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CLINICAL MICROSCOPY Flashcards

1
Q

Potential harmful microorganisms

A

BIOLOGICAL HAZARD

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2
Q

3 routes of infection

A
  1. Inhalation
  2. Ingestion
  3. Direct inoculation or skin contact
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3
Q

6 components (Chain of infection)

A

IREMES
1. Infectious agent
2. Reservoir
3. Exit portal
4. Mode of transmission
5. Entry portal
6. Susceptible host

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4
Q

PPE

A
  1. Gloves
  2. Fluid resistant gowns
  3. Eye and face shields
  4. Countertop shields
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5
Q

The primary method of infection transmission

A

HAND CONTACT

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6
Q

BEST WAY to break the chain of infection

A

HANDWASHING

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7
Q

HANDWASHING PROCEDURE

A
  1. Wet hands with warm water.
  2. Apply antimicrobial soap.
  3. Rub to form a lather, create friction, and loosen debris.
  4. Thoroughiy clean between fingers, including thumbs, under fingernails and rings, and up to the
    When hands wrist for at least [15 (or 20) seconds]
  5. Rinse hands in a DOWNWARD POSITION.
  6. Dry with a paper towel.
  7. Turn off faucets with a clean paper towel to apply alcohol prevent recontamination.
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8
Q

HANDWASHING SONG

A

Happy Birthday (2x)

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9
Q

When hands are visibly soiled

A

Wash hands with soap and water

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10
Q

When hands are NOT visibly soiled

A

Apply alocohol based hand rub
(ex. Sanitizer)

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11
Q

ALL biological waste, except _____, must be placed in appropriate containers labeled with the biohazard symbol.

A

URINE

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12
Q

Accepted BIOHAZARD label

A

FLUORESCENT ORANGE

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13
Q

Disinfection of the sink using a _____, should be perform _____. (Effective for ____; used for disinfecting countertops and spills)

A

1:5 or 1:10 dilution of sodium hypochlorite
Daily
1 month

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14
Q

Eliminates many or all pathogenic microorganisms, except bacterial spores.

A

DISINFECTION

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15
Q

Chemical spills best first aid

A

Flush the area with amounts of water for at least 15 minutes the seek for medical attention.

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16
Q

What will you do for alkali or acid burn in the eye?

A

Wash out eye thoroughly with running water for 15 minutes.
DO NOT NEUTRALIZE CHEMICALS that come in contact with the skin.
Acid spills on floors can be neutralized and then soaked up with wet rags or spills.

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17
Q

CHEMICAL HANDLING

A

ALWAYS ADD ACID TO WATER

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18
Q

NFPA number 1 quadrant

A

YELLOW
(Reactivity/Stability hazard)

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19
Q

May deteriorate/ detonate

A

4

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20
Q

2 represents?

A

Violent chemical change

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21
Q

3 represents

A

Shock & heat may deteriorate/detonate

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22
Q

0 and 1 represents

A

0- stable
1- unstable when heated

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23
Q

Second quadrant

A

WHITE quadrant (Specific hazard)
OXY- oxidizer
ACID- acid
ALK- alkali
COR- corrosive
W- use no water
Radiation

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24
Q

3rd quadrant

A

BLUE quadrant (HEALTH hazard)

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25
Q

0, 2 and 3 represents?

A

0- normal material
2- hazardous
3- extreme danger

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26
Q

1 and 4 represents

A

1- slightly hazardous
4- deadly

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27
Q

4th quadrant

A

RED (flammability hazard)

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28
Q

Will not burn

A

0

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29
Q

1 and 2 represents

A

1- above 200^F
2- below 200^F

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30
Q

3 and 4 represents

A

3- below 100^F
4- below 73^F

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31
Q

DEGREE OF HAZARDS (hazard index)
“No SMS Ex’s”

A

0- NO/Minimal hazard
1- Slight hazard
2- Moderate hazard
3- Serious hazard
4- Extreme/Severe

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32
Q

Electrical hazard

A

*DO NOT OPERATE equipment with wet hands.
*All electrical equipment is grounded in a 3-cronsed plug to avoid electric shock.
*If electrical shock occurs, never touch the person er the equipment involved.
- Turn off the circuit breaker
- Unplug the equipment
- Move the equipment using a nonconductive glass or wood object

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33
Q

All laboratory personnel must be involved in laboratory fire drills at least ____

A

ANNUALLY

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34
Q

When a fire is discovered?

A

RACE
RESCUE anyone in immediate danger
ALARM (Activate the institutional fire alarm system)
CONTAIN (Close all doors to potentially affected areas)
EXTINGUISH/ EVACUATE (Attempt to extinguish the fire, if possible; exit the area) ALWAYS CHOOSE EXTINGUISH!!

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35
Q

To operate a Fire extinguisher?

A

PASS
PULL the pin
AIM the base of the fire
SQUEEZE handles
SWEEP nozzle side to side

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36
Q

Ordinary combustibles; PAPER, cloth, rubbish, plastic, WOOD
Type of fire?
Type of extinguisher?

A

Type A fire
WATER, dry chemical, loaded steam

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37
Q

Cooking media: grease, oils, tats
Type of fire and extinguisher?

A

Type K fire

Liquid designed to prevent splashing and cool the fire

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38
Q

Flammable metals: mercury, magnesium, sodium, lithium

A

Type D fire

Metal X, sand; dry powder; fought by fire fighters only

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39
Q

Flammable liquids: grease, gasoline, paints, oil

A

Type B fire

Dry chemical, carbon dioxide, halon foam

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40
Q

Electrical equipment and motor switches

A

Type C fire

Dry chemical, carbon dioxide, halon

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41
Q

Detonation (Arsenal fire)

A

Type E fire

Allowed to burn out and nearby materials protected

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42
Q

Best fire extinguisher for electrical fire?

A

HALON (BC)

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43
Q

The most common all purpose extinguishers

A

ABC (dry chemical extinguishers)

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44
Q

Kidney weights approximately ____ & measures ____

A

150 g

12.5 cm x6 cm x2.5 cm

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45
Q

Ureter length ___

Urethra - ___ cm long in women and ___ cm long in men

About every ______, small amounts of urine are emptied into the bladder from the ureters.

Urine is actually a fur biopsy of the kidney

A

25 cm long

4 cm long in women
24 cm long in men

10-15 seconds

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46
Q

Basic strustural & functional unit of the kidney

A

Nephrons
1. Cortical nephrons (85%)
- removal of waste products and nutrients reabsorption
2. Juxtamedullary
- urine concentration

1 to 1.5 million nephrons PER kidney
Consists of glomerulus and renal tubules

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47
Q

ORDER OF URINE FORMATION:

A
  1. Glomerulus
  2. Proximal convoluted tubule (PCT) -NEAR
  3. Loop of Henle (LH)
  4. Distal convoluted tubule (DCT)- FAR
  5. Collecting duct (CD)- last part of nephron
  6. Calyx
  7. Renal Pelvis
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48
Q

The kidney receives ____ of the total cardiac output.

A

25%

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49
Q

ORDER of RENAL blood flow

A
  1. RENAL ARTERY
    - blood in
    -unfiltered
  2. Afferent arteriole
    - approaching
  3. Glomerulus
    - plasma filtration of substances
  4. Efferent arteriole
    - exiting
  5. Peritubular capillaries
    - capillaries surrounding renal tubules (reabsorption and secretion)
  6. Vasa recta in LH (selective reabsorption)
  7. Renal vein
    - blood out
    - filtered
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50
Q

2 kidneys

Total renal blood flow:

A

1,200 mL/min

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51
Q

Total renal plasma flow:

A

600-700 mL/min

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52
Q

The “working portion” of the kidney
Coil of approx. 8 capillary lobes (capillary tuff) located w/in the Bowman’s capsule
★Attached to the glomerular basement membrane are the podocytes (epithelial cells)
★ Resembles a SIEVE “salaan”

Non-selective filter of plasma substances with MW of <70,000 Da - easy pass

Approximately 1% of the filtered plasma volume is actually excreted as urine

A

GLOMERULUS

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53
Q

GLOMERULAR FILTRATION BARRIER

A
  1. Capillary endothelium with its large open pores “ Fenestrated”
  2. Trilayer basement membrane (lamina rara interna, lamina densa, lamina rara externa)
  3. Filtration diaphragm found between the podocytes of Bowman’s space
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54
Q

What are the glomerular filtrate?

