Clinmic Flashcards
Review
Best way to break chain of infection
Hand washing
How long to wash hands
15-20 seconds
Most important part of handwashing
Friction
Label of biohazard container
3 over lapping circles
Solution to disinfect sink
1:5-1:10 NaCl solution
How often do you disinfect sinks
Daily
Container used for sharp wastes
Red, puncture-resistant container
Storage of radioactive material: storage at locked room until background count is down to: _____________
10 half life
Best first aid for chem spills
Flush area with running water for atleast 15 minutes
Always add ______ to ______
Acid to water
Color for health hazard
Blue
Color for fire hazard
Red
Color for instability/reactivity
Yellow
Color for specific hazard
White
Location of each hazard (quadrants)
Right: yellow
Bottom: white
Left: blue
Top: red
Degree of hazard(hazard) index
- no or minimal
- Slight
- Moderate
- Serious
- Extreme or severe
Storage for flammable chemicals
Explosion-proof refrigerators
Meaning of RACE
RESCUE
ALARM
CONTAIN
EXTINGUISH/EVACUTE
What is the only type of fire water extinguisher is for
Type A
Extinguisher for types ABC
Dry chemical
Type of fire carbondioxide extinguishes
TYPE BC
What type of fire metal X and Sand is used for
Type D
Fire types
A = ORDINARY B = LIQUIDS C = ELECTRIC D = METALS E = EXPLOSIVE K = COOKING
Meaning of PASS
Pull
Aim
Squeeze
Sweep
Types of fire to be handled. By trained personel only
Type D(metal) Type E(explosive)
Work related hazards and include strain due to repeated position
Ergonomic hazard
Hazard related to cold temperature
Cryogenic
Disinfection eliminates all or many pathogens except _________
Bacterial spores
Where blood enters in the kidney
Renal artery
Number of nephrons per kidney
1-1.5 million
Renal blood flow
1200ml
Renal plasma flow
600-700
Glomerules filters substances with MW of what
> 70,000 dalton
Glomerular filtrate S. G.
1.010
ADH in SIADH
EXCESS
Effects of RAAS
Release of ADH and aldosterone
Vasoconstriction
Substances reabsorbed through passive transport
Water
Urea
Sodium
Transport involved in glucose, amino acid, salts, chloride, sodium
Active
Inability of kidneys to produce an acid urine
Renal tubular acidosis
Used to evalute glomerular filtration
Clearance
Used to assess renal transplant patients
B2-microglobulin
Measurement useful in detection of early changes in kidney function
Cystatin c
Original reference method for clearance test
Inulin clearance
Creatinine clearance formule
UV/P
U=urine crea
V=total/1440 ml/day
P=plasma crea
Variables in cockgroft and gault
Age, sex, body weight in kg, serum crea
Variables in MDRD system
BEAC = BUN, ethnicity, albumin, crea
Recommended by the national kidney disease education program for crea clearance
MDRD-IDMS
Used to evaluate tubular reabsorption
Concentration test
Fishberg, mosenthal, specific gravity, osmolarity are tests to evaluate which parameter
Tubular reabsorption
Difference of S. G. And osmolarity
SG = number and density of solute OSMOLARITY = number only
PAH and PSP are used to test what
TUBULAR SECRETION AND RENAL BLOOD FLOW
Where does renal concentration begin
Descending and ascending loops of henle
Greatest source of error in any clearance procedure using urine
Improperly timed specimen
Discovered uroscopy
Hippocrates
Albuminuria by boiling
Frederik dekkers
Pisse prophets writing
Thomas Bryant
Person credited for Examination of urine sediments
Thomas addis
Introduced UA as routine exam
Richard Bright
Discovered urochrome
Ludwig thudichum
Person who discovered CSF
Domenico Cotugno
Phenylketonuria
Ivan folling
Discovered Alkaptonuria
Archibald garrod
Discovered cystine calculi
William Wollaston
Major organic substance in the urine
Urea
Major inorganic substance in the urine
Chloride > na > k
Ideal specimen for routine UA
First morning
Ideal specimen for pregnancy test
First morning
Specimen for evaluation of orthostatic proteinuria
