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CLINCIAL MICROSCOPY (Topnotcher QT) > CHEMICAL EXAMINATION OF URINE > Flashcards

CHEMICAL EXAMINATION OF URINE Flashcards

memorization

1
Q

Urine strip parameter(s) with 30 secs reading time

A
  1. Glucose
  2. Bilirubin
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2
Q

Urine strip parameter(s) with 40 secs reading time

A
  1. Ketones
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3
Q

Urine strip parameter(s) with 45 secs reading time

A
  1. Specific gravity
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4
Q

Urine strip parameter(s) with 60 secs reading time

A
  1. Protein
  2. pH
  3. Blood
  4. Urobilinogen
  5. Nitrite
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5
Q

Urine strip parameter(s) with 120 secs reading time

A
  1. Leukocyte esterase
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6
Q

Principle of Glucose urine strip

A

Double sequential enzyme reaction

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7
Q

Principle of Bilirubin urine strip

A

Diazo reaction

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8
Q

Principle of Ketones urine strip

A

Sodium nitroprusside reaction

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9
Q

Principle of Specific Gravity Urine Strip

A

pKa change of a polyelectrolytes

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10
Q

Principle of Protein urine strip

A

Protein error of indicators

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11
Q

Principle of pH urine strip

A

Double indicator system

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12
Q

Principle of Blood urine strip

A

Pseudoperoxidase activity of hemoglobin

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13
Q

Principle of urobilinogen urine strip

A

Ehrlich reaction

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14
Q

Principle of Nitrite urine strip

A

Greiss reaction

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15
Q

Principle of Leukocytes urine strip

A

Leukocyte esterase

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16
Q

Reagent Strip technique (true or false)

Dip the reagent strip briefly (no longer than 1 second) into a centrifuged urine specimen at RT.

A

false - dip the reagent strip into a will-mixed UNCENTRIFUGED urine specimen

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17
Q

Reagent Strip technique (true or false)

Remove excess urine by touching the edge of the strip to the container as the strip is withdrawn

A

True

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18
Q

Reagent Strip technique (true or false)

Blot the underside of the strip on a disposable absorbent pad

A

False - Blot the EDGE OF THE STRIP on a disposable absorbent pad

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19
Q

Reagent Strip technique (true or false)

Hold the strip vertically, and compare the color reaction of the strip pads to the manufacturer’s color chart in good lighting

A

False - Hold the strip HORIZONTALLY

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20
Q

true or false

Store without desiccant in an opaque, tightly closed container

A

False - Store WITH DESICCANT in an opaque, tightly closed container

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21
Q

true or false

Store below 30C (room temperature); do not freeze

A

True

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22
Q

Principle of automated reagent strip readers

A

Reflectance photometry

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23
Q

A measure of the amount of dissolved substances in a solution; Density of solution compared with density of similar volume of distilled water at a similar temperature

A

Specific Gravity

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24
Q

Reference ranges of specific gravity:

Random urine: __________
1st morning: __________
24-hour urine: _________

A

Random urine: 1.003 to 1.035
1st morning: >1.020
24-hour urine: 1.016 - 1.022

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25
Q

if S.G. is <1.003:

A

Not a urine n(except in D.I)

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26
Q

if S.G. is >1.040

A

Radiographic dye present (if refractometer is used)

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27
Q

S.G of:

Isosthenuria:
Hyposthenuria:
Hypersthenuria:

A

Isosthenuria: = 1.010
Hyposthenuria: < 1.010
Hypersthenuria: > 1.010

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28
Q

Calibration temperature of Urinometry (urinometer)

A

20C

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29
Q

______ for every 3C that the specimen temperature is below the calibration temp.

A
  • 0.001 for every 3C that the specimen temp. is below the calibration temp.
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30
Q

______ for every 3C that the specimen temperature is above the calibration temp.

A

+ 0.001 for every 3C that the specimen temperature is above the calibration temp.

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31
Q

Correction for glucose and protein:

1 g/dL Glucose = __________
1g/dL Protein = _________

A

1 g/dL Glucose = -0.004
1g/dL Protein = -0.003

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32
Q

Urine volume required for urinometer:

A

10 - 15 mL

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33
Q

Principle or device for specific gravity measurement that doesn’t need temperature correction; requires correction for glucose and protein.

