Chemical Examination of Urine | from Strasinger (6th ed.) Flashcards

Question

True or False The bottles (of rgnt strips) can be opened in the presence of volatile fumes

Answer 1

False, because the bottles (of rgnt strips) should not be opened in the presence of volatile fumes

Answer 2

Room temp below 30 DC (but never refrigerated)

Answer 3

Expiration date (w/c is stamped in all bottles)

Answer 4

It represents the fxnal life expectancy of the chemical pads

Answer 5

Visual inspection

Answer 6

To detect deterioration

Answer 7

These must be checked w/ both (+) and (-) controls

Answer 8

A minimum of once every 24 hrs

Answer 9

At the beginning of each shift

Answer 10

1) When a new bottle of rgnt strips is opened 2) When questionable results are obtained 3) When there is concern about the integrity of strips

Answer 11

All QC results must be recorded (following lab protocol)

Answer 12

Because rgnt strip chemical rxns are designed to perform at ionic concs similar to urine

Answer 13

This must be resolved through the testing of the additional strips and controls

Answer 14

False, because demonstration of chemically acceptable rgnt strips does not entirely rule out the possibility of inaccurate results

Answer 15

1) Interfering substances in the urine 2) Technical carelessness 3) Color blindness

Answer 16

The masking of color rxns by the orange pigment present in the urine or persons taking phenazopyridine compounds

Answer 17

They will report many erroneous results

Answer 18

These are defined as test using different rgnts or methodologies to detect the same substances as detected by rgnt strips w/ the same or greater sensitivity / specificity

Answer 19

Nonrgnt strip testing procedures may be available when: 1) Questionable results are obtained 2) Highly pigmented sxs are encountered

Answer 20

False, because in the past, many of the nonrgnt strip testing procedures (via the use of tablets and liquid chemicals) were used routinely to confirm (+) results

Answer 21

These have reduced the need for routine use of these procedures

Answer 22

Via the use of (+) and (-) controls

Answer 23

1) Lungs | 2) Kidneys

Answer 24

They secrete hydrogen (in the form of ammonium ions), hydrogen phosphate, and weak organic acids, and by the reabsorption of bicarbonate from the filtrate in the convoluted tubules

Answer 25

Slightly acidic pH (5.0 - 6.0)

Answer 26

Alkaline pH (alkaline tide)

Answer 27

In conjunction w/: 1) Other pt info a. Acid-base content of the blood b. Pt's renal fxn c. Presence of a UTI d. Pt's dietary intake e. Age of the sx

Answer 28

1) Emphysema 2) Diabetes mellitus (DM) 3) Starvation 4) Dehydration 5) Diarrhea 6) Presence of acid-producing bacteria (Escherichia coli) 7) High-protein diet 8) Cranberry juice 9) Medications a. Methenamine b. Mandelate (Mandelamine) c. Fosfomycin tromethamine (Monurol)

Answer 29

1) Hyperventilation 2) Vomiting 3) Renal tubular acidosis 4) Presence of urease-producing bacteria 5) Vegetarian diet 6) Old sxs

Answer 30

1) It is the primary aid in determining the existence of systemic acid-base disorders of metabolic / respiratory origin 2) It also aids in the management of urinary conditions that require the urine to be maintained at a sp pH

Answer 31

If the urinary pH does not conform to the pattern (in relation to such disorders) Patterns: 1) For pt's w/ respiratory / metabolic acidosis -> pt have acidic urine 2) For pt's w/ respiratory / metabolic alkalosis -> pt have alkaline urine

Answer 32

It may indicate a disorder resulting from kidneys' inability to secrete or to reabsorb acid / base

Answer 33

These are formed via the precipitation of inorganic chemicals dissolved in the urine

Answer 34

Urinary pH

Answer 35

It can be controlled via maintaining the urine at a pH that is incompatible w/ the precipitation of the particular chemicals causing calculi formation

Answer 36

Calcium oxalate

Answer 37

In acidic urine (not in alkaline urine)

Answer 38

Maintaining urine at an alkaline pH

Answer 39

False, because knowledge of urinary pH is impt in the identification of crystals observed during microscopic examination of the urine sediment

Answer 40

Maintaining an acidic urine

Answer 41

Because they do not multiply as readily in an acidic medium

Answer 42

Urea-splitting organisms

Answer 43

Dietary regulation

Answer 44

Acidic urine

Answer 45

More alkaline (compared to pts who have high-protein and high-meat diets | / alkaline)

Answer 46

Due to the formation of bicarbonate following digestion of many fruits and vegetables

Answer 47

Acidic (w/c is the exemption to the rule whereas pts who are vegetarians [/ pts who eat many fruits and vegetables] have alkaline urinary pH)

Answer 48

It has long been used as a home remedy for minor bladder infections

Answer 49

Because it inhibits the colonization of certain urinary pathogens

Answer 50

They are often advised to drink cranberry juice or take over-the-counter cranberry pills

Answer 51

1) Methenamine mandelate (Mandelamine) | 2) Fosfomycin tromethamine (Monurol)

Answer 52

These are metabolized to produce acidic urine

Answer 53

Its pH does not reach above 8.5 (in normal or abnormal conditions)

Answer 54

It indicates that a fresh sx should be obtained to ensure the validity of the analysis

Answer 55

It can produce pH above 8.5

Answer 56

1) Store w/ desiccant in an opaque, tightly closed container 2) Store below 30 DC; do not freeze 3) Do not expose to volatile fumes 4) Do not use past the expiration date 5) Do not use if chemical pads become discolored 6) Remove strips immediately prior to use

Answer 57

1) Mix sx well 2) Let refrigerated sxs warm to room temp before testing 3) Dip the strip completely, but briefly, into sx 4) Remove excess urine by withdrawing the strip against the rim of the container and by blotting the edge of the strip 5) Compare rxn colors w/ the manufacturer's chart under good light source at the specified time 6) Perform backup tests when indicated 7) Be alert for the presence of interfering substances 8) Understand the principles and significance of the test; read package inserts 9) Relate chemical findings to each other and to the physical and microscopic UA results

Answer 58

1) Test open bottles of rgnt strips w/ known (+) and (-) controls every 24 hrs 2) Resolve control results that are out of range by further testing 3) Test rgnts used in backup tests w/ (+) and (-) controls 4) Perform (+) and (-) controls on new rgnts and newly opened bottles of rgnt strips 5) Record all control results and rgnt lot numbers

Answer 59

1) Multistix | 2) Chemstrip

Answer 60

0.5- or 1-unit increments between pH 5 and 9

Answer 61

Both manufacturers (of Multistix and Chemstrip) use a double-indicator system of methyl red and bromthymol blue

Answer 62

From red to yellow (in the pH range 4 - 6) Red -> yellow (at pH 4 - 6)

Answer 63

From yellow to blue (in the pH range of 6 - 9) Yellow -> blue (at pH 6 - 9)

Answer 64

In the pH range 5 - 9 measured by the rgnt strips (Multistix and Chemstrip), 1 sees colors progressing from orange at pH 5 through yellow and green to a final deep blue at pH 9 At pH 5 (orange -> yellow); at pH 9 (green -> deep blue)

Answer 65

Methyl red + H^+ -> bromthymol blue - H^+ | red-orange -> yellow) (green -> blue

Answer 66

False, because there are no known substances that interfere w/ urinary pH measurements performed by rgnt strips

Answer 67

1) Respiratory or metabolic acidosis / ketosis 2) Respiratory or metabolic alkalosis 3) Defects in renal tubular secretion and reabsorption of acids and bases- renal tubular acidosis 4) Renal calculi formation and prevention 5) Treatment of UTIs 6) Precipitation / identification of crystals 7) Determination of unsatisfactory sxs

Answer 68

1) Methyl red and bromthymol blue 2) 5.0 - 8.5 in 0.5 increments 3) No known interfering substances, run-over from adjacent pads, and old sxs 4) Nitrite, leukocytes, and microscopic

Answer 69

1) Methyl red and bromthymol blue 2) 5.0 - 9.0 in 1.0 increments 3) No known interfering substances, run-over from adjacent pads, and old sxs 4) Nitrite, leukocytes, and microscopic

Answer 70

Protein determination

Answer 71

It is often associated w/ early renal disease

Answer 72

False, because normal urine contains very little protein

Answer 73

Usually < 10 mg/dL or 100 mg per 24 hrs is excreted

Answer 74

This consists primarily of: 1) Low-molecular-weight serum proteins (w/c have been filtered by the glomerulus) 2) Proteins produced in the genitourinary tract (GUT)

