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Visceral Disorders COPY > Exam 1 - Urine Part 2 > Flashcards

Exam 1 - Urine Part 2 Flashcards

1
Q

What age group is more likely to get MM?

A

Older population (think around 70)

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2
Q

What is the name of the visual indicator seen with PEP to diagnosis MM?

A

M-spike

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3
Q

What are the definitive tests for immunoglobulins in urine?

A

Electrophoresis and immunoelectrophoresis

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4
Q

What is the “CRAB” mnemonic to remember signs and symptoms associated with MM?

A

Calcium (elevated), Renal failure/dysfunction, Anemia, Bone lesions

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5
Q

What is the best next step to determine if a pathological fracture is due to osteoporosis (most common)?

A

Look at old films

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6
Q

If old films are not helpful or nonexistent when evaluating whether a pathological fracture is due to osteoporosis or not, what should the next move be?

A

Lab work: CBC, ESR, C-RP, BCP, UA

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7
Q

What are the steps when suspecting lytic metastasis as a cause for a pathological fracture due to findings on X-ray?

A

Bone scan —> MRI —> Biopsy

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8
Q

What are the steps when suspecting MM as a cause for a pathological fracture due to findings on X-ray?

A

PEP —> Skeletal Survey —> MRI —> Biopsy

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9
Q

Why don’t bone scans contribute to a MM diagnosis?

A

Lack of osteoblastic activity

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10
Q

Should we run bone scans when suspected MM?

A

NOPE - not sensitive for MM at all!

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11
Q

In the 3% of MM patients where the M-spike is not noted following PEP, what other test should be done?

A

Serum free light chain assay

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12
Q

What condition is present with a serum M protein level less than 3g/dL,

A

Monoclonal gammopathy of undetermined significance (MGUS)

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13
Q

What condition is present with a serum M protein level greater than 3g/dL, >10% bone marrow plasma cells present, and no CRAB signs and symptoms?

A

Smoldering MM

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14
Q

What condition is present with a serum M protein level greater than 3g/dL, >10% bone marrow plasma cells present, AND CRAB signs and symptoms?

A

True MM

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15
Q

What is the normal glucose measurement for urine?

A

Negative

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16
Q

What is the condition where blood glucose levels are okay, but glucose is being dumped into the urine?

A

Renal glycosuria (probably due to kidney disease affecting renal tubules and therefore lowering renal threshold levels)

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17
Q

What is the classic condition that causes hyperglycemia and glucosuria?

A

Diabetes mellitus

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18
Q

Why would ketones be found in the urine?

A

Due to lack of available sugar getting to the cells due to lack of insulin, so the body metabolizes fat for energy therefore forming the ketones instead (physiological cause)

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19
Q

What are ketones?

A

Byproduct of fat metabolism (used for energy when glucose isn’t present)

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20
Q

What are examples of possible ketones?

A

Acetone, beta hydroxybutric acid, acetoacetic acid

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21
Q

Higher levels of ketones in the body indicate that what substance is being used as the major source of energy?

A

FAT

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22
Q

What does ketonuria indicate in diabetic patients?

A

Uncontrolled disease

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23
Q

What does ketonuria indicate in non diabetic patients?

A

Reduced carbohydrate metabolism and excessive fat metabolism

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24
Q

Where does bilirubin come from?

A

Formed in the reticuloendothelial system as a breakdown product of RBC/hemoglobin

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25
Q

Why can’t unconjugated bilirubin pass through the glomerular filter?

A

Not water soluble

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26
Q

What conjugates the released bilirubin to make it become water soluble?

A

Glucuronic acid in the liver

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27
Q

What binds to bilirubin to transport it to the liver to be conjugated?

A

Albumin

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28
Q

Where does direct/conjugated bilirubin then go?

A

Into bile then ultimately the small intestine

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29
Q

What would conjugated bilirubin in the urine indicate?

A

Obstruction to flow of bile from liver (possible gall stones, tumor, pancreatic cancer, liver inflammation/infection)

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30
Q

When acted on by bacteria, what is the byproduct of bilirubin?

A

Urobilinogen

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31
Q

What color feces are associated with bilirubinuria?

A

Pale

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32
Q

What kind of bilirubin does NOT appear in the urine?

A

Unconjugated (therefore, a positive test for urine bilirubin confirms that any raised plasma levels are from CONJUGATED hyperbilirubinemia)

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33
Q

What could be the cause of pre-hepatic liver disease?

A

Anemias, excessive breakdown of RBCs

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34
Q

What could be the cause of liver disease?

A

Hepatitis, cirrhosis, biliary duct obstruction, toxic liver damage

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35
Q

What could be the cause of post-hepative liver disease?

