CM LECTURE / Sir Errol Coderes Flashcards
Chain of infection require a continuous link between:
“SMS”
Source
Method of transmission
Susceptible host
What are the 6 components of the chain of infection?
“IREMES”
Infectious agent
Reservoir
Exit of portal
Mode of transmission
Entry portal
Susceptible host
Personal protective equipment
Gloves
Gowns
Eye and face shields
Countertop shields
The primary method of infection transmission
Hand contact
The best way to break the chain of infection or best way to prevent infection
Handwashing
Handwashing procedure
Wet hands with warm water
Apply antimicrobial soap
Rub to form a lather, create FRICTION and loosen debris
Thoroughly clean between fingers, including thumbs, under fingernails and rings, and up to the wrist for at least 15 or 20 seconds
Rinse hands in a DOWNWARD position
Dry with a paper towel
Turn off faucet with a clean paper towel to prevent contamination
If hands are visibly soiled, ______
Wash hands
If hands are NOT visibly soiled, ______
Apply sanitizer
The handwashing song
Happy Birthday Song (twice)
All biological waste, must be placed in appropriate containers labeled with _______ symbol, except _____.
Biohazard; Urine
The accepted biohazard label is _______ color
Fluorescent Orange
Discard urine by pouring it into the ________ , avoid splashing , and then flush with water
Laboratory sink
True or False.
Empty urine containers can be discarded as nonbiologically hazrdous waste
TRUE
Disinfection of the sink using a _________ should be done ______
1:5 or 1:10 dilution of Sodium Hypochlorite (10% bleach) ; Daily
_______ eliminates many or all pathogenic microorganisms, except the bacterial spores
Disinfection
Disinfectant is effective for ______
1 month
The basic outline of the biohazard symbol is a plain trefoil, which is ___________ .
Three circles overlapping each other equally
Sharps are disposed in _________
Red puncture-resistant containers
An accidental needlestick must be reported to the ______
Supervisor
Best first aid for Chemical spills
Flush the area with amounts of water for at least 15 minutes then seek for medical attention
For alkali or acid burns in the eye, wash out eye thoroughly with _____ for _____
Running water ; for 15 minutes
True or False.
Neutralize chemical that come in contact with the skin
FALSE
DO NOT NEUTRALIZE chemicals that come in contact with the skin
True or False.
Acid spills on floors can be neutralized and then soaked up with wet rags or spill pillows
True
In chemical handling always add _____ to _____
Always add ACID to WATER, to avoid plashing. An explosion can occur if water is added to acid
Color of Reactivity / Stability hazard in the NFPA symbol
Yellow
Color of Specific hazard in the NFPA symbol
White
Color of Health hazard in the NFPA symbol
Blue
Color of Flammability / Fire hazard in the NFPA symbol
Red
In reactivity or stability hazard, what number is classified as violent chemical change
Number 2
“SUV in SM”
0 - Stable
1 - Unstable if heated
2 - Violent Chemical Change
3 - Shock and heat may detonate
4 - May detonate / detonate
In health hazard, what number is classified as extreme danger
Number 3
“NSHED”
0 - Normal
1 - Slightly hazardous
2 - Hazardous
3 - Extreme danger
4 - Deadly
In flammability or fire hazard, what number is classified as below 73 F
Number 4
0 - Will not burn
1 - Above 200 F
2 - Below 200 F
3 - Below 100 F
4 - Below 73 F
Degree of hazard classified as number 3
Serious
“No SMS Ex”
0 - No / minimal
1 - Slight
2 - Moderate
3 - Serious
4 - Extreme / severe
True or False.
Do NOT operate electrical equipments with wet hands
True
All electrical equipment is grounded in a _______ to avoid electric shock
3-pronged plug
If electrical shock occurs, never touch the person or the equipment involved. What are the three things you should do? (In order)
TURN OFF the circuit breaker
UNPLUG the equipment
MOVE the equipment
Flammable chemicals should be stored in _______ and _______ away from heat sources.
Safety Cabinets and Explosion-proof Refrigerators
All laboratory personnel must be involved in laboratory fire drills at least _______
Annually / once a year or every year
When fire is discovered what should you do?