Answer 75

Because majority of the albumin presented to the glomerulus is not filtered, and much of the filtered albumin is reabsorbed by the tubules (even though that albumin is present in high concs in the plasma)

Answer 76

1) Serum microglobulins | 2) Tubular microglobulins

Answer 77

Uromodulin

Answer 78

1) Renal tubular epithelial cells 2) Proteins a. From prostatic secretions b. From seminal secretions c. From vaginal secretions

Answer 79

In the distal convoluted tubule (DCT)

Answer 80

False, because demonstration of proteinuria in a routine analysis does not always signify a renal disease

Answer 81

It is required to do additional testing

Answer 82

To determine whether the protein represents a normal / pathologic condition

Answer 83

30 mg/dL or greater (300 mg/L)

Answer 84

1) Prerenal 2) Renal 3) Postrenal

Answer 85

As it name implies, it is caused by conditions affecting the plasma prior to its reaching the kidney, and, therefore, is not indicative of actual renal disease

Answer 86

It is frequently transient

Answer 87

Increased lvls of low-molecular-weight plasma proteins (such as hgb, myoglobin, and acute phase reactants) w/c is associated w/ infection and inflammation Increased lvls of low MW plasma protein (hgb, myoglobin, and acute phase reactants) + infection and inflammation

Answer 88

There is an increased filtration of these proteins (hgb, myoglobin, and acute phase reactants) w/c exceeds the normal reabsorptive capacity of the renal tubules, resulting in an overflow of the proteins into the urine

Answer 89

No, because rgnt strips detect primarily albumin, hence prerenal proteinuria is usually not discovered in a routine UA

Answer 90

Excretion of Bence Jones protein

Answer 91

Pts w/ multiple myeloma

Answer 92

It is a proliferative disorder of the immunoglobulin-producing plasma cells

Answer 93

Their serum contains markedly elevated lvls of monoclonal immunoglobulin light chains (Bence Jones protein)

Answer 94

It is a low MW protein

Answer 95

Bence Jones protein is filtered in quantities exceeding the tubular reabsorption capacity and is excreted in the urine

Answer 96

1) Serum electrophoresis | 2) Immunoelectrophoresis

Answer 97

No, because cases of multiple myeloma are easily detected by chemical methods

Answer 98

It is the proteinuria associated w/ true renal disease (w/c may be the result of either glomerular or tubular damage)

Answer 99

When the glomerular membrane is damaged, selective filtration is impaired, and increased amts of serum protein and eventually RBCs and WBCs pass through the membrane and are excreted in the urine Damaged glomerular membrane (resulting to selective filtration being impaired) -> presence of increased amts of serum protein and eventually, presence of RBCs and WBCs -> these pass through the membrane -> these are excreted in the urine

Answer 100

Conditions that present the glomerular membrane w/ abnormal substances such as: 1) Amyloid material 2) Toxic substances 3) Immune complexes a. Found in lupus erythematosus b. Found in streptococcal glomerulonephritis

Answer 101

It may override the selective filtration of the glomerulus, causing increased albumin to enter the filtrate

Answer 102

Yes, this occurs during strenuous exercise and dehydration or is associated w/ hypertension

Answer 103

Pre-eclamptic state

Answer 104

To determine if this condition exists

Answer 105

No, because the discovery of protein, particularly in a random sx, is not always of pathologic significance

Answer 106

Because several benign causes of renal proteinuria exist

Answer 107

It is usually transient

Answer 108

1) Strenuous exercise 2) High fever 3) Dehydration 4) Exposure to cold

Answer 109

The development of diabetic nephropathy leading to reduced glomerular filtration and eventual renal failure

Answer 110

By detection of microalbuminuria

Answer 111

Through better stabilization of blood glucose lvls and control of hypertension

Answer 112

W/ an increased risk of cardiovascular disease

Answer 113

It is a persistent benign proteinuria w/c occurs frequently in young adults

Answer 114

Postural proteinuria

Answer 115

It occurs following periods spent in a vertical posture and disappears when a horizontal position is assumed

Answer 116

Increased pressure on the renal vein when in vertical position

Answer 117

They are requested to: 1) Empty the bladder before going to bed 2) Collect a sx immediately upon arising in the morning 3) Collect a 2nd sx after remaining in a vertical position for several hrs

Answer 118

Both sxs are tested for protein, if orthostatic proteinuria is present, a (-) reading will be seen on the 1st morning sx, and a (+) result will be found on the 2nd sx Both sxs are tested for protein -> if orthostatic proteinuria is present -> 1st morning sx: (-) reading | 2nd sx: (+) reading / result

Answer 119

Because the normally filtered albumin can no longer be reabsorbed

Answer 120

1) Exposure to toxic substances 2) Exposure to heavy metals 3) Severe viral infections 4) Fanconi syndrome

Answer 121

From slightly above normal - 4 g/day

Answer 122

False, because markedly elevated protein lvls are seldom seen in tubular disorders

Answer 123

Yes, as it passes through the structures of lower urinary tract

Answer 124

1) Ureters 2) Bladder 3) Urethra 4) Prostate 5) Vagina

Answer 125

These produce exudates containing protein from the interstitial fluid

Answer 126

1) Injury | 2) Menstrual contamination

Answer 127

1) Presence of prostatic fluid | 2) Large amts of spermatozoa

Answer 128

Protein error of indicators

Answer 129

Production of a visible colorimetric rxn

Answer 130

Because protein (primarily albumin) accepts hydrogen ions from the indicator

Answer 131

Yes, because albumin contains more amino grps to accept the hydrogen ions than other proteins

Answer 132

False, because the component present in the protein area of the strip varies depending on the manufacturer of the rgnt strips

Answer 133

Tetrabromophenol blue

Answer 134

1) 3', 3", 5', 5"-tetrachlorophenol, 3, 4, 5, 6-tetrabromosulfonphthalein 2) Acid buffer

Answer 135

To maintain the pH at a constant lvl

Answer 136

Both indicators appear yellow

Answer 137

The color progresses through various shades of green and finally to blue

Answer 138

1) (-) 2) Trace (< 30 mg/dL) 3) 1+ 4) 2+ 5) 3+ 6) 4+ Or via semiquantitative values (in mg/dL | corresponding each color change): 1) 30 2) 100 3) 300 4) 2000

Answer 139

No, because interpretation of trace readings can be difficult

Answer 140

False, reporting of trace values may be a lab option

Answer 141

pH 3.0 Indicator + protein --------> protein + H^+ (yellow) indicator - H^+ (blue-green)

Answer 142

Prerenal: 1) Intravascular hemolysis 2) Muscle injury 3) Acute phase reactants 4) Multiple myeloma Renal: 1) Glomerular disorders 2) Immune complex disorders 3) Amyloidosis 4) Toxic agents 5) Diabetic nephropathy 6) Strenuous exercise 7) Dehydration 8) Hypertension 9) Pre-eclampsia 10) Orthostatic or postural proteinuria Tubular Disorders: 1) Fanconi syndrome 2) Toxic agents / heavy metals 3) Severe viral infections Postrenal: 1) Lower UTIs / inflammation 2) Injury / trauma 3) Menstrual contamination 4) Prostatic fluid / spermatozoa 5) Vaginal secretions

Answer 143

At highly alkaline urine that overrides the acid buffer system, producing a rise in pH and a color change unrelated to protein conc

Answer 144

This technical error may remove the buffer

Answer 145

When the rxn does not take place under acidic conditions

Answer 146

1) Highly pigmented urine 2) Contamination of the container a. W/ quaternary ammonium compounds b. W/ detergents c. W/ antiseptics

Answer 147

It may occur in sxs w/ a high SG

Answer 148

Sulfosalicylic acid test

Answer 149

It is a cold precipitation test that reacts equally w/ all forms of protein

Answer 150

All precipitation tests must be performed on centrifuged sxs to remove any extraneous contamination

Answer 151

So that pts at risk for renal disease can be monitored

Answer 152

1) Random | 2) Or first morning sxs

Answer 153

1) Immunochemical assays for albumin a. Micral-Test b. ImmunoDip 2) Or albumin-specific rgnt strips (w/c also measure creatinine to produce an albumin:creatinine ratio)

Answer 154

Both are read visually

Answer 155

First morning sxs

Answer 156

Gold-labeled antihuman albumin antibody-enzyme conjugate

Answer 157

These strips are dipped into the urine up to a lvl marked on the strip and held for 5 secs

Answer 158

It binds to the Ab

Answer 159

These move up the strip by wicking action

Answer 160

Because a trace protein in a dilute sx is more significant than in a concentrated sx