A

Refractometry (Refractometer, Rf/ TS (total solids) meter)

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34
Q

Calibration for refractometer:

Distilled/deionized H2O =

A

S.G. 1.000

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35
Q

Calibration for refractometer:

3% NaCl:

A

1.015 +/- 0.001

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36
Q

Calibration for refractometer:

5% NaC:

A

1.022 +/- 0.001

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37
Q

Calibration for refractometer:

7% NaCl:

A

1.035 +/- 0.001

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38
Q

Calibration for refractometer:

9% Sucrose

A

1.034 +/- 0.001

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39
Q

Sample problem: (URINOMETRY)
Urine S.G. reading by urinometer is 1.025
Urine temperature is 26C
Urinometer calibration temp. is 20C

what is the corrected SG?

A

1.027

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40
Q

Sample problem: (REFRACTOMETRY)
Urine S.G. reading by refractometer is 1.025 with 2 g/dL glucose and 2 g/dL protein
Temperature: 37C

what is the corrected SG?

A

1.011

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41
Q

Reagent for the rgt. strip reaction for specific gravity

A

bromthymol blue (multistix & chemstrip)

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42
Q

Obsolete method; based on frequency of soundwave entering a solution. changes in proportion to the density of the solution.

A

Harmonic oscillation densitometry (H.O.D)

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43
Q

Example of H.O.D

A

Yellow IRIS (International Remote Imaging System)

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44
Q

Urine volume required for IRIS diagnostics

A

6 mL urine volume

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45
Q

how much urine volume from the 6 mL is required for the IRIS mass Gravity meter?

A

2 mL (of 6mL)

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46
Q

how much volume from the 6 mL is required for IRIS Slideless microscope?

A

4 mL (of 6 mL)

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47
Q

Acidity refers to the “_______” of a solution, whereas alkalinity refers to its “_______”

A

Acidity: sourness
Alkalinity: bitterness

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48
Q

Normal urine pH:

Random urine:
1st morning:

A

Random urine: 4.5 - 8.0
1st morning: 5.0 - 6.0

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49
Q

When urine pH is >9.0:

A

unpreserved urine

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50
Q

occurs after meals due to the withdrawal of H+ ions for the purpose of secretion of HCl.

A

Alkaline tide

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51
Q

Causes of acid urine:

A
  1. Diabetes Mellitus (high ketone bodies)
  2. Starvation (high ketone bodies)
  3. High protein diet
  4. Cranberry juice (quinic acid–.Hippuric acid)
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52
Q

Causes of alkaline urine:

A
  1. Renal tubular acidosis
  2. Vegetarian diet
  3. After meal (alkaline tide)
  4. Vomiting
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53
Q

Reagent for the rgt. strip reaction for pH

A

Methyl red
bromthymol blue

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54
Q

interferences of reagent strip reaction for pH

A

No known interference
Runover from adjacent pads, old specimens

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55
Q

The parameter that is the most indicative of renal disease; produces white foam in urine when shaken

A

Protein

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56
Q

Normal urinary protein:

A

<10 mg/dL or <100 mg/day (Strasinger)
<150 mg/day (Henry)

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57
Q

Proteins in normal urine consist of ____ albumin and ____ globulins

A

1/3 albumin
2/3 globulins

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58
Q

Most abundant protein in normal urine

A

Tamm-Horsfall protein (Uromodulin)

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59
Q

Caused by conditions that affect the plasma prior to its reaching the kidney

A

Pre-renal (before) or Overflow proteinuria

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60
Q

conditions that can cause pre-renal proteinuria:

A
  1. Intravascular hemolysis = hemoglobin
  2. Muscle injury = myoglobin
  3. Severe infection & inflammation = increased APRs
  4. Multiple myeloma
61
Q

Protein present in urine in patients with multiple myeloma

A

Bence Jones Proteins

62
Q

BJP in urine precipitates at _____ C (cloudyt) & dissolves at ____ C (clear)

A

BJP precipitates at 40-60C & dissolves at 100C

63
Q

Normal Albumin Excretion Rate:

A

0-20 ug/min

64
Q

Microalbuminuria AER:

A

20-200 ug/min
or 30-300 ug/min/24 hours

65
Q

Clinical albuminuria AER:

A

> 200 ug/min

66
Q

Onset of renal complications can be first be predicted by detection of _________.

