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Urinalysis > Clinical Study Questions > Flashcards

Clinical Study Questions Flashcards

1
Q

What are the three ketone bodies?

A

acetone, acetoacetic acid, beta-hydroxybutyric acid

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2
Q

What does the presence of ketone bodies in urine indicate?

A

carbohydrate metabolism is deficient, body is using fat as the major energy source

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3
Q

Which ketone body exists in the highest concentration?

A

beta-hydroxybutyric acid

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4
Q

Which ketone body are most urinalysis strip tests most sensitive to?

A

acetoacetic acid

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5
Q

What is the principle of the reaction for ketone bodies with Multistix testing?

A

sodium nitroprusside, in the presence of acetoacetic acid, produces a color change from buff pink (=) to purple (+) as ketone concentration increases

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6
Q

Are acetone and/or beta-hydroxybutyric acid detected with Multistix testing?

A

no

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7
Q

What is the pH a measure of in terms of kidney function?

A

measures the kidney’s ability to maintain normal hydrogen ion concentration in plasma and extracellular fluid

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8
Q

What is the principle of the reaction for pH with Multistix testing?

A

utilizes the methyl red/bromthymol blue indicator system, which provides pH readings from 5.0-8.5; test pad color changes from orange to green to blue in this pH range

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9
Q

What is hematuria and when would it be seen?

A

abnormal number of intact red cells; kidney or urinary tract disease

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10
Q

What is hemoglobinuria and when would it be seen?

A

free hemoglobin in the urine; any condition resulting in intravascular hemolysis

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11
Q

What is myoglobinuria and when would it be seen?

A

myoglobin (heme-containing protein) in the urine; rhabdomyolysis (muscle destruction)

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12
Q

What is the principle of the reaction for occult blood in Multistix testing?

A

based on the peroxidase-like activity of hemoglobin, which catalyzes the reaction of diisopropylbenzene dihydroperoxide and uses 3,3’,5,5’-tetramethylbenzidine; blood is detected as intact red cells or as free hemoglobin; liberation of oxygen from peroxide through heme causes a benzidine compound to oxidize to a colored product ranging from orange to green to dark blue

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13
Q

How is protein measured with Multistix testing?

A

protein error of indicators; utilizes tetrabromophenol blue reagent buffered at a pH of 3; the point of color change is different in the presence or absence of certain proteins, ranging from yellow (=) through yellow-green, green, and blue-green

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14
Q

What must one keep in mind when testing for protein with Multistix in regards to sensitivity?

A

test pad is more sensitive to albumin than globulins (gammaglobulins, Bence-Jones proteins, hemoglobin, mucoprotein), and a negative result does not necessarily rule out the presence of the other proteins

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15
Q

What reaction can be caused by buffered alkaline urine in regards to protein Multistix testing?

A

may produce false positives

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16
Q

What is the difference between specific gravity and osmolality?

A

specific gravity measures the ratio of the density of a substance to the density of a reference substance; osmolality measures the concentration of a substance contained within a reference substance

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17
Q

Between specific gravity and osmolality, which is more accurate and why?

A

osmolality; it is not affected by large or heavy particles, whereas specific gravity is

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18
Q

Which protein in urine coagulates on heating to 45-60*C and re-dissolves on further heating to the boiling point?

A

Bence-Jones protein

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19
Q

What two structures may be confused with white cells in a urine specimen, and how would they be differentiated?

A

red cells (smaller, bi-concave, can be lysed with 2% acetic acid); collecting duct cells (large and dense nuclei, polygonal shape)

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20
Q

What two structures may be confused with red cells in a urine specimen, and how would they be differentiated?

A

bubbles (variation in size, highly refractile); yeast (variation in size, tends to be more spherical/ovoid rather than bi-concave, exhibits budding, will not lyse in acetic acid)

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21
Q

What is the reaction of the Multistix reaction for glucose?

A

double sequential enzyme reaction: glucose + O2 –glucose oxidase–> gluconic acid + H2O2 –> H2O2 + chromagen –peroxidase–> oxidized chromagen + H2O

22
Q

Under what conditions would you see a negative dipstick and a positive Clinitest when testing for glucose?