Answer 161

These are removed in a captive zone by combining w/ albumin embedded in the strip

Answer 162

These continue up the strip and reach an area containing enzyme substrate

Answer 163

It reacts w/ the substrate, producing colors ranging from white to red

Answer 164

It is compared w/ a chart on the rgnt strip bottle after 1 min

Answer 165

0 - 10 mg/dL

Answer 166

Immunochromographic technique

Answer 167

These are individually packaged in specially designed containers

Answer 168

This is placed in the urine sx for 3 mins

Answer 169

1) A controlled amt of urine enters the container through a vent hole 2) The urine encounters blue latex particles coated w/ antihuman albumin Ab 3) Albumin (present in the urine) binds w/ the coated particles 4) The bound and unbound particles continue to migrate up the strip - > the migration is controlled by the size of the particles - > unbound particles do not migrate as far as the bound particles 5) First, a blue band is formed by the unbound particles 6) The bound particles continue to migrate and form a 2nd blue band further up the strip 7) The top band therefore represents the bound particles (urine albumin) and the bottom band represents unbound particles

Answer 170

It is compared against the manufacturer's color chart

Answer 171

< 1.2 mg/dL of albumin

Answer 172

1.2 - 1.8 mg/dL of albumin

Answer 173

2.0 - 8.0 mg/dL of albumin

Answer 174

(-) results

Answer 175

Borderline results

Answer 176

(+) results

Answer 177

1) Tetrabromophenol blue 2) 15 - 30 mg/dL albumin 3) False-(+): a. Highly buffered interference alkaline urine b. Pigmented sxs, phenazopyridine c. Quaternary ammonium compounds (detergents) d. Antiseptics, chlorhexidine e. Loss of buffer from prolonged exposure of the strip to the sx rgnt f. High SG 3. 1) False-(-): a. Proteins other than albumin b. Microalbuminuria 4) Blood

Answer 178

1) 3', 3", 5', 5"-tetrachlorophenol and 3, 4, 5, 6-tetrabromosulfonphthalein 2) 6 mg/dL albumin 3) False-(+): a. Highly buffered interference alkaline urine b. Pigmented sxs, phenazopyridine c. Quaternary ammonium compounds (detergents) d. Antiseptics, chlorhexidine e. Loss of buffer from prolonged exposure of the strip to the sx rgnt f. High SG 3. 1) False-(-): a. Proteins other than albumin b. Microalbuminuria 4) Nitrite, leukocytes, and microscopic

Answer 179

Both of these provide simultaneous measurement of albumin/protein and creatinine that permits an estimation of the 24-hr microalbumin excretion

Answer 180

By comparing the albumin excretion to the creatinine excretion

Answer 181

Bis(3', 3"-diiodo-4', 4"-dihydroxy-5', 5"-dinitrophenyl)-3, 4, 5, 6-tetrabromosulphonphthalein (DIDNTB)

Answer 182

It has a higher sensitivity and specificity for albumin

Answer 183

30 mg/dL or greater

Answer 184

It may include proteins other than albumin

Answer 185

It can measure albumin between 8 and 15 mg/dL (80 - 150 mg/L) w/out inclusion of other proteins

Answer 186

Rxn interference by highly buffered alkaline urine

Answer 187

Via using paper treated w/ bis-(heptapropylene glycol) carbonate

Answer 188

It decreases the nonspecific binding of polyamino acids to the albumin pads

Answer 189

From pale green to aqua blue

Answer 190

Visibly bloody urine

Answer 191

Abnormally colored urines

Answer 192

Pseudoperoxidase activity of copper-creatinine complexes

Answer 193

1) Copper sulfate (CuSO4) 2) 3, 3', 5, 5'-tetramethylbenzidine (TMB) 3) Diisopropyl benzene dihydroperoxide (DBDH)

Answer 194

It combines w/ the CuSO4 to form copper-creatinine peroxidase Creatinine (present in pt's urine) + CuSO4 = Copper-creatinine peroxidase

Answer 195

It reacts w/ the peroxide DBDH

Answer 196

Oxygen ions are released w/c oxidize the chromogen TMB and producing a color change from orange through green to blue

Answer 197

CuSO4 + CRE -> Cu(CRE) peroxidase Cu(CRE) peroxidase DBDH + TMB -----------------------------> oxidized TMB + H2O (peroxidase) (chromogen) (orange to blue)

Answer 198

All in mg/dL: 1) 10 2) 50 3) 100 4) 200 5) 300 All in mmol/L (of creatinine): 1) 0.9 2) 4.4 3) 8.8 4) 17.7 5) 26.5

Answer 199

1) Visibly bloody urine | 2) Presence of gastric acid-reducing medication cimetidine (Tagamet)

Answer 200

False, because no creatinine readings are considered abnormal

Answer 201

Because creatinine readings is normally present in concentrations of 10 - 300 mg/dL

Answer 202

To correlate the albumin conc to the urine conc, producing a semiquantitative albumin:creatinine ratio (A:C) ratio

Answer 203

1) Automated methods | 2) Manual methids

Answer 204

These are designed for instrumental use only

Answer 205

Clinitek Urine Chemistry Analyzers

Answer 206

These measure only: 1) Albumin 2) Creatinine Also, these calculate the A:C ratio

Answer 207

1) These are displayed 2) These are printed a. For albumin b. For creatinine c. For A:C ratio

Answer 208

Both conventional and S.I. units

Answer 209

30 - 300 mg/g or 3.4 - 33.9 mg/mmol

Answer 210

1) Creatinine 2) Protein-high 3) Protein-low (albumin) 4) Pads a. For glucose b. Ketones c. Blood d. Nitrite e. LE f. pH g. Bilirubin h. SG

Answer 211

Either: 1) Manually 2) Automated Clinitek instruments

Answer 212

Protein error of indicators principle

Answer 213

Dye-binding method

Answer 214

These are reported as the protein:creatinine ratio

Answer 215

Protein-low result

Answer 216

These are automatically calculated

Answer 217

These are reported as: 1) Normal 2) Or abnormal

Answer 218

It indicates that the sx should be recollected, making sure that it's a 1st morning sx

Answer 219

A manufacturer supplied chart is used to determine the ratio based on the results of the protein-high, protein-low, and creatinine readings

Answer 220

The higher or the protein-low or protein-high result is used

Answer 221

1) Add 3 mL of 3% SSA rgnt to 3 mL of centrifuged urine 2) Mix by inversion and observe for cloudiness 3) Grade the degree of turbidity

Answer 222

1) No increase in turbidity | 2) <6

Answer 223

1) Noticeable turbidity | 2) 6 - 30

Answer 224

1) Distinct turbidity, no granulation | 2) 30 - 100

Answer 225

1) Turbidity, granulation, no flocculation | 2) 100 - 200

Answer 226

1) Turbidity, granulation, flocculation | 2) 200 - 400

Answer 227

1) Clumps of protein | 2) 400 >

Answer 228

Glucose test, because of its value (glucose) in the detection and monitoring of DM

Answer 229

False, because due to nonspecific symptoms associated w/ the onset of diabetes, it is estimated that more than half of the cases in the world are undiagnosed

Answer 230

1) Blood glucose test | 2) Urine glucose test

Answer 231

Through blood and urine glucose tests

Answer 232

It provides a greatly improved px

Answer 233

1) Pts can monitor themselves at home | 2) Pts can detect regulatory problems prior to the development of serious complications

Answer 234

Almost all the glucose filtered by the glomerulus is actively reabsorbed in the proximal convoluted tubule (PCT)

Answer 235

The urine contains only minute amts of glucose

Answer 236

By active transport in response to the body's need to maintain an adequate conc of glucose

Answer 237

The blood lvl of glucose of the pt is elevated

Answer 238

Because the tubular transport of glucose has reached its renal threshold, and glucose appears in the urine

Answer 239

Approx 160 - 180 mg/dL

Answer 240

It fluctuates

Answer 241

The pt may have glycosuria

Answer 242

These are obtained from sxs collected under controlled conditions

Answer 243

Usually tested 2 hrs after meals

Answer 244

False, because a 1st morning sx does not always represent a fasting sx

Answer 245

Because glucose from an evening meal may remain in the bladder overnight, and pts should be advised to empty the bladder and collect the 2nd sx

Answer 246

It is the condition whereas hyperglycemia occurs during pregnancy and disappears after delivery

Answer 247

Normally around the 6th month of pregnancy (although, glycosuria may occur sooner)

Answer 248

These block the action of insulin, resulting to insulin resistance and hyperglycemia

Answer 249

Yes, because it is impt to the welfare of the baby, because glucose crosses the placenta whereas insulin does not