A

SWAGU
Salts
Water
Amino acids
Glucose
Urea

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55
Q

Glomerular filtrate SG

A
  1. 010
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56
Q

A protein that is not filtered by the glomerulus because of its negative charge.
Has a molecular weight of 69, 000 Da
Can be positive if the pH is _____

A

ALBUMIN

<4.9

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57
Q

First function to be affected in renal disease

A

TUBULAR REABSORPTION

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58
Q

RENAL THRESHOLD FOR GLUCOSE

A

160-180 mg/dL

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59
Q

Alter urine concentration

A

PCT, LH, DCT, CD

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60
Q

The major site for reabsorption

A

PCT (65%)

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61
Q

Highly impermeable to water

A

Ascending LH

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62
Q

During Hyponatremia what will happen to amino acids, glucose and urea?

Aldosterone _____ (increase or decrease)
ADH ______

A

100% amino acids are reabsorbs
Glucose reabsorbs (<RTG)
40% of urea will be reabsorbs.

Aldosterone- INCREASED
ADH - INCREASED

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63
Q

Hypernatremia

A

SWGU will be excreted in the urine.

Aldosterone -DECREASED
ADH- DECREASED
0% amino acids
More than or equal renal threshold for GLUCOSE
60% urea will be excreted

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64
Q

What are the substances that are ACTIVELY transport by the PCT?

A

Glucose
Amino acids
Salts

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65
Q

What is the substance that is ACTIVELY transport by the ASCENDING LH?

A

Chloride

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66
Q

What is the substances that is ACTIVELY transport by the PCT and DCT?

A

Sodium

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67
Q

What is/are the substances that is/are PASSIVELY transport by the PCT, ascending LH and CD?

A

WATER

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68
Q

What is/are the substances that is/are PASSIVELY transport by the PCT, ascending LH?

A

UREA

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69
Q

What is/are the substances that is/are PASSIVELY transport by the ascending loop of henle?

A

SODIUM

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70
Q

Regulates WATER REABSORPTION in the DCT and CD?

A

Anti-Diuretic hormone (ADH/VASOPRESSIN)

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71
Q

ADH deficiency

A

DIABETES INSIPIDUS
DI- “Dami Ihi”

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72
Q

ADH excess

A

Syndrome of inappropriate ADH secretion (SIADH)

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73
Q

Increased Body Hydration ___ ADH ____ Urine volume

A

Decreased, Increased

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74
Q

Decreased body hydration ____ADH ____urine volume

A

INCREASED, DECREASED

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75
Q

Regulates SODIUM REABSORPTION

A

ALDOSTERONE

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76
Q

RAAS is activated by:

A

Decreased Na, Decreased BP

Dilation: afferent
Constriction: efferent

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77
Q

Activated RAAS

A

Increased BP
Constriction: Afferent

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78
Q

Effects of Angiotension II

A
  • Release of Aldosterone S ADH (Increased Sodium & water reabsorption)
  • Vasoconstriction (Increased blood pressure)
  • Corrects renal blood flow
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79
Q

Juxtaglomerular apparatus consists of the JG cells produces ____ in the afferent arteriole

A

RENIN

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80
Q

Macula Densa ________ of the DCT

A

Detects decrease in BP

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81
Q

ACTION OF RAAS

A
  1. Dilates the afferent arteriole & constricts the efferent arteriole
  2. Stimulates sodium reabsorption in the PCT
  3. Triggers the adrenal cortex to release aldosterone to cause sodium reabsorption & potassium excretion in the DCT and CD
  4. Triggers release of anti-diuretic hormone by the hypothalamus to stimulate water reabsorption in the CD
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82
Q

2 Major Functions of tubular secretion

A
  1. Regulation of the acid-base balance in the body through secretion of hydrogen ions (in the form of NH4 and H2P04).
  2. Elimination of waste products not filtered by the glomerulus
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83
Q

Major site for removal of non-filtered substances.

A

PROXIMAL CONVOLUTED TUBULE

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84
Q

Failure to produce an acid urine due to inability to secrete hydrogen ions

A

RENAL TUBULAR ACIDOSIS

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85
Q

What is the relationship between pH and Hydrogen ions?

A

INVERSELY PROPORTIONAL

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86
Q

RENAL TUBULAR ACIDOSIS

A

Increased hydrogen ions in the blood
Decreased hydrogen ions in the urine
Increased pH = alkaline

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87
Q

Used to evaluate glomerular filtration.
Measure the rate at which the kidneys are able to remove a filterable substance from the blood.

A

CLEARANCE TEST

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88
Q

What clearance test is obsolete, oldest, not accurate, present in all urine specimen (40% is reabsorbed)

A

UREA

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89
Q

Most common but not reliable indicator to patient suffering from muscle wasting diseases.

A

CREATININE (ENDOGENOUS)

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90
Q

GOLD STANDARD test for glomerular filtration

A

INULIN (EXOGENOUS)

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91
Q

better marker of renal tubular function than of GFR

A

Beta2-microglobulin (MW: 11,800 Da)

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92
Q

Creatinine Clearance Formula

A

Ccr (mL/min)= UV/P x 1.73m^2

Where:
Ccr= Creatinine clearance
U = Urine creatinine (mg/dL)
P= Plasma creatinine
V= Urine volume (mL/min)
A= Body surface area

Normal values
Male 107-139 mL/min
Female 87-107 mL/min

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93
Q

Is a measure of the completeness of a
24-hour urine collection

A

CREATININE CLEARANCE

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94
Q

By far the greatest source of error in any clearance procedure utilizing urine is the use of ______

A

IMPROPERLY TIMED URINE SPECIMENS

Around 7-10% of creatinine is secreted by the renal tubules.

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95
Q

Variables used in Estimated GFR formula developed by cockgroft and gault

A

Age
Sex
Body weight in kg

Formula:
Ccr= (140–age)(body wight in kg)/72x serum creatinine in mg/dL

Results x 0.85 (if female)

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96
Q

Modification of Diet in Renal disease (MDRD) system formula variables:

A

Ethinicity
BUN
Serum albumin

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97
Q

used to evaluate tubular reabsorption

A

CONCENTRATION TESTS

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98
Q

Patient is deprived of fluid for up to 24 hours
# Urine S.G. after 12-hour restricted fluid diet is about 1.022 or more
# Urine S.G. after 24-hour restricted fluid diet is about 1.026 or more

A

Obsolete test

  1. Fishberg test
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99
Q

Patient maintains normal diet and fluid intake
Compare day & night urine in terms of volume & S.G.

A

Obsolete test

  1. Mosenthal test
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100
Q

Influenced by the number & density of particles in a solution

A

Recently used tests
1. Specific gravity

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101
Q

Influenced by the number of particles in a solution
More preferred than S.G. determination
More precise than osmolarity because it does not vary with temperature Methods include freezing point osmometry & vapor pressure osmometry
NV =1-3x (275 to 900 mOsm/kg) than of serum (275 to 300 mOsm/ kg)

A
  1. Osmolality
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102
Q

most commonly used; reference method for tubular secretion and renal blood flow

A

p-aminohippuric acid (PAH) test

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103
Q

obsolete; results are hard to interpret

A

Phenolsulfonphthaiein (PSP) test

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104
Q

inferred diagnoses from urine evaluation

A

Hippocrates, Aristotle and the ancient Egyptians

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105
Q

4 temperaments/ humors:

A
  1. Sanguineous (blood)
  2. Choieric (vellow bile)
  3. Phlegmatic (phlegm)
  4. Melancholic (black bile)
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106
Q

The __________ of urine was used by the Babylonians and Egyptians to detect diabetes
Hindu physicians noticed that ________ attracted ants

A

“taste test”
“honey urine”

