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Urinalysis > Chapter 6 > Flashcards

Chapter 6 Flashcards

1
Q

Reagent strips provide-

A

a simple, rapid means for performing routine chemical tests on urine

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2
Q

The brand and number of tests used are a matter of-

A

laboratory preference

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3
Q

reagent strips specified by-

A

urinalysis instrumentation manufacturers

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4
Q

reagent Strips consist of-

A

chemical-impregnated absorbent pads on a plastic strip

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5
Q

A color-producing chemical reaction takes place when-

A

the absorbent pad comes in contact with urine

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6
Q

Several degrees of color are shown to provide semi-quantitative readings of- (6)

A

-negative
-trace
-1+
-2+
-3+
-4+

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7
Q

reactions are interpreted by-

A

comparing the color produced on the pad within the required time frame with a chart supplied by the manufacturer

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8
Q

Estimates of mg/dL are also provided for-

A

many of the test areas

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9
Q

Urine reagent strips- (8)

A

-pH
-Protein
-Glucose
-Ketones
-Blood
-Bilirubin & urobilinogen
-Nitrate & leukocytes
-Specific gravity

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10
Q

reagent strip technique- (5)

A

-Dip strip briefly into well-mixed specimen at room temperature
-Remove excess urine by touching edge of strip to container as strip is withdrawn
-Blot edge of strip on absorbent pad
-Wait specified amount of time
-Read using a good light source

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11
Q

Formed elements such as red and white blood cells sink to the bottom of the specimen and will be-

A

undetected in an unmixed specimen

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12
Q

Allowing the strip to remain in the urine for an extended period may cause-

A

leaching of reagents from the pads

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13
Q

Excess urine remaining on the strip after its removal from the specimen can produce a runover between-

A

chemicals on adjacent pads, producing distortion of the colors

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14
Q

The timing for reactions to take place varies between-

A

tests and manufacturers; the manufacturer’s stated time should be followed

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15
Q

A good light source is essential for accurate interpretation of-

A

color reactions

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16
Q

The strip must be held close to the color chart without actually being placed on the chart; reagent strips and color charts from different manufacturers are not-

A

interchangeable

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17
Q

Specimens that have been refrigerated must be allowed to-

A

return to room temperature prior to reagent strip testing

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18
Q

handling & storing reagent strips- (6)

A

-Store with desiccant in an opaque, tightly sealed container
-Remove strips immediately prior to use
-Do not expose to volatile fumes
-Store below 30°C
-Do not use past the expiration date
-Visually inspect for discoloration/deterioration

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19
Q

Run positive and negative controls, usually at-

A

the beginning of a shift

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20
Q

Run additional controls
on reagent strips when- (3)

A

-a new bottle of strips is opened
-results are questionable
-there are concerns over strip integrity

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21
Q

Do not use distilled water as a negative control because-

A

reactions are designed for urine ionic concentration

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22
Q

All negative control readings should be-

A

negative

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23
Q

Positive control readings should agree with-

A

published control values

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24
Q

Confirmatory tests use different reagents or methodologies to detect-

A

the same substances as reagent strips with the same or greater sensitivity or specificity

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25
Q

Non-reagent strip testing procedures using tablets and liquid chemicals may be available when-

A

questionable results are obtained

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26
Q

Chemical reliability of these procedures also must be checked using-

A

positive & negative controls

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27
Q

Based on pKa (dissociation constant) of a-

A

polyelectrolyte in alkaline medium

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28
Q

Polyelectrolyte ionizes releasing H+ in relation to-

A

concentration of urine

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29
Q

a higher concentration of specific gravity in confirmatory tests means-

A

more H+ released

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30
Q

Indicator bromthymol blue measures-

A

pH change

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31
Q

Reagent Strip-Specific Gravity Reaction has no reaction interference from- (3)

A

-large molecules
-urea & glucose
-radiographic dye & plasma expanders

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32
Q

no reaction interference is the reason for-

A

difference in refractometer reading

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33
Q

Confirmatory Testing has a slight elevation of reaction interference from-

A

protein

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34
Q

decreased reaction interference reading- (2)