Answer 250

The baby develops high glucose lvls, causing the baby's pancreas to produce more insulin

Answer 251

These are stored as fat

Answer 252

It results in macrosomia (/ a large baby)

Answer 253

The baby is at risk for obesity and later type 2 diabetes

Answer 254

They are also prone to developing type 2 DM in later yrs

Answer 255

1) Hyperglycemia is seen in a variety of disorders (w/c are associated w/ hormonal fxn) such as: a. Pancreatitis b. Acromegaly c. Cushing syndrome d. Hyperthyroidism e. Pheochromocytoma f. Thyrotoxicosis

Answer 256

1) Glucagon 2) Epinephrine 3) Cortisol 4) Thyroxine 5) Growth hormone (GH)

Answer 257

These hormones work in opposition to insulin, thereby producing hyperglycemia and glucosuria

Answer 258

To convert glucose to glycogen for storage (glycogenesis)

Answer 259

These cause the breakdown of glycogen to glucose (glycogenolysis)

Answer 260

Glycogenolysis results in increased lvls of circulating glucose

Answer 261

1) It is also a strong inhibitor of insulin secretion 2) It is increased when the body is subjected to severe stress (w/c accounts for the glucosuria seen in conjunction w/ cerebrovascular trauma and myocardial infarction [MI])

Answer 262

It occurs in the absence of hyperglycemia when the reabsorption of glucose by the renal tubules is compromised (this is frequently referred to as renal glycosuria)

Answer 263

1) End-stage renal disease 2) Cystinosis 3) Fanconi syndrome

Answer 264

It is occasionally seen as a result of a temporary lowering of the renal threshold for glucose during pregnancy

Answer 265

Recollecting of sx should be done because the sx is too dilute to determine the ratio result accurately. Repeat test on new sx, preferably a first-morning collection

Answer 266

1) Micral-Test 2) ImmunoDip 3) Albumin:Creatinine Ratio 4) Clinitest Microalbumin Strips/Multistix-Pro

Answer 267

1) Enzyme immunoassay 2) 0 - 10 mg/dL 3) Gold-labeled antibody 3. 1) B-galactosidase 3. 2) Chlorophenol red galactoside 4) Dilute urine (false-[-])

Answer 268

1) Immunochromographics 2) 1.2 - 8.0 mg/dL 3) Antibody-coated blue latex particles 4) Dilute urine (false-[-])

Answer 269

1) Sensitive albumin tests related to creatinine conc to correct for pt hydration 2) Dye bis(3', 3"-diiodo-4', 4"-dihydroxy-5', 5"-dinitrophenyl)-3,4,5,6-tetrabromo sulphonphtalein (DIDNTB) (for albumin) 2. 1) CuSO4 3,3' ,5,5'-tetranethylbenzidine (TMB) and diisopropyl benzene dihydroperoxide (DBDH) 3) 10 - 150 mg/L (for albumin) 3. 1) 10 - 300 mg/dL, 0.9 - 26.5 mmol/L (for creatinine) 4) Visibly bloody or abnormally colored urine 4. 1) Cimetidine (false [+] | for creatinine)

Answer 270

Hyperglycemia-Associated: 1) DM 2) Pancreatitis 3) Pancreatic CA 4) Acromegaly 5) Cushing syndrome 6) Hyperthyroidism 7) Pheochromocytoma 8) Central nervous system damage 9) Stress 10) GDM Renal-Associated: 1) Fanconi syndrome 2) Advanced renal disease 3) Osteomalacia 4) Pregnancy

Answer 271

It provides a sp test for glucose

Answer 272

Via impregnating the testing area w/ a mixture of glucose oxidase, peroxidase, chromogen, and buffer to produce a double sequential enzyme rxn

Answer 273

1 (1st step) Glucose oxidase catalyzes a rxn between glucose and room air (oxygen) to produce gluconic acid and peroxide 2 (2nd step) Peroxidase catalyzes the rxn between peroxide and chromogen to form an oxidized colored compound that is produced in direct proportion to the conc of glucose

Answer 274

glucose oxidase 1. Glucose + O2 (air) -----------------------> gluconic acid + H2O2 peroxidase 2. H2O2 + chromogen ------------------> oxidized colored chromogen + H2O

Answer 275

1) Potassium iodide (green to brown) (Multistix) | 2) TMB (yellow to green) (Chemstrip)

Answer 276

It may be reported in terms of: 1) Negative 2) Trace 3) 1+ 4) 2+ 5) 3+ 6) 4+

Answer 277

Color charts also provide quantitative measurements ranging from 100 mg/dL - 2 g/dL, or 0.1% - 2%

Answer 278

Quantitative reporting

Answer 279

It is sp for glucose

Answer 280

Yes, if the containers become contaminated w/ peroxide / strong oxidizing detergents

Answer 281

Ascorbic acid

Answer 282

It prevent oxidation of the chromogen may produce false-(-) results

Answer 283

Rgnt strip manufacturers are incorporating additional chemicals into the test pads

Answer 284

Iodate oxidized ascorbic acid so that it cannot interfere w/ the oxidation of the chromogen

Answer 285

Product literature should be carefully reviewed for current info regarding all interfering substances

Answer 286

This seldom presents a problem, because high lvls of ketones are usually accompanied by marked glycosuria

Answer 287

1) High SG | 2) Low temp

Answer 288

Technical error of allowing sxs to remain unpreserved at room temp for extended periods, subjecting glucose to bacterial degradation

Answer 289

Measurement of glucose (by the copper reduction method)

Answer 290

This test relies on the ability of glucose and other substances to reduce copper sulfate to cuprous oxide in the presence of alkali and heat

Answer 291

A color change progressing from a (-) blue (CuSO4) through green, yellow, and orange/red (Cu2O)

Answer 292

heat CuSO4 (cupric sulfide) + reducing substance --------> alkali Cu2O (cuprous oxide) + oxidized substance -> color (blue/green ---> orange / red)

Answer 293

1) Copper sulfate 2) Sodium carbonate 3) Sodium citrate buffer

Answer 294

1) Urine was added to the solution 2) Heat was applied 3) The resulting ppt was observed for color

Answer 295

Clinitest tablet

Answer 296

1) Copper sulfate 2) Sodium carbonate 3) Sodium citrate 4) Sodium hydroxide

Answer 297

Upon addition of the tablet to H2O and urine, heat is produced by the hydrolysis of sodium hydroxide and its rxn w/ sodium citrate, and carbon dioxide is released from the sodium carbonate to prevent room air from interfering w/ the reduction rxn

Answer 298

Thick-walled tubes

Answer 299

It should be placed in a heat-resistant rack and not held in the hand

Answer 300

Because the rxn heat could cause a burn

Answer 301

It should be gently shaken

Answer 302

It should be compared w/ the manufacturer's color chart

Answer 303

The color present ranges from blue to orange/red

Answer 304

To determine the approx amt of reducing substance

Answer 305

False, because care must be taken to observe the rxn closely as it is taking place, because at high glucose lvls, a phenomenon known as "pass through" may occur (in Clinitest)

Answer 306

When this happens, the color produced passes through orange/red stage and returns to a green-brown color, and if not observed, a high glucose lvl may be reported as (-)

Answer 307

Instead of using 5 drops of urine, use 2 drops

Answer 308

A separate color chart

Answer 309

Up to 5 g/dL

Answer 310

Limited to 2 g/dL

Answer 311

It is reduced to a minimum of 200 mg/dL

Answer 312

It is a nonspecific test for reducing substances

Answer 313

False, because Clinitest is subjected to interference from other reducing sugars, including galactose, lactose, fructose, maltose, pentoses, ascorbic acid, certain drug metabolites, and antibiotics such as cephalosporins

Answer 314

These are very hygroscopic

Answer 315

These should be stored in their tightly closed packages

Answer 316

It suggests deterioration due to moisture accumulation, as does vigorous tablet fizzing

Answer 317

1) Galactose 2) Fructose 3) Pentose 4) Lactose

Answer 318

Inborn error of metabolism

Answer 319

The enzyme galactose-1-phosphate uridyl transferase is lacking, hence, it prevents breakdown of ingested galactose and results in the failure to thrive and other complications, including death

Answer 320

Because early detection followed by dietary restriction can control the condition

Answer 321

False, because depending on the lab population Clinitest is often performed on pediatric sxs from pts up to at least the age of 2 yrs