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107
Q

Uroscopy; first documented the importance of sputum examination

A

Hippocrates

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108
Q

Albuminuria by boiling urine

A

Frederik Dekkers

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109
Q

Wrote a book about “pisse prophets” (charlatans)

A

Thomas Bryant

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110
Q

Examination of urine sediment

A

Thomas Addis

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111
Q

Introduced urinalysis as part of doctor’s routine patient examination

A

Richard Bright

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112
Q

Urochrome

A

Ludwig Thudichum

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113
Q

Cerebrospinal fluid

A

Domenico Cotugno

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114
Q

Phenylketonuria

A

Ivan Folling

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115
Q

Alkaptonuria

A

Archibald Garrod

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116
Q

Cystine calculi

A

William Wollaston

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117
Q

Benedict’s reagent

A

Stanley Benedict

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118
Q

URINE COMPOSITION
_____% water
_____% solids (______ total solids in 24 hours)

A

95-97% water
3-5% solids (60% total solids in 24 hours)

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119
Q

Total solids
_____ grams organic

_____major organic compound
_____2nd organic compound

A

35 grams

UREA
CREATININE

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120
Q

_____grams inorganic compound

_____major inorganic compound >_____ >______

_____principal salt

A

25 grams

Chloride > Sodium > Potassium

NaCl

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121
Q

For routine and qualitative urinalysis
* Ideal for cytology studies (ONLY IF with prior hydration, & exercise 5 mins before collection!

A
  1. RANDOM/OCCASIONAL / SINGLE
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122
Q

Ideal specimen for routine urinalysis and pregnancy testing (hEG)

Often preferred for cytology studies/ cyto diagnostic urine testing

Most concentrated and most acidic - allows well preservation of cells and casts

For evaluation of orthostatic pruteinuria.

Patient voids before going to bed, and immediately on rising from sleep collects urine specimen

Alternative for cyto

A

FIRST MORNING

!!concentrated>hypertonic>shrink cells
Hypocentilation>respiratory acidosis

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123
Q

2nd voided urine after a period of fasting
For glucose determination

A

SECOND MORNING /FASTING

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124
Q

For diabetic screening or monitoring
Preferred for testing glucose

A

2-hour post-prandial

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125
Q

Optional with blood samples in glucose tolerance test

A

Glucose tolerance

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126
Q

At least 2 voided collection

Series of blood and urine samples are collected at specific time intervals to compare concentration of a substance in urine with its concentration in the blood
Used in the diagnosis of diabetes

A

Fractional specimen

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127
Q

For routine screening and bacterial culture
Patient should thoroughly cleanse his glans penis or her urethral meats before collection
Less contaminated by epithelial and bacterial cells

A

MIDSTREAM CLEAN CATCH

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128
Q

May be urethral or ureteral
For bacterial culture

A

CATHETERIZED

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129
Q

Abdominal wail is punctured, and urine is directly aspirated from the bladder
Bladder urine for anaerobic bacterial culture and urine cytology
Most sterile

A

SUPRAPUBIC ASPIRATION

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130
Q

Use of soft, clear plastic bag with adhesive

Sterile specimen obtained by catheterization or suprapubic aspiratica

Urine collected from diaper is NOT recommended for testing

A

PEDIATRIC SPECIMEN

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131
Q

For prostatic infection

A

THREE -GLASS TECHNIQUE

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132
Q

if the # of WBC and bacteria in the 3rd spx is 10x GREATER than that of the 1st

A

PROSTATITIS

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133
Q

Serves as a CONTROL for bladder & kidney infection.

A

2nd specimen

If control is (+) for WBCs and bacteria, the results from the 3rd specimen are considered invalid

If may laman <UTI></UTI>

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134
Q

The four-glass method consists of bacterial cultures of the
initial voided urine (VB1), midstream urine (VB2), expressed prostatic secretions (EPS), and a post-prostatic massage urine specimen (VB3). Urethral infection or inflammation is tested for by the VB1, and the VB2 tests for urinary bladder infection. The prostatic secretions are cultured and examined for white blood cells. Having more than 10 to 20 white blood cells per high-power field is considered abnormal.

A

STAMEY-MEARS TEST EOR PROSTATITIS

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135
Q

At start time, patient empties bladder into toilet; then all subsequent urine is collected At end time, patient empties bladder into collection container
Requires preservative - it depends on the test performed

A

24-hour (Ex: 8 AM -> 8 AM)

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136
Q

For addis count

A

12-hour (Ex: 8 AM -> 8 PM)

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137
Q

for nitrite determination

Urine remains in bladder for at least 4 hours before voiding

A

4-hour

(First morning urine- best for nitrite determination)

138
Q

For UROBILINOGEN determination

A

Afternoon (2-4 PM)

139
Q

Process providing documentation of proper sample ID from the time of collection to the receipt of laboratory results.

A

CHAIN OF CUSTODY

140
Q

Required urine volume for DRUG test

A

30-45 ml

141
Q

Drug test Container capacity

A

60 ml

142
Q

Optimal temperature of urine in DRUG test

A

32.5- 37.7°C (checked within 4 minutes)

143
Q

Added to the toilet water reservoir to prevent specimen adulteration

A

Blueing agent

144
Q

Urine containers should have a wide base, and has an opening of at least ______ cm. The wide base prevents spillage, and a _____cm opening is an adequate target for urine collection.

A

4 cm

145
Q

24-hr urine containers should hold up to _____ and may be colored to protect light sensitive analytes.

Addition of urine before the start of 24-hour collection period causes ________ results.

Failure to include urine at the end of 24-hour collection period causes ______ results

A

3L

False increased

False decreased

146
Q

When both a routine UA and culture are requested on a catheterized or midstream collection, what will you do first?

A

CULTURE should be performed first to prevent contamination of the specimen

147
Q

Following collection, urine specimens should be delivered to the laboratory promptly and tested within ________
(Strasinger, Harr); ideally within _____ minutes (Turgeon)

Physical, chemical and microscopic characteristics of a urine specimen begin to change _________

A

Within 2 hours

Ideally- 30 minutes

AS SOON AS THE URINE IS VOIDED

148
Q

CHANGES IN UNPRESERVED URINE
Increased analytes?
Decreased analytes?

A

Increased analytes
-pH
-Bacteria
-Odor
-Nitrite

Darkened/Modified
-Color

Decreased analytes
Clarity
Glucose
Ketone
Blood
Urobilinogen
RBC/WBC/Casts
Trichomonas- resembles WBC

149
Q

Least affected analyte in unpreserved urine?

A

PROTEIN

150
Q

What is the ideal urine preservative?

A

Ideal urine preservative does not exist (Sirasinger)

151
Q

Does not interfere with chemical tests

Raises SG by hydrometer
Precipitates amorphous phosphates and urates

Preservative of choice for routine UA & urine culture
Prevents bacterial growth for 24 hours

A

REFRIGERATION (2-8 degree celsius)

152
Q

Excellent sediment preservative

Reducing agent, interieres with chemical tests for glucose, blood, leukocytes & copper reduction

Rinse specimen container with formalin to preserve cells and casts

Preservative of choice for Addis count

A

FORMALIN (formaldehyde)

153
Q

Freserves protein & formed elements well. Does not interfere w/ routine analyses other then pH

May precipitate crystals when used in large amcunts «cloudy urine

Keeps pH about 6 0
Bacteriostatic at 18 g/L;
For culture transport, C&S
Interferes with drug & hormone analyses

A

BORIC ACID

Boric acid and HCl
-preserves albumin and 5-HIAA, but always choose HCl

154
Q

Preserves glucose & sediments well

Interferes with acid precipitation test for protein

A

THYMOL

155
Q

Floats on urine surface;
Clings to pipettes & testing materials

Best all-around preservative

A

Toluene (Toluol)

156
Q

Prevents glycolysis
Good preservative for drug analysis

Inhibits reagent strip tests for glucose, blood & leukocytes

May use sodium benzoate instead of _____ for reagent strip testing

A

Sodium fluoride

157
Q

Causes an odor change

A

Phenol

158
Q

Convenient when refrigeration not possible

A

Commercial preservative tablets

159
Q

Components of Saccomanno fixative

A

(50% ethanol + 2% carbowax)