“RACE”
Rescue
Alarm
Contain
Extinguish / Evacuate / Exit
To operate a fire extinguisher …
“PASS”
Pull
Aim
Squeeze
Sweep
Type of fire: Ordinary combustible solids
Class A fire
“A tigas” — solids
Type of fire: Flammable liquids
Class B fire
“B-asa”— liquids
Type of fire: Electrical equipment
Class C fire
“eleCtrical” — eleCtric
Type of fire: Flammable metals
Class D fire
“meDals” — metals
Type of fire: Detonation (Arsenal Fire)
Class E fire
“E-xplosives” — detonate/explode
Type of fire: Cooking media like oils, fats …
Class K fire
“K-itchen”
Water can be used as fire extinguisher for what class of fire?
Class A fire
Dry chemical can be used as fire extinguisher for what class of fire?
Classes A, B and C fire
Dry chemical and halon can be used as fire extinguisher for what class of fire?
Classes B and C fire
The most common all purpose extinguisher
Dry Chemical Extinguisher
Type of fire/s that should be handled only by trained personnel
Class D and Class E fire
These hazards are work-related and include strain due to repeated positions
Ergonomic Hazards
These are hazards due to extremely low temperatures
Cryogenic Hazards
These hazards include centrifuges, refrigerators, autoclaves, homogenizers, and glasswares
Mechanical Hazards
Centrifuge accidents or improper removal of rubber stopper from test tubes may produce _____
Aerosol
The kidney weighs _____ and measures ____ in length, ____ in width and _____ in depth
The kidney weighs 150 g, and measures 12.5 cm x 6 cm x 2.5 cm
How long is the ureter in cm?
Ureter is 25 cm long
Bladder when approximately _____ ml urine accumulates a nerve reflex is initiated
150 ml
Urethra is ___ cm long in men and ___ cm long in men
Urethra is 4 cm long in women and 24 cm long in men
About how many seconds does small amounts of urine are emptied into the bladder from the ureters
10 - 15 seconds
True or False.
Urine is actually a fluid biopsy of the kidney
True
It is the basic structural and functional unit of the kidney
Nephron
How many nephrons are there in PER kidney
1 to 1.5 million nephrons per kidney
Two types of nephron
Cortical and Juxtamedullary nephrons
Order of Urine Formation
“Go Pro LDC CaRe”
Glomerulus
Proximal Convoluted Tubule (PCT)
Loop of Henle
Distal Convoluted Tubule (DCT)
Collecting Duct
Calyx
Renal Pelvis ( “ RUBU “ Renal pelvis — Ureter — Bladder — Urethra )
In renal blood flow, the kidneys receive ____ % of the total cardiac output
25 %
Total renal blood flow = ____
1200 mL / min
Total renal plasma flow = _____
600 - 700 mL / min
Renal blood flow order
“RAGE PVR”
Renal Artery (blood in)
Afferent Arteriole
Glomerulus
Efferent Arteriole
Peritubular Capillaries
Vasa recta
Renal Vein (blood out)
The “working portion” of the kidney
Glomerulus
Resembles a sieve
Glomerulus
Non-selective filter of plasma substances with MW of ____
<70 kDa
Approximately ___ % of the filtered plasma volume is actually excreted in the urine
1 %
Albumin is negative, unless at pH ___
< 4.9
Glomerular filtrate specific gravity = ____
1.010
The first function to be affected in renal disease
Renal tubular reabsorption
The plasma concentration at which active transport stops
Renal Threshold
Renal threshold for glucose
160 - 180 mg/dL
True or False.