Answer 322

1) Glucose oxidase 1.1) Peroxidase 1.2) Potassium iodide 2) 75 - 125 mg/dL 3) Contamination by oxidizing agents and detergents (false-[+]) False-(-): 3.1) High lvls of ascorbic acid 3.2) High lvls of ketones 3.3) High SG 3.4) Low temps 3.5) Improperly preserved sxs 4) Ketones 4.1) Protein

Answer 323

1) Glucose oxidase 1.1) Peroxidase 1.2) TMB 2) 40 mg/dL 3) Contamination by oxidizing agents and detergents (false-[+]) False-(-): 3.1) High lvls of ascorbic acid 3.2) High lvls of ketones 3.3) High SG 3.4) Low temps 3.5) Improperly preserved sxs 4) Ketones 4.1) Protein

Answer 324

1) Place a thick glass test tube in a rack; add 5 drops of urine 2) Add 10 drops of distilled H2O to the urine in the test tube 3) Drop 1 Clinitest tablet into the test tube and observe the rxn until completion (cessation of boiling) CAUTION: The rxn mixture gets very hot. Do not touch the bottom area of the test tube. Use thick glass test tube only 4) Wait 15 secs after boiling has stopped and gently shake the contents of the tube 5) Compare the color of the mixture to the Clinitest color chart and record the result in mg/dL or percent. Observe for the possibility of the "pass-through" phenomenon. If present, repeat the procedure using 2 drops of urine instead of 5 drops

Answer 325

It represents the 3 intermediate products of fat metabolism w/c are: 1) Acetone 2) Acetoacetic acid 3) β-hydroxybutyrate

Answer 326

1) Acetone (2%) 2) Acetoacetic acid (20%) 3) β-hydroxybutyrate (78%)

Answer 327

False, because normally, measurable amts of ketones appear in the urine

Answer 328

Because all the metabolized fat is completely broken down into carbon dioxide and H2O

Answer 329

The body stores of fat must be metabolized to supply energy

Answer 330

Ketones are then detected in the urine

Answer 331

1) Inability to metabolize carbohydrate (w/c occurs in DM) 2) Increased loss of carbohydrate (from vomiting) 3) Inadequate intake of carbohydrate associated w/ starvation and malabsorption

Answer 332

Testing for urinary ketones

Answer 333

1) It shows a deficiency in insulin, indicating the need to regulate dosage 2) It is often an early indicator of insufficient insulin dosage (in type 1 diabetes and in pts w/ diabetes who experience medical problems in addition to diabetes)

Answer 334

1) Electrolyte imbalance | 2) Dehydration

Answer 335

Acidosis and eventual diabetic coma

Answer 336

Because the pt's illness either: 1) Prevents adequate intake 2) Or absorption of carbs 3) Or produces an accelerated loss (in cases of vomiting)

Answer 337

Frequent strenuous exercise

Answer 338

1) It is a nonreducing sugar | 2) It does not react w/ Clinitest or glucose oxidase strips

Answer 339

1) Diabetic acidosis 2) Insulin damage monitoring 3) Starvation 4) Malabsorption / pancreatic disorders 5) Strenuous exercise 6) Vomiting 7) Inborn errors of amino acid metabolism

Answer 340

False, because the 3 ketone compounds (w/c are acetone, acetoacetic acid, and β-hydroxybutyrate) are not present in equal amts in urine

Answer 341

Sodium nitroprusside rxn

Answer 342

Acetoacetic acid (in an alkaline medium) reacts w/ sodium nitroprusside to produce a purple color Acetoacetic acid (in alkaline medium) -> reacts w/ sodium nitroprusside = purple color

Answer 343

When glycine is also present

Answer 344

1) Qualitative | 2) Semiquantitative

Answer 345

1) Negative 2) Trace 3) Small (1+) 4) Moderate (2+) 5) Large (3+)

Answer 346

1) Negative 2) Trace (5 mg/dL) 3) Small (15 mg/dL) 4) Moderate (40 mg/dL) 5) Large (80 - 160 mg/dL)

Answer 347

Acetoacetate (and acetone) + sodium nitroprusside alkaline + (glycine) --------------> purple color

Answer 348

1) Large amts of levodopa 2) Medications containing sulfhydryl grps a. Mercaptoethane sulfonate sodium (MESNA) b. Captopril

Answer 349

1) The rxns w/ interfering substances frequently fade | 2) The color development from acetoacetic acid increases, resulting in false-(+) results from improperly timed readings

Answer 350

1) Volatilization of acetone | 2) Breakdown of acetoacetic acid (by bacteria)

Answer 351

In improperly preserved sxs

Answer 352

Acetest tablet test

Answer 353

1) For testing serum and other bodily fluids | 2) Dilutions of these fluids (bodily fluids) for severe ketosis

Answer 354

Rgnt strips

Answer 355

To provide automated methods for testing serum and other body fluids

Answer 356

1) Sodium nitroprusside 2) Glycine 3) Disodium phosphate 4) Lactose

Answer 357

False, because the addition of lactose (in Acetest) gives better color differentiation

Answer 358

These are hygroscopic

Answer 359

A new tablet should be used

Answer 360

1) *Sodium nitroprusside 2) 5 - 10 mg/dL acetoacetic acid 3) False-(+): a. Phthalein dyes b. Highly pigmented red urine c. Levodopa d. Medications containing free sulfhydryl grps 3. 1) False-(-): a. Improperly preserved sxs 4) Glucose

Answer 361

1) Glycine 2) 9 mg/dL acetoacetic acid | 70 mg/dL acetone 3) False-(+): a. Phthalein dyes b. Highly pigmented red urine c. Levodopa d. Medications containing free sulfhydryl grps 3. 1) False-(-): a. Improperly preserved sxs 4) Glucose

Answer 362

1) Remove the Acetest tablet from the bottle and place on a clean, dry pc of white paper 2) Place 1 drop of urine on top of the tablet 3) Wait 30 secs 4) Compare the tablet color w/ the manufacturer-supplied color chart 5) Report as negative, small, moderate, or large

Answer 363

1) In the form of intact RBCs (hematuria) | 2) Product of RBC destruction, hgb (hgburia)

Answer 364

The urine is: 1) Cloudy 2) Red

Answer 365

The urine is: 1) Clear 2) Red

Answer 366

Chemical tests for hgb

Answer 367

Microscopic examination

Answer 368

Presence of: 1) RBCs 2) Hgb 3) Myoglobin

Answer 369

Disorders of renal or genitourinary origin in w/c bleeding is the result of trauma or damage to the organs of these systems

Answer 370

1) Renal calculi 2) Glomerular diseases 3) Tumors 4) Trauma 5) Pyelonephritis 6) Exposure to toxic chemicals 7) Anticoagulant therapy

Answer 371

The lab is frequently requested to perform a UA

Answer 372

When pts present severe back and abdominal pain who are suspected of having renal calculi

Answer 373

1) Strenuous exercise | 2) During menstruation

Answer 374

Lysis of RBCs produced in the urinary tract, particularly in dilute, alkaline urine

Answer 375

1) Intravascular hemolysis | 2) Subsequent filtering of hgb through the glomerulus

Answer 376

A mixture of hgburia and hematuria Hgburia + hematuria

Answer 377

It prevents the glomerular filtration of hgb

Answer 378

1) Hemolytic anemias 2) Transfusion rxns 3) Severe burns 4) Brown recluse spider bites 5) Infections 6) Strenuous exercise

Answer 379

When the amt of free hgb present exceeds the haptoglobin content (in certain conditions)

Answer 380

In the appearance of large yellow-brown granules of denatured ferritin called hemosiderin

Answer 381

In: 1) Renal tubular epithelial cells 2) Urine sediment

Answer 382

It is a heme-containing protein found in muscle tissue

Answer 383

1) It only reacts positively w/ the rgnt strip test for blood 2) It also produces a clear red-brown urine

Answer 384

1) Trauma 2) Crush syndromes 3) Prolonged coma 4) Convulsions 5) Muscle-wasting diseases 6) Alcoholism 7) Heroin abuse 8) Extensive exertion

Answer 385

Development of rhabdomyolysis

Answer 386

It is toxic to the renal tubules

Answer 387

Acute renal failure

Answer 388

Acute renal failure

Answer 389

Pseudoperoxidase activity of hgb to catalyze a rxn between the heme component of both hgb and myoglobin and the chromogen TMB to produce an oxidized chromogen (w/c has a green-blue color) Heme component (hgb and myoglobin) -> reacts w/ chromogen TMB (catalyzed by the pseudoperoxidase activity of hgb) = oxidized chromogen (green-blue in color)

