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Clinical Microscopy > Chemical Examination Of Urine > Flashcards

Chemical Examination Of Urine Flashcards

1
Q

Urine parameter/s that is read at 30 sec

A

Glucose and Bilirubin

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2
Q

Ketones are read at how many seconds?

A

40 seconds

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3
Q

Specific gravity is read at how many seconds?

A

45 seconds

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4
Q

Give the 5 urine parameters read at 60 seconds

A

Protein, pH, blood, urobilinogen, nitrite

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5
Q

The longest to urine parameter to read (give the time and parameter)

A

Leukocytes = 120 seconds

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6
Q

What is the purpose of a desiccant in an opaque tightly closed container for reagent strips

A

It absorbs moisture

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7
Q

Reagent strips should be stored below __.

A

Below 30C (do not freeze)

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8
Q

Principle behind automated reagent strip readers

A

Reflectance photometry

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9
Q

Normal specific gravity in a normal random urine

A

1.003-1.035

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10
Q

The specific gravity when radiographic dye is present

A

> 1.040

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11
Q

Complete the equation:

Isosthenuria: SG __ 1.010
Hyposthenuria: SG __ 1.010
Hyper strenuous: SG __ 1.010

A

Isosthenuria SG = 1.010
Hyposthenuria SG <1.010
Hypersthenuria SG >1.010

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12
Q

Needed volume for urinometer and the calibration temperature

A

10-15* mL ; 20C

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13
Q

Refractometry utilizes what principle

A

Refractive index

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14
Q

TRUE/ FALSE

Refractometer needs temperature correction, but does not require glucose and protein correction

A

FALSE.

  • temperature correction is not required
  • glucose and protein correction is required
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15
Q

Give the calibration for the refractometer specific gravity:

  1. Distilled water
  2. 3% NaCl
  3. 5% NaCl
  4. 7% NaCl
  5. 9% Sucrose
A
  1. Distilled water - 1.000
  2. 3% NaCl - 1.015 +/- 0.001
  3. 5% NaCl - 1.022 +/- 0.001
  4. 7% NaCl - 1.035 +/- 0.001
  5. 9% Sucrose - 1.034 +/- 0.001
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16
Q

The principle behind reagent strip reaction for SpGr

A

Change in dissociation constant (pKa)

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17
Q

A 1.000 SpGr indicates a __ color; a 1.030 SpGr indicates a __ color

  • SG strip sensitivity = 1.000-1.030
A

1.000 = blue ; 1.030 = yellow

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18
Q

Reagent utilized in SpGr strip

A

Poly* Bromthymol blue

Ethyl * Bromthymol blue

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19
Q

Harmonic oscillation density meter is based on the frequency of ___, and requires ___ mL urine volume in which ___ mL is utilized for IRIS Mass Gravity Meter

A

Soundwave ; 6mL ; 2mL

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20
Q

What does IRIS stand for

A

International Remote Imaging System

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21
Q

A high concentration of __ may yield a false (+) in the determination of SpGr; while a/n __ may yield a false (-)

A

Protein (+)

Highly alkaline urine (pH>/=6.5) (-)

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22
Q

A pH of 9 signifies a __

A

Unpreserved urine

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23
Q

Normal pH in random specimen and 1st morning specimen

A

Random 4.5-8.00

First morning 5.0-6.0

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24
Q

Principle of the reagent strip reaction for pH, and give the reagents

A

Double indicator system; methyl red and bromthymol blue

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25
Q

This parameter is the most indicative of renal disease

A

Protein

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26
Q

Protein in urine produces (yellow/white) foam in urine when shaken

A

White foam

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27
Q

Major serum protein found in urine ; give the normal excretion rate

A

Albumin (<150mg/Day)

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28
Q

Proliferation of Ig-producing plasma cells

A

Multiple myeloma

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29
Q

This protein is seen and is indicative of multiple myeloma. In the urine, this protein precipitates at __ and dissolves at __.

