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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
In a patient with uncontrolled diabetes mellitus how would the pH, ketones, glucose, and specific gravity be affected?
pH will be decreased; ketones will be high; glucose will be high; specific gravity will be high
26
What complications are associated with a positive Clinitest?
Failure to thrive and other complications, including death
27
How do you store reagent strips?
Store at room temperature with a desiccant; keep away from light and volatile chemicals
28
What effect does epinephrine have on insulin secretion?
Epinephrine inhibits insulin secretion which can cause glycosuria
29
What is a "pass through" on the clinitest?
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
30
What could cause glycosuria in the absence of hyperglycemia?
Hormonal disorders (pancreatitis, pancreatic cancer, acromegaly, Cushing's syndrome, hyperthyroidism, pheochromocytoma), epinephrine, renal glycosuria
31
What is the first reagent strip reaction read?
Glucose (30s)
32
What is the last reagent strip reaction read?
Leukocyte esterase (120s)
33
What tests use diazonium salt in their reactions?
Bilirubin, leukocyte esterase, and nitrite
34
What is microalbumuria?
Low levels of urine protein that are not detected by routine reagent strips
35
Why test for microalbumuria?
It can be used to detect small amounts of albumin which can be an early indicator of renal disease
36
What group of patients benefit from microalbumuria testing
Diabetics (I & II) and patients at risk for renal disease
37
What is the best specimen for the microalbumin test?
First morning
38
What causes a false positive for the protein test?
Highly pigmented urine, high SG, quaternary ammonia compounds, detergents, antiseptics, chlorhexadine
39
What is significance of trace glucose on reagent strip but 3+ for Clinitest?
This indicates the presence of reducing sugars other than glucose in the urine such as galactose, fructose, pentose, and lactose
40
What can cause false negative or falsely lowered glucose results in urine?
Greatest source is old specimen (bacterial degredation); vitamin C and strong reducing agents, high levels of ketones(unlikely), high SG, low temperature
41
Increased intake of vitamin C affects which tests?
Blood, bilirubin, nitrite
42
Which test is better for specific gravity if patient had radiographic dye injected? Reagent strip or refractometer?
Reagent strip uses pKa to measure SG so it isn't affected by high MW substances like radiographic dyes
43
When should you run quality control on reagent strips?
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
How close should positive control readings be to reference value?
They should agree with the published control value
45
What causes ‘runover’ resulting in errors of color interpretation?
Excess urine remaining on the strip after its removal from the specimen
46
What information does urine pH tell us?
Acid-base content of the blood, patient's renal function, presence of a UTI, patient's dietary intake, age of the specimen
47
What would cause a false negative result on the microalbumin test?
Dilute urine
48
What can cause ketonuria?
Increased fat metabolism due to inablity to metabolize carbohydrates; diabetes mellitus, starvation, vomiting, malabsorbtion
49
What ketones are detected by the reagent dipstick?
Acetoacetic acid
50
What is cloudy red urine and indication of?
RBCs
51
What causes blood in urine?
Damage to renal system: renal calculi, glomerular disease, tumors, trauma, pyelonephritis, exposure to toxic chemicals, anticoagulants
52
What causes myoglobin in urine?
Rhabdomylysis(muscle destruction): muscle trauma/crush syndromes, prolonged coma, convulsions, muscle-wasting disease, alcoholism, drug abuse, extensive exertion, statins
53
If ammonium sulfate is added to red urine and sediment is red. What caused the red color?
Hemoglobin produces the red precipitate when mixed wit ammonium sulfate.
54
Hemosiderin in urine is due to what being present in urine? Where does it come from?
Reabsorption of filtered hemoglobin results in the appearance of large yellow-brown granules of denatured ferritin called hemosiderin
55
If you get a spotted reaction on the reagent strip for blood, what does that mean?
Spotting indicates intact RBCs
56
If no rbcs in microscopic but blood test on reagent strip is positive, what caused the reaction?
Hemoglobin/myoglobin produce positive results on the blood reagent test
57
Causes of positive blood on reagent strip?
RBCs, hemoglobin, myoglobin
58
If patient has lower back pain and pulsating flank pain with positive blood reagent strip, what is most likely cause?
Kidney trauma
59
43. Urine yellow-green from jaundiced patient. Bilirubin negative. Why?
Specimen was not protected from light and the bilirubin was photo-oxidized to biliverdin
60
What bilirubin shows up in urine? Conjugated or unconguated? What does that term mean? Which one binds to albumin?
Conjugated; the bilirubin is bound to glucuronic acid; unconjugated bilirubin is bound to albumin
61
What is the ictotest? Why is it better than dipstick test?
The Ictotest tests for bilirubin in the urine; It removes any interfering substances to give a more reliable result
62
Billirubin: +++ Urobilinogen: Normal
Indicates bile duct obstruction
63
Bilirubin: + or - Urobilinogen: ++
Indicates liver damage
64
Bilirubin: Negative Urobilinogen: +++
Indicates hemolytic disease
65
What is stercobilinogen?
Substance derived from bilirubin that is found in the feces and is oxidized to form urobilin forming the brown color of feces
66
What is urobilinogen? Formed from what? Where in body? Does it recyle back to liver?
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
Where does urobilin come from?
The oxidization of stercobilinogen
68
What is alkaline tide?
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
When is the best time to collect specimen for urobilinogen?
When the patient has been fasting or before a meal
70
What organisms is the most common cause of UTI?
Gram-negative bacteria (Enterobacteriaceae
71
Positive nitrite test indicates what? How many organisms present in urine specimen?
Presence of nitrate reducing bacteria; 100,000 per mL
72
52. Can bacteria be present in urine but dipstick negative? Why?
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
What causes false negative reaction on leukocyte esterase test?
Inaccurate timing; high SG; high protein, vitamin C, glucose, oxalic acid, presence of antibiotics

Phlebotomy (3 decks)

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