A

-Urine pH 6.5 or higher
-Interferes with indicator; add 0.005 to the reading; readers automatically add this

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35
Q

Lungs and kidneys are major regulators of-

A

acid-base content

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36
Q

First morning urine pH specimens are-

A

slightly acidic at 5.0 to 6.0

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37
Q

Postprandial urine pH specimen are more-

A

alkaline

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38
Q

normal urine pH range-

A

4.5 to 8.0

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39
Q

no absolute values are assigned in-

A

urine pH

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40
Q

urine pH Considerations include- (5)

A

-Acid-base content of the blood
-Patient’s renal function
-Presence of a uti
-Patient’s dietary intake
-Age of the specimen

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41
Q

Respiratory or metabolic alkalosis urine is-

A

alkaline

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42
Q

urine pH tests treat-

A

uti’s

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43
Q

urine pH tests are the Precipitation/identification of-

A

crystals

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44
Q

High-protein diets=

A

acidic urine

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45
Q

Low-protein diets=

A

alkaline urine

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46
Q

Respiratory or metabolic acidosis/ketosis urine is-

A

acidic

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47
Q

A pH above 8.5 is associated with a specimen that-

A

has been preserved improperly

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48
Q

A pH above 8.5 is associated with a specimen that has been preserved improperly and indicates-

A

that a fresh specimen should be obtained to ensure the validity of testing

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49
Q

pH-Reagent Strip Reactions are needed to measure between-

A

5.0 and 9.0 in one half or one unit increments

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50
Q

Double-indicator system reaction- (2)

A

-Methyl red = 4 to 6 red/orange to yellow
-Bromthymol blue = 6 to 9 green to blue

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51
Q

protein is most indicative of-

A

renal disease

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52
Q

Proteinuria seen in-

A

early renal disease

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53
Q

Normal protein reading-

A

<10 mg/dL or 100 mg/24 h

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54
Q

Low-molecular-weight serum proteins are-

A

filtered; many are reabsorbed

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55
Q

primary protein of concern-

A

albumin

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56
Q

Other proteins include- (2)

A

-Prostatic/seminal/vaginal secretions
-Uromodulin/tamm-horsefall

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57
Q

Presence of protein requires determination of-

A

normal or pathological condition

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58
Q

Clinical proteinuria becomes concern when-

A

30 mg/dL - 300 mg/24 h

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59
Q

Variety of causes of proteinuria- (3)

A

-Prerenal
-Renal
-Postrenal

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60
Q

pre renal proteinuria conditions affect-

A

the plasma, not the kidney

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61
Q

pre renal proteinuria isn’t indicative of-

A

renal disease

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62
Q

pre renal proteinuria are rarely seen on-

A

reagent strip (not albumin)

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63
Q

Multiple myeloma confirmation- (2)

A

-serum electrophoresis
-immunoelectrophoresis

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64
Q

Screening for BJP is not performed-

A

routinely

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65
Q

Screening Test for Bence Jones Protein (BJP) coagulates between-

A

40 C & 60 C

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66
Q

Screening Test for Bence Jones Protein (BJP) dissolves when-

A

temp reaches 100 C

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67
Q

Specimens suspected of containing BJP appear- (2)

A

-turbid between 40°C & 60°C
-clear at 100°

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68
Q

renal proteinuria, glomerular or tubular damage- (4)

A

-Glomerular proteinuria
-Microalbuminuria
-Orthostatic (postural) proteinuria
-Tubular proteinuria

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69
Q

glomerular proteinuria is damage to-

A

glomerular membrane

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70
Q

Impaired selective filtration causes-

A

increased protein filtration leading to cellular excretion

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71
Q

Abnormal substances deposit on-

A

membrane

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72
Q

Primarily immune disorders result in-

A

immune complex formation

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73
Q

primary immune disorders ex- (4)

A

-Lupus erythematosus
-glomerulonephritis
-amyloids
-other toxins

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74
Q

glomerular proteinuria increased pressure on the filtration mechanism- (4)

A

-Hypertension
-Strenuous exercise
-Dehydration
-Pregnancy (Preeclampsia)