A

Bence-Jones protein (precipates at 40-60C; dissolves at 100C)

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30
Q

Glomerular proteinuria is caused by what disease

A

Diabetic nephropathy

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31
Q

Normal albumin excretion rate

A

0-20 ug/min

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32
Q

Indicator for glomerular nephropathy (give the AER)

A

Microalbuminuria (20-200 ug/min)

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33
Q

A >200 ug/min AER indicates ___ albuminuria

A

Clinical albuminuria

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34
Q

Test for microalbuminuria which utilizes _ principle

A

Micral test ; enzyme immunoassay

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35
Q

Reading time for micral test and a the color that indicates a positive reaction

A

60 s; red

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36
Q

Orthostatic proteinuria shows a __ of protein in 1st morning specimen and a __ protein after 2 hrs. standing

A

Negative ; positive

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37
Q

Principle behind protein reagent strip

A

Protein sorensen’s error of indicators

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38
Q

Reagent for protein strip

A

Citrate buffet at pH 3.00

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39
Q

A high specific gravity will yield a false _ result in the determination of protein

A

False positive

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40
Q

Indicator for protein (protein sorensens error of indicators) is highly sensitive to _

A

Albumin ONLY

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41
Q

Test used to measure all forms of proteins

A

Sulfosalicylic acid (SSA) precipitation test

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42
Q

Most frequently tested in urine

A

Glucose (dextrose)

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43
Q

It is a defective tubular reabsorption of glucose and amino acids

A

Fanconi syndrome

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44
Q

Principle for glucose strip

A

Double sequential enzyme reaction

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45
Q

Sensitivity of reagent strip to glucose is __ mg/dL

A

100 mg/dL

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46
Q

Copper reduction test is also called as __

A

Clinitest/ Benedict’s Test

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47
Q

This test is a nonspecific test for reducing sugars

A

Copper reduction test

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48
Q

True / False

Clinitest can detect all sugars

A

False. It cannot detect SUCROSE

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49
Q

To prevent pass through phenomenon, what should be done

A

Lower the volume (5gtts —> 2gtts)

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50
Q

Give the percent composition of ketone bodies

  1. Beta-hydroxybutyric acid
  2. Acetoacetic acid / diacetic acid
  3. Acetone
A
  1. 78% = Beta-hydroxybutyric acid
  2. 20% = Acetoacetic acid / diacetic acid
  3. 2%= Acetone
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51
Q

Parent ketone

A

AAA

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52
Q

Major ketone but is not detected in the reagent strip

A

Betahydroxybutyric acid

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53
Q

Principle employed in ketone reagent strip

A

Sodium nitroprusside reaction

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54
Q

Why is mixing a urine specimen prior to testing important

A

So that formed elements will not settle at the bottom, and be detected

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55
Q

Reagent strips should be dipped in an uncentrifuged / centrifuged urine at __ temperature

A

Uncentrifuged; room temperature

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56
Q

Why do specimens that have been refrigerated be allowed to return to room temp before reagent strip testing

A

Because enzymatic reactions on the strip are temperature dependent

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57
Q

Reagent bottles should not be opened in the presence of __

A

Volatile fumes

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58
Q

Reagent strips must be tested with both (+) and (-) controls a minimum of once every __

A

24 hrs

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59
Q

True / false

Distilled water is recommended as a negative control for reagent strips

A

False. Strips are designed to follow an ionic concentrations similar to urine

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60
Q

Persons taking phenazopyrodine compounds may interfere the strip reaction due to the ___ colored urine

A

Orange pigment

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61
Q

What are the major regulators of the acid-base content in the body

A

Kidney and lungs

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62
Q

Refers to a more alkaline urine pH following a meal

A

Alkaline tide

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63
Q

In respiratory / metabolic acidosis not relations to renal function disorder, urine is __

A

Acidic

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64
Q

True / False
urinary pH that does not conform to the respiratory / metabolic pH may indicate a disorder of the kidneys to reabsorb / secrete acids or bases

