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Visceral Disorders > Exam 1 - Urine Part 1 > Flashcards

Exam 1 - Urine Part 1 Flashcards

1
Q

What condition is most likely present when the clavicles are underdeveloped or absent on a film?

A

Cleidocranial dysplasia

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2
Q

What lab test should be ordered if your patient presents with signs and symptoms of anemia?

A

Complete blood count (CBC)

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3
Q

What imaging should be ordered if you see an abdominal aortic aneurysm on X-ray?

A

Abdominal CT (size-depending)

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4
Q

What imaging should be done if a patient has a congenital absence of the posterior arch?

A

Flexion/extension

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5
Q

When OPLL is seen on X-ray, what does the patient then need?

A

CT/MRI and a neuro/ortho consult

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6
Q

What test should be ordered for a patient with DISH?

A

Fasting blood sugar (possible diabetic)

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7
Q

What test is needed for a patient with a kidney stone?

A

Urine analysis

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8
Q

Increased levels of what enzyme in the blood are indicative of probable prostate cancer?

A

Alkaline phosphatase

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9
Q

What kind of X-ray finding could appear on the vertebral bodies in a patient with increased levels of alkaline phosphatase?

A

Hemispherical sclerosis (blastic metastasis)

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10
Q

What imaging does a patient with signs and symptoms of pneumonia need?

A

Chest film

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11
Q

What kind of test does a patient with burning urination and flank pain need?

A

Urine analysis

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12
Q

What kind of test does a patient with pain in the right upper quadrant of the abdomen need?

A

Liver function tests (check enzymes)

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13
Q

What are the federal regulatory standards that apply to all clinical laboratory testing performed on humans in the United States, except clinical trials and basic research?

A

CLIA (clinical laboratory improvement amendements)

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14
Q

If a chiropractor chooses to do his lab work in his office, what standards must be met for legalities?

A

CLIA and OSHA standards

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15
Q

What percentage of cardiac output perfuse the kidneys every minute?

A

25% (a lot, guys)

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16
Q

What is the name of the hormone produced in the kidneys that stimulates RBC and renin production?

A

Erythropoitin

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17
Q

What are the 3 properties that make up a routine UA?

A

1 physical 2 chemical 3 microscopic

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18
Q

What is the functional unit of the kidney?

A

Nephron

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19
Q

How many nephrons (approx.) are in 1 kidney?

A

1 million

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20
Q

What anatomy makes up a nephron?

A

Glomerulus, capillary network, proximal convoluted tubule, loops of Henle, distal tubule, collecting duct

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21
Q

What is the oldest clinical lab procedure?

A

UA

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22
Q

What is the nickname for the ancient Sumarian, Babylonian, and Egyptian physicians that were highly skilled in urine examinations (aka urine gazers)?

A

Pisse-prophets

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23
Q

The glomerular filtrate becomes urine after leaving what specific part of the nephron?

A

Distal convoluted tubule

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24
Q

What are the principle solutes of urine?

A

Urea, sodium, chloride, potassium, creatinine, uric acid, and ammonia

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25
Q

The body excretes approximately how many grams of dissolved material in 24 hours? Half of it is what substance?

A

60 grams; 50% = urea

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26
Q

What percentage of urine is water?

A

95% (rest are dissolved solids)

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27
Q

What is the normal range for daily volume of urine?

A

600-2000ml/day (average if 1200-1500ml/day)

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28
Q

What is the term for urine output of greater than 2000ml/day?

A

Polyuria

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29
Q

What are some potential causes of polyuria?

A

Diabetes mellitus, diabetes insipidus, large fluid intake, diuretics

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30
Q

What is the term for urine output that is less than 500ml/day?

A

Oliguria

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31
Q

What are some potential causes for oliguria?

A

Renal tubule dysfunction, end stage renal disease, obstruction, edema, dehydration, diarrhea, vomiting, shock

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32
Q

What is the term for an absence of urine?

A

Anuria

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33
Q

What can cause anuria?

A

Renal failure, obstruction, heart attack

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34
Q

What is the term for excessive water intake?

A

Polydipsia

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35
Q

At what time of the day is the best urine analysis specimen usually retrieved and why?

A

Early morning (urine has been in the bladder for hours and is the most concentrated)

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36
Q

After what amount of time does decomposition of urine begin?

A

Within 30 minutes at room temperature and 4 hours if refrigerated

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37
Q

How does the color of urine change when unpreserved?

A

Gets darker

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38
Q

How does the turbidity of urine change when unpreserved?

A

Increases

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39
Q

How does the odor of urine change when unpreserved?

A

More foul smelling

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40
Q

How does the pH of urine change when unpreserved?

A

Increases

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41
Q

How do the levels of glucose, ketones, bilirubin, and urobilinogen change in urine when unpreserved?

A

Decrease

42
Q

How do the levels the nitrites and bacteria of urine change when unpreserved?

A

Increased

43
Q

What happens to RBCs in unpreserved urine?

A

Lysis

44
Q

What happens to WBCs and casts in unpreserved urine?

A

Disintegrate

45
Q

What color urine is seen with dehydration from fever, vomiting, and certain foods like rhubarb?

A

Orange

46
Q

Excess of what nutrient can cause BRIGHT yellow urine?

A

B vitamins

47
Q

What can cause black urine?

A

Alkaptonuria, melanin problems like malignant melanoma

48
Q

What can cause colorless urine?

A

Diabetes insipidus, over hydration

49
Q

What would brownish yellow/green urine indicate?

A

Liver problems (so check bilirubin an urobilinogen

50
Q

Milky urine is associated with what overlying condition?

