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AUBF LEC MIDTERMS > CHEMICAL EXAMINATION > Flashcards

CHEMICAL EXAMINATION Flashcards

1
Q

Provide a simple, rapid means for performing medically significant chemical analysis of urine
– pH: 60 seconds
– Protein: 60 seconds
– Glucose: _____
– Ketones: _____
– Blood: 60 seconds
– Bilirubin: _____
– Urobilinogen: 60 seconds
– Nitrite: 60 seconds
– Leukocyte esterase: _____
– Specific gravity: _____

A

– Glucose: 30 seconds
– Ketones: 40 seconds
– Bilirubin: 30 seconds
– Leukocyte esterase: 120 seconds
– Specific gravity: 45 seconds

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2
Q
  • Kidneys secrete hydrogen in the form of ammonium ions, hydrogen phosphate,
    and weak organic acids and reabsorb bicarbonate
A

PH

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3
Q
  • First morning urine pH of a healthy individual: _____
  • Random urine pH: _____
A

5.0 to 6.0

4.5 to 8.0

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4
Q

give 1 Clinical significance (under ph)

A
  • Aids in determining the existence of systemic acid-base disorders of
    metabolic or respiratory origin
  • Management of urinary conditions that require a specific pH to be
    maintained
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5
Q

Most indicative of renal disease

A

protein

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6
Q
  • Major serum protein found in urine:
A

albumin

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7
Q

Causes of proteinuria can be grouped into three major categories:

A
  • Pre-renal
  • Renal
  • Post-renal
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8
Q

Caused by conditions affecting the plasma prior to reaching the kidney

A

Pre-renal proteinuria

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9
Q

Pre-renal proteinuria

Caused by increased levels of ____ that exceed the normal reabsorptive capacity of the tubules

A

LMW plasma proteins

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10
Q
  • Monoclonal immunoglobulin light chains excreted by patients with
    multiple myeloma
A

Bence-jones protein

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11
Q
  • Historical screening test for BJP
    – If protein coagulates (becomes turbid) at 40℃ and 60℃ and dissolves (clears)
    at _____ (other proteins remain coagulated)
A

100℃

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12
Q

May be the result of either glomerular or tubular damage

A

Renal proteinuria

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13
Q

Renal proteinuria
* May be the result of either glomerular or tubular damage
- _____
– _____
– _____
– _____

A
  • Glomerular proteinuria
    – Microalbuminuria
    –Orthostatic (postural) proteinuria
    –Tubular proteinuria
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14
Q

presence of abnormal substances in the glomerular membrane may damage the glomerular membrane

A

Glomerular proteinuria

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15
Q

Glomerular proteinuria
* presence of abnormal substances in the glomerular membrane may damage the glomerular membrane
– _____
– _____
– _____

A

– Amyloid material in amyloidosis (buildup can cause organ failure)
– Toxic substances
– Immune complexes (main cause)

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16
Q

Common in patients with early-stage diabetic nephropathy leading to reduced glomerular filtration

A

microalbuminuria

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17
Q

microalbuminuria
* urinary albumin excretion of ____ mg/day, or _____ µg/min

A

30-300 mg/day

20-200 µg/min

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18
Q

Microalbuminuria/micral testing
* Micral-Test Reagent Strips

– Strips are dipped in urine for ___ and compared with the color chart after _____

A

5 seconds (1)

1 minute (2)

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19
Q

Microalbuminuria/micral testing
* Micral-Test Reagent Strips

What are the 7 steps ???

A

– Contain gold-labeled antihuman albumin antibody-enzyme conjugate
– Strips are dipped in urine for 5 seconds and compared with the color chart after 1 minute
– Albumin in the urine binds to the antibody. The bound and unbound conjugates move up the strip by wicking action.
– Unbound conjugates are removed in a captive zone by combining with albumin embedded in the strip.
– The urine albumin–bound conjugates continue up the strip and reach an area containing enzyme substrate.
– The conjugated enzyme reacts with the substrate, producing colors ranging from white to red.
– The amount of color produced represents the amount of albumin present in the urine.