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75
Q

Benign proteinuria (transient)- (4)

A

-Strenuous exercise
-high fever
-dehydration
-exposure to cold

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76
Q

occurs in diabetic nephropathy in people with type 1 & 2 diabetes mellitus- (2)

A

-microalbuminuria detection
-eventually renal failure

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77
Q

believed to account for orthostatic (postural) proteinuria-

A

Increased pressure on the renal vein when in the vertical position

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78
Q

orthostatic (postural) proteinuria occurs-

A

in vertical position, disappears in horizontal position

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79
Q

collection instructions for orthostatic (postural) proteinuria- (2)

A

-empty bladder before bed
-Collect 1st specimen immediately on arising & collect 2nd specimen after remaining in vertical position for several hours

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80
Q

Negative orthostatic (postural) proteinuria reading will be seen on-

A

first morning specimen

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81
Q

positive orthostatic (postural) proteinuria result will be found on-

A

second specimen

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82
Q

tubular damage affecting reabsorptive ability-

A

tubular dysfunction

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83
Q

causes of tubular dysfunction- (4)

A

-toxic substances
-heavy metals
-viral infections
-fanconi syndrome

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84
Q

fanconi syndrome-

A

generalized proximal convoluted tubule defect

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85
Q

amount of protein in urine found in glomerular disorders-

A

up to 4 g/day

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86
Q

amount of protein in urine found in tubular disorders-

A

much lower levels

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87
Q

protein can be added to the urine as it passes through- (2)

A

-lower urinary tract
-genitourinary tract

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88
Q

Microbial infections & inflammations cause release of-

A

interstitial fluid protein

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89
Q

the presence of blood in the urine contributes protein- (2)

A

-menstrual contamination
-semen/prostatic fluid

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90
Q

traditional reagent strip testing for protein uses the principle of-

A

protein error indicators

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91
Q

Certain indicators change color in the presence of-

A

protein at a constant pH

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92
Q

Protein accepts H+ from the indicator because-

A

increased sensitivity to albumin due to more amino groups to accept H+ than other proteins

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93
Q

indicators of reagent strip reactions- (4)

A

-Tetrabromophenol blue
-tetrachlorophenol
-tetrabromosulfonephthalein
-acid buffer

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94
Q

in the absence of protein at a pH level of 3, both indicators appear-

A

yellow

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95
Q

as protein concentration increases, color progresses through-

A

green to blue

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96
Q

negative reagent strip reactions in Postrenal Proteinuria are reported as- (3)

A

-negative trace
-1+, 2+, 3+, 4+
-30, 100, 300, 2000 mg/dL

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97
Q

reagent strip reaction trace values are considered to be-

A

less than 30 mg/dL

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98
Q

Highly buffered alkaline urine overrides acid buffer system causing-

A

color change unrelated to protein concentration

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99
Q

Leaving reagent pad in urine too long removes-

A

buffer

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100
Q

false-positives in postrenal proteinuria occur from- (2)

A

-Highly pigmented urine
-High SG

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101
Q

highly pigmented urine can be caused by-

A

AZO

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102
Q

Sulfosalicylic Acid (SSA) precipitation confirmatory test for-

A

protein

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103
Q

SSA is a Cold precipitation test that reacts equally with-

A

all forms of protein

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104
Q

SSA Precipitation tests Must be performed on centrifuged specimens to-

A

remove any extraneous contamination

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105
Q

Semiquantitative Microalbuminuria testing for-

A

patients at risk for renal disease

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106
Q

Immunochemical assays for- (2)

A

-albumin
-albumin-specific reagent strips

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107
Q

recommended tests for Microalbuminuria-

A

first morning specimens

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108
Q

micral-test reagent strips contain-

A

gold-labeled antihuman antibody-enzyme conjugate

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109
Q

Dip Microalbuminuria test strip in urine to mark level for-

A

5 seconds

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110
Q

albumin in the urine binds to-

A

the antibody

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111
Q

Bound and unbound conjugates move-

A

up strip

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112
Q

Unbound conjugates are removed in captive zone by containing-

A

albumin

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113
Q

bound conjugates continues up-

A

the strip

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114
Q

the conjugate enzyme reacts with the substrate producing colors ranging from-

A

white (neg) to red (varying deg)