160
Q

PHYSICAL EXAMINATION OF URINE

Normal range (24 hours) ______

Average (24 hours) _______

Night urine output_______

Day: Night ratio______

Container capacity (UA)_______

Required for routine UA_____

A

Normal range (24 hours) 600-2000 ml

Average (24 hours) 1200-1500 ml

Night urine output <400 ml

Day: Night ratio 2-3:1

Container capacity (UA) 50 ml

Required for routine UA 10-15 ml (ave.12 ml)-urinometry and reagent strips

161
Q

Increased urine volume

A

POLYURIA

> 2.000 mL/24 hrs (in adults - Henry
2.5 L/day (in adults - Strasinger)
2.5-3.0 mL/kg/day (in children)

Causes:
Increased fluid intake
Diuretics, nervousness
DM (sweet) ⬆️ SG (glucose)
DI (tasteless) ⬇️ SG (diluted urine)

162
Q

Decreased urine volume

A

OLIGURIA

<500 mL/24 hrs (in adults - Henry)
<400 mL/day (in adults - Strasinger)
<1 mL/kg/hr (in infants)
<0.5 mL/kg/hr (in children)

Causes:
Dehydration
Renal diseases
Renal calculi or tumor

163
Q

Complete cessation of urine flow

A

ANURIA

<100 mL/ 24 hrs (Graff)

Causes:
Complete obstruction (stones, tumors)
Toxic agents
Decreased renal blood flow

164
Q

Excretion of more than 500 mL of urine at night

A

NOCTURIA

> 500 ml/night
S.G. < 1.018

Causes:
Pregnancy
Renal diseases, bladder stones
Prostate enlargement

165
Q

Any increase in urine excretion

A

DIURESIS

Causes:
Excessive water intake (polydipsia)
Diuretics therapy, hormonal imbalance
Renal dysfunction, drug ingestion

166
Q

Rough indicator of the degree of hydration and should correlate with urine S.G.

A

URINE COLOR

167
Q

Normal urine color

A

Colorless to deep yellow

⬆️fluid intake=Pale yellow=⬇️SG
⬇️fluid intake=Dark yellow⬆️SG

168
Q

Abnormal urine color

A

Red/red-brown (most common)

169
Q

URINE COLOR DETERMINATION

A

Look down through the container against a white background (also works for determining urine clarity but not the best way)

170
Q

Major pigment in urine
Lipid-soluble pigment that is a product of endogenous metabolism
Production is directly proportional to metabolic rate

A

UROCHROME

⬆️ in thyrotoxicosis, fever, starvation, fasting

171
Q

Pink (or red)
Derived from melanin metabolism
May denosit in amornhous urates and uric acid crystals

A

UROERYTHRIN

172
Q

(Dark yellow/orange-brown)
Derived from oxidation of colorless urobilinogen
Present in old specimens.

A

UROBILIN

173
Q

Recent fluid consumption, polyuria, dilute random specimen

A

Colorless to pale yellow

174
Q

Pyuria/leukocyturia (⬆️ WBCs)

A

Milky white

175
Q

Methemoglobin (acidic urine)

Hemogentisic acid (alkaline urine): Alkaptonuria

Melanin (upon air exposure): Melanuria

Phenol derivative, Argyrol, Methyldopa/ Levodopa, Metronidazole (Flagyl)

A

Brown/Black

176
Q

Porphyrins

A

Burgundy/ Purplish red/ PORTWINE

(If there’s no portwine in the choices, choose RED)

177
Q

Concentrated specimen: strenuous exercise, dehydration, fever, burns.
First morning specimen
Excessive urobilin, bilirubin, carotene

A

Dark yellow to amber

178
Q

Bilirubin has been oxidized to biliverdin

A

Yellow-green
Yellow-brown

179
Q

Pseudomonas infection

A

Green

180
Q

Phenol
Indican

A

Blue-green

181
Q

Pink, Red urine

A

RBCs (Cloudy/ smoky red): Hematuria blood in urine

Hemoglobin (Clear red) pigments

Myoglobin (Clear red/reddish-brown/cola-colored/tea-colored)

Porphobilin (derived from porphobilinogen)

Beets (alkaline urine in genetically susceptible persons), menstrual contamination

Fuchsin (aniline dye from foods and candy)

Rifampin - most body fluids are red and TB medication

182
Q

Drug that causes green color of urine

A

Phenol poisoning

183
Q

Bright orange-red
Bright yellow

A

Rifampin
Riboflavin (multivitamins)

184
Q

URINE CLARITY DETERMINATION

A

Thoroughly mix the specimen
Examine the specimen while holding in front of a light source
View through a newspaper print - BEST WAY

185
Q

No visible particulates, transparent

A

Clear

186
Q

May PRECIPITATE or be CLOTTED

A

Milky

187
Q

Many particulates, print BLURRED through urine

A

CLOUDY

188
Q

PRINT CANNOT be seen through urine

A

TURBID

189
Q

Few particulates, print EASILY seen through urine

A

HAZY

190
Q

Pathologic causes of urine turbidity

A
  1. RBCs, WBGs
  2. Bacteria (uniform turbidity not cleared by acidification or filtration)
  3. Yeasts (1DM)
  4. Non squamous epithelial celis
  5. Abnormal crystals, lymph fluid (chyluria), lipids
191
Q

Non-pathologic cause of urine turbidity

A
  1. Squamous epithelial cells (⬆️ in females).
  2. Amorphous urates (pink sediment)
  3. Amorphous phosphates & carbonates
    (white or beige precipitate)
  4. Vaginal cream, semen, fecal contamination, radiographic contrast media, talcum power
192
Q

Present in ACIDIC urine

A

Amorphous urates
Radiographic contrast media

193
Q

Present in ALKALINE urine

A

Amorphous phosphates, carbonates

194
Q

Soluble with Heat

A

Amorphous urates, uric acid crystals

195
Q

Soluble in Dilute acetic acid

A

RBCs, amorphous phosphates, carbonates

196
Q

Insoluble in Dilute Acetic Acid

A

WGCs, bacteria, yeast, spermatozoa

197
Q

Soluble in Ether

A

Lipids, lymphatic fluid, chyle

198
Q

Normal ODOR of urine due to presence of volatile acids from food

A

AROMATIC
FAINTLY
DISTINCT
FRAGRANT

199
Q

Odorless urine

A

ACUTE TUBULAR NECROSIS (acute renal failure)

200
Q

UTI, old urine odor

A

FOUL
AMMONIACAL
PUNGENT

201
Q

Ketones (DM, starvation, vomiting)

A

FRUITY
Sweet

202
Q

Maple syrup urine disease (MSUD)

A

CARAMELIZED SUGAR
CURRY
MAPLE SYRUP

203
Q

MOUSY, MUSTY, BARNY

A

Phenylketonuria (PKU)

204
Q

Rancid butter

A

Tyrosinemia

205
Q

Sweaty feet, acrid

A

Isovaleric acidemia, glutaric acidemia

206
Q

Menthol-like

A

Phenol containing medications

207
Q

Cabbage, hops

A

Methionine malabsorption (Oasthouse syndrome)

208
Q

Cystine disorder

A

Sulfur odor

209
Q

Trimethylaminuria

A

Rotting Fish (GG)

210
Q

Ingestion of onions, garlic, and ASPARAGUS, UTI

A

PUNGENT
Fetid

211
Q

Swimming pool

A

Hawkinsinuria

212
Q

3-hydroxy-3-methylglutaric aciduria

A

Cat urine

213
Q

Multiple carboxylase deficiency

A

Tomcat urine

214
Q

GLUCOSE
Principle:
Reading time:
Positive color:

A

Principle: Double Sequential enzyme reaction
Reading time: 30 seconds
Positive color: Green to brown

215
Q

_________
Principle: Diazo reaction
Reading time:
Positive color:

A

BILIRUBIN
Reading time: 30 seconds
Positive color: Pink to violet

216
Q

_________
Principle:
Reading time: 40 seconds
Positive color:

A

KETONES

Principle: Sodium Nitroprusside reaction
Positive color: PURPLE

217
Q

_________
Principle: Greiss Reaction
Reading time:
Positive color:

A

NITRITE

Reading time: 60 seconds
Positive color: UNIFORM PINK

218
Q

PROTEIN

Principle:
Reading time:
Positive color:

A

Principle: Protein error of indicators
Reading time: 60 seconds
Positive color: Blue-green

219
Q

pH

Principle:
Reading time:
Positive color:

A

Principle: Double indicator system
Reading time: 60 seconds
Positive color: orange (pH 5.0) to blue (pH 9.0)

220
Q

BLOOD

Principle:
Reading time:
Positive color:

A

Principle: Pseudoperoxidase activity of hemoglobin
Reading time: 60 seconds
Positive color:
- Uniform green/blue (Hgb/Mb)
- Speckled /spotted (intact RBCS)

221
Q

UROBILINOGEN

A

Principle: Ehrlich reaction
Reading time: 60 seconds
Positive color: Red

222
Q

_________

Principle:
Reading time: 120 seconds
Positive color:

A

LEUKOCYTE

Principle: LEUKOCYTE ESTERASE
Positive color: PURPLE

223
Q

Principle:
Reading time: 45 seconds
Positive color:

A

SG

Principle: pKa change of polyelectrolyte
Positive color: Blue (1.000) to yellow (1.030)

224
Q

Specimens must be returned to room temp before chemical testing by reagent strips, why?

A

Enzyme reactions on the strips perform best at room temp

225
Q
  1. Dip the reagent strip briefly (____________) into a well-mixed uncentrifuged urine specimen at RT.
  2. Remove excess urine by _____________ to the container as the strip is withdrawn.
  3. _________________
  4. Wait the specified amount of time for the reaction to occur.
  5. Compare the color reaction of the strip pads to the manufacturer’s color chart in good lighting.
A
  1. No longer than 1 second
  2. Touching the edge of the strip
  3. Blot the edge of the strin on a disposable absorbent pad.
226
Q

Care of reagent strips

A

COOL, DRY AREA
a. Store with dessicant in an opaque, tightly closed container.
b. Store below 30C (RT), do not freeze

227
Q

Automated reagent strips reader principle

A

REFLECTANCE PHOTOMETRY

228
Q

Automated reagent strips reader principle

A

REFLECTANCE PHOTOMETRY
the darker the color of the reagent pad, the lesser the light reflection (inversely related)

229
Q

A measure of the amount of dissolved substances in a solution
Density of solution compared with density of similar volume of distilied water at a similar temp.
Influenced by number and size of particles in a solution

A

SPECIFIC GRAVITY

230
Q

SG of random urine

A

1.003-1.035

231
Q

1st morning urine SG

A

≤ 1.020

232
Q

24-hour urine SG

A

1.016-1.022

233
Q

If SG is <1.003
If SG is >1.040

A

Not a urine (except in D.I) 1.001
Radiographic dye present-sharp image

234
Q

SG = 1.010
SG < 1.010
SG > 1.010

A

ISOTHENURIA
HYPOSTHENURIA
HYPERSTHENURIA

235
Q

URINOMETRY (urinometer/hydrometer)
-calibration temp _____
-requires temp correction:
______ for every 3 °C that the specimen temp is BELOW the calib temp
______ for every 3 °C that the specimen temp is ABOVE the calib temp.

-requires correction for GLUCOSE and PROTEIN
1 g/dL Glucose= _______
1 g/dL Protein= ________

Urine Volume required =_________

Calibration:
[Potassium sulfate solution]
[SG reading should be _____ ]

Disadvantage:

A

calibration temp: 20 °C

-0. 001 for every 3 °C that the specimen temp is BELOW the calib temp
+0.001 for every 3 °C that the specimen temp is ABOVE the calib temp.

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

Urine Volume required = 10-15 ml

SG reading should be 1.015

Disadvantage: uses large urine volume

236
Q

When using the urinometer, an adequate amount of urine is poured into a proper-size container and the urinometer is added with a ______ motion.
The scale reading is then taken at the ______ of the urine meniscus.

A

SPINNING
BOTTOM

237
Q

Refactometer is also known as?

A

RF
TS METER (total solids)

Put 1-2 drops of sample on the prism

238
Q

Refractometry is an INDIRECT method based on _________.

Compensated to temperature________
Advantage________

A

Refractive index
RI= light velocity in air/light velocity in solution

Compensated to temperature (15-38 °C) or 60 °F-100 °F

Advantage: NO NEED FOR TEMPERATURE CORRECTION

REQUIRES CORRECTION FOR GLUCOSE AND PROTEIN

239
Q

Calibration Reading
1. DISTILLED/deionized H2O=___________
2. 3% NaCl= ___________
4. 5% NaCl= ___________
5. 7% NaCl=___________
5. 9% Sucrose=_________________________

A
  1. 1.000 ± 0.001
  2. 1.015 ± 0.001
  3. 1.022 ± 0.001
  4. 1.035 ± 0.001
  5. 1.034 ± 0.001
240
Q

Both refractometer and urinometer requires correction for ____________.
Refractometer reading is ______ than that of the urinometer by 0.002

A

GLUCOSE and PROTEIN
LOWER (Rf<U by 0.002)

241
Q

SG DILUTION

  • Specimens with very high S.G. readings can be diluted and retested
  • To obtain the actual S.G., multiply the _____ of S.G. by the ______.
A

Decimal portion x dilution factor

Example: Urine specimen diluted 1:4 has a reading of 1.014. What is the actual S.G. reading?

Actual SG= 0.014 x 4= 0.056 (1. 056)

242
Q

REAGENT STRIP for SG
REAGENT:
False +:
False -:
Add _____ to reading when pH ≥ 6.5 due to interference with brothymol blue indicator
Not affected by glucose, protein & radiographic dye (Henry)

A

REAGENT:
- Poly (methyl vinyl ether /maleic anhydride) BROMTHYMOL BLUE
- Ethylene glycol diaminoethyl ether tetraacetic acid BROMTHYMOL BLUE

False +: High concentration of protein (Strasinger)
False -: Highly alkaline urines (>6.5)

0.005

243
Q

Obsolete method
Based on frequency of soundwave entering a soln. changes in proportion to the density of soln.
Ex: Yellow IRIS (International Remote Imaging System)

A

HARMONIC OSCILLATION DENSITOMETRY (H.O.D.)

244
Q

IRIS DIAGNOSTICS
____ required urine volume
____ for IRIS Slideless microscope
____ for IRIS Mass Gravity Meter

A

Models 300 and 500 workstations
6 mL = required urine volume
4 mL (of 6 mL) = for IRIS Slideless microscope

2 mL (of 6 mL) = for IRIS Mass Gravity Meter (for S.G. determination - by using H.O.D.)

245
Q

______ refers to the “sourness” of a solution, whereas _______ refers to its “bitterness”

A

ACIDITY
ALKALINITY

246
Q

Important in the identification of crystals and determination of unsatisfactory specimens

A

pH

A blood pH <5.8 or >7.8 will result in death

247
Q

Normal urine RANDOM pH_____
First morning pH_____
When pH is ≥ 9.0 ______

A

4.5-8.0
5.0-6.0
UNPRESEVED URINE

248
Q

Causes of ACIDIC urine

A
  1. Diabetes Mellitus (⬆️ ketone bodies)
  2. Starvation (⬆️ ketone bodies)
  3. High protein diet
  4. Cranberry juice - treatment for UTI (antibaderial)
  5. Emphysema, dehydration, diarrhea, acid-producing bacteria (E. coli), medications
249
Q

Causes of Alkaline Urine

A
  1. Renal tubular acidosis
  2. Vegetarian diet
  3. After meal - due to alkaline tide
  4. Vomiting - metabolic alkalosis
  5. Old specimens, hyperventilation, presence of wrease-producing bacteria
250
Q

_______occurs after meals due to withdrawal of H ions for the purpose of secretion of H ions, Cranberry juice contains quinic acid that causes urinary excretion of hippuric acid (antibacterial).