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20
Q
  • Occurs following long periods spent in a vertical position and
    disappears when a horizontal position is assumed
  • Due to increased pressure on the renal vein
A

Orthostatic proteinuria

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21
Q

____ : if specimen 1 is negative for protein and specimen 2 is positive for protein

A

Orthostatic proteinuria

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22
Q

Failure to reabsorb filtered albumin

A

Tubular proteinuria

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23
Q

cause of Tubular proteinuria

A

exposure to toxic substances and heavy metals,
severe viral infections, Fanconi syndrome

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24
Q

a defect of proximal tubule leading to malabsorption of various electrolytes and substances that are usually absorbed by the proximal tubule

A

Fanconi syndrome

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25
Q
  • Bacterial and fungal infections and inflammations produce
    exudates containing protein
  • Presence of blood from injury or menstrual contamination
  • Prostatic fluid and large amounts of spermatozoa
A

Post-renal proteinuria

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26
Q
  • A cold precipitation test that reacts equally with all
    forms of protein
  • Add 3 ml of 3% SSA reagent to 3 ml centrifuged urine
A

Sulfosalicylic acid test

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27
Q
  • Most frequently performed chemical analysis on urine
  • Early diagnosis of diabetes mellitus through blood and urine glucose tests provides a greatly improved prognosis
A

glucose

28
Q
  • Blood glucose levels fluctuate, and a non-fasting normal person may have ____ following a meal containing a high glucose content
  • Ideal specimen: ____
  • For diabetes monitoring: ____
A

glycosuria (1)
fasting specimen (2)
2-hour post-prandial specimen(3)

29
Q

clinitest
* Measurement of glucose by ____
* A color change progressing from a
negative blue (CuSO4) through green, yellow, and ____ (Cu2O)

A

copper reduction method (1)
orange/red (2)

30
Q

Present only when the use of available carbohydrates becomes
compromised

A

KETONES

31
Q

KETONES
* Intermediate products of fat metabolism
– Acetone (____%)
– Acetoacetic acid (____%)
– β-hydroxybutyrate (____%)

A

2%
20%
78%

32
Q

Clinical significance
* ______
– Diabetes mellitus, mostly type 1 (diabetic ketoacidosis)

A

Inability to metabolize carbohydrate

33
Q

Clinical significance
* Increased loss of carbohydrate
– Vomiting
* ________
– Prolonged starvation
– Malabsorption/pancreatic disorders
– Severe alcoholism (alcoholic ketoacidosis)

A

Inadequate intake of carbohydrate

34
Q
  • Once carbohydrate stores become depleted and gluconeogenesis cannot occur anymore,
    ketogenesis is substantially increased, leading to metabolic acidosis.
  • Patients are usually very dehydrated from being hyperglycemic
A

DIABETIC KETOACIDOSIS

35
Q
  • The pathophysiology of AKA starts with low glycogen stores and a lack of oral food intake
  • Decreased oral intake causes decreased insulin levels and increased counterregulatory hormones such as cortisol, glucagon, and epinephrine
A

ALCOHOLIC KETOACIDOSIS

36
Q

Classic tests for ketone
* _______
– Discontinued due to many false-positive reactions
(salicylates)
* ______
– More sensitive to acetone and acetoacetate than reagent strips
– Acetoacetate: 1-5 mg/dL
– Acetone: 10-25 mg/dL

A

Ferric chloride test (Gerhardt’s test, 1865) (1)

Nitroprusside test (Legal’s test, 1883; modified by Rothera in 1908) (2)

37
Q

Reagent strip reactions
The addition of _____enables
detection of acetone (Chemstrip)

A

glycine

38
Q

Reaction interference

– Phthalein dyes
– Highly-pigmented red urine
– Levodopa (medication for Parkinson’s disease)

A

False positive (difference: color fades rapidly on standing)

39
Q

Reaction interference

– Improperly preserved specimens due to rapid volatilization of ketones (remedy: test
immediately or refrigerate!)

A

False negative

40
Q

Acetest tablets
Contains ___ ,___ , ___

Acetoacetate: ___ mg/dL
Acetone: ___mg/dL

A

nitroprusside, glycine, and lactose

Acetoacetate: 5-10
Acetone: 20

41
Q

Positive chemical test for blood is nonspecific: ___ , ___ , ___

A

red blood cells (hematuria)
hemoglobin (hemoglobinuria)
myoglobin (myoglobinuria)

42
Q

____ RBCs/μL of urine is clinically significant

A

5

43
Q

CLINICAL SIGNIFICANCE
*___ (cloudy or smoky red urine)
*____ (clear red-brown urine)
* ____(clear red urine)

A

Hematuria (1)
Myoglobinuria (2)
Hemoglobinuria (3)