A

TRUE

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65
Q

True / False

Bacteria readily multiply in acidic urine

A

False. Bacteria favors alkaline

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66
Q

Persons on high protein and high meat diets tend to have acidic / basic urine; while vegetarians tend to have an acidic / alkaline urine

A

Acidic ; alkaline

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67
Q

Hyperventilation yields an acidic/alkaline urine

A

Alkaline

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68
Q

Renal tubular acidosis yields an acidic/alkaline urine

A

Alkaline

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69
Q

In the pH reagent strip reaction, methyl red produces a color change from red to yellow in the pH of __; while bromthymol blue produces a color change from yellow to blue in the pH of __.

A

Red to yellow: 4-6 pH

Yellow to blue: 6-9 pH

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70
Q

pH range of the reagent strip

A

5-9

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71
Q

Proteinuria is often associated with __.

A

Early renal disease

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72
Q

This protein is produced by the renal tubular epithelial cells (give its new name as well)

A

Tamm-Horsfall protein (uromodulin)

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73
Q

Where specifically is uromodulin produced?

A

Distal convoluted tubule

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74
Q

This type of proteinuria is NOT indicative of renal disease. It is caused by increased levels of plasma proteins (myoglobin/hemoglobin), and the acute phase reactants in the blood.

A

Prerenal Proteinuria

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75
Q

True / False: Bence Jones protein is seen in renal proteinuria

A

False. Bence Jones protein is associated with Multiple myeloma (increased proteins (Ig) in the blood) therefore it is seen in PRE-RENAL PROTEINURIA.

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76
Q

Proteinuria associated with true renal disease

A

Renal proteinuria

77
Q

True / False:
Amyloid material and the immune complexes found in SLE and streptococcal glomerulonephritis are major causes of proteinuria due to glomerular damage

78
Q

True/ False:
Increased pressure from the blood entering the glomerulus may override the selective filtration of the glomerulus, causing increased albumin to enter the filtrate. This condition is irreversible.

A

False. This condition is REVERSIBLE (e.g. exercise, dehydration, hypertension)

79
Q

Benign/malignant proteinuria is produced in conditions such as strenuous exercise, high fever, dehydration, and exposure to cold.

80
Q

Patients with microalbuminuria are associated with an increased risk of __.

A

Cardiovascular disease

81
Q

In orthostatic/ postural proteinuria (benign), increased pressure on the renal vein when in the __ position is believed to account for this condition.

A

Vertical / Standing

82
Q

Fanconi syndrome is classified under which type of proteinuria? (orthostatic/glomerular/tubular/pre-renal)

A

Tubular. *Defective tubular reabsorption of glucose and AAs

83
Q

True / False:
The presence of blood (e.g. injury/menstrual contamination) as well as prostatic fluid and large amounts of spermatozoa may contribute to protein

84
Q

Why is the protein reagent strip more specific to albumin?

A

Albumin contains more amino groups to accept the Hydrogen ions from the indicator

85
Q

__ color indicates the absence of protein

86
Q

Trace values of protein are considered to be less than __ mg/dL

87
Q

A false-positive reaction for protein may be due to: (2)

A
  1. Highly Alkaline urine

2. High Specific Gravity

88
Q

Sulfosalicylis Acid Precipitation reacts equally to all forms of __

89
Q

Specimen for SSA

A

Centrifuged urine

90
Q

Reagent for micral-test

A

Gold-labeled antihuman albumin antibody-enzyme conjugate

91
Q

How many seconds is the strip for the micral test dipped in the urine?

92
Q

Proteins other than Albumin will yield a false __ result in the protein determination

93
Q

Microalbuminuria will yield a false __ result in the protein determination

94
Q

Immunodip reagent strip uses ___ technique. This is also for the determination of ___.

A

Immunochromatographic technique; Protein (albumin)

95
Q

In the immunodip reagent strip, a darker bottom band is __, equal band color is __, and a darker top band represents a __ result.