A

Biliary tree obstruction

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36
Q

What is the normal range for urobilinogen?

A

0.1-1.0 mg/dL (just less than one..)

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37
Q

When urobilinogen levels are abnormal (aka greater than 1), problems with which organ would be indicated

A

Liver problems

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38
Q

Which form of bilirubin is pre hepatic?

A

Unconjugated

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39
Q

What would increased levels of urobilinogen indicate?

A

Excessive RBC breakdown, infection, liver cirrhosis, etc.

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40
Q

What would decreased levels of urobilinogen indicate?

A

Failure of bile production or obstruction of passage

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41
Q

What is the normal measurement for bilirubin in urine?

A

ZERO (remember: urobilinogen being under 1 is normal)

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42
Q

What are the general urobilinogen and bilirubin levels seen with liver/biliary disease?

A

Increased urobilinogen, positive bilirubin

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43
Q

What are the general urobilinogen and bilirubin levels seen with biliary tract obstruction?

A

Low/absent urobilinogen, positive bilirubin

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44
Q

What are the general urobilinogen and bilirubin levels seen with pre hepatic disease/hemolytic anemia?

A

Increased urobilinogen, negative/normal bilirubin

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45
Q

What are the main cause of biliary obstruction?

A

Gallstones (cholecystitis)

46
Q

How do gallstones affect the color of feces?

A

Gray/white stools

47
Q

How does liver/biliary tract disease affect liver enzyme amounts?

A

Increased

48
Q

What is the initial and most common follow up for gallstones?

A

Expectant management (“wait and see”) while a patient has no symptoms

49
Q

What does smokey colored urine imply?

A

Blood

50
Q

For a diagnosis of hematuria, which substance must be elevated in the blood?

A

RBCs (if not, then look to hemoglobinuria or myoglobinuria)

51
Q

What is an important fact to note with hematuria in kids?

A

1/3 of the time, it’s idiopathic

52
Q

If a patient presents with yellow and clear urine with moderate occult blood but WBC and RBC counts are normal, what is the issue?

A

Either microhemo- or micromyoglobinuria (due to no RBC elevation but present occult blood)

53
Q

What are external causes of hemolysis that could lead to hemoglobinuria?

A

Drugs, crushing injuries, transfusion reaction, burns

54
Q

What is the internal cause of hemolysis that could lead to hemoglobinuria?

A

Hemolytic anemia

55
Q

What kind of things could lead to free myoglobin in the urine?

A

Muscle trauma (like a snake bite), heart attack, crushing injuries

56
Q

Occult blood in the urine with no elevation of RBCs following a heart attack would indicate what diagnosis?

A

Myoglobinuria

57
Q

What would be the diagnosis with increased RBCs although there is no change in urine color (yellow)?

A

Microhematuria

58
Q

What is the possible diagnosis of yellow colored urine and occult blood with normal RBC count?

A

Micromyo- or micro-hemoglobinuria

59
Q

What is the diagnosis for red, pink, smokey colored urine with increased RBC count?

A

Hematuria

60
Q

What is the diagnosis for red, pink, smokey colored urine with normal RBC count?

A

Myo- or hemoglobinuria

61
Q

What screening test is used to detect WBCs in urine?

A

Leukocyte esterase

62
Q

What does a positive leukocyte esterase test indicate?

A

UTI

63
Q

What is leukocyte esterase?

A

Enzyme found in WBCs

64
Q

What is pyuria?

A

Presence of pus in the urine

65
Q

What does a positive nitrite test indicate with urine?

A

Bacteria present (enough gram negative bacteria to convert or reduce nitrates to nitrites)

66
Q

What bacteria is usually to blame for positive nitrates seen in urine?

A

E. coli (normal flora in the GI tract that becomes pathological elsewhere)

67
Q

Does a negative nitrite test mean there’s absence of bacteria?

A

Not necessarily (sometimes UTIs can be caused by infections that don’t convert nitrate to nitrite and therefore aren’t detected on this test…examples = staph and strep)

68
Q

What are normal levels seen with urinary sediment?

A

A few RBCs, WBCs, epithelial cells, and casts (A FEW ONLY)

69
Q

What is the normal WBC and RBC count for urinary sediment?

A

0-3/high powered field (HFP)

70
Q

What would increased WBCs indicate?

A

Inflammation/infection

71
Q

What can cause increased RBCs?

A

Glomerulonephritis, trauma, systemic and renal disease

72
Q

What does TNTC mean?

A

Too numerous to count

73
Q

What type of UTI is usually self-limiting: lower or upper?