Answer 390

hgb H2O2 + chromogen -------------------> oxidized chromogen peroxidase + H2O

Answer 391

1) Peroxide | 2) TMB

Answer 392

2 color charts

Answer 393

Uniform color ranging from a (-) yellow through green to a strongly (+) green-blue (-) yellow -> green -> green-blue (strongly [+])

Answer 394

These intact RBCs lyse (when they come in contact w/ the pad)

Answer 395

The liberated hgb produces an isolated rxn that results in a speckled pattern on the pad

Answer 396

As low as 5 RBCs per microliter

Answer 397

Care must be taken when the concs. (obtained via rgnt strip tests [for blood]) comparing these figures w/ the actual microscopic values, because the absorbent nature of the pad attracts some of urine

Answer 398

1) Trace 2) Small 3) Moderate 4) Large or 1) Trace 2) 1+ 3) 2+ 4) 3+

Answer 399

1) Menstrual contamination 2) Strong oxidizing detergents (w/c are present in the sx container) 3) Vegetable peroxidase 4) Bacterial enzymes a. Escherichia coli peroxidase

Answer 400

These should be checked closely for the presence of RBCs

Answer 401

1) Ascorbic acid (vitamin C) | 2) If a urine w/ high SG containes crenated RBCs that do not lyse when they come in contact w/ the rgnt pad

Answer 402

Both have modified their rgnt strips to reduce this interference to very high lvls (25 mg/dL) of ascorbic acid

Answer 403

It uses a peroxide that is less subject to reduction by ascorbic acid

Answer 404

It overlays the rgnt pad w/ an iodate-impregnated mesh that oxidizes the ascorbic acid prior to its reaching the rxn pad

Answer 405

1) When formalin is used as a preservative 2) When the hypertension medication are present such as: a. Captopril b. High concs. of nitrite ( > 10 mg/dL)

Answer 406

When RBCs settle to the bottom of the sx container and when the sx prior to testing is failed to be mixed

Answer 407

1) Hematuria a. Renal calculi b. Glomerulonephritis c. Pyelonephritis d. Tumors e. Trauma f. Exposure to toxic chemicals g. Anticoagulants h. Strenuous exercise 2) Hgburia a. Transfusion rxns b. Hemolytic anemias c. Severe burns d. Infections / malaria e. Strenuous exercise / RBC trauma f. Brown recluse spider bites 3) Myoglobinuria a. Muscular trauma / crush syndromes b. Prolonged coma c. Convulsions d. Muscle-wasting diseases e. Alcoholism / overdose f. Drug abuse h. Extensive exertion i. Cholesterol-lowering statin medications

Answer 408

1) Diisopropylbenzene dihydroperoxide and 3,3',5,5'-tetramethylbenzidine 2) 5 - 20 RBCs/mL, 0.015 - 0.062 mg/dL hgb 3) False-(+): a. Strong oxidizing agents b. Bacterial peroxidases c. Menstrual contamination 3.1) False-(-): a. High SG / crenated cells b. Formalin c. Captopril d. High concs, of nitrite e. Ascorbic acid ( > 25 mg/dL) f, Unmixed sxs 4) Protein 4.1) Microscopic

Answer 409

1) dimethyldihydroperoxyhexane and TMB 2) 5 RBCs/mL, hgb corresponding to 10 RBCs/mL 3) False-(+): a. Strong oxidizing agents b. Bacterial peroxidases c. Menstrual contamination 3.1) False-(-): a. High SG / crenated cells b. Formalin c. Captopril d. High concs, of nitrite e. Ascorbic acid ( > 25 mg/dL) f, Unmixed sxs 4) Protein 4.1) Microscopic

Answer 410

Liver disease

Answer 411

It is the degradation product of hgb

Answer 412

It is a highly pigmented yellow compound

Answer 413

Approx 120 days

Answer 414

The RBCs that already reached 120 days are destroyed in the spleen and liver (by phagocytic cells of the reticuloendothelial system) -> the liberated hgb is broken down into its components parts (iron, protein, and protoporphyrin) -> the body reuses iron and protein and the cells of the reticuloendothelial system convert the remaining protoporphyrin to bili -> then bili is then released into the circulation (where it binds w/ albumin and is transported to the liver)

Answer 415

When bili is released into the circulation (where it binds to albumin and is transported to the liver) -> the kidneys cannot excrete the circulating bili (because not only it is bound to albumin, but it is also H2O insoluble [w/c is called as unconjugated bili]) -> in the liver, bili is conjugated w/ glucuronic acid (by the action of glucuronyl transferase) to form H2O-soluble bilirubin diglucuronide (w/c is called as conjugated bili) -> usually, this conjugated bili does not appear in the urine (because it is passed directly from the liver into the bile duct and on to the intestine -> in the intestine, the intestinal bacteria reduce bili to urobilinogen -> urobilinogen is then oxidized and excreted in the feces (in the form of stercobilinogen and urobilin)

Answer 416

1) Iron 2) Protein 3) Protoporphyrin

Answer 417

Protoporphyrin

Answer 418

1) Because it is bounded to albumin | 2) Because it is H2O insoluble

Answer 419

Glucuronic acid

Answer 420

Glucuronyl transferase

Answer 421

1) It is H2O-soluble

Answer 422

1) Stercobilinogen | 2) Urobilin

Answer 423

Conjugated bili

Answer 424

1) Gallstones | 2) CA

Answer 425

It allows the leakage of conjugated bili into the circulation

Answer 426

1) Hepatitis | 2) Cirrhosis

Answer 427

Presence or absence of urinary bili

Answer 428

1) Urine bili: +++ ; urine urobilinogen: normal 2) Urine bili: (+) or (-) ; urine urobilinogen: ++ 3) Urine bili: (-) ; urine urobilinogen: +++

Answer 429

When bili results are combined w/ urinary urobilinogen

Answer 430

False, because jaundice due to increased destruction of RBCs does not produce bilirubinuria

Answer 431

Because the serum bili is present in the unconjugated form and the kidneys cannot excrete it

Answer 432

1) Hepatitis a. Other liver disorders 2) Cirrhosis a. Biliary obstruction (gallstones, carcinoma)

Answer 433

Diazo reaction

Answer 434

Bili combines w/ 2, 4-dichloroaniline diazonium salt or 2, 6-dichlorobenzene-diazonium-tetrafluoroborate (in an acid medium) -> to produce an azodye (w/ colors ranging from increasing degrees of tan or pink to violet, respectively) Bili + 2, 4-dichloroaniline diazonium salt or 2, 6-dichlorobenzene-diazonium-tetrafluoroborate (in an acid medium) = azodye (increasing degrees of tan / pink to violet, respectively)

Answer 435

Qualitatively or quantitatively

Answer 436

1) Negative 2) Small 3) Moderate 4) Large

Answer 437

1) Negative 2) 1+ 3) 2+ 4) 3+

Answer 438

1) These are more difficult to interpret than other rgnt strip rxns 2) These are easily influenced by other pigments present in the urine

Answer 439

1) These are frequently noted on visual examination | 2) These are measured by automated readers

Answer 440

Further testing

Answer 441

Acid | Bilirubin glucuronide + diazonium salt ----------> azodye

Answer 442

Urine pigments

Answer 443

Yellow-orange urines (from persons taking phenazopyridine compounds), because the thick pigment produced may be mistaken for bili on initial examination

Answer 444

Presence of: 1) Indican 2) Metabolites (of the medication Lodine)

Answer 445

1) Testing of sxs that are not fresh (most frequent errors associated w/ bili testing) 2) When hydrolysis of bilirubin diglucuronide producing free bili is present (because this is less reactive in the rgnt strip tests)

Answer 446

It is an unstable compound that is rapidly photo-oxidized to biliverdin when exposed to light

Answer 447

High concs. of: 1) Ascorbic acid ( > 25 mg/dL) 2) Nitrite

Answer 448

Because they combine w/ the diazonium salt and prevent its rxn w/ bili

Answer 449

1) Testing mats 2) Tablets (containing p=nitrobenzene-diazonium-p-toluenesulfonate) 3) SSA 4) Sodium carbonate 5) Boric acid

Answer 450

1) 10 drops of urine are added to the mat (w/c has special properties that cause bili to remain on the surface as the urine is absorbed) 2) Following the chemical rxn, a blue-to-purple color appears on the mat when bili is present 3) Colors other than blue or purple appearing on the mat are considered to be a (-) result 4) If interference in the Ictotest is suspected, it can usually be removed by adding H2O directly to the mat after the urine has been added 5) Interfering substances are washed into the mat, and only bili remains on the surface