A

Bottom - negative
Equal - borderline
Top - positive

96
Q

True / False:
By comparing the albumin excretion to the creatinine excretion, the albumin reading can be corrected for over-hydration and dehydration in a random sample.

A

True. Creatinine is produced and excreted at a consistent rate.

97
Q

The reagent strip for creatinine follows the same principle as the reaction for __

A

Blood

* Creatinine strip principle: Psuedoperoxidase activity of copper-creatinine complexes

98
Q

Normal creatinine concentration in the urine

A

10-300 mg/dL

99
Q

Glucose is actively reabsorbed at __

A

Proximal convoluted tubule

100
Q

It refers to the blood level at which tubular reabsorption stops.

A

Renal Threshold

101
Q

Renal threshold of glucose

A

160-180 mg/dL

102
Q

True/False

Fasting is not necessary when testing for glucose

A

FALSE. The most informative glucose results are obtained from specimens collected under controlled conditions (avoiding glycosuria following meals)

103
Q

For purpose of diabetes monitoring, specimens are usually tested __ min/hrs after meals

104
Q

Hyperglycemia that occurs during pregnancy

A

Gestational diabetes

105
Q

The onset of hyperglycemia and glycosuria is usually on the __ month of pregnancy

A 
6th month (2nd trimester) 
* hormones secreted by the placenta block the action of insulin
106
Q

True or false: Insulin can pass the placenta

A

FALSE. Only glucose can pass the placenta

107
Q

Babies who are affected by gestational diabetes

A

Macrosomia (large baby)

108
Q

The primary function of insulin

A

Glycogenesis (glucose-> glycogen)

109
Q

This refers to glycosuria in the absence of hyperglycemia

A

Renal glycosuria

110
Q

Intermediate product of the reagent strip glucose oxidase reaction

A

Gluconic acid and peroxidase

111
Q

False-positive reactions for glucose may be a result of _.

A

Contamination by oxidizing reagents

112
Q

Contamination of ascorbic acid for glucose strip may result in a false _ reaction

A

Negative

* Ascorbic acid prevents the oxidation of the chromogen

113
Q

The greatest source of error for false (-) for glucose strip

A

Technical error of allowing specimens to remain unpreserved at room temperature for extended periods

114
Q

Reagents of Benedict Solution

A
  1. Copper sulfate
  2. Sodium bicarbonate
  3. Sodium citrate buffer
115
Q

True/False

Clinitest can provide confirmatory testing for glucose

116
Q

This type of sugar in the urine of a newborn represents an inborn error of metabolism

117
Q

Galactose in the urine of a newborn may indicate that there is a lack of the enzyme called _ which prevents the breakdown of ingested galactose which often leads to death

A

galactose-1-phosphate uridyl transferase

118
Q

Clinitest is performed on pediatric specimens from patients up to __.

A

At least 2 years of age

119
Q

A phenomenon that occurs at high glucose levels wherein the orange/red stage returns to a __ color, and may be reported as __.

A

Pass through phenomenon; greenish-brown color; negative

120
Q

Testing for ketones is most valuable in the management and monitoring of Type __ DM.

A

Type I (Insulin-dependent)

121
Q

Ketonuria signifies a deficiency in __

122
Q

Positive color that indicates the presence of Protein

123
Q

Positive color that indicates the presence of Ketones

124
Q

Confirmatory test for ketones

A

Acetest tablet test

125
Q

Blood present in the urine in intact red blood cells

126
Q

Blood present in the urine as the product of RBC destruction

A

Hemoglobinuria

127
Q

How to differentiate hematuria and hemoglobinuria?

A

Hematuria: Cloudy red urine
Hemoglobinuria: Clear red urine

128
Q

Blood gathered at _uL of urine is clinically significant

A

> 5 microliters of urine

129
Q

True/False:

Microscopic tests provide the most accurate means for determining the presence of blood.

A

False. Chemical tests provide the most accurate means for determining the presence of blood. Free hemoglobin is NOT seen in microscopic examination.

130
Q

A (+) reagent strip test for blood indicates the presence of __, __, and __.