A

non-glucose reducing substance (typically galactose)

23
Q

What are oval fat bodies?

A

renal tubular epithelial cells containing fat

24
Q

What do oval fat bodies exhibit under polarized microscopy?

A

Maltese cross formation

25
Q

Where are casts formed?

A

distal and collecting tubules of the kidneys

26
Q

What conditions bring about cast formation?

A

can appear normally (hyaline casts), glomerulonephritis, acute interstitial nephritis, pyelonephritis, chronic or acute renal disease, athletic pseudonephritis

27
Q

What do casts signify clinically?

A

number of casts reflects the extent of tubular involvement and severity of disease; type and number together can indicate a specific disease state

28
Q

Can the width of a cast be an indication of the severity of renal disease? Explain.

A

yes; broad casts (called renal failure casts) indicate cast formation in dilated convoluted tubules or in the collecting ducts; because one collecting duct may serve several nephrons, cast formation within them indicates significant urinary stasis due to either obstruction or disease

29
Q

What are hyaline casts composed of and when can they appear?

A

Tamm-Horsefall protein matrices; following strenuous exercise and stress

30
Q

What constitutes a cellular cast?

A

protein matrix filled with degenerating cells

31
Q

When can bacterial casts appear?

A

pyelonephritis and kidney infections

32
Q

When can red cell casts appear?

A

glomerulonephritis and strenuous exercise

33
Q

What are fatty casts and what are they associated with?

A

protein matrix containing fat globules; nephrotic syndrome

34
Q

What are waxy casts and how do they appear?

A

final breakdown product of a cellular cast; sharp, refractile outline with irregular, broken-off ends

35
Q

What kind of casts can appear in renal tubular damage?

A

renal tubular epithelial cell casts

36
Q

What is nephrotic syndrome?

A

caused by damage to the kidneys resulting in the release of too much protein into the urine

37
Q

What results would be expected in a urinalysis on a patient with nephrotic syndrome?

A

large amounts of protein, fatty casts

38
Q

What is the synonym for nephrotic syndrome?

A

nephrosis

39
Q

What is the source of bleeding if urine contains red cells but minimal protein?

A

kidneys (glomerulonephritis)

40
Q

What does the creatinine clearance test measure?

A

glomerular filtration rate

41
Q

In what two types of jaundice will bilirubin be found in the urine?

A

hepatic, obstructive

42
Q

What is the principle of the reaction for bilirubin with Multistix testing?

A

bilirubin reacts with diazonium salt (2,4-dichloroaniline) to form a tan color

43
Q

What three urine constituents are detected by the SSA protein procedure but not by the protein portion of Multistix?

A

albumin, Bence-Jones protein, and immunoglobulin light chains

44
Q

In what two types of jaundice will increased urobilinogen be found in the urine?

A

hepatic, hemolytic

45
Q

What is the principle of the reaction for urobilinogen with Multistix testing?

A

urobilinogen will react with p-dimethylaminobenzaldehyde in an acid medium to produce a pink-red color

46
Q

In what two conditions will urobilinogen be decreased in the urine, and why?

A

obstructive jaundice - bile containing direct bilirubin cannot enter the intestines, where it becomes urobilinogen; chronic liver disease - indirect bilirubin cannot be further processed by the liver, meaning there is little direct bilirubin available for conversion to urobilinogen

47
Q

What is a glitter cell?

A

swollen white cells whose cytoplasmic granules exhibit Brownian movement; associated with pyelonephritis and low specific gravity

48
Q

What are kidney stones?

A

solid material formed in the kidneys from minerals present in the urine; also called renal calculi or nephroliths

49
Q

What is the most common type of kidney stone?

A

calcium compounds, such as calcium oxalate or calcium phosphate

50
Q

What is the spot plate method of calculi analysis?

A

a drop of chemical reagent is added to the unidentified calculi; if the compound being tested for is present, observable changes will take place

51
Q

What effect does radiographic dye have on specific gravity?

A

increases it

Urinalysis (4 decks)

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