PCT, LH, DCT & CD alter urine concentration
True
It is the major site (65 %) of reabsorptiion of plasma substances
PCT
Renal concentration begins in the _____ and ____
Descending and Ascending LH
Solute concentration is highest in the ____
LH (Renal Medulla)
It is highly impermeable to water
Ascending Loop of Henle
Reabsorbs water
Descending Loop of Henle
Reabsorbs salt, but NOT water
Ascending Loop of Henle
Active transport substnaces
Glucose
Amino acids
Salts
Sodium
Chloride
Passive transport substances
Water
Urea
Sodium
It is the movement of a substance across cell membranes into the bloodstream by electrochemical energy
Active Transport
It is the movement of molecules across a membrane by diffusion because of a physical gradient
Passive Transport
It regulates water reabsorption in the DCT and CD
ADH / Vasopressin
Condition associated to ADH deficiency
Diabetes Insipidus
Condition associated with ADH excess
SIADH (Syndrome of Inappropriate ADH secretion
Regulates sodium reabsorption in the DCT
Aldosterone
Converts angiotensinogen to angiotensin I
Renin
Inactive form
Angiotensin I
Converts angiotensin I to angiotensin II
ACE (Angiotensin Converting Enzyme)
Effects of angiotensin II
Release of Aldosterone and ADH ( Increases Sodium and Water Reabsorption )
Vasoconstriction (Increase Blood Pressure )
Corrects renal blood flow
Cells that produces the renin in the afferent arteriole
JG cells
Detects decrease in BP
Macula Densa
Actions of RAAS
Dilates afferent arteriole and constricts efferent arteriole
Stimulates sodium reabsorption in the PCT
Triggers adrenal cortex to release aldosterone to cause sodium reabsorption and potassium excretion in the DCT and CD
Triggers release of ADH by the hypothalamus o stimulate water reabsorption in the CD
Two major functions the renal tubular secretion
Regulation of acid-base balance in the body through secretion by hydrogen ions
Elimination of waste products not filtered by the glomerulus
The major site or removal of nonfiltered substances
PCT
Failure to produce an acid urine due to inability to secrete hydrogen ions
Renal Tubular Acidosis
Blood pH in RTA
Acidic
Urine pH in RTA
Alkaline / Basic
Used to evaluate glomerular filtration
Clearance Tests
Most common clearance test
Creatinine
Gold standard or reference method for clerance tests
Inulin
Better marker of renal tubular function than GFR
Beta 2 -microglobulin
It is a measure of the completeness of a 24 hr urine collection
Creatinine Clearance
By far the greatest source of error in any clearance procedure utilizing urine is ____
The use of improperly timed urine specimens
Around ___ % of creatinine is secreted by the renal tubules
7-10 %
Useful to detect and monitor kidney disease
eGFR ( Estimated GFR )
Variables in the estimated GFR formula developed by Cockgroft and Gault
Age
Sex
Body Weight in kg
Variables in MDRD System formula
Ethnicity
BUN
Serum Albumin
Recommended formula by the NKDEP for GFR
MDRD - IDMS
Used to evaluate tubular reabsorption
Concentration Test
A test wherein patient is deprived of fluid for up to 24 hrs
Fishberg Test
Test wherein patient maintains normal diet and fluid intake
Mosenthal Test
Recently used tests for tubular reabsorption, influenced by the number and density of particles in a solution
Specific Gravity
Recently used tests for tubular reabsorption, influenced by the number of particles in a solution, more accurate and preferred than SG determiantion
Osmolality
Most commonly used and reference method for tubular secretion and renal blood flow
PAH test (p-aminohippuric acid)
Discovered uroscopy, one who first documented the importance of sputum examination
Hippocrates
Discovery of albuminuria by boiling urine
Frederik Dekkers
He wrote a book about “pisse prophets” (charlatans)
Thomas Bryant
Introduced examination of urine sediment
Thomas Addis
Introduced urinalysis as part of doctor’s routine patient examination
Richard Bright
Discovered urochrome
Ludwig Thudichum
Cerebrospinal fluid
Domenico Cotugno
Phenylketonuria
Ivan Folling
Alkaptonuria
Archibald Garrod
Orthostatic or cyclic proteinuria
Frederick William Pavy
Cystine Calculi
William Wollaston
Benedict Reagent
Stanley Benedict
Urine is composed of ___ % water and ____ % solids
95-97 % water and 3-5 % solids
Total solids in urine for 4 hrs
60 grams solids = 35 g organic and 25 g inorganic
Major organic component of urine
Urea
Major inorganic component of urine
Chloride > Sodium > Potassium
Principal salt in urine composition
NaCl ( sodium chloride )