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115
Q

the color of Microalbuminuria results are compared with a chart on the reagent strip bottle after-

A

1 minute

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116
Q

microalbuminuria results read from-

A

0 - 10 mg/dL

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117
Q

immunodip reagent strips use ______ technique-

A

Immunochromographic technique

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118
Q

strips are packaged individually in-

A

Specially designed container for strip

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119
Q

Testing for Microalbuminuria place container in controlled amount of specimen for-

A

3 min

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120
Q

urine in Microalbuminuria tests enters container through a-

A

vent hole

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121
Q

Albumin binds to blue latex particles coated with-

A

antihuman albumin antibody

122
Q

Bound and unbound particles migrate-

A

up strip

123
Q

Unbound particles encounters area of immobilized albumin on strip & forms-

A

blue band

124
Q

Bound particles continues migrating to an area of immobilized antibody and forms-

A

a second blue band

125
Q

Color of the band is compared with-

A

manufacturers color chart

126
Q

albumin reagent strip colors range from-

A

pale green to aqua blue

127
Q

Visibly bloody urine elevates-

A

results

127
Q

Abnormally colored urines may interfere with-

A

readings

128
Q

The most frequent chemical analysis performed on urine-

A

glucose

129
Q

Blood and urine glucose tests are included in-

A

all physical examinations

130
Q

blood & urine glucose tests are often the focus of-

A

mass health screening programs

131
Q

ureine & blood glucose tests are the major screening test for-

A

diabetes mellitus

132
Q

ureine & blood glucose renal threshold is-

A

160 - 180 mg/dL

133
Q

glycosuria-

A

higher blood sugar

134
Q

ureine & blood glucose test recommendations-

A

fasting

135
Q

urine & blood glucose test specimens are usually tested-

A

2 hours postprandial

136
Q

gestational diabetes occurs when-

A

hormones secreted by the placenta block action of insulin

137
Q

hormones secreted by the placenta block action of insulin causes- (3)

A

-High fetal glucose stresses baby’s pancreas
-Result is fat baby
-Mother prone to type 2 diabetes

138
Q

Glucose oxidase reaction has a specific test for-

A

glucose

139
Q

on glucose oxidase reagent strip test pad- (4)

A

-buffer
-glucose oxidase
-peroxide
-chromogen

140
Q

Glucose oxidase, peroxide, chromogen, & buffer on the test pad produce-

A

Double sequential enzyme reaction

141
Q

Glucose oxidase catalyzes a reaction between-

A

glucose and oxygen

142
Q

Glucose oxidase catalyzes a reaction between glucose and oxygen producing- (2)

A

-gluconic acid
-peroxide

143
Q

Peroxidase catalyzes the reaction between peroxide and chromogen to form-

A

an oxidized colored compound

144
Q

Peroxidase forms an oxidized colored compound that is directly proportional to-

A

the concentration of glucose

145
Q

chromogens used in Reagent Strip Glucose Oxidase Reactions- (2)

A

-Potassium iodide (green to brown) (Multistix)
-Tetramethylbenzidine (yellow to green) (Chemstrip)

146
Q

chromagens reporting results- (2)

A

-Neg, trace, 1+, 2+, 3+, 4+
-100 mg/dL to 2 g/dL

147
Q

False-positive glucose oxidase caused by-

A

only peroxide-oxidizing detergents from disinfectants used on lab instruments

148
Q

False-negative glucose oxidase caused by- (3)

A

-Ascorbic acid and strong reducing agents
-High levels of ketones (unlikely)
-High specific gravity and low temperature

149
Q

Greatest source of error is unpreserved specimens sitting at-

A

room temperature for extended periods, subjecting the glucose to bacterial degradation

150
Q

Reduction of copper sulfate to cuprous oxide with-

A

alkali and heat

151
Q

Clinitest tablets contain- (4)

