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Clin Med Lab Med > Exam #2: UA > Flashcards

Exam #2: UA Flashcards

1
Q

What three things are assessed with gross examination?

A
  • Color
  • Turbidity
  • Odor
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2
Q

What urine color is normal? What two urine colors are abnormal?

A

Normal: pale straw/dark amber

Abnormal:

  • Red/red brown
  • Dark brown/black
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3
Q

What urine turbidity is considered abnormal?

A

Cloudy

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4
Q

What does foul/putrid smelling urine indicate?

What does fruity smelling urine indicate?

What does maple syrup smelling urine indicate?

A
  • Foul/putrid: UTI
  • Fruity: high ketones
  • Maple syrup: AA disorders (PKU)
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5
Q

What pH range is indicative of acidic urine?

A

ACIDIC = 4.5-5.5

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6
Q

What pH range is indicative of basic urine?

A

ALKALINE = 6.5-8.0

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7
Q

What does specific gravity of urine measure, and what does this reflect?

A

Concentration of solutes in urine (more concentrated = higher number of solutes)
- Reflects kidneys ability to concentrate/dilute urine

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8
Q

What finding on specific gravity is indicative of renal disease?

A

Isosthenuria

- SG fixed due to inability to concentrate urine

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9
Q

Is glucose normally detectable in urine? What are two reasons as you might get false + for glucose in urine?

A

NO

False positives possible due to:

  • Ascorbic acid (Vitamin C)
  • ASA
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10
Q

What does + Ketones in urine indicate?

A

Acidosis (DKA)

- Also rapid weight loss, fasting, starvation, pregnancy

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11
Q

What is the most sensitive protein evaluated for in urine, and what is this a potentially early sign of?

A

Albumin

- Early sign of renal disease

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12
Q

What could possibly give a false + for proteins in urine?

A

Pyridium

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13
Q

What test can be used to determine staging/prognosis of renal disease, especially in high risk patients? Who is considered high risk (2)?

A

Albumin (Moderately increased Albumin)

- High risk is DM, HTN

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14
Q

What three things can be measured via blood in urine? How can you differentiate between the three?

A
  • RBCs
  • Hb
  • Mb

WHICH one = centrifuge

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15
Q

What is produced by bacteria in urine (normally negative)?

A

Nitrites

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16
Q

What finding is a marker for presence of WBCs/infection?

A

Leukocyte Esterase

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17
Q

What two positive findings are likely indicative of UTI?

A
  • Nitrites

- Leukocyte Esterase

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18
Q

What color does urine turn when Bilirubin/Urobilinogen is positive?

A

Brown

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19
Q

What three things might a positive Bilirubin/Urobilinogen indicate?

A
  • Liver disease
  • Hemolysis
  • Biliary obstruction
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20
Q

If a patient has red/brown urine and the result is sediment red, what is the next step?

A

Hematuria = determine etiology

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21
Q

If a patient has red/brown urine and the result is supernatant red, what is the next step?

A

GET DIPSTICK HEME

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22
Q

If a patient has red/brown urine that is supernatant red, and dipstick heme is -, what does this indicate (3)?

What is the next step, if anything?

A
  • Beeturia
  • Pyridium (Phenazopyridine)
  • Porphyria

NO NEXT STEP

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23
Q

If a patient has red/brown urine that is supernatant red, and dipstick heme is +, what does this indicate?

What is the next step, if anything?

A

Myoglobin vs. Hemoglobin

NEXT STEP: CENTRIFUGE blood sample to check plasma color

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24
Q

If a patient has red/brown urine that is supernatant red, and dipstick heme is + (Mb vs. Hb), what finding is indicative of Mb and which finding is indicative of Hb?

A
  • Mb: clear plasma

- Hb: red plasma

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25
Q

When using microscopic evaluation of urine, what is found on high power field (2), and what is found on lower power field?

A

HIGH:

  • RBCs
  • WBCs

LOW: casts

26
Q

What RBC finding on microscopic evaluation of urine is abnormal?

A

> 3 RBC/HPF

27
Q

What WBC finding on microscopic evaluation of urine is suspicious for UTI? What is indicative of UTI?

A
  • 10-20 WBC/HPF = suspicious for UTI

- 20+ WBC/HPF = UTI

28
Q

What type of cast is normal and most common?

A

Hyaline casts

29
Q

What type of cast is suggestive of glomerulonephritis?

A

Red Cell casts

30
Q

What type of cast is suggestive of acute pyelonephritis?

A

White Cell casts

31
Q

What type of cast is suggestive of acute tubular necrosis?

A

Renal Tubular Cell casts

32
Q

What type of cast is nonspecific to any disease?