A

RBCs, Hemoglobin, Myoglobin

131
Q

Patients with severe back and abdominal pain are suspected of having __.

A

Renal calculi

132
Q

Hemoglobinuria may be produced in the urinary tract as a product of ___ urine.

A

dilute, alkaline urine

133
Q

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

A

Hemosiderin

134
Q

Color of urine in myoglobinuria

A

Clear red-brown urine (at atleast 25mg/dL myoglobin0

135
Q

Patients with this condition are suspected of myoglobinuria

A

Rhabdomyolysis

136
Q

True/False

The heme portion of myoglobin is toxic to the renal tubules, and high concentrations can cause renal failure.

137
Q

Chromogen for blood reagent strip

A

Tetramethylbenzidine

138
Q

Used to differentiate myoglobinuria and hemoglobinuria

A

Blondheim’s test

** Hemoglobinuria will yield a red precipitate

139
Q

A uniform green-blue in the Blood strip indicates __, while a speckled pattern indicates __.

A 
Uniform = Hemoglobin 
Speckled = RBCs
140
Q

In plasma examination, a red/pink plasma indicates _, while a pale yellow plasma indicates _.

A

Red/pink = hemoglobin

Pale yellow = myoglobin

141
Q

Vitamin C yields a false _ reaction in the blood reagent strip

142
Q

Escherichia coli will yield a __ reaction in the blood reagent strip.

A

Positive (because of its peroxidase enzyme)

143
Q

Neutralizes Ascorbic acid

144
Q

This parameter may provide an early indication of liver disease

145
Q

Bilirubin in its unconverted form

A

Protoporphyrin

146
Q

The kidneys cannot excrete bilirubin because _.

A
  1. Bilirubin is bound to albumin *(-) charge

2. Bilirubin is water insoluble

147
Q

Water-insoluble bilirubin

A

Unconjugated bilirubin

148
Q

Converts water-insoluble bilirubin to water-soluble bilirubin

A

Glucoronyl transferase

149
Q

True/False:

Conjugated bilirubin is normally found in the urine because it is water-soluble.

A

FALSE. Conjugated bilirubin is passed to the intestine where intestinal bacteria reduce bilirubin to urobilinogen, which is then oxidized and excreted as STERCOBILINOGEN & UROBILINOGEN

150
Q

this type of bilirubin can appear in the urine when the normal degradation cycle is disrupted by bile duct obstruction (post-hepatic jaundice) or when the integrity of the liver is damaged (hepatic jaundice)

A

Conjugated bilirubin

151
Q

Indicate if pos/neg/normal:

LIVER DAMAGE
Urine Bilirubin: _
Urine Urobilinogen: _

A

LIVER DAMAGE:
Urine Bilirubin: +/-
Urine Urobilinogen: ++

152
Q

Indicate if pos/neg/normal:

BILE DUCT OBSTRUCTION
Urine Bilirubin: _
Urine urobilinogen: _

A

BILE DUCT OBSTRUCTION
Urine Bilirubin: +++
Urine Urobilinogen: Normal

153
Q

Indicate if pos/neg/normal:

HEMOLYTIC DISEASE
Urine Bilirubin: _
Urine urobilinogen: _

A

HEMOLYTIC DISEASE
Urine Bilirubin: Negative
Urine urobilinogen: +++

154
Q

TRUE / FALSE: Jaundice due to increased destruction of RBCs produces bilirubinemia.

A

FALSE. Serum bilirubin is present in the unconjugated form and the kidneys CANNOT excrete it.

