Clinical Skills

Question 1

What could be abnormal on observation of urine?

Answer 1

Colour - Turbidity - Odour

Question 2

What are causes of abnormal colour of urine?

Answer 2

Brown = bile pigments, myoglobin - brown/black = bile pigments, melanin, methaemaglobin - green/blue = pseudomonas UTI, biliverdin - orange = bile pigments - red = haematuria, haemoglobinuria, myoglobinuria, porphyria - yellow = dehydration

Question 3

Name some causes of cloudy urine

Answer 3

Contamination with vaginal mucus or epithelial cells
Excess phosphate crystals in alkaline urine
Pyuria - infection
Lipiduria

Question 4

What are causes of abnormal odour?

Answer 4

Pungent = concentrated
Ammonia = alkaline fermentation
Fruity = diabetic ketoacidosis
Faecal = GI fistulae

Question 5

What is specific gravity?

Answer 5

Says how much more dense urine is than water

Question 6

What are causes of increased specific gravity?

Answer 6

Dehydration - glycosuria - renal artery stenosis - heart failure - inappropriate ADH secretion - proteinuria

Question 7

What are causes of decreased specific gravity?

Answer 7

Excessive fluid intake - renal failure - pyelonephritis - central and nephrogenic diabetes insipidus

Question 8

What is the normal pH of urine?

Answer 8

4.5 - 8

Question 9

Is urine normally acid or alkaline?

Answer 9

Acidic (5.5-6.5) - due to metabolic activity

Question 10

What are causes of acidic urine?

Answer 10

Dietary intake and uric acid calculi

Question 11

Define haematuria

Answer 11

Presence of blood in the urine

Question 12

Why may you get a false positive reading for haematuria?

Answer 12

Contamination with menstrual blood, dehydration and exercise

Question 13

Define proteinuria

Answer 13

Presence of protein in the urine - albumin:creatinine ratio >30mg/mmol

Question 14

How much protein is normally excreted per day?

Answer 14

80-150mg

Question 15

What does the presence of proteinuria indicate?

Answer 15

Renovascular disease - glomerular interstitial disease - tubulointerstitial disease - multiple myeloma

Question 16

What is the normal concentration of glucose in urine?

Answer 16

10mmol/L

Question 17

What does increased glucose in urine indicate?

Answer 17

Diabetes mellitus

Question 18

Are ketones normally found in the urine?

Answer 18

No

Question 19

What does a positive dip for ketones indicate?

Answer 19

Uncontrolled diabetes, pregnancy without diabetes, carbohydrate free diets and starvation

Question 20

Does bilirubin normally appear in urine?

Answer 20

Unconjugated bilirubin is not water soluble so doesnt appear in urine
Conjugated bilirubin appears in liver disease or obstruction of bile ducts
Insignificant amount of urobilinogen found in urine

Question 21

In what situation would urobilinogen be increased?

Answer 21

Conditions associated with increased nitrate levels - eg. UTI

Question 22

Why would nitrites be found in the urine?

Answer 22

Gram -ve and +ve bacteria breakdown urinary nitrates to nitrites

Question 23

Why would leukocyte esterase be found in the urine?

Answer 23

It is produced by neutrophils - pyuria associated with UTI

Question 24

How do pulse oximeters work?

Answer 24

Relative absorption of red by deoxygenated haemoglobin and infrared by oxygenated haemoglobin light of systolic wave form correlates to blood saturations. Two light emitting diodes are positioned opposite their detectors through tissue

Question 25

What is the most common cause of an inadequate pulse reading?

Answer 25

Poor perfusion - cold or hypotension

Question 26

Why might you get an inaccurate oxygen saturation reading in carbon monoxide poisoning?

Answer 26

Cannot differentiate between different forms of haemoglobin - carboxyhaemoglobin is measured as 90% oxygenated and 10% deoxygenated - so overestimates oxygen saturation

Question 27

What should you do if you get a poor oxygen saturation reading?

Answer 27

Warm skin (apply topical vasodilator if necessary) Alternative probe site Different probe Different machine

Question 28

Name some abnormalities in pulse character

Answer 28

Slow and strong - high stroke volume Fast and weak - hypovolaemic shock, cardiogenic shock, congestive heart failure Hyperdynamic - emotion, heat, exercise, anxiety, pregnancy, anaemia, thyrotoxicosis

Question 29

Where can you measure temperature?

Answer 29

Mouth, rectum, armpit, ear, forehead

Question 30

What is the range of normal temperature?

Answer 30

36.1 - 37.2

Question 31

What may a high temperature be indicative of?

Answer 31

Blood clots - cancer - rheumatoid arthritis - SLE - IBD - infection

Question 32

How may cuff size affect blood pressure reading?

Answer 32

Cuff too small - cuff cannot completely close off blood vessels so bladder inflates too much and reading is higher than it should be Cuff too large - cuff inflates on self so cuts off supply to easily and reading is lower than it should be

Question 33

How long should patient have been resting for before BP reading?

Answer 33

5 minutes

Question 34

How will arm position affect BP reading?

Answer 34

Above heart - falsely low BP | Below heart - falsely high BP

Question 35

Explain the Korotkoff sounds

Answer 35

``` Phase I = tapping - systolic pressure Phase II = intensity of tapping increases Phase III = tapping then murmur Phase IV = muffled Phase V = no sound - diastolic pressure ```

Question 36

What is the ausculatatory gap?

Answer 36

Between phases II and III of Korotkoff sounds

Question 37

What causes a regularly irregular pulse?

Answer 37

Second Degree Heart Block - sinus arrhythmia

Question 38

What causes an irregularly irregular pulse?

Answer 38

Atrial fibrillation - atrial/ventricular ectopics

Question 39

What would cause radio-radial delay?

Answer 39

Coarctation of aorta before left subclavian - thromboembolus

Question 40

What would cause radio-femoral delay?

Answer 40

coarctation of aorta