A

-copper sulfate
-sodium carbonate
-sodium citrate
-sodium hydroxide

152
Q

Sodium citrate + NaOH produce-

A

heat

153
Q

CO2 is released from the sodium carbonate to prevent-

A

room air from interfering with the reduction reaction

154
Q

Reducing substance + CuSO4 causes a color change- (4)

A

-negative blue (CuSO4)
-green
-yellow
-orange/red (Cu2O)

155
Q

“Pass through” phenomenon may occur-

A

at high levels of glucose

156
Q

when “pass through” occurs, rapid reaction happens & color passes through-

A

orange/red and returns to green-brown

157
Q

repeat copper reduction clinitest with ____ procedure-

A

two-drop procedure

158
Q

two drop procedure instructions- (4)

A

-10 drops water
-2 drops urine
-Values up to 5 g/L versus 2 g/L
-Separate chart must be used

159
Q

clinitest is not a specific test for-

A

glucose

160
Q

Sensitivity of clinitest to glucose-

A

200 mg/dL (lower) than strip

161
Q

Clinitest does not provide a confirmatory test for-

A

glucose

162
Q

clinitest has interference from reducing sugars- (8)

A

-Galactose
-lactose
-fructose
-maltose
-pentoses
-ascorbic acid
-certain drug metabolites
-antibiotics

163
Q

Hygroscopic tablets deterioration due to moisture accumulation determined by-

A

strong blue color and excess fizzing

164
Q

Galactose in the urine of a newborn signifies-

A

an “inborn error of metabolism”

165
Q

galactose in urine of newborn- (2)

A

-Prevents breakdown of ingested galactose
-Results in failure to thrive and possible death

166
Q

All states must screen for galactosemia as part of-

A

newborn screening process

167
Q

early detection of galactose in urine of newborns method to control the condition-

A

Dietary restriction

168
Q

ketones represents 3 intermediate products of-

A

fat metabolism

169
Q

ketones fat metabolism- (3)

A

-Acetone: 2%
-Acetoacetic acid: 20%
-β-hydroxybutyrate: 78%

170
Q

ketones appear in urine when-

A

body stores of fat must be metabolized to supply energy

171
Q

clinical reasons for increased fat metabolism include-

A

inability to metabolize carbohydrate

172
Q

primary causes for clinical significance of ketones in the urine- (3)

A

-Diabetes mellitus
-Vomiting (loss of carbohydrates)
-Starvation, malabsorption, dieting (↓ intake)

173
Q

Ketonuria shows-

A

insulin deficiency

174
Q

ketonuria indicates the need to monitor-

A

diabetes

175
Q

Diabetic ketoacidosis-

A

increased accumulation of ketones in the blood

176
Q

ketoacidosis leads to- (3)

A

-Electrolyte imbalance
-dehydration
-diabetic coma

177
Q

Ketonuria is unrelated to-

A

diabetes

178
Q

positive ketone tests produced because the patients illness shows- (5)

A

-Inadequate intake/absorption of carbohydrates
-Vomiting
-Weight loss
-Eating disorders
-Frequent strenuous exercise

179
Q

Primary reagent strip for ketones-

A

sodium nitroprusside
(Nitroferricyanide)

180
Q

sodium nitroprusside (Nitroferricyanide) Measure primarily-

A

acetoacetic acid

181
Q

sodium nitroprusside (Nitroferricyanide) assumes the presence of-

A

β-hydroxybutyrate and acetone

182
Q

Acetoacetic acid (alkaline) reacts with nitroprusside to produce-

A

purple color

183
Q

reagent strip Report qualitatively- (5)

A

-Negative
-Trace
-Small (1+)
-Moderate (2+)
-Large (3+)

184
Q

large dosages of levodopa & medications containing sulfhydryl groups may produce-

A

atypical color reactions

185
Q

reactions with interfering substances may lead to false positive ketone results from-

A

improperly timed readings

186
Q

Falsely decreased values in improperly preserved specimens breakdown-

A

acetoacetic acid by bacteria

187
Q

Acetest tablet test used as confirmatory test for-

A

questionable results

188
Q

acetest tablets primarily used for- (2)

A

-testing serum
-other bodily fluids

189
Q

in tablet form, acetest provides- (4)