155
Q

Principle for Bilirubin strip test

A

Diazo Reaction

156
Q

Positive color for bilirubin strip test

A

Tan or Pink to Violet

157
Q

The presence of Indican and metabolites of the medication __ will cause a false positive reading in the Bilirubin test

158
Q

Bilirubin rapidly oxidized to _ in the presence of light

A

Biliverdin

159
Q

TRUE/FALSE:

Biliverdin is unreactive to diazo tests

160
Q

Confirmatory test for bilirubin

161
Q

An amount of _ mg/dL or Ehrlich unit of urobilinogen is normally found in the urine

162
Q

Increased urine urobilinogen is seen in __ and __

A

Liver disease and hemolytic disorders

In liver disease, the ability of the liver to process the urobilinogen recirculated from the blood is impaired, thus excess urobilinogen remaining in the blood is filtered by the kidneys and appears in the urine

In hemolytic disorders, there is an increased amount of unconjugated bilirubin. This UB is presented to the liver for conjugation, which results in an increased CB entering the intestine. As a result, increased urobilinogen is produced

163
Q

Patients who lack the pigment urobilin have a __ characteristic stool.

A

Pale stool

164
Q

Principle of urobilinogen strip

A

Ehrlich reaction

165
Q

Component of Ehrlich reagent

A

p-dimethylaminobenzaldehyde (PDAB)

166
Q

Convertion factor of urobilinogen in mg/dL to Ehrlich units

167
Q

Differentiates urobilinogen (UBG), Porphobilinogen (PBG), and other Erlich Reactive compounds (ERCs)

A

Watson-Schwartz Test

168
Q

Watson-Schwartz Test utilizes the organic solvents __ and __

A

Chloroform and Butanol

** CHLOROFORM BELOW BUTANOL ABOVE

169
Q

A rapid screening test for porphobilinogen

A

Hoesch Test (Inverse Ehrlich Reaction principle)

170
Q

A parameter that provides rapid screening test for UTI

171
Q

Initial bladder infection

A

Cystitis (lower urinary tract)

172
Q

The inflammatory process of the kidney

A

Pyelonephritis (upper urinary tract)

173
Q

True/False

Pregnant women are considered to be of high risk for UTI

174
Q

Nitrite test is combined with _ test to determine the necessity of performing urine culture.

A

Leukocyte esterase test

175
Q

Principle for nitrite reagent strip test

A

Greiss reaction

176
Q

Positive reaction for nitrite

A

Uniform pink

177
Q

Sensitivity of nitrite test

A

100,000 organisms per mm (corresponding with a quantitative bacterial culture)

178
Q

Results in nitrite is reported as neg, trace, +, ++, +++ / or through color degree

A

False. Nitrite test are only reported as POSITIVE/ NEGATIVE

179
Q

Bacteria that lack the enzyme _ do not possess the ability to reduce nitrate to nitrite

A

Reductase

* Reductase is found in gram (-) bacteria - E.g. Enterobacteriaceae which causes UTI

180
Q

Nitrite tests should be performed on first morning specimens or specimens collected after urine has remained in the bladder for at least _ hrs.

A

4 hrs.

** Bacteria capable of reducing nitrate must remain in contact with urinary nitrate long enough to produce nitrite

181
Q

Reduction of nitrite to nitrogen due to large numbers of bacteria causes a false _ reaction

A

False-negative

182
Q

Can the LE reagent strip test detect the presence of lysed leukocytes

183
Q

The LE test can detect esterase in granulocytic WBCs, and monocytes EXCEPT _

A

Lymphocytes

184
Q

True/False

Esterase is also present in Trichomonas and histiocytes

185
Q

Infections produced by _, _, _, and _ produce leukocyturia WITHOUT bacteriuria

A
  1. Chlamydia
  2. Trichomonas
  3. Yeast
  4. Interstitial nephritis
186
Q

Reagent for Leukocyte esterase test

A

Diazonium salt

187
Q

Principle for Leukocyte esterase test

A

Leukocyte Esterase Reaction

188
Q

A >500mg/dL protein, >3g/dL glucose, oxalic acid, and ascorbic acid yields a false _ result in the LE test

A

False-negative

189
Q

Ascorbic acid causes false-negative reactions on: (5 parameters)

A

BB LNG

  • Blood
  • Bilirubin
  • Leukocytes
  • Nitrite
  • Glucose

Clinical Microscopy (7 decks)

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