A

ALKALINE TIDE

251
Q

pH

REAGENTS:
Interferences:
Correlation with other tests:

A

Reagents: METHYL RED & BROMTHYMOL BLUE

Interferences: Runover from adjacent pads, old specimens

Correlation with other tests:
NITRITE
LEUKOCYTE
MICROSCOPIC

252
Q

Most indicative of renal disease
Produces ______ in urine when shaken

A

PROTEIN
WHITE FOAM

253
Q

NORMAL URINARY PROTEIN____
Mild/minimal proteinuria ____
Moderate proteinuria_____
Large/heavy proteinuria____

A

NORMAL URINARY PROTEIN

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

Mild/minimal proteinuria
<1 g/day

Moderate proteinuria
1-3 or 4 g/day

Large/heavy proteinuria
>3 or 4 g/day

254
Q

Major seruin protein found in the urine

______ of plasma albumin enters the uitrafiltrate
______ of all filtered protein is reabsorbed

A

ALBUMIN

<0.1%
95-99%

255
Q

PROTEINS in normal urine consist of
_____ ALBUMIN and _____ globulins.

A

1/3 albumin [95-98% reabsorb, <0.1% ultrafiltrate]

2/3 globulins

256
Q

Caused by conditions that affect the plasma PRIOR to its reaching the kidney
Will not detected in routine UA
NOT indicative of actual renal disease

A

PRE-RENAL (BEFORE) or OVERFLOW PROTEINURIA

257
Q

a. Intravascular hemolysis = ____
b. Muscle injury = _____
c. Severe infection & inflammation = ____

A

a. Hemoglobin
b. Myoglobin
c. ⬆️ APR’s

258
Q

Proliferation of Ig-producing plasma cells

A

MULTIPLE MYELOMA

259
Q

Immunoglobulin light chains (identical: K - K, γ-γ)

Tests = ______

Urine = precipitates at ______ (cloudy) & dissolves at _____ (clear)

A

BENCE- JONES PROTEIN

Tests: Serum electrophoresis, immunofixation electrophoresis

40-60 °C; 100 °C

260
Q

(‘true renal disease”)

A

RENAL PROTEINURIA

261
Q

_____________
Decreased glomerular filtration
May lead to renal failure

A

A. Glomerular Proteinuria
1. Diabetic nephropathy

262
Q

Indicator of Diabetic Nephropathy?

A

MICROALBUMINURIA
- proteinuria undetectable by routine reagent step

263
Q

Albumin Excretion Rate (AER) = in ug/ min or in mg/24 hours

Normal AER = ______
Microalbuminuria =_______
Clinical albuminuria=_________

A

Normal AER = 0-20 ug/min
NEGATIVE routine rgt. strip

Microalbuminuria = 20-200 ug/min (30-300 mg/24 hrs)
NEGATIVE routine rgt. strip

Clinical albuminuria= >200 ug/min
POSITIVE routine rgt. strip

264
Q

Test for microalbuminuria

A strip employing antibody-enzyme conjugate that binds albumin

A

MICRAL TEST

Reagents: Gold-labeled antibody, -galactosidase, Chlorophenol red galactoside

Sensitivity: 0 - 10 mg/mL

Interference: False (-) = Dilute urine

265
Q

PEINCIPLE of MICRAL test

A

ENZYME IMMUNOASSAY

266
Q

IMMUNODIP TEST FOR MICROALBUMINURIA
Principle:
Sensitivity:
Reagents:
Interferences:

A

Principle: Immunochromographics
Sensitivity: 1.2-8.0 mg/dL
Reagents: Antibody coated blue latex particles
Interferences: False (-)= Dilute urine

267
Q

ALBUMIN: CREATININE RATIO - CLINITEST MICROAL BUMIN STRIPS/MULTISTIX-PRO

Principle:
Reagents:
Sensitivity:
Interference:

A

Principle: Sensitive albumin tests related to creatinine conc, to correct for patient hydration.

Reagents
• Albumin: diodo-dihydroxydinitrophenyl tetrabromosulfonphthaleir.
• Creatinine: copper sulfate, tetramethylbenzidine, disopropylbenzenedihydroperoxide

Sensitivity:
Albumin = 10 - 150 mg/L
Creatinine = 10 - 300 mg/ dL 0.9 - 26.5 mmol/L)

Interferences: Visibly bloody/abnormally colored urine.| Creatinine = Cimetidine - False (+)

268
Q

-Proteinuria when standing due to increased pressure to renal veins
-Increased venous pressure causes renal congestion and glomerular changes
-Monitored every 6 months and re-evaluated as necessary

A

Orthostatic / Cadet / Postural proteinuria
- young adults are mostly affected

269
Q

Negative (-) FIRST MORNING
Positive (+) 2 hours after standing

A

ORTHOSTATIC PROTEINURIA

270
Q

Negative (+) FIRST MORNING
Positive (+) 2 hours after standing

A

CLINICAL PROTEINURIA

271
Q

⬆️ BP disorder occur during pregnancy

A

PRE-ECLAMPSIA

272
Q

Other causes of glomerular proteinuria

A

Nephrotic syndrome
Toxic agents
Dehydration
Strenuous exercise
Hypertention
Amyloidosis
Pre-eclampsia

273
Q

Originally discovered in workers exposed to cadmiun dust (a heavy metal).
Normaily filtered albumin can no longer be reabsorbed

A

Tubular Proteinuria

  1. Fanconi’s syndrome
  2. Toxic agents heavy metals
  3. Viral infections
274
Q

Post- Renal Proteinuria (after) causes:

A
  1. Lower UTI/ inflammation
  2. Menstrual contamination
  3. Injury / trauma
  4. Vaginal secretions
  5. Prostatic fluid / spermatozoa
275
Q

Protein rgt. Strips

Reagents:
False (+):
False (-):

Indicator is SENSITIVE to _______

Correlations:

A

Reagents:

TETRABROMphenol blue, citrate buffer at pH 3.0
Tetrachlorophenol TETRABROMosulfonphthalein, citrate buffer at pH3.0

False (+):
-high SG
-highly buffered alkaline urine
-pigmented specimen

False (-): Proteins other than albumin, microalbuminuria

Sensitive to ALBUMIN

CORRELATIONS
- Blood nitrite
- Leukocytes
- Microscopic

276
Q

A cold precipitation test that reacts equally with all forms of protein.
Aka: Exton’s test

A

SULFOSALICYLIC ACID PRECIPITATION TEST

277
Q

SSA reagent= _______

A

Exton’s reagent (3% SSA + sodiurn sulfate)

Procedure:

3 ml of 3% SSA + 3 mL centrifuged urine —10 mins incubation—> (+) Cloudiness
or
3 ml of 7% SSA + 11 mL centrifuged urine —10 mins incubation—>
(+) Cloudiness

278
Q

No increase in turbidity
If viewed from top, circle is visible in test tube bottom

Grade:
Range (mg/dL) {stras}:
Range (Henry):

A

Grade: Neg
Range (mg/dL) {stras}: <6
Range (Henry): 5 mg/dL

279
Q

Noticeable or perceptible turbidity.
If viewed from top, circle not visible in test tube bottom
Can read newsprint through mixture

Grade:
Range (mg/dL) {stras}:
Range (Henry):

A

Grade: Trace
Range (mg/dL) {stras}: 6-30
Range (Henry): 20 mg/dL

280
Q

Distinct turbidity with no granulation Cannot read newsprint through mixture

Grade:
Range (mg/dL) {stras}:
Range (Henry):

A

Grade: 1+
Range (mg/dL) {stras}: 30-100
Range (Henry): 50 mg/dL

281
Q

Turbidity with granulation but NO flocculation.