A

-sodium nitroprusside
-glycine
-disodium phosphate
-lactose (gives better color)

190
Q

specimen should be absorbed in tablet within-

A

30 seconds

191
Q

blood may be present in the urine in the form of- (2)

A

-hematuria
-hemoglobinuria

192
Q

hematuria- (2)

A

-intact RBCs
-Cloudy red urine

193
Q

hemoglobinuria- (2)

A

-product of RBC destruction
-Clear red urine

194
Q

Any amount of blood greater than five cells per microliter of urine is considered-

A

clinically significant

195
Q

Chemical tests for hemoglobin provide most accurate means for-

A

determining the presence of blood

196
Q

microscopic examination can be used to differentiate between-

A

hematuria and hemoglobinuria

197
Q

hematuria is most closely related to-

A

damage of renal system

198
Q

major causes of hematuria include- (7)

A

-Renal calculi
-Glomerular disease
-Tumors
-Trauma
-Pyelonephritis
-Exposure to toxic chemicals
-Anticoagulant therapy

199
Q

when the amount of free hemoglobin present exceeds the hepgaotglobin content is caused by- (6)

A

-Hemolytic anemias
-Transfusion reactions
-Severe burns
-Brown recluse spider bites
-Infections
-Strenuous exercise

200
Q

Hemoglobinuria may result from-

A

the lysis of red blood cells in dilute, alkaline urine

201
Q

Hemosiderin appears as-

A

yellow brown granules in sediment

202
Q

Myoglobinuria is a heme-containing protein in muscle tissue produces-

A

clear, red/brown urine

203
Q

Rhabdomyolysis also called-

A

muscle destruction

204
Q

Rhabdomyolysis examples- (8)

A

-Muscular trauma/crush syndromes
-Prolonged coma
-Convulsions
-Muscle-wasting diseases
-Alcoholism
-Heroin abuse
-Extensive exertion
-Cholesterol-lowering statin medications

205
Q

Principle pseudoperoxidase is the activity of-

A

hemoglobin

206
Q

pseudoperoxidase catalyze a reaction between the-

A

heme component

207
Q

reactions between the heme component of- (3)

A

-Hemoglobin and myoglobin
-Chromogen tetramethylbenzidine
-Produce an oxidized chromogen (Green-blue color)

208
Q

2 reagent strip color charts are provided that correspond to-

A

the reactions that occur

209
Q

free hemoglobin shows-

A

uniform color

210
Q

intact RBCs show-

A

speckled pattern on the pad

211
Q

used for reporting intact RBCs- (4)

A

-trace
-small (1+)
-moderate (2+)
-large (3+)

212
Q

intact RBCs sensitivity-

A

5 RBCs/μL

213
Q

false positive for blood in the urine- (4)

A

-menstrual contamination
-strong oxidizing agents
-vegetable peroxidase
-bacterial peroxidases

214
Q

false negative for blood in the urine- (6)

A

-Ascorbic acid >25 mg/dL
-High SG/crenated cells
-Formalin
-Captopril
-High concentrations of nitrite
-Unmixed specimens

215
Q

Urine bilirubin is an early indicator of-

A

liver disease

216
Q

bilirubin is a normal degradation product of-

A

hemoglobin

217
Q

RBCs destroyed by liver and spleen following-

A

120-day life span

218
Q

body recycles- (2)

A

-iron
-protein

219
Q

protoporphyrin is broken down into-

A

bilirubin

220
Q

bilirubin is bound to-

A

albumin

221
Q

kidneys cannot excrete-

A

bilirubin

222
Q

unconjugated bilirubin-

A

water insoluble: indirect

223
Q

Conjugated bilirubin-

A

water soluble: direct

224
Q

in the liver, bilirubin is conjugated with-

A

glucuronic acid

225
Q

when bilirubin is conjugated with glucuronic acid, it forms

A

conjugated bilirubin

226
Q

conjugated bilirubin passes from-

A

liver to intestines

227
Q

intestinal bacteria reduces bilirubin to- (3)

A

-urobilinogen
-stercobilinogen
-urobilin

228
Q

bilirubin is excreted in-

A

feces

229
Q

Conjugated bilirubin appears in urine with- (2)