A

Granular casts

33
Q

What finding do Oval Fat Bodies exhibit, and what is this indicative of?

A

“Maltese cross”

- Indicates nephrotic syndromes

34
Q

What is associated with “Maltese cross”?

A

Oval Fat Bodies

35
Q

What are large polygonal squamous cells with small nuclei? What are they indicative of?

A

Squamous Epithelial cells

- Indicates contaminated specimen of skin or external origin

36
Q

What type of crystal is in acidic urine, secondary to hyperuricemia (gout)?

A

Uric Acid crystals

37
Q

What type of crystal is in alkaline urine, secondary to infection by urease producing bacteria?

A

Struvite crystals

38
Q

What type of crystals cause cause kidney stones? What other type of crystal is RARELY a cause of kidney stones (but still possible)?

A

Calcium Oxylate crystals

- RARE: Cystine crystals

39
Q

What is the purpose of urine culture, and what finding is indicative of a UTI?

A

Confirm presence of bacteriuria

- >100,000 colonies/mL = UTI

40
Q

What UA finding is seen in larger numbers if tubular degeneration is present (2)?

A
  • Renal Tubular cells

- Transitional Epithelial cells

41
Q

What is the major intracellular cation?

A

K+

42
Q

What serum [K+] level is indicative of Hyperkalemia?

A

Above 6.0

- Sxs at around 7.0+

43
Q

What are the four major etiologies of Hyperkalemia?

A
  • Pseudohyperkalemia
  • Inadequate excretion
  • Redistribution from ICF → ECF
  • Excess K+ administration
44
Q

What is a false elevation of K+ from hemolysis due to poor venipuncture technique?

A

Pseudohyperkalemia

45
Q

What is the most common cause of inadequate excretion by kidneys, and what are three possible causes behind this?

A

RAAS failure due to…

  • Renal failure
  • Medications that inhibit K+ excretion
  • Hypoaldosteronism
46
Q

What are the three most common reasons for redistribution of K+ from ICF → ECF?

A
  • Tissue damage
  • Acidosis
  • Decreased insulin
47
Q

What are the two most common reasons for excess K+ administration?

A
  • Potassium supplements

- Potassium-containing salt substitutes

48
Q

Which condition involves arrhythmias (T waves), conduction abnormalities?

A

Hyperkalemia

49
Q

If RAPID correction of Hyperkalemia is needed, what treatment is recommended?

What other two treatments could be used to shift K+ from ECF → ICF?

A

IV calcium chloride

Maneuvers to shift K+ from ECF → ICF:

  • IV sodium bicarbonate
  • D50W + IV insulin
50
Q

If SLOW correction of Hyperkalemia is needed, what treatment is recommended (2)?

A

Loop/Thiazide diuretics to increase K+ loss

51
Q

What serum [K+] level is indicative of Hypokalemia?

A

Below 3.5

- Dangerous if <3.0

52
Q

What are the four major etiologies of Hypokalemia? Which is most common?

A
  • Inadequate intake
  • GI tract loss = MOST common
  • Renal loss
  • Redistribution from ECF → ICF
53
Q

What is the common cause of renal loss causing Hypokalemia?

A

Loop/Thiazide diuretics

54
Q

What are three possible causes of redistribution from ECF → ICF (leads to Hypokalemia)?

A
  • Metabolic alkalosis
  • Insulin administration
  • Beta agonists
55
Q

What condition involves U waves, cramping, respiratory failure, rhabdomyolysis, anorexia, N/V?

A

Hypokalemia

56
Q

If RAPID correction of Hypokalemia is needed, what treatment is recommended?

A

IV potassium chloride

57
Q

If SLOW correction of Hypokalemia is needed, what treatment is recommended?

A

ORAL K+

58
Q

IF a patient has Hypokalemia, what else should be checked for?

A

Hypomagnesemia

- Low K+ is difficult to correct if low Mg2+ is also not corrected

59
Q

Is Hypokalemia or Hyperkalemia associated with T waves?

A

Hyperkalemia

60
Q

Is Hypokalemia or Hyperkalemia associated with U waves?

A

Hypokalemia

61
Q

Sx associated with hyper-K+ (mnemonic to remember this)

A

“It’s a FACT”

  • flaccid paralysis
  • ascending paralysis
  • conduction abnormalities
  • T waves peaked
62
Q

Sx associated with hypo-K+ (mnemonic to remember this)

A

“YOU CRAMP”

  • hYpOkalemia
  • U waves
  • Cramping (opposite of hyper-K flaccid paralysis)
  • Respiratory failure & Rhabdomyolysis
  • Anorexia (n/v)
  • Muscle weakness ascending pattern (same as hyper-K)
  • Paralysis

Clin Med Lab Med (13 decks)

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