Type of specimen used for routine screening tests and qualitative urinalysis, ideal for cytologic studies only if with prior hydration and exercise 5 mins before collection
Random / Occasional / Single
Ideal specimen for routine screening / urinalysis and pregnancy testing ,often preferred for cytology studies / cytodiagnostic urine testing, most concentrated and most acidic and use for evaluation of orthostatic proteinuria
First Morning
2nd voided urine after a period f fasting, use for glucose determination
Second Morning / Fasting
Type of specimen used for diabetic screening or monitoring and is preferred for testing glucose
2-Hour Post-Prandial
Used in the diagnosis of diabetes
Fractional Specimen
For routine screening and bacterial culture (OPD) ,and patients should thoroughly cleanse his glans penis or her urethral meatus before collection
Midstream Clean Catch
May be urethral or ureteral, and is used for bacterial culture
Catheterized
Abdominal wall is punctured, and urine is directly aspirated from the bladder, bladder urine for anaerobicbacterial culture and cytology
Suprapubic Aspiration
Used for prostatic infection
Three Glass Technique
1 — first portion
2 — middle portion
3 — Urine after post massage
If the number of WBCs and bacteria in the 3rd spx is 10x greater than aht of the 1st
Prostatitis
Serves as a control for bladder and kidney function
2nd specimen
The four glass method used for prostatitis
Stamey-Meares Test
Number of WBCs in Stamey-Meares Test that is considered to be abnormal
10 - 20 WBCs
Specimen used for Addis count (for quantitation of urine sediments)
12 hour urine
Specimen used for nitrite determination
4 hour specimen
Specimen used for urobilinogen determination
Afternoon
Process providing documentation of proper ample ID from the time of collection to the receipt of lab results
COC ( Chain of Custody )
Required urine volume for drug specimen
30 - 45 mL
Urine container capacity for drug specimen
60 mL
Urine temperature for drug specimen
32.5 - 37.7 C
Added to the toilet water reservoir to prevent specimen adulteration in drug specimen collection
Bluing Agent ( dye )
Urine in drug specimen collection may possibly adulterated if pH is ____ and SG is ____.
ph > 9 and SG is < 1.005
Urine containers should have a wide base and has an opening of at least ___ cm
4 cm
24 hr urine containers should hold up to ____ and maybe ____ to protect light sensitive analytes
3 L ; colored
Addition of urine before the start of 24 hr collection period causes _____
False Increased Results
Failure to include urine at the end of 24 hr collection period causes ____
False Decreased Results
When both routine UA and culture are requested, the ____ should be performed first
Culture
Following collection, urine specimens should be delivered to the laboratory promptly and tested within ____; and ideally within _____.
2 hrs; 30 mins
Physical, chemical and microscopic characteristics of urine specimen begin to change as soon as it is ____
As soon as it is VOIDED
Increased in unpreserved urine
“PaBaON”
pH
Bacteria
Odor
Nitrite
Darkened or modified in unpreserved urine
Color
Decreases in unpreserved urine
“CGe Kay BURT”
Clarity
Glucose
Ketones
Bilirubin
Urobilinogen
RBCs / WBCs / Casts
Trichomonas
Preservative of choice for routine UA and routine culture, prevents bacterial growth for 24 hrs, but it precipitate amorphous phosphates and urates
Refrigeration
Preserves protein and formed elements ell, and does not interfere with routine analyses other than pH, it is bacteriostatic a 18 g/L , and is used for culture transport and C&S, but it interferes with drug and hormone analyses
Boric Acid
The excellent sediment preservative, it is the preservative of choice for Addis Count
Formalin or Formaldehyde
It prevents glycolysis, good preservative for drug analysis
Sodium Fluoride
Preserves cellular elements, and is used or cytology studies ( 50 mL urine )
Saccomano Fixative ( 50 % ethanol and 2 % carbowax )
Urine volume normal range (24 hrs)
600 - 2000 mL
Urine volume average ( 24 hrs )
1200 - 1500 mL
Night urine output
< 400 mL
Urine Volume Day:Night ratio
2 - 3 : 1
Container capacity for UA
50 mL
Required urine volume for routine UA
10 - 15 mL ( average: 12 mL )
Increased urine volume
Polyuria ( > 2000 ml / 24 hrs )
Decreased urine volume
Oliguria ( < 400 - 500 mL / 24 hrs )
Complete cessation of urine flow
Anuria ( < 100 mL /24 hrs )
Excretion of more than 500 mL of urine at night
Nocturia
Any increase in urine excretion
Diuresis
It is the rough indicator of the degree of hydration
Urine color
Normal urine color
Colorless to deep yellow
Most common abnormal color of urine
Red / Red brown