Answer 451

1) Place 10 drops of urine onto 1 square of the absorbent test mat 2) Using forceps, remove 1 Ictotest rgnt tablet, recap the bottle promptly, and place the tablet in the center of the moistened area 3) Place 1 drop of H2O onto the tablet and wait 5 secs 4) Place a 2nd drop of H2O onto the tablet so that the H2O runs off the tablet onto the mat 5) Observe the color of the mat around the tablet at the end of 60 secs. The presence of blue-to-purple color on the mat indicates that bili is present. A slight pink / red color should be ignored. Report as positive or negative (+): presence of blue-to-purple color (means that bili is present) (-): presence of slight pink / red color

Answer 452

1) 2,4-dichloroaniline diazonium salt 2) 0.4 - 0.8 mg/dL bilirubin 3) False-(+): a. Highly pigmented urines, phenazopyridine b. Indican (intestinal disorders) c. Metabolites of Lodine 3. 1) False-(-): a. Sx exposure to light b. Ascobic acid ( > 25 mg/dL) c. High concs. of nitrite 4) Urobilinogen

Answer 453

1) 2,6-dichlorobenzene-diazonium salt 2) 0.5 mg/dL bilirubin 3) False-(+): a. Highly pigmented urines, phenazopyridine b. Indican (intestinal disorders) c. Metabolites of Lodine 3. 1) False-(-): a. Sx exposure to light b. Ascobic acid ( > 25 mg/dL) c. High concs. of nitrite 4) Urobilinogen

Answer 454

The intestinal bacteria convert the bili to a combination of urobilinogen and stercobilinogen

Answer 455

This is reabsorbed from the intestine into the blood, recirculates to the liver, and is excreted back into the intestine through the bile duct Reabsorbed from intestine into the blood -> recirculates to the liver -> excreted back into the intestine (through the bile duct)

Answer 456

It cannot be reabsorbed and remains in the intestine where it is oxidized to stercobilin

Answer 457

It is also oxidized to urobilin

Answer 458

1) Stercobilin | 2) Urobilin

Answer 459

Yes, because as it circulates in the blood back to the liver, it passes through the kidney and is filtered by glomerulus

Answer 460

Small amt ( < 1 mg/dL or Ehrlich unit)

Answer 461

1) Liver disease | 2) Hemolytic disorders

Answer 462

It can be valuable in the detection of early liver disease

Answer 463

Constipation

Answer 464

It decreases the ability of the liver to process the urobilinogen recirculated from the intestine

Answer 465

It is filtered by the kidneys and appears in the urine

Answer 466

From the increased amt of circulating unconjugated bili

Answer 467

The uncojugated bili is presented to the liver for conjugation, resulting in a markedly increased amt of conjugated bili entering the intestines

Answer 468

Increased urobilinogen is produced, and increased amts of urobilinogen are reabsorbed into the blood and circulated through the kidneys where filtration takes place. In addition, the overworked liver does not process the reabsorbed urobilinogen as efficiently, and additional urobilinogen is presented for urinary excretion

Answer 469

Absence of urobilinogen in the urine and feces is also diagnostically significant and represents an obstruction of the bile duct that prevents the normal passage of bili into the intestine

Answer 470

Pale stools are the result of lack of urobilin

Answer 471

Ehrlich's aldehyde rxn

Answer 472

Urobilinogen reacts w/ p-dimethylaminobenzaldehyde to produce colors ranging from light to dark pink

Answer 473

Ehrlich rgnt

Answer 474

Results are reported as Ehrlich units (EU)

Answer 475

Normal readings (0.2 and 1) through abnormal readings (2, 4, and 8)

Answer 476

Azo-coupling (diazo) rxn using 4-methoxybenzene-diazonium-tetrafluoroborate to react w/ urobilinogen, producing colors ranging from white to pink

Answer 477

Rxn of Chemstrip than Ehrlich rxn

Answer 478

False, because both tests (via the use of Multistix and Chemstrip) detect urobilinogen that is present in normal quantities, and color comparisons are provided for the upper limits of normal as well as abnormal concs.

Answer 479

False, because rgnt strip tests cannot determine the absence of urobilinogen, w/c is significant in biliary obstruction