A

-bile duct obstruction
-liver disease or damage

230
Q

Bilirubin backs up into circulation and is excreted in-

A

urine, no Urobilinogen is formed

231
Q

Hepatitis, cirrhosis-

A

Conjugated bilirubin leaks back into circulation from damaged liver; some bilirubin passes to intestine

232
Q

Detection of bilirubin can also be used in determining the cause of-

A

clinical jaundice

233
Q

bilirubin reagent strip principle is-

A

diazo reaction

234
Q

bilirubin reactions reported as- (4)

A

-neg
-small (1+)
-moderate (2+)
-large (3+)

235
Q

diazo reagent strip colors may be difficult to interpret because-

A

they’re easily influenced by other pigments present in the urine

236
Q

atypical colors in diazo reagent strips can be problematic for-

A

automated readers

237
Q

false positive in bilirubin tests caused by- (3)

A

-Urine pigments
-Pyridium (phenazopyridine)
-Lodine (NSAID)

238
Q

false negative in bilirubin tests caused by- (3)

A

-Old specimens (biliverdin does not react)
-Ascorbic acid >25 mg/dL
-Nitrite

239
Q

nitrite may cause false negatives in bilirubin tests because-

A

substances combine with diazonium salt and block bilirubin reaction

240
Q

Confirmatory test for bilirubin-

A

ictotest

241
Q

ictotest tablets contain- (4)

A

-p-nitrobenzene-diazonium-p-toluenesulfonate
-SSA
-sodium carbonate
-boric acid

242
Q

ictotest mats keeps-

A

bilirubin on surface for reaction

243
Q

ictotest positive reaction (color)-

A

blue - purple color

244
Q

interfering substances in ictotest-

A

are washed into the mat, and only bilirubin remains on the surface

245
Q

Bilirubin in intestines is converted to-

A

-urobilinogen
-stercobilinogen

246
Q

urobilinogen is reabsorbed into-

A

circulation

247
Q

stercobilinogen cannot be reabsorbed, but is oxidized to-

A

stercobilin

248
Q

Pigments responsible for the characteristic brown color of feces- (2)

A

-stercobilin
-urobilin

249
Q

measurement of urobilinogen filtered by the kidneys & found in the urine-

A

less than 1 mg/dL (less than 1 EU/dL)

250
Q

increased urine urobilinogen is the early detection of- (2)

A

-liver disease
-hemolytic disorders

251
Q

measurement of increased urine urobilinogen-

A

greater than 1 mg/dL (EU/dL)

252
Q

disorders associated with increased urin Urobilinogen- (4)

A

-Liver disorders
-hepatitis
-cirrhosis
-carcinoma

253
Q

hemolytic disorders in increased urine urobilinogen-

A

Excess bilirubin being converted to urobilinogen and ↑ urobilinogen recirculated to liver

254
Q

Negative bilirubin and strong positive urobilinogen are seen in-

A

hemolytic disorders

255
Q

when urobilinogen tests are performed ____% of the non-hospitalized population show elevated results-

A

1%

256
Q

when urobilinogen tests are performed ____% of the hospitalized population show elevated results-

A

9%

257
Q

elevated urobilinogen results are frequently caused by-

A

constipation

258
Q

No urobilinogen is seen in the urine with-

A

bile duct obstruction (strip will give normal results

259
Q

urobilinogen reagent strips cannot report-

A

a negative reading

260
Q

urobilinogen reagent strip reactions differ between- (2)

A

-Multistix
-Chemstrip

261
Q

multistix uses a modification of Ehrlich’s reaction where urobilinogen reacts with-

A

p-dimethylaminobenzaldehyde (Ehrlich reagent)

262
Q

multistix results are reported in-

A

Ehrlich units (EU) 1 EU = 1 mg/dL

263
Q

multistix normal readings- (3)

A

-0.2 - 1
-abnormal
-2,4,8

264
Q

multistix color reading-

A

light to dark pink

265
Q

chemstrip uses _____ reaction-

A

diazo (azo-coupling) reaction

266
Q

chemstrip diazo (azo-coupling) reaction using-

A

4-Methoxybenzene-diazonium-tetrafluoroborate (more specific than Ehrlich reaction)

