
Q

What 3 ketones are produced in normal fat metabolism?

A

Acetone (2%), acetoacetic acid (20%), β-hydroxybutyrate (78%)

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22
Q

Can the Clinitest detect glucose?

A

Yes, but it is not a confirmatory test for glucose. It also tests for reducing sugars including galactose, fructose, pentose, and lactose

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23
Q

What does excessive fizzing on the Clinitest indicate?

A

Deterioration of the hygroscopic Clinitest tablet due to accumulation of moisture

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24
Q

What is the Clinitest testing for, especially for children under 2 years of age?

A

Galactose presence represents an inborn error of metabolism - the enzyme glactose-1-phosphate uridyl transferase

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25
Q

In a patient with uncontrolled diabetes mellitus how would the pH, ketones, glucose, and specific gravity be affected?

A

pH will be decreased; ketones will be high; glucose will be high; specific gravity will be high

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26
Q

What complications are associated with a positive Clinitest?

A

Failure to thrive and other complications, including death

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27
Q

How do you store reagent strips?

A

Store at room temperature with a desiccant; keep away from light and volatile chemicals

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28
Q

What effect does epinephrine have on insulin secretion?

A

Epinephrine inhibits insulin secretion which can cause glycosuria

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29
Q

What is a “pass through” on the clinitest?

A

High levels of glucose can cause the color of the reactatnts to pass through the orange/red stage and return to a green-brown color, if not observed, a high glucose level may be reported as negative

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30
Q

What could cause glycosuria in the absence of hyperglycemia?

A

Hormonal disorders (pancreatitis, pancreatic cancer, acromegaly, Cushing’s syndrome, hyperthyroidism, pheochromocytoma), epinephrine, renal glycosuria

31
Q

What is the first reagent strip reaction read?

A

Glucose (30s)

32
Q

What is the last reagent strip reaction read?

A

Leukocyte esterase (120s)

33
Q

What tests use diazonium salt in their reactions?

A

Bilirubin, leukocyte esterase, and nitrite

34
Q

What is microalbumuria?

A

Low levels of urine protein that are not detected by routine reagent strips

35
Q

Why test for microalbumuria?

A

It can be used to detect small amounts of albumin which can be an early indicator of renal disease

36
Q

What group of patients benefit from microalbumuria testing

A

Diabetics (I & II) and patients at risk for renal disease

37
Q

What is the best specimen for the microalbumin test?

A

First morning

38
Q

What causes a false positive for the protein test?

A

Highly pigmented urine, high SG, quaternary ammonia compounds, detergents, antiseptics, chlorhexadine

39
Q

What is significance of trace glucose on reagent strip but 3+ for Clinitest?

A

This indicates the presence of reducing sugars other than glucose in the urine such as galactose, fructose, pentose, and lactose

40
Q

What can cause false negative or falsely lowered glucose results in urine?

A

Greatest source is old specimen (bacterial degredation); vitamin C and strong reducing agents, high levels of ketones(unlikely), high SG, low temperature

41
Q

Increased intake of vitamin C affects which tests?

A

Blood, bilirubin, nitrite

42
Q

Which test is better for specific gravity if patient had radiographic dye injected? Reagent strip or refractometer?

A

Reagent strip uses pKa to measure SG so it isn’t affected by high MW substances like radiographic dyes

43
Q

When should you run quality control on reagent strips?

A

Once every 24 hours, when a new bottle of strips is opened, when the results are questionable, when there are concerns about the integrity of the strip

44
Q

How close should positive control readings be to reference value?

A

They should agree with the published control value

45
Q

What causes ‘runover’ resulting in errors of color interpretation?

A

Excess urine remaining on the strip after its removal from the specimen

46
Q

What information does urine pH tell us?

A

Acid-base content of the blood, patient’s renal function, presence of a UTI, patient’s dietary intake, age of the specimen

47
Q

What would cause a false negative result on the microalbumin test?

A

Dilute urine

48
Q

What can cause ketonuria?