Answer 480

``` Acid Urobilinogen + p-dimethylaminobenzaldehyde --------> red color (Ehrlich's (Ehrlich's rgnt) reactive substances) ```

Answer 481

Acid Urobilinogen + diazonium salt -----------> red azodye (4-methyloxybenzene-diazonium-tetrafluoroborate)

Answer 482

To a variety of interferences, referred to as Ehrlich-reactive compounds

Answer 483

False-(+) rxns

Answer 484

1) Porphobilinogen 2) Indican 3) p-aminosalicylic acid 4) Sulfonamides 5) Methyldopa 6) Procaine 7) Chlorpromazine compounds

Answer 485

At room temp

Answer 486

When sxs are improperly preserved

Answer 487

Improperly preserved sxs allow urobilinogen to be photo-oxidized to urobilin

Answer 488

High concs. of nitrite

Answer 489

1) p-dimethylaminobenzaldehyde 2) 0.2 mg/dL urobilinogen 3) False-(+): a. Porphobilinogen b. Indican c. p-aminosalicylic acid d. Sulfonamides e. Methyldopa f. Procaine g. Chlorpromazine h. Highly pigmented urine 3. 1) False-(-): a. Old sxs b. Preservation in formalin 4) Bilirubin

Answer 490

1) 4-methoxybenzene-diazonium-tetrafluoroborate 2) 0.4 mg/dL urobilinogen 3) False-(+): a. Highly pigmented urine 3. 1) False-(-): a. Old sxs b. Preservation in formalin c. High concs. of nitrite 4) Bilirubin

Answer 491

1) Early detection of liver disease 2) Liver disorders, hepatitis, cirrhosis, carcinoma 3) Hemolytic disorders

Answer 492

Rapid screening test for the presence of UTI

Answer 493

To detect cases in w/c the need for a culture may not be apparent

Answer 494

Many UTIs are believed to start in the bladder (as a result of external contamination) -> it progress upward through the ureters to the tubules, renal pelvis, and kidney (if untreated)

Answer 495

Initial bladder infection (cystitis)

Answer 496

Because pts are often asymptomatic or have vague symptoms that would not lead the physician to order a urine culture

Answer 497

1) It is an inflammatory process of the kidney and adjacent renal pelvis 2) It is a frequent complication of untreated cystitis and can lead to renal tissue damage, impairment of renal fxn, hypertension, and even septicemia

Answer 498

1) Detection of bacteriuria (through the use of nitrite screening test) 2) Subsequent antibiotic therapy

Answer 499

1) To evaluate the success of antibiotic therapy | 2) To periodically screen persons w/ recurrent infections, pts w/ diabetes, and pregnant women

Answer 500

1) Pts w/ recurrent infections 2) Pts w/ diabetes 3) Pregnant women

Answer 501

The ability of certain bacteria to reduce nitrate to nitrite

Answer 502

Greiss reaction

Answer 503

Nitrite (at an acidic pH) reacts w/ an aromatic amine (para-arsanilic acid or sulfanilamide) to form a diazonium compound -> diazonium compound then reacts w/ tetrahydrobenzoquinolin compounds -> w/c leads to the production of a pink-colored azodye Nitrite (at acidic pH) reacts w/ para-arsanilic acid or sulfanilamide -> forming diazonium compound -> diazonium compound reacts w/ tetrahydrobenzoquinolin compounds = pink-colored azodye

Answer 504

The sensitivity of the test is standardized to correspond w/ a quantitative bacterial culture criterion of 100,000 organisms per milliliter

Answer 505

1) Negative | 2) Positive

Answer 506

Acid Para-arsanilic acid or sulfanilamide + NO2 ---------> diazonium salt (nitrite) Acid Diazonium salt + tetrahydrobenzoquinolin ------------> pink azodye

Answer 507

1) These should always be repeated | 2) Or these should be followed by a urine culture

Answer 508

1) Bacteria that lack enzyme reductase do not possess the ability to reduce nitrate to nitrite. Reductase is found in the gram-(-) bacteria that most frequently cause UTIs. Non-nitrate reducing gram-(+) bacteria and yeasts, however, cause a significant # of infections, and the nitrite test does not detect the presence of these organisms 2) Bacteria capable of reducing nitrate must remain in contact w/ the urinary nitrate long enough to produce nitrite. Therefore, nitrite tests should be performed on 1st morning sxs or sxs collected after urine has remained in the bladder for at least 4 hrs. The correlation between (+) cultures and (+) nitrite test results is significantly lower when testing is performed on random sxs 3) The reliability of the test depends on the presence of adequate amts of nitrate in the urine. This is seldom a problem in pts on a normal diet that contains green vegetables; however, because diet usually is not controlled prior to testing, the possibility of a false-(-) result owing to lack of dietary nitrate does exist 4) Further reduction of nitrite to nitrogen may occur when large #s of bacteria are present, and this causes a false-(-) rxn 5) Other causes of false-(-) results include inhibition of bacterial metabolism by the presence of antibiotics, large quantities of ascorbic acid interfering w/ diazo rxn, and decreased sensitivity in sxs w/ a high SG. Large amts of ascorbic acid compete w/ nitrite to combine w/ the diazonium salt, therefore preventing a true nitrite measurement

Answer 509

In gram-(-) bacteria

Answer 510

Enterobacteriaceae

Answer 511

Gram-(-) bacteria (such as Enterobacteriaceae)

Answer 512

1) First morning sxs | 2) Or sxs collected after urine has remained in the bladder (for at least 4 hrs)

Answer 513

False, because the correlation between (+) cultures and (+) nitrite test results is significantly lower when testing is performed on random sxs

Answer 514

It depends on the presence of adequate amts of nitrate in the urine

Answer 515

Presence of adequate amts of nitrate in the urine

Answer 516

When large #s of bacteria present

Answer 517

Further reduction of nitrite to nitrogen

Answer 518

1) Inhibition of bacterial metabolism by the presence of antibiotics 2) Large quantities of ascorbic acid interfering w/ the diazo rxn 3) Decreased sensitivity in sxs w/ a high SG

Answer 519

1) Cystitis 2) Pyelonephritis 3) Evaluation of antibiotic therapy 4) Monitoring of pts at high risk for UTI 5) Screening of urine culture sxs

Answer 520

1) p-arsanilic acid 1. 1) Tetrahydrobenzo(h)-quinolin-3-ol 2) 0.06 - 0.1 mg/dL nitrite ion 3) False-(-): a. Nonreductase-containing bacteria b. Insufficient contact time between bacteria and urinary nitrate c. Large quantities of bacteria converting nitrite to nitrogen d. Presence of antibiotics e. High concs. of ascorbic acid f. High SG 3. 1) False-(+): a. Improperly preserved sxs b. Highly pigmented urine 4) Protein 4. 1) Leukocytes 4. 2) Microscopic

Answer 521

1) Sulfanilamide, hydroxytetrahydro benzoquinoline 2) 0.05 mg/dL nitrite ion 3) False-(-): a. Nonreductase-containing bacteria b. Insufficient contact time between bacteria and urinary nitrate c. Large quantities of bacteria converting nitrite to nitrogen d. Presence of antibiotics e. High concs. of ascorbic acid f. High SG 3. 1) False-(+): a. Improperly preserved sxs b. Highly pigmented urine 4) Protein 4. 1) Leukocytes 4. 2) Microscopic

Answer 522

Microscopic examination of the urine sediment

Answer 523

To variation depending on the method used to prepare the sediment and the technical personnel examining the sediment

Answer 524

It offers a more standardized means for the detection of leukocytes

Answer 525

It detects the presence of leukocytes that have been lysed, particularly in dilute alkaline urine, and would not appear in the microscopic examination

Answer 526

On the microscopic sediment examination

Answer 527

From 0 to 2 to 0 to 5 per high-power field

Answer 528

False, because women tend to have higher numbers of leukocytes than men

Answer 529

Due to vaginal contamination

Answer 530

Increased urinary leukocytes

Answer 531

It detects the presence of esterase in the granulocytic WBCs such as: 1) Neutrophils 2) Eosinophils 3) Basophils 4) Monocytes

Answer 532

Neutrophils

Answer 533

1) Trichomonas | 2) Histiocytes

Answer 534

By the presence of bacteria (w/c may or may not produce a [+] nitrite rxn)

Answer 535

1) Infections caused by: a. Trichomonas b. Chlamydia c. Yeast 2) Inflammation of renal tissues a. Interstitial nephritis

Answer 536

Screening urine sxs using the LE and nitrite chemical rxns

Answer 537

To the reliability of the practice of screening urine sxs (using the LE and nitrite chemical rxns) to determine the necessity of performing urine cultures (as a cost-effective measure) than does the nitrite test

Answer 538

It uses the action of LE to catalyze the hydrolysis of an acid ester embedded on the rgnt pad to produce an aromatic compound and acid. The aromatic compound then combines w/ a diazonium salt present on the pad to produce a purple azodye

Answer 539

Leukocyte Indoxylcarbonic acid ester -----------------> indoxyl + acid indoxyl Esterase Acid + diazonium salt ----------> purple azodye

Answer 540

1) Trace 2) Small 3) Moderate 4) Large Or 1) Trace 2) 1+ 3) 2+ 4) 3+

Answer 541

It may not be significant

Answer 542

It should be repeated on a fresh sx

Answer 543

Presence of strong oxidizing agents or formalin (in the collection container)

Answer 544

1) Highly pigmented urines | 2) Presence of antibiotic nitrofurantoin

Answer 545

Presence of: 1) High concs. of protein ( > 500 mg/dL) 2) High concs. of glucose ( > 3 mg/dL) 3) High concs. of oxalic acid 4) High concs. of ascorbic acid

Answer 546

In urines w/ high SG

Answer 547

1) Gentamicin 2) Cephalexin 3) Cephalothin 4) Tetracycline

Answer 548

1) Bacterial and nonbacterial UTI 2) Inflammation of the urinary tract 3) Screening of urine culture sxs

Answer 549

1) Derivatized pyrrole amino acid ester 1. 1) Diazonium salt 2) 5 - 15 WBC/hpf 3) False-(+): a. Strong oxidizing agents b. Formalin c. Highly pigmented urine, nitrofurantoin 3. 1) False-(-): a. High concs. of protein b. High concs. of glucose c. High concs. of oxalic acid d. High concs. of ascorbic acid e. High concs. of gentamicin f. High concs. of cephalosporins g. High concs. of tetracyclines h. Inaccurate timing 4) Protein 4. 1) Nitrite 4. 2) Microscopic

Answer 550

1) Indoxylcarbonic acid ester 1. 1) Diazonium salt 2) 10 - 25 WBC/hpf 3) False-(+): a. Strong oxidizing agents b. Formalin c. Highly pigmented urine, nitrofurantoin 3. 1) False-(-): a. High concs. of protein b. High concs. of glucose c. High concs. of oxalic acid d. High concs. of ascorbic acid e. High concs. of gentamicin f. High concs. of cephalosporins g. High concs. of tetracyclines h. Inaccurate timing 4) Protein 4. 1) Nitrite 4. 2) Microscopic

Answer 551

It is based on the change of pKa (dissociation constant) of a polyelectrolyte in an alkaline medium

Answer 552

The polyelectrolyte ionizes, releasing hydrogen ions in proportion to the # of ions in the solution. The higher the conc. of urine, the more hydrogen ions are released, thereby lowering pH

Answer 553

Bromthymol blue

Answer 554

It measures the change in pH

Answer 555

It changes from blue (1.000 [alkaline]), through shades of green, to yellow (1.030 [acid]) Blue (1.000 [alkaline]) -> shades of green -> yellow (1.030 [acid])

Answer 556

It should be carefully compared w/ the color chart

Answer 557

Ionic solutes

Answer 558

The interference by large organic molecules, radiographic contrast media, and plasma expanders (w/c are included in physical measurements of SG) are eliminated

Answer 559

1) Urea | 2) Glucose

Answer 560

It slightly increase the readings (for SG)

Answer 561

Due protein anions

Answer 562

In sxs w/ a pH of 6.5 or higher

Answer 563

Interference w/ the bromthymol blue indicator (the blue-green readings associated w/ an alkaline pH correspond to a low SG reading)

Answer 564

They recommend adding 0.005 to SG readings (when the pH is 6.5 or higher)

Answer 565

It is performed by automated strip readers

Answer 566

1) Monitoring pt hydration and dehydration 2) Loss of renal tubular concentrating ability 3) Diabetes insipidus (DI) 4) Determination of unsatisfactory sxs due to low conc.

Answer 567

1) Poly (methyl vinyl ether/maleicanhydride) bromthymol blue 2) 1.000 - 1.030 3) False-(+): a. High concs. of protein 3. 1) False-(-): a. Highly alkaline urines ( > 6.5)

Answer 568

1) Ethylene glycol diaminoethyl ether tetraacetic acid, bromthymol blue 2) 1.000 - 1.030 3) False-(+): a. High concs. of protein 3. 1) False-(-): a. Highly alkaline urines ( > 6.5)