44
Q
  • From trauma or damage of renal or genitourinary origin
  • May also be due to post-strenuous exercise and menstrual
    contamination
A

HEMATURIA

45
Q

HEMOGLOBINURIA
* Intravascular hemolysis
* If all available haptoglobin is bound, free Hgb is filtered by glomerulus and
excreted or processed by renal tubular cells into ______

A

hemosiderin

46
Q
  • Myoglobin: heme-containing protein found in muscle tissue
  • Muscle destruction/rhabdomyolysis
A

MYOGLOBINURIA

47
Q

HEMOGLOBINURIA VS.
MYOGLOBINURIA

Historical test:

A

ammonium sulfate precipitation

48
Q

HEMOGLOBINURIA VS.
MYOGLOBINURIA

  • Hemoglobin is larger and is precipitated
  • Myoglobin present: ___
  • Hemoglobin present: ____
A

(1) supernatant remains red, positive for blood

(2) red precipitate, negative for blood

49
Q

HEMOGLOBINURIA VS.
MYOGLOBINURIA

REACTION INTERFERENCE

Formalin as preservative -
Strong oxidizing reagents -

A

False negative (2)
False positive (1)

50
Q

Provides an early indication of liver disease (only conjugated
bilirubin is detected in urine)

A

BILIRUBIN

51
Q

BILIRUBIN
REACTION INTERFERENCE

  • Indican (intestinal disorders) -
  • Exposure to light -
A
  • False positive (1)
    False negative (2)
52
Q

ICTOTEST TABLETS
* Confirmatory test for bilirubin
* Can detect __ mg/dL of bilirubin

A

0.05 to 0.1 mg/dL of bilirubin

53
Q
  • Normally present in urine in concentrations of 1 mg/dL or less
A

UROBILINOGEN

54
Q

CLINICAL SIGNIFICANCE of UROBILINOGEN

give 1

A
  • Early detection of liver disease
  • Liver disorders, hepatitis, cirrhosis, carcinoma (hepatic)
  • Hemolytic disorders (pre-hepatic)
55
Q
  • Old qualitative screening for urobilinogen
A

CLASSIC EHRLICH’S
REACTION

56
Q
  • Urobilinogen reacts with _________________ (Ehrlich’s reagent) in an acid medium to form a pink, magenta, or red color
A

pdimethylaminobenzaldehyde

57
Q
  • Rapid screening test for the presence of UTI
  • Valuable in detecting initial bladder infection (cystitis)
A

NITRITE

58
Q

NITRITE
* Based on the ability of certain bacteria to reduce nitrate (normal constituent) to nitrite
* Sensitivity: ____organisms/mL

A

100,000 organisms/mL

59
Q

REACTION INTERFERENCE under nitrite
give 2-3

A
  • Bacteria that lack nitrate reductase
  • Insufficient contact time between bacteria and nitrate
  • Lack of urinary nitrate
  • Large quantities of bacteria further reducing nitrite to nitrogen
  • Antibiotics which inhibit bacterial metabolism
60
Q

A more standardized test than microscopic examination of urine sediment
* Can detect lysed WBCs which are not seen in microscopic examination

A

LEUKOCYTE ESTERASE

61
Q

LEUKOCYTE ESTERASE
* Normally, WBCs may be present in urine in small numbers
* ____ indicate a pathologic process
* Sensitivity: ____ WBCs/microliter

A

20/HPF (1)
10-25 (2)

62
Q

CLINICAL SIGNIFICANCE
* Infections caused by Trichomonas, Chlamydia, yeast, and inflammation of renal tissue produce _________

A

leukocyturia without bacteriuria

63
Q

REACTION INTERFERENCE of LEUKOCYTE ESTERASE
Highly –pigmented urine - ___
High concentrations of protein, glucose, oxalic acid, Vitamin C, gentamicin, cephalosporins, tetracyclines - ____

A
  • False positive (1)
  • False negative (2)
64
Q

SPECIFIC GRAVITY
* Expression of solute concentration
* A fixed SG of ___ regardless of
hydration implies significant renal
tubular dysfunction
* Reagent strip measures _______ solutes only

A

1.010 (1)
ionic or charged (2)

65
Q

T or F:
Direct specific gravity methods determine the actual or true density of urine, regardless of the solvents present. All solvents are detected and measured.

A

F - all solvents na words are solutes

AUBF LEC MIDTERMS (3 decks)

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