Grade:
Range (mg/dL) {stras}:
Range (Henry):

A

Grade: 2+
Range (mg/dL) {stras}: 100-200
Range (Henry): 200 mg/dL

282
Q

Turbidity with granulation AND flocculation

Grade:
Range (mg/dL) {stras}:
Range (Henry):

A

Grade: 3+
Range (mg/dL) {stras}: 200-400
Range (Henry): 500 mg/dL

283
Q

Clumps of protein

Grade:
Range (mg/dL) {stras}:
Range (Henry):

A

Grade: 4+
Range (mg/dL) {stras}: >400
Range (Henry): 1.0 g/dL or 1000 mg/dL

284
Q

COMPARISON OF REAGENT STRIP AND SSA PROTEIN TEST RESULTS

Strip result: POSITIVE (+)
SSA result: NEGATIVE (-)

A

Highly buffered alkaline with no albumin present - false-positive reagent strip

Highly buffered alkaline with albumin present - false-negative SSA test
(To differentiate, acidify urine to pH ~ 5.0 and retest)

285
Q

COMPARISON OF REAGENT STRIP AND SSA PROTEIN TEST RESULTS

Strip result: NEGATIVE (-)
SSA result: POSITIVE (+)

A

Proteins other than albumin present
False (+)
=Radiographic contrast media (delayed reaction)
=Drugs and/or drug metabolites (tolbutamide, penicillins, cephalosporins, sulfonamides)
(Examine precipitate microscopically - drugs and radiographic dye form crystalline precipitates; whereas protein precipitates are amorphous)

286
Q

Large volume of urine can produce a _______ protein reaction despite significant proteinuria because the protein present is being excessively diluted…

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

A

Negative

Trace

287
Q

Most frequently tested in urine

A

GLUCOSE

288
Q

CLINICAL SIGNIFICANCE OF URINE GLUCOSE
⬆️ blood glucose
⬆️ urine glucose

Causes:_______

A

HYPERGLYCEMIA-associated

Causes:
1. Diabetes Mellitus
2. Cushing’s syndrome (⬆️cortisol)
3. Pheochromocytoma (⬆️catecholamines)
4. Acromegaly (⬆️ growth hormone)
5. Hyperthyroidism (⬆️T3, T4)

289
Q

Normal blood glucose
⬆️ urine glucose

A

RENAL-ASSOCIATED

Causes:
1. Impaired tubular reabsorption of glucose
2. Fanconi syndrome
“ Defective tubular reabsorption of glucose and amino acids”.

290
Q

Is it possible for an individual to have hyperglycemia without glucosuria?

A

Yes! It is possible for an individual to have hyperglycemia without glucosuria when the glomerular filtration rate is decreased due to certain diseases. Only limited amounts of glucose are able to
LL pass into the ultra-filtrate, and the tubules are able to reabsorb
all the glucose presented to them.

291
Q

GLUCOSE rgt. Strip

Reagents:
False (+):
False (-):

Correlations:

A

Reagents:
Glucose oxidase, Peroxidase, Potassium iodide (blue to green to brown)

Glucose oxidase, Peroxidase, Tetrameihylbenzidine (yellow to green)

False (+): Oxidizing agents, detergents

False (-): High levels of ascorbic acid, ketones, high S.G., LOW TEMP, improperly preserved specimen

Glucose strip was the 1st “dip and read” reagent strip developed by Miles, Inc., in 1950
Sensitivity = 100 mg/dL

Other chromogers:
-Aminopropylcarbazole (yellow to orange-brown)
-o-toluidine (pink to purple)

Correlations: Ketones and protein

292
Q

Nonspecific test for reducing sugars

A

COPPER REDUCTION TEST (CLINITEST / BENEDICT’S TEST)

293
Q

Principle used in Copper reduction test for glucose

A

Copper reduction
CuSO4 (copper sulfate)—-> (+)Cu2O (copper oxide)
Blue—->Brick red

294
Q

Reporting of Benedicts test
___= clear blue color, biue precipitate may form
___= reddish-yellow color, brick red or red precipitate

A

(-)

4+

295
Q

___=bluish- green color
___=yellow-orange color, yellow-orange precipitate

A

Tr

3+

296
Q

____= green color, green or yellow precipitate
____=yellow to green color, yellow precipitate

A

1+

2+

297
Q

False positive

A

Reducing agents (ascorbic acid, uric acid)

Tip (same action as the test principle)

298
Q

False negative

A

Oxidizing agents (detergents)

Tip (opposite of the test principle)

299
Q

CLINITEST TABLET PROCEDURE
________+ 10 gtts H2O+ Clinitest tablet
-> Read reaction 15 secs after bubbling stops

A

5 gtts urine (5 drops)

300
Q

Occurs when > 2 g/di sugar is present

A

Pass-through phenomenon:

• Blue > Green > Yellow > Brick red&raquo_space;» Blue or Green-brown
• Due to reoxidation of cuprous oxide to cupric oxide and other cupric complexes (green)
• To prevent pass through, use 2gtts urine (use separate color chart to interpret the reaction)

301
Q

The tablets contain:
CuSO4, =
Na citrate =
NaCO3 =
NaOH=

A

The tablets contain:
CuSO4, = main reacting agent
Na citrate - for heat production
NaCO3 = eliminates interfering 02
NaOH= for heat production

302
Q

Glucose oxidase = 1+positive
Clinitest= negative

A

Small amount of glucose present

303
Q

Glucose oxidase = 4+positive
Clinitest= negative

A

Possible oxidizing agent interference on reagent strip

304
Q

Glucose oxidase = negative
Clinitest= positive

A

Non-glucose reducing substance present
Possible interfering substance for rgt. Strip (ex. Ascorbic acid)

305
Q

Result from increased fat metabolism due to inability to metabolize carbohydrates

A

KETONES

306
Q

Ketones renal threshold

A

70 mg/dL

307
Q

Ketones are seen in:

A

Type 1 DM
Vomiting
Starvation
Malabsorption

308
Q

Major ketone but not detected in reagent strip

A

Beta-hydroxybutyric acid

309
Q

Parent ketone (1st ketone body formed)

A

Acetoacetic acid (AAA)/Diacetic acid (20%)

310
Q

Acetone

A

2%

311
Q

Rgt. Strip for ketone

Principle:
Reagents:
Interferences:
Correlations:

A

Principle:
Acetoacetic acid (acetone) + Na nitroprusside (&glycine)———-» (+) PURPLE

Reagents:
Na nitroprusside/nitreferricvanide, Clycine

False (+): Pthalein dyes, pigmented red urinc, levodopa, drugs with suifhydryl groups
False (-): Improperly preserved specimens

Correlations: GLUCOSE

312
Q

ACETEST (Tablet)
________ urine + Acetest tablet
- -> (+) Purple color after 30 seconds

Composition = Sodium nitroprusside, Disodium phosphate, Glycine and Lactose

A

1 gtts urine

313
Q

CLOUDY RED URINE
Sensitive early indicator of renal disease

Seen in: _______
Microscopic: ______

A

HEMATURIA

Seen in:

Glomerulonephritis
Renal calculi, tumors
Strenuous exercise trauma
Anticoagulant therapy

Intact RBC’s

314
Q

Hemoglobinuria

Color of urine:
Seen in:
Microscopic:

A

Clear red urine

Seen in: INTRAVASCULAR HEMOLYSIS

Transfusion reactions
Hemolytic anemia
Severe burns
Brown recluse spider bites

No RBC’s seen

Heme portion of the hgb is TOXIC TO THE RENAL TUBULES

315
Q

MYOGLOBINURIA

Must be at least _______, to show clear red (red-brown) urine.

Seen in:

A

Must be at least 25 mg/dl, to show clear red (red-brown) urine.

RHABDOMYOLYSIS
- Muscular trauma
- Crush syndrome
- Extensive exertion
- CHOLESTEROL-LOWERING STATIN MEDICATIONS

Heme portion of the myoglobin is toxic to the renal tubules

> 1.5 mg/dL= renal failure risk

316
Q

What is more toxic to the renal tubules?
a. Heme
b. Hemoglobin
c. Myoglobin

A

C. Myoglobin

317
Q

True or False:
LYSIS of RBCs in the urine usually shows a mixture of hemoglobinuria and hematuria.