267
Q

chemstrip results reported in-

A

mg/dL

268
Q

chemstrip color reaction-

A

white - pink

269
Q

Ehrlich reactive compounds- (7)

A

-porphobilinogen
-indican
-p-aminosalicylic acid
-sulfonamides
-methyldopa
-procaine
-chlorpromazine

270
Q

ehrlich testing should be at-

A

room temp

271
Q

urobilinogen is highest- (2)

A

-after meals (increased bile salts)
-old specimens & formalin preservation decrease results

272
Q

Chemstrip false-negative with-

A

high nitrite interferes with diazo reaction

273
Q

nitrite tests-

A

Rapid screening test for the presence of urinary tract infection (UTI)

274
Q

nitrite tests valuable for detecting-

A

cystitis (initial bladder infection)

275
Q

pyelonephritis (tubules) caused by-

A

untreated cystitis

276
Q

nitrite test also used for- (2)

A

-Evaluation of antibiotic therapy
-Monitoring of patients at high risk for urinary tract infection

277
Q

many labs use nitrite test in combination with LE test to-

A

Screen urine culture specimens

278
Q

UTIs most commonly caused by gram-negative organisms- (4)

A

-E. Coli
-Proteus species
-Enterobacter species
-Klebsiella species

279
Q

chem basis of nitrite test is the ability of bacteria to-

A

reduce nitrate (normal constituent) to nitrite (abnormal)

280
Q

greiss reaction happens when nitrite reacts with aromatic amine to form-

A

diazonium salt that then reacts with tetrahydrobenzoquinoline to form a pink azodye

281
Q

nitrite tests correspond with a quantitative bacterial culture criterion of-

A

100,000 organisms/mL

282
Q

nitrite test results reported as- (2)

A

-negative
-positive

283
Q

causes false negative in nitrite tests- (7)

A

-Non-reductase-containing bacteria
-Insufficient contact time between bacteria and urinary nitrate
-Lack of urinary nitrate
-Large quantities of bacteria converting nitrite to nitrogen
-Presence of antibiotics
-High concentrations of ascorbic acid
-High specific gravity

284
Q

negative nitrite test results in the presence of even vaguely suspicious clinical symptoms should always be - (2)

A

-repeated
-followed by a urine culture

285
Q

leukocyte esterase tests offers-

A

more standardized means for the detection of leukocytes

286
Q

purpose of LE tests-

A

detect leukocytes so as not to rely on microscopic

287
Q

advantage of LE tests-

A

detects presence of lysed leukocytes

288
Q

LE tests aren’t considered-

A

quantitative tests

289
Q

if LE tests are positive, perform-

A

microscopic

290
Q

LE test normal values vary from-

A

0 - 2 to 0 - 5 per high-power field (hpf)

291
Q

increased WBCs in LE tests indicate-

A

UTI

292
Q

Neutrophils are most frequently associated with-

A

bacterial infections

293
Q

LE tests also seen with- (4)

A

-Trichomonas
-Chlamydia
-yeast
-interstitial nephritis

294
Q

LE catalyzes hydrolysis of acid esterase on pad to- (2)

A

-aromatic compound
-acid

295
Q

aromatic compound reacts with diazonium salt on pad for-

A

purple color

296
Q

LE reaction requires-

A

the longest time of all the reagent strip reactions (2 min)

297
Q

LE results reported as- (4)

A

-Trace
-Small: 1+
-Moderate: 2+
-Large: 3+

298
Q

LE trace readings may not be significant and should be repeated on-

A

a fresh specimen

299
Q

LE false positive caused by- (3)

A

-Strong oxidizing agents
-Formalin
-Highly pigmented urine, nitrofurantoin

300
Q

LE false negative caused by- (4)

A

-High concentrations of protein, glucose, oxalic acid, ascorbic acid
-Crenation from high specific gravity
-Inaccurate timing: must have 2 min
-Presence of the antibiotics; gentamicin, cephalosporins, tetracyclines

Urinalysis (7 decks)

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