A

Lower (uppers are more serious)

74
Q

What would crystals found in urine sediment indicate?

A

Possible stone formation

75
Q

Which are alkaline urine crystals?

A

Amorphous phosphates, calcium carbonate, triple phosphate

76
Q

Which are acid urine crystals?

A

Calcium oxalate, uric acid

77
Q

What is the gender bias for renal calculi/kidney stones?

A

Men

78
Q

What is the peak age for kidney stones?

A

20-30

79
Q

What condition would be an example of an inborn error of metabolism that could be a hereditary factor for developing kidney stones?

A

Gout (associated with uric acid crystals)

80
Q

Most kidney stones are made with what kind of crystals?

A

Calcium oxalate (75%)

81
Q

What is the pain pattern for kidney stones?

A

Starts in kidney region and radiates into the abdomen, genitalia, and legs

82
Q

Where would kidney stones appear on a lateral X-ray?

A

Either overly vertebral bodies or be slightly anterior (because they’re retroperitoneal)

83
Q

Where would gallstones be on an AP X-ray?

A

Right UPPER abdominal quadrant

84
Q

What is the term for an upper urinary tract stone that involves the renal pelvis and involves 2 calyces?

A

Staghorn calculus

85
Q

Which crystals are seen in kidney stones with gout patients?

A

Uric acid

86
Q

Bilateral sacroilitis would be indicative of which group of pathologies?

A

Seronegative spondyloarthropathies like reactive/Reiter’s arthritis, enteropathic, and psoriatic

87
Q

Most amino acids are usually insignificant except for which 3, and what do they possible indicate?

A

Tyrosine, leucine, cysteine; indicative of severe liver disease

88
Q

With present epithelial cells in the urine, what type should always initially be assumed to be present if not reported specifically?

A

Squamous (other options would be transitional or renal cell)

89
Q

What is the least serious and most common type of epithelial cells seen in the urine?

A

Squamous

90
Q

Where is squamous epithelium found in the urinary that?

A

Lower half of bladder and urethra

91
Q

Where is transitional epithelium found in the urinary tract?

A

Upper half of bladder and ureters

92
Q

What would renal cell epithelium indicate if found in urine?

A

Kidney disease (way more serious than other epithelium)

93
Q

If bacteria and epithelial cells are found with no other bacterial findings like increased WBCs, mucus, nitrites, etc., what is most likely the issue?

A

Contamination (it would be weird to have a UTI without increased WBCs, for example)

94
Q

Mucus present in the urine is usually associated with what general problem

A

Infection

95
Q

Casts in the urine give an overall picture and condition of what specific piece of anatomy?

A

Nephron (where they come from directly)

96
Q

What can enhance urinary cast formation?

A

Acidic pH, urinary stasis, increased solutes and proteins

97
Q

What does a RBC cast indicate?

A

Bleeding in the nephron due to GLOMERULONEPHRITIS, which is a form of an upper UTI (is usually immune related)

98
Q

What is the most common cause of hematuria due to glomerulonephritis?

A

Mismanaged strep

99
Q

RBC casts usually come from which specific part of the nephron?

A

Distal convoluted tubule

100
Q

What is the most common age range for strep derived glomerulonephritis?

A

6-10 YOA

101
Q

What do WBC casts indicate?

A

Infection/inflammation of kidney due to PYELONEPHRITIS

102
Q

What is pyelonephritis??

A

Infection of the kidney INTERSTITIUM (also a form of a UTI just like glomerulonephritis, just a different kind of one)

103
Q

Which physical exam test would be positive with a patient with WBC casts in the urine?

A

Punch test (kidneys –> pyelonephritis

104
Q

What are the 2 upper UTIs discussed?

A

Pyelonephritis and glomerulonephritis

105
Q

What are the 2 lower UTIs discussed?

A

Cystitis and urethritis

106
Q

If hyaline casts are present alone, what is the issue? If with other abnormalities?

A

Alone = insignificant

With others = increase usually means renal problems

107
Q

What is the term for neutrophils seen in the urine (WBCs undergoing phagocytosis), and what does it indicate?

A

Glitter cells; indicates UTI

108
Q

What do waxy, broad, and fatty casts indicate?

A

Chronic renal failure (NOT GOOD)

109
Q

What is usually the culprit of yeast cells being present?

A

Candida

110
Q

Cholesterol plates in the urine are usually indicative of what condition?

A

Hyperlipidemia

111
Q

Which type of UTI has proteins present and is more serious: lower or upper?

A

UPPER

112
Q

What is the pain location for upper vs lower UTIs?

A

Upper = flank pain; Lower = lower back and pubic pain

Visceral Disorders COPY (7 decks)

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