First morning
Specimen for anaerobic bacterial culture and urine cytology
Suprapubic aspiration
Control for 3 glass collection
2nd glass - midstream
Time For addis count
12 hours
Time for nitrite determination
Atleast 4 hours
Timed specimen for urobilinogen
Afternoon (2-4pm)
Required volume for drug testing
And container
And temperature
30-45ml
60ml
32.5-37.7
Least affected in unpreserved urine
Protein
Four glass method for prostatitis
Stamey-mears
Bacteriostic at 18g/L and used for cultural transport
Boric acid
Excellent sediment preservative
Formalin
Prevents glycolysis and good for drug analysis
Sodium flouride
Composition of saccomano fixative
50% ethanol and 2% carbowax
Used for cytology studies and how many ml of urine
Saccomano fixative
50 ml
Average 24 hr urine volume
1200-1500ml
Excretion of more than 500ml of urine at night
Nocturia
Major pigment in urine and what colour
Urochrome - yellow
Pink pigment and may deposit in amorphous uratesans uric crystals
Uroerythrin
Black color
Acidic
Alkalin
Air exposure
Methemoglobin
Alkaptonuria(homogentisic acid)
Melanin
Clarity and term
Clear = no particulates Hazy = few particulates, print easily seen Cloudy = many particulates, blurred print Turbid = print cannot be seen Milky = may precipitate and clot
Acidic urine sediments
Amorphous urates
Radiographic dye
Alkarine urine sediments
Amorphous phosphates
Carbonates
Soluble with heat
Amorphous urates
Uric acid
Soluble in ether
Lipids
Lymphatic fluid
Chyle
Odorless
ATN
Foul/ammoniacal
UTI
Mousy, musty odor
PKU
Rancid butter odor
Tyrosinuria
Cabbage, hops
Methionine malabsorption (oasthouse syndrome)
Sulfur odor
Cystinuria
Rotting fish
Trimethylaminuria
Tomcat urine
Multiple carboxylase deficiency
Glucose reading time, principle, positive color
30
Double sequential enzyme reaction
Green to brown
Bilirubin reading time, principle, positive color
30, diazo, tan to violet
Ketone Reading time, principle, positive color
40, sodium nitropusside, purple
SG time, principle, positive color
45, pk change of a polyelectrolyte, blue (1.000) to yellow (1.030)
Reading time for protein, principle, positive color
60, protein error of indicator, blue
Ph reading time, principle, color
60, double indicator system, orange to blue (5.0-9.0)
Blood reading time, principle, color
60, pseudo peroxidase activity of hb, uniform green(hgb, mb) speckled(intact rbc)
Urobilinogen time, principle, color
60, ehrlich, red
Nitrite rt, principle, color
60, greiss, pink
Leukocyte rt, principle, color
120 secs, leukocyte esterase, purple
Principle for automate regeant strip
Reflectance photometry
Normal SG
1.003-1.035
Calibration temp for urinometer
20.0C
Temperature correction for urinometer
+0.001 for every 3C above 20
-0.001 for every 3C below 20
3%NaCl SG
1.015
5% NaCl
1.022
9% sucrose
1.034
Urinometer is higher than refractomer by
0.002
Reagent for SG chemstrip
Bromthymol blue
Total ML for IRIS diagnostic
6ml
ML for slideless microscope
4ml
ML for IRIS mass gravity meter
2 ml
Reagents for pH strip
Methyl red
Bromthymol blue
Amount of protein secreted in the urine per day
<150mg/day
Indicator of diabetic nephropathy
Microalbuminuria
Normal Albumim excretion rate
0-20ug/min
Microalbuminuria
20-200 ug/min
Clinical albuminuria
> 200 ug/min
Test for microalbuminuria
Micral test
Principl of micral test
Enzyme immunoassay
Positive and negative color for micral
Positive = red Negative = white
Reagents in proteim Strip
Tetrabrom
High SG cause false _____ in protein strip
Positive
Reagent in SSA
3ml 3%SSA
SSA GRADING
Negative = no turbidity = <6 Trace = noticeable turbidity = 6-30 1 = turbidity = 30-100 2 = turbidity, granulation = 100-200 3 = turbidity, granulation, flocculation = 200-400 4 = clumps > 400
Reagents used in glucose strip
Multistix
Chemstrip
Potassium iodide
Tetramethylbenzidine
Oxidizing agents such as detergents cause false ______ in glucose strip
Positive