A

Microalbuminuria

67
Q

Test for microalbuminuria; A strip employing antibody-enzyme conjugate that binds albumin

A

MICRAL TEST

68
Q

Proteinuria when standing due to increased pressure to renal veins; increased venous pressure causes renal congestion and glomerular changes

A

Orthostatic/Cadet/Postural/Cyclic proteinuria

69
Q

Originally discovered in workers exposed to cadmium dust (a heavy metal); Normally filtered albumin can no longer be reabsorbed

A

Tubular proteinuria

70
Q

Reagent present for the rgt strip reaction for protein

A

Citrate buffer at pH 3.0 (multistix & chemstrip)

other reminders: “tetra”
-tetrabromphenol blue
-tetrachlorophenol tetrabromosulfonphthalein

71
Q

The indicator of protein in the strip reaction is sensitive to _______.

72
Q

A cold precipitation test that reacts equally with all forms of protein

A

Sulfosalisylic acid precipitation test

73
Q

SSA test is also known as:

A

EXTON’S test

74
Q

procedure in SSA test:

3mL of ___ % SSA + __ mL centrifuged urine —> 10 mins incubation —> (+) cloudiness

A

3% SSA
3 mL centrifuged urine

75
Q

SSA gradings:

Grade: Negative
Turbidity:
Range (mL/dL) [Strasinger]:
Range [Henry]:

A

Grade: Negative
Turbidity: No increase in turbidity
Range (mg/dL) [Strasinger]: <6 mg/dL
Range [Henry]: = 5 mL/dL

76
Q

SSA gradings:

Grade: Trace
Turbidity:
Range (mL/dL) [Strasinger]:
Range [Henry]:

A

SSA gradings:

Grade: Trace
Turbidity: Noticeable or perceptible turbidity
Range (mg/dL) [Strasinger]: 6 - 30 mg/dL
Range [Henry]: = 20 mg/dL

77
Q

SSA gradings:

Grade: 1+
Turbidity:
Range (mL/dL) [Strasinger]:
Range [Henry]:

A

SSA gradings:

Grade: 1+
Turbidity: Distinct turbidity with no granulation
Range (mL/dL) [Strasinger]: 30 - 100 mg/dL
Range [Henry]: = 50 mg/dL

78
Q

SSA gradings:

Grade: 2+
Turbidity:
Range (mL/dL) [Strasinger]:
Range [Henry]:

A

SSA gradings:

Grade: 2+
Turbidity: Turbidity with granulation but NO flocculation
Range (mL/dL) [Strasinger]: 100 - 200 mg/dL
Range [Henry]: = 200 mg/dL

79
Q

SSA gradings:

Grade: 3+
Turbidity:
Range (mL/dL) [Strasinger]:
Range [Henry]:

A

SSA gradings:

Grade: 3+
Turbidity: Turbidity with granulation AND flocculation
Range (mL/dL) [Strasinger]: 200 - 400 mg/dL
Range [Henry]: = 500 mg/dL

80
Q

SSA gradings:

Grade: 4+
Turbidity:
Range (mL/dL) [Strasinger]:
Range [Henry]:

A

SSA gradings:

Grade: 4+
Turbidity: Clumps of protein
Range (mL/dL) [Strasinger]: >400 mg/dL
Range [Henry]: = 1.0 g/dL

81
Q

A highly buffered alkaline with no albumin present can cause _______ reagent strip

False-positive
False-negative

A

False-positive

82
Q

A highly buffered alkaline with albumin present can cause _________ SSA test

False-positive
False-negative

A

False-negative

83
Q

Chem strip result is negative but positive in SSA.

explanation:

A
  • Proteins other than albumin are present
  • False (+) in SSA = Radiographic contrast media (delayed reaction), Drugs and/or drug metabolites (tolbutamide, penicillins)
84
Q

S.G. should be considered in evaluating urine protein because a trace protein in a dilute specimen is more significant than in a concentrated specimen

true or false

85
Q

Large volumes of urine can produce a negative protein reaction despite significant proteinuria because the protein present is being excessively diluted

true or false

86
Q

Parameter that is most frequently tested in urine

86
Q

In Hyperglycemia:

Blood glucose:
Urine glucose:

A

Blood glucose - increased
Urine glucose - increased/ present

87
Q

In Renal-associated (Renal Glycosuria)

Blood glucose:
Urine glucose:

A

Blood glucose - Normal
Urine glucose - increased

88
Q

Reagent present in rgt strip reaction for glucose:

A
  • Potassium iodide (Multistix)
  • Tetramethylbenzidine (Chemstrip)
89
Q

A non-specific test for reducing sugars:

A

Copper reduction test (Clinitest/Benedict’s test)

90
Q

Reporting (Benedict’s test)

Clear blue color, blue precipitate may form:

A

Negative (-)

91
Q

Reporting (Benedict’s test)

Bluish-green color

A

Tr (Trace)

92
Q

Reporting (Benedict’s test)

Green color, green or yellow precipitate

93
Q

Reporting (Benedict’s test)

Yellow to green color, yellow precipitate

94
Q

Reporting (Benedict’s test)

Yellow-orange color, yellow-orange precipitate

95
Q

Reporting (Benedict’s test)

Reddish-yellow color, brick red or red precipitate

96
Q

False-positive Benedict’s test causes:

A

Presence of reducing agents (ascorbic acid, uric acid)

97
Q

False-negative Benedict’s test causes:

A

Presence of Oxidizing agents (detergents)

98
Q

A phenomenon that occurs when >2 g/dL sugar is present in clinitest tablet procedure

A

Pass through phenomenon

99
Q

to prevent pass-through phenomenon, use _____ gtts urine instead of 5 gtts urine

A

2 gtts urine

100
Q

Clinitest sensitivity

101
Q

Summary of glucose oxidase and clinitest reaction:

Glucose oxidase: 1+ positive
Clinitest: Negative
Interpretation: ??

A

Interpretation: Small amount of glucose is present

102
Q

Summary of glucose oxidase and clinitest reaction:

Glucose oxidase: 4+ positive
Clinitest: Negative
Interpretation: ??

A

Interpretation: Possible oxidizing agent interference on reagent strip

103
Q

Summary of glucose oxidase and clinitest reaction:

Glucose oxidase: Negative
Clinitest: Positive
Interpretation: ??

A

Interpretation: Non-glucose reducing substance present; possible interfering substance for reagent strip (ex. ascorbic acid)

104
Q

Result form increased fat metabolism due to inability to metabolize carbohydrate

105
Q

Renal threshold of ketones:

106
Q

Major ketone but not detected in routine reagent strip

A

Beta-hydroxybutyric acid (BHA)

107
Q

parent ketone (first ketone body formed)

A

Acetoacetic acid (AAA) ? Diacetic acid

108
Q

BHA = ?%
AAA = ?%
Acetone = ?%

A

BHA = 78%
AAA = 20%
Acetone = 2%

109
Q

Reagent present for the rgt strip reaction for ketones:

A

Na nitroprusside
Nitroferricyanide
Glycine (Chemstrip)

110
Q

Acetone is detected only when _____ is present.

111
Q

Hematuria is described as:

A

Cloudy red urine

112
Q

Hemoglobinuria is described as:

A

Clear red urine

113
Q

Microscopic analysis in hematuria:

A

Intact RBCs (>5 RBCs/uL = significant)<

114
Q

Microscopic analysis in hemoglobinuria:

A

No RBCs seen

note: Heme portion of the hemoglobin is toxic to the renal tubules

115
Q

Myoglobinuria is described as:

A

Clear red (red-brown) urine

116
Q

Myoglobinuria can also be caused by:

A

Cholesterol-lowering statin medications

117
Q

Hemoglobin vs Myoglobin

In Hemoglobin, plasma color is ______.
In Myoglobin, plasma color is ______.

A

Hemoglobin: Red/pink plasma
Myoglobin: Pale yellow plasma

118
Q

In Blondheim’s test (Ammonium sulfate test) for hemoglobin and myoglobin,

Hemoglobin = _________.
Myoglobin = _________.