A

Increased fat metabolism due to inablity to metabolize carbohydrates; diabetes mellitus, starvation, vomiting, malabsorbtion

49
Q

What ketones are detected by the reagent dipstick?

A

Acetoacetic acid

50
Q

What is cloudy red urine and indication of?

A

RBCs

51
Q

What causes blood in urine?

A

Damage to renal system: renal calculi, glomerular disease, tumors, trauma, pyelonephritis, exposure to toxic chemicals, anticoagulants

52
Q

What causes myoglobin in urine?

A

Rhabdomylysis(muscle destruction): muscle trauma/crush syndromes, prolonged coma, convulsions, muscle-wasting disease, alcoholism, drug abuse, extensive exertion, statins

53
Q

If ammonium sulfate is added to red urine and sediment is red. What caused the red color?

A

Hemoglobin produces the red precipitate when mixed wit ammonium sulfate.

54
Q

Hemosiderin in urine is due to what being present in urine? Where does it come from?

A

Reabsorption of filtered hemoglobin results in the appearance of large yellow-brown granules of denatured ferritin called hemosiderin

55
Q

If you get a spotted reaction on the reagent strip for blood, what does that mean?

A

Spotting indicates intact RBCs

56
Q

If no rbcs in microscopic but blood test on reagent strip is positive, what caused the reaction?

A

Hemoglobin/myoglobin produce positive results on the blood reagent test

57
Q

Causes of positive blood on reagent strip?

A

RBCs, hemoglobin, myoglobin

58
Q

If patient has lower back pain and pulsating flank pain with positive blood reagent strip, what is most likely cause?

A

Kidney trauma

59
Q
  1. Urine yellow-green from jaundiced patient. Bilirubin negative. Why?
A

Specimen was not protected from light and the bilirubin was photo-oxidized to biliverdin

60
Q

What bilirubin shows up in urine? Conjugated or unconguated? What does that term mean? Which one binds to albumin?

A

Conjugated; the bilirubin is bound to glucuronic acid; unconjugated bilirubin is bound to albumin

61
Q

What is the ictotest? Why is it better than dipstick test?

A

The Ictotest tests for bilirubin in the urine; It removes any interfering substances to give a more reliable result

62
Q

Billirubin: +++
Urobilinogen: Normal

A

Indicates bile duct obstruction

63
Q

Bilirubin: + or -
Urobilinogen: ++

A

Indicates liver damage

64
Q

Bilirubin: Negative
Urobilinogen: +++

A

Indicates hemolytic disease

65
Q

What is stercobilinogen?

A

Substance derived from bilirubin that is found in the feces and is oxidized to form urobilin forming the brown color of feces

66
Q

What is urobilinogen? Formed from what? Where in body? Does it recyle back to liver?

A

A compound formed in the intestines by the bacterial reduction of bilirubin; some recirculates to the liver and excreted back to the intestine via the bile duct

67
Q

Where does urobilin come from?

A

The oxidization of stercobilinogen

68
Q

What is alkaline tide?

A

a period of urinary neutrality or even alkalinity after meals, resulting from withdrawal of hydrogen ion for the purpose of secretion of the highly acid gastric juice

69
Q

When is the best time to collect specimen for urobilinogen?

A

When the patient has been fasting or before a meal

70
Q

What organisms is the most common cause of UTI?

A

Gram-negative bacteria (Enterobacteriaceae

71
Q

Positive nitrite test indicates what? How many organisms present in urine specimen?

A

Presence of nitrate reducing bacteria; 100,000 per mL

72
Q
  1. Can bacteria be present in urine but dipstick negative? Why?
A

Non-nitrate reducing bacteria; bacteria weren’t in contact long enough with urine; bacteria reduced nitrite to nitrogen; no nitrate for the bacteria to reduce; antibiotics; vitamin C

73
Q

What causes false negative reaction on leukocyte esterase test?

A

Inaccurate timing; high SG; high protein, vitamin C, glucose, oxalic acid, presence of antibiotics

Phlebotomy (3 decks)

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