Low temp
High SG
Ketone
Ascorbic acids cause false ______ in glucose strip
Negative
Sensitivity of glucose strip
100 mg/dl
How many drops of urine is used in clinitest table
5 drops
How to prevent pass through phenomenon in clinitest
Apply 2 drops of urine
Also known as parent ketone
Acetoacetic acid/diacetic acid
Also known as parent ketone
Acetoacetic acid/diacetic acid
Major ketone found in the urine
Beta-hydroxybutiric acid
Legals test is also known as
Sodium nitroprusside
Reagents used in ketone strip
Sodium nitroprusside
Acetone is only measured when ____ reagent is used
Glycine
Reaction time of acetest table
30 seconds
Test to differentiate myoglobin and hemoglobin
Blondheim’s test
Reagent used in blondheim’s and test results
2.8 g Ammonium sulfate (80%)
Positive = myoglobin Negative = hemoglobin
Regeant used in blood strip
Tetramethylbenzidene
Comfirmatory test for bilirubin
Ictotest
Reagents used in biliribun strip
Dichloro plus benzidene
Normal value for UBG
<1mg/dl or ehrlich unit
Formaline causes false ______ in urobiniligen strip
Negative
P-aminosalycosic acid causes false ________ in urobilinogen test
Positive
Rapid screening test for porphobilinogen
Hoesch test (inverse ehrlich reaction)
Rapid screening test of UTI
Nitrite
Reagents used in nitrite
Diazonium salt and quinolin
Large quantities of bacteria converting nitrite to nitrogen causes false ______ in nitrite strip
Negative
Reagents for leukocyte
ester + diazo salt
Wbc with no esterase
Lymphocytes
Positive for LE
Neutrophils, basophils, eosinophil, monocyte, histiocyte, trichomonas
Reading time for c-stix and stix
C-stix = 10 Stix = 60
Reading time for c-stix and stix
C-stix = 10 Stix = 60
Reading time for c-stix and stix
C-stix = 10 Stix = 60
Quantitative measure of formed urine elements uring hemocytomer
Addos count
Micrscop that forms halo
Phase contrast
3D microscope
Interference-contrast
Differential 3D microscope
Normaski
Modulation 3D microscope
Hoffman
Component of sternheimer-malbin stain
Crystal violet and safrarin O
Distinguishes rbc from wbc, yeast, oil droplets and crystals
2% acetic acid
Identifies urinary eosinophils
Hansel stain
Stains DNA
Phenathridine (orange)
Stains nuclear membrane, mitochondria and cell membrane
Carbocyanin (green)
Formalin causes false _____ in LE strip
False positive
High protein and medicines cause false _____ in LE
Negative
Most predominant wbc in urine
Neutrophils
NV of RBC in urine
0-2 or 0-3/hpf
NV of wbc in urine
0-5 or 0-8/hpf
In _____ urine neutrophil swell and undergo ____ movement
Hypotonic, brownian
Value of eosinophils in interstitial nephiritis
> 1%
Color of glitter cell in SM stain
Pale blue
Color of leukocyte in SM stain
Pale pink
Variation of squamous epithelial cell associated with bacteria
Clue cell
Bacteria associated with clue cell
Gardnerella vaginalis
Also known as bladder cell
Transitional epithelial (uroethial)
Epithelial cell with centrally located cell
TEC
Most clinically significant epithelial cell
RTE
Origin of RTE
Nephron
Epithelial cell with eccentric nucleus
RTE
Value of RTE that signifies tubular injury
> 2 rte/hpf
Lipid containing RTE found in nephrotic syndrome
Oval fat body
RTE with non lipid vacuoles
Bubble cell
Most frequently encountered parasite in urine
Trichomonas vaginalis
Most common fecal contaminant
Enterobius vermicularis
Urinary bladder cancer markers
NMP = nuclear matrix protein BTA = bladder tumor antigen
Elements read on HPF
WBC RBC normal Crystals bacteria OFB TEC RTE
Reporting of abnormal crystals
Average number/LPF
Reporting of RTE
Average number/hpf
Number of crystals in reporting Rare Few Moderate Many
0-2
2-5
5-20
>20
Number of bacteria in rare
0-10
Number of bacteria in few
10-50
Number of bacteria in moderate
50-200
Number of bacteria in many
> 200
Reporting of TEC
Rare, few, moderate/HPF
Reporting of abnormal crystals/casts
Average number/LPF
Casts are formed primarily in the _______