A

TRUE

318
Q

RED or PINK plasma
⬇️ haptoglobin levels

Blondheim’s test (ammonium sulfate test) ——-> PRECIPITATED

BLOOD (-)

Procedure:

Urine + 2.8g NH4Sulfate (80% satd.)
Allow the mixture to sit for 5 mins

Filter/Centrifuge

Test supernatant for blood with a reagent strip

A

HEMOGLOBIN

319
Q

PALE YELLOW PLASMA
⬆️ CK and aldolase activity

NOT PRECIPITATED by Ammonium sulfate

BLOOD (+)

A

MYOGLOBIN

320
Q

Rgt. Strip for BLOOD

Principle:
Reagents:
Interferences:
Correlations:

A

Principle: PSEUDOPEROXIDASE ACTIVITY OF HEMOGLOBIN

Reagents: =
Diisoprobylbenzene dehydroperoxide tetramethylBENZINE
Dimethyldihvdroperoxyhexane tetramethyl BENZIDINE

False +
Strong oxidizing agents, bacterial peroxidases, menstrual contamination.

False -
High SG, created cells, formalin, captopril, high concentrations of nitrite, ascorbic acid (>25 mg / dL), unmixed specimens

Uniform green / blue color =Hemoglobin / Myoglobin

Speckled / spotted
= Hematuria (Intact RBCs)

Chemstrip contains iodate overlay that eliminates ascorbic acid interference
Ilemoglobin level of 10 mg/ dL produces a positive protein reagent strip reaction

Correlations: Protein, Microscope

321
Q

Early indication of liver disease

A

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

Clinical significance:
Hepatitis
Cirrhosis
Biliary obstruction (gallstones, carcinoma)

322
Q

Rgt. Strip for BILIRUBIN

Principle:
Reagents:
Interferences:
Correlations:

A

Principle: DIAZO REACTION
Bilirubin diglucuronide (CB) + Diazonium salt ————> Azodye

Reagents:
2,4-dichloroaniline diazonium salt
2,6-dichlorobenzene diazonium salt

False (+): Highly pigmented urines, phenazopyridine, indican, metab. of Lodine
False (-): Specimen exposure to light, high conc. of nitrite, ascorbic acid (>25 mg/dL)

(+) Tan or Pink to Violet (but VIOLET is the best answer)

Correlations: UROBILINOGEN

323
Q

ICTOTEST (Tablet)
_________ + Ictotest tablet + 2 gtts H20
–> {+) _________ color after 60 seconds

A

ICTOTEST (Tablet)
10 gtts urine + Ictotest tablet + 2 gtts H20 –> {+) Blue to purple color after 60 seconds

  • Confirmatory test; more sensitive than strip with less interference
324
Q

Bile pigment that resuited from hemogiobin degradation

A

UROBILINOGEN

325
Q

Normal value of UROBILINOGEN in urine?

Specimen____

A

<1 mg/dl or Ehrlich unit

Afternoon urine (2-4 pm)

326
Q

Rgt. Strip for urobilinogen

Principle:
Reagents:
False (+):
False (-):
Correlations:

A

Principle: Ehrlich reaction

Urobilinogen (and Ehrlich-reactive compounds) + PDAB ——-> (+) Red

Reagents:
o-dimethylaminobenzaldehyde (PDAB or Ehrlich reagent)
4-methovbenzene-diazonium-tetrafluoroborate (specific for UBG)

False (+):

Ehrlich-reactive comp. (porphobilinogen, indican, methyldopa, procaine sulfonamides, p-aminosalicylic acid chlorpromazine), pigmented urine

False (-):
Old specimens, preservation in formalin high concentrations of nitrite

Correlations: BILIRUBIN

327
Q

Differentiate urobilinogen (UBG), porphobilinogen (PBG) and other Ehrlich-reactive compounds (ERC).

Uses extraction with organic solvents:____&_____

A

WATSON- SCHWARTZ TEST

Chloroform and Butanol

328
Q

Souble in CHLOROFORM & BUTANOL

A

Urobilinogen(UBG)

329
Q

Insoluble in BUTANOL and CHLOROFORM

A

Porphobilinogen (PBG)

330
Q

Soluble in BUTANOL
Insoluble in CHLOROFORM

A

Ehrlich reactive compounds (ERC)

331
Q

(Inverse Ehrlich reaction)
Rapid screening test for porphobilinogen only. (≥ _____ mg/dL)

+ color:

A

HOESCH TEST
(≥2 mg/dL)

RED

332
Q

Extravascular hemolytic disease
(Pre-hepatic hemolytic disease)

Blood:
Urine Bilirubin (CB):
Urine urobilinogen:

A

Blood: ⬆️ UB
Urine Bilirubin (CB): NEGATIVE
Urine urobilinogen: POSITIVE

333
Q

Liver damage (hepatic jaundice)

Blood:
Urine Bilirubin (CB):
Urine urobilinogen:

A

Blood: ⬆️UB/CB
Urine Bilirubin (CB): +/-
Urine urobilinogen: POSITIVE

334
Q

Bile duct obstruction
(Post-hepatic or obstructive jaundice)

Blood:
Urine Bilirubin (CB):
Urine urobilinogen:

A

Blood: ⬆️CB
Urine Bilirubin (CB): POSITIVE
Urine urobilinogen: -/+ (Strip= NORMAL)

335
Q

Rapid screening test of UTI or bacteriuria

Specimen:

A

NITRITE

Nitrate converters are generally Grain-negative bacilli, such as the Enterobacteriaceae

Specimen: 4 hour collection or first morning urine (referred)

336
Q

Rgt. Strip for NITRITE

Principle:
Reagents:
False (+):
False (-):
Correlations:

A

Principle: Greiss reaction

P-arsanilic acid (or sulfanilamide) + Nitrite ——-> Diazonium salt
Diazonium salt + Tetrahydrobenzoquinolin——->
(+) Uniform pink

Reagents:

Multistix = p-arsanilic acid, tetrahydrobenzo(h)-QUINOLIN-3-ol
Chemstrip = Sulfanilamide, hydroxytetrahydro benzoQUINOLINE

False (+): Improperly preserved specimens, highly pigmented urine

False (-): Nonreductase-containing bact, insufficient contact time bet bacteria & urinary nitrate, lack of urinary nitrate, large quantities of bacteria converting nitrite to nitrogen, antibiotics, high ascorbic acid, high SG

Pink spots/edges = considered NEGATIVE
(+) Nitrite corresponds to 100,000 organisms/ mL
If the nitrite test area shows a negative reaction, UTI cannot be ruled out
(Some UTIs are caused by Gram (+) cocci & yeasts - they lack nitrate reductase enzyme)
Dietary nitrate can be found in green vegetables

Correlations: protein, leukocytes, microscopic

337
Q

Significance:

Urinary tract infection or inflammation
Screening of urine culture specimens

A

LEUKOCYTES

338
Q

Rgt. Strip for Leukocytes

Principle:
Reagents:
False (+):
False (-):
Correlations:

A

Principle: Leukocyte esterase

Indoxylcarbonic acid——> Indoxyl + Acid indoxyl + Diazonium salt ——> (+) Purple

Reagents: =
Derivatives pyrrole amino acid ester, Diazonium salt

Indoxylcarbonic acid ester, Diazonium salt

False (+): Strong oxidizing agts, formalin, highly pigmented urine, nitrofurantoin
False (-): High concentrations of protein, glucose, oxalic acid, ascorbic acid

With esterase: Neutrophil, Eosinophil, Basophil, Monocyte, Histiocyte, Trichomonas
No esterase: Lymphocyte

Strip can detect lysed WBCs.
Trichomonas, Chlamydia, yeast, & interstitial nephritis produce pyuria w/o bacteriuria

Correlations: protein, nitrite, microscopic

339
Q

Water-soluble vitamin

11th Reagent Pad

Brands:
C-stix=_____
STix=_____
others: VChem. Urispec GP + A, and Merckoquant

A

ASCORBIC ACID

Ascorbicacid (2 5 mg/dL) + Phosphomolybdate ——> (+) Molybdenum blue

Brands:
C-stix= 10 seconds
STix= 60 seconds

GC-MS= more accurate quantitative method

340
Q

Ascorbic acid FALSE NEGATIVE reactions on: BB LNG

A

Blood
Bilirubin
Leukocyte
Nitrite
Glucose

RMT (10 decks)

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