A

Blonheim’s test:

Hemoglobin = precipitated
Myoglobin = not precipitated

119
Q

Reagent present in rgt strip reaction for blood:

A
  • Tetramethylbenzidine (multistix)
  • Tetramethylbenzidine (Chemstrip)

other reminders:
- Diisopropylbenzene dehydroperoxide (multistix)
- Dimethyldihydroperoxyhexane (chemstrip)

120
Q

Bilirubin type that is detected in urine:

A

Conjugated bilirubin

121
Q

Physical indication of the presence of bilirubin in urine:

A

Tea-colored/amber/beer-brown urine with yellow foam

122
Q

Reagent present for rgt strip reaction for bilirubin:

A
  • 2,4-dichloroaniline diazonium salt (multistix)
  • 2,6-dichlorobenzene diazonium salt (chemstrip)

remember: “dichloro”

123
Q

color reaction of bilirubin in reagent strip:

A

(+) Tan or Pink Violet

124
Q

Bile pigment that resulted from hemoglobin degradation

A

Urobilinogen

125
Q

Normal value of urobilinogen in urine:

A

<1 mg/dL or Ehrlich unit

126
Q

Specimen for urobilinogen determination:

A

Afternoon urine (2-4 PM)

127
Q

Confirmatory test for Bilirubin determination in urine; more sensitive than strip with less interference

A

ICTOTEST (Tablet)

128
Q

Reagent present in rgt strip reaction for urobilinogen:

A

p-dimethylaminobenzaldehyde (PDAB) or Ehrlich reagent) (Multistix)

4-methoxybenzene-diazonium-tetrafluoroborate (specific for UBG)

129
Q

Causes false-positive results in urobilinogen strip test:

A

p-aminosalicylic acid

130
Q

Causes false-negative results in urobilinogen strip test:

A

Old specimens
Formalin (preservative)

131
Q

A test that differentiates urobilinogen (UBG), porphobilinogen (PBG) and other Ehrlich-reactive compounds (ERC)

A

Watson-Schwartz Test

132
Q

Organic solvents used in the Watson-Schwartz test:

A

Chloroform
Butanol

133
Q

In the Watson-Schwartz test, UBG is:

A

Soluble in Chloroform and Butanol

134
Q

In the Watson-Schwartz test, PBG is:

A

Insoluble in Chloroform and Butanol

135
Q

In the Watson-Schwartz test, ERC is:

A

Soluble in Butanol
Insoluble in Chloroform

136
Q

A rapid screening test for porphobilinogen (≥ 2 mg/dL)

A

HOESCH TEST (Inverse reaction)

137
Q

Correlations:

Blood: Increased UB
Urine Bilirubin (CB): Negative
Urine urobilinogen: +++

Condition: ??

A

Extravascular hemolytic disease
(Pre-hepatic jaundice)

138
Q

Correlations:

Blood: increased UB/CB
Urine bilirubin (CB): +/-
Urine urobilinogen: ++

Condition: ??

A

Liver damage
(Hepatic Jaundice)

139
Q

Correlations:

Blood: increased CB
Urine bilirubin (CB): +++
Urine urobilinogen: -/decreased (Strip = NORMAL)

Condition: ??

A

Bile duct obstruction
(Post-hepatic or obstructive jaundice)

140
Q

Jaundice due to increased destruction of red blood cells does not produce bilirubinuria

true or false

A

True

  • because the serum bilirubin is in the unconjugated form and the kidneys cannot excrete it.
141
Q

Rapid screening test of UTI or bacteria:

142
Q

Specimen of choice for urine strip for nitrite determination:

A

4-hour collection or
First morning urine (preferred)

143
Q

Regent present in rgt strip reaction for nitrite:

A

Remember: “quinoline”

  • p-arsanilic acid, tetrahydrobenzo(h)-quinolin-3-ol (multistix)
  • Sulfanilamide, hydroxytetrahydro benzoquinoline (chemstrip)
144
Q

If the nitrite test area shows a negative reaction, UTI cannot be ruled out

true or false

A

True

  • Some UTIs are caused by gram (+) cocci & yeasts - they lack nitrate reductase enzyme)
145
Q

Reagent present in rgt strip reaction for leukocytes:

A

Remember: “ester”

  • Derivatized pyrrole amino acid ester, Diazonium salt (multistix)
  • Indoxylcarbonic acid ester, Diazonium salt (chemstrip)
146
Q

type of leukocyte without esterase

A

lymphocyte

147
Q

the 11th reagent pad of urine strip reaction:

A

Ascorbic acid (Vitamin C)

148
Q

Ascorbic acid causes false-negative reactions on:

A
  1. Blood
  2. Bilirubin
  3. Leukocytes
  4. Nitrite
  5. Glucose

Remember: “BaBy LaNGga” or “BB LNG”

CLINCIAL MICROSCOPY (Topnotcher QT) (6 decks)

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