DCT, CD
Prototype cast
Hyaline
Normal value of hyaline cast
0-2/LPF
Finaly degenerative form of all types of cast
Waxy cast
Cast that signifies chronic renal failure
Waxy cast
Most common type of broad cast
Granular and waxy
Factors contributing to crystal formation
Temperature
Solute concentrarion
PH
First consideration when identifying crystals
Urine PH
Normal crystals
Armp
Most pleomorphic crystal
Uric acid
Brick dust, yellow brown granules soluble in heat and alkali
Amorphous urates
Crystal found in ethylene glycol poisoning(antifreeze)
Monohydrate CaOx (whewelite)
“Cigarette butt” appearance
Calcium sulfate
Yellow brown/colorless prism soluble in water and ether
Hippuric acid
Thorny apple appearance and found in what ph
Amorphous biurate
Alkaline
Prism shaped, coffin-lid, fern-leaf, feathery appearance
Triple phosphate (struvite)
Differentiate cystine from uric acid
Cystine = soluble in dilute HCL, positive in Cyanide
Uric = insoluble in diluted HCl, birefringent
Rectangular plate with in 1 or more corners (staircase pattern)
Cholesterol
Radiographic dye
Fine colorless to yellow needles in clumps or Rossette, soluble in heat and alkali
Tyrosine
Yellow-brown spheres with concentric circles and radial striations
Leucine
Precipitated with tyrosine after adding alcohol
Leucine
Precipitated with tyrosine after adding alcohol
Leucine
Clumped granules or needles with bright yellow color
Bilirubin
Crystal positive in lignin test and diazo reaction
Sulfonamide
Colorless needles that tend to form following refrigeration
Ampicillin
Crystal increased in massive doses of penicillin
Ampicillin
Spheres with dimpled center
Starch granules
Maltese cross formers
OFB
FATTY CAST
FAT DROPLETS
STARCH GRANULES
Optical surfaces of the microscope should be cleaned with a _________
Lens paper
Clean any contaminated lens immediately with a _____________
Commercial lens paper
Optical surfaces of the microscope should be cleaned with a ________
Lens paper
Optical surfaces of the microscope coated with dust should be clean with a ________
Camel’s hair
The presence of crystals in freshly voided urine is most frequently associated with _______
High SG (concentrated specimen)
Testing for many substance in IEM/newborn screening
MS/MS
Phenylalanine is known as
Tyrosine disorder
Most well known aminoacidurias in the world
Phenylketonuria
Gene missing in PKU
Phenyl analine hydroxylase
Guthrie bacterial inhibition test positive result
Growth
Bacteria used in guthrie test
Bacillus subtilis
Guthrie test used for detecting
PKU
Confirmatory test for PKU
Ion exchange HPLC
Gene absent in Alkaptonuria
Homogentisic acid
Most common IEM in the PH
MSUD
Genes absent in coding for enzymes in MSUD
Leucine
Isoleucine
Valine
Hartnup disease is what disorder
Indicanuria
Blue diaper syndrome
Hartnup disease
Cells that produce serotonin
Argentaffin/entochromaffin
Cystinuria is the defective reabsoprtion of
cystine
Ornithine
Lysine
Argenine
Defect in the metabolism of methionine
Homocystinuria
Colorless urine of porphyria in _______
Lead poisoning
Specimens in screening test of porphyria
Stool, urine, bile, blood
CDC Recommended test for lead poisoning
Free erythrocyte protoporphyrin (FEP)
MPS affecting eyes, skeletal, brain
Hurler
MPS affecting Skeletal and mental, sexlinked
Hunter
MPS disease affecting mental only
Sanflippo
Screening test for MPS and positive colors
Albumin - white turbidity
CTAB - white turbidity
MPS paper test - blue
Gene absent in lesch-nyhan disease
Hypoxanthine guanine phosphoribsyltransferase
Carbohydrate disorder associated with infant liver failure, cataract and mental disorder
Galactosemia
Glomerular disorders are of what common origin
Immune complex
Depositition of immune complex formed in conjuction of group A strep
Acute post-streptococcal glomerulonephritis
Disease findings:
Macroscopic hematuria Proteinuria Dysmorphic rbc Rbc Granular cast (+) aso titer