A

Hyperlipidemia (risk factor for heart disease)

51
Q

Is slightly hazy urine considered normal?

A

Yeah

52
Q

What does cloudy urine usually indicate?

A

Pus, bacteria, RBCs, spermatozoa

53
Q

What does frothy urine indicate?

A

Proteins

54
Q

What color froth would be associated with levels of bilirubin?

A

Yellow

55
Q

What color froth would be associated with levels of proteins?

A

White

56
Q

What is the purpose of measuring for specific gravity?

A

Evaluates the kidneys’ ability to concentrate urine

57
Q

What is the normal range for specific gravity of urine?

A

1.015-1.035

58
Q

What is the specific gravity, technically?

A

The weight of the urine compared to distilled water (SpG of water = 1.000)

59
Q

What is the term for low or high specific gravity of urine?

A

High = hypersthenuria; Low = hyposthenuria

60
Q

What is the term for a fixed SpG of urine at 1.010?

A

Isosthenuria

61
Q

What does isosthenuria indicate?

A

Protein free plasma and the end stage of renal failure

62
Q

What can cause increased urine specific gravity?

A

Proteinuria or glucosuria (due to heavy molecules), dehydration, decreased renal blood flow

63
Q

What can cause decreased urine specific gravity?

A

Over hydration, glomerulonephritis, pyelonephritis, DI, renal failure

64
Q

A foul or fishy urine smell usually indicates what?

A

UTI

65
Q

A fruity or sweet urine smell usually indicates what?

A

Diabetes mellitus/ketosis

66
Q

A feces odor of urine usually indicates what?

A

Asparagus, enterobladder fistula

67
Q

What is the normal pH range of urine?

A

4.5-7.5 (slightly acidic)

68
Q

What causes the pH of urine to increase and become alkaline as it sits?

A

Bacterial growth and breakdown of urea

69
Q

Diets high in what foods lead to urine that is typically acidic in nature?

A

Animal products

70
Q

Diets high in what foods lead to urine that is typically alkaline in nature?

A

Citrus fruits and vegetables

71
Q

What can cause urine to be more acidic?

A

Respiratory acidosis (emphysema), metabolic acidosis, DM, large amounts of meat and cranberries

72
Q

What can cause urine to be more alkaline?

A

Respiratory alkalosis (hyperventilation), metabolic alkalosis (common with UTI), diets high in veggies and citrus fruits

73
Q

Should a patient with a UTI with a urine pH of 5 drink heavy amounts of cranberry juice to combat the balance?

A

NO; urine is already acidic (increase fluids, adjust, and monitor)

74
Q

What type of UTI (upper or lower) needs a consult right away?

A

UPPER

75
Q

Should acidic urine with xanthine, cysteine, and/or uric acid stones be kept acidic or alkaline?

A

Alkaline

76
Q

Should alkaline urine with calcium carbonate and/or calcium and magnesium phosphate stones be kept acidic or alkaline?

A

Acidic

77
Q

Which protein is the dipstick most sensitive to?

A

Albumin

78
Q

What is a synonym for proteinuria?

A

Albuminuria

79
Q

Is it normal to release protein in the urine?

A

Only in trace amounts… (150mg/day aka non measurable)

80
Q

Does protein in the urine indicate an upper or lower UTI?

A

Upper

81
Q

Why is it important to always analyze for proteinuria?

A

Primary indicator for renal disease

82
Q

What part of the nephron is damaged when proteinuria is seen?

A

Glomerular filter

83
Q

What does a positive dipstick for proteinuria need to be confirmed with?

A

Sulfosalicylic Acid Precipitation Test (SSA)

84
Q

What can cause proteinuria?

A

Diabetes, glomerulonephritis, nephrotic syndrome, preeclampsia, trauma, exposure to cold, pregnancy increasing abdominal pressure

85
Q

What is the term for when a patient presents with normal urine when supine and displays proteinuria when standing?

A

Orthostatic proteinuria

86
Q

Orthostatic proteinuria is associated with what spinal change?

A

Exaggerated lumbar lordosis

87
Q

How can nephrotic syndrome affect the urine?

A

Massive proteinuria (+4), frothy in appearance

88
Q

What extra test should be run on all patients with a 4+ protein level?

A

Bence Jones test (PEP)

89
Q

What is the #1 radiographic feature for Multiple Myeloma?

A

Rain drop skull

90
Q

What are the 3 probable causes of pathological fracture in order from most common to least common?

A

1 osteoporosis 2 lytic metastasis 3 multiple myeloma

91
Q

What is another name for MM?

A

Kahler’s disease

92
Q

What is MM?

A

Malignant proliferation of plasma cells

93
Q

What do plasma cells do?

A

Produce antibodies

94
Q

What is the light chain part of the immunoglobulin sometimes excreted into the urine in patients with MM?

A

Bence-Jones protein

95
Q

What is the test used for finding a monoclonal immunoglobulin in urine (aka looking for Bence-Jones proteins for a patient with suspected MM)?

A

Protein electrophoresis (urine immunofixation)

96
Q

Which will detect Bence Jones proteins: routine UA or PEP?

A

PEP (NOT UA!!!)

97
Q

Why won’t a routine urine analysis detect Bence Jones proteins?

A

Dipsticks are sensitive to albumin

98
Q

What is the procedure used to measure the exact amount of Bence Jones proteins?

A

Immunoelectrophoresis

99
Q

What other coexisting condition is commonly seen with those with MM?

A

Anemia

100
Q

Why is anemia commonly seen in MM patients?

A

Cloned immunoglobulins are being made more than RBCs

101
Q

What kind of sickness is a common complication in patients with MM?

A

Respiratory infections

Visceral Disorders (7 decks)

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