Acute post-streptococcal glomerulonephritis
Deposition of immune complexes from systemic immume disorders (sle)
Rapidly progressive (cresentic) glomerulonephritis
Deposition of antiglomerular basement membrane antibody
Goodpasture syndrome
Presence of ANCA against neutrophil
Wegener’s granulomatosis
Decrease in platelets disrupt vascular integrity
Henoch schonlein purpura
Thickening of glomerular membrane following IgG immune complex deposition
Membranous glomerulonephritis
Cellular proliferation affecting capillary walls
Presence tram truck
Membranoproliferative glomerulonephritis
Presence of waxy and broad cast
Chronic glomerulonephritis
Deposition of IgA on the glomerular membrane
IgA nephropathy (berger’s)
Disruption of podocytes and little cellular changes
Minimal change disease (nil disease, lipid nephrosis)
Most common cause of ESRD
Microalbuminuria
(+) micral test
Diabetic nephropathy (kimmelstiel-wilson disease)
Genetic disorder showing lamellated and thinning of glomerular basement membrame
Alport syndrome
Disruption of electric charges
Massive loss of lipid and protein
OFB
Nephrotic syndrome
Damaged to renal tubular cells caused by ischemia or toxic agents
Presents of rte cells, rte casts, hyaline, grnaular, waxy and broadcasts
Acute tubular necrosis
Crystals generally associated with uromodilin-associated kidney disease (UKD)
Uric acid
Inhereted defect in the production of normal uromodulin, increases uric acid causing gout.
UKD
Generalised failurenof tubular reabsoprtion in the pct
Fanconi’s syndrome
What crystals are possibly formed in fanconi’s syndrome
Cystine
Findings:
low specific gravity
Polyuria
Failures of hypothalamus to produce ADH
Neurogenic DI
Failure of renal tubules to respond to ADH
Nephrogenic DI
Findings:
Wbc, bacteria, NO CAST, microscopic hematuria, mild Proteinuria, increased PH
Cystitis (lower uti)
Findings:
Wbc casts, bacterial casts, microscopic hematuria, protenuria
Vesicoureteral reflux, untreated cystitis)
Acute pyelonephritis (upper UTI)
Findings:
Broad cast, waxy cast, wbc, bacteria, wbc cast, bacterial cast, granular cast, hematuria, protenuria
Due to recurrent infection
Chronic pyelonephritis
Findings: Eosinophilia (>1%) Wbc casts Hematuria Proteinuria NO bacteria
Acute interstitial nephritis
Simultaneous appearance of the elements of acute/chronic GN & nephrotic syndrome (cells, casts, lipid droplets, ofb)
Telescoped urine
GFR in renal failure
<25ml/min
Specific gravity in Renal failure
Consistently 1.010
Findings: Telescoped urine Azotemia GFR: <25/ml Isothenuria Protenuria, glycosuria (+) telescoped urine
Renal failure
Primary UA finding in renal lithiais
Microscopic hematuria
Conditions favouring the formation of renal calculi
PH
Solute concentration
Urinary stasis
Calculi: very hard, dark in color, rough surfaces
Calcium oxalate
Calculi: yellowish to brownish red, moderately hard
Uric acid/urate calculi
Calculi: Yellow-brown, greasy, resembles old soap (least common)
Cystine
Calculi: pale and friable
Phosphate
Calculi: accompanied by urea splitting bacteria, branching/staghorn calculi
Triple phosphate
Insoluble diuretic, mustard colored stones
Triamterene calculi
Calculi: associated with inherited enzyme deficiency and hyperuricemia
Adenine calculi
If neutrophils are fixed in ethanol ANCA forms a _______ pattern called _____
Perinuclear, p-anca
If neutrophils are fixed with formalin the pattern is ______ through out the ______ called the ______
Granular, cytoplasm, c-anca
The rate of proteinuria in nephrotic syndrome
> 3.5g/day
Antigen associated with minimal change disease
HLA-B12
Uses high energy shockwaves to break kidney stones
Lithotripsy
Uses high energy shockwaves to break kidney stones
Lithotripsy
Stones often found in renal calculi
Caox, calcium phosphate
High SG causes false ______ in glucose
Decrease
Effect of a >6.5 pH to SG
False decrease
