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Urinalysis > Exam II > Flashcards

Exam II Flashcards

1
Q

How does the pH of urine relate to its hydrogen ion concentration?

A

inversely; the higher the number of ions, the lower the pH

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2
Q

Ketone bodies in the urine are suggestive of the elevated metabolism of what substance?

A

fat

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3
Q

What causes myoglobinuria?

A

usually rhabdomyolysis (muscle destruction); can also be caused by trauma, venoms, and certain drugs

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4
Q

What is the general purpose of test strip screening?

A

provides immediate answers as to whether or not pathological concentrations of substances are present in the urine, which can determine if further clinical testing is necessary to confirm a diagnosis suggested by the screen

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5
Q

What color is a positive nitrite reading on a dipstick?

A

any degree of uniform pink color

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6
Q

What substance is most likely to be present in urine that could cause a false negative reaction for glucose on a dipstick?

A

ascorbic acid (vitamin C)

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7
Q

What is sulfosalicylic acid (SSA) used for?

A

detecting urinary proteins, especially Bence-Jones proteins or immunoglobulin light chains, which cannot be detected with dipsticks

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8
Q

What test is used for detecting reducing sugars in urine, and what would the microscopic correlation be expected to show?

A

Clinitest; nothing would show on the microscopic exam

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9
Q

What two dipstick reactions are usually positive in pyelonephritis and cystitis?

A

leukocytes and nitrites

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10
Q

What conditions could be indicated by an elevated urinary urobilinogen?

A

liver disease (cirrhosis, hepatitis), hemolytic states (hemolytic anemia, pernicious anemia)

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11
Q

What conditions can cause hemoglobinuria?

A

intravascular hemolysis (transfusion reactions, hemolytic anemia, paroxysmal nocturnal hemoglobinuria [PNH]), extensive burns, infections (malaria, Clostridium perfringens, syphilis, Mycoplasma pneumoniae), chemical toxicity, exercise

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12
Q

What is specificity in regards to dipstick reactions?

A

each test zone should react specifically to the substance being tested for and no other

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13
Q

What does the test pad for ketone bodies detect?

A

acetoacetic acid

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14
Q

What is the principle of the dipstick method for protein?

A

protein error of indicators - ability of protein to alter the color of some acid-base indicators without altering the pH

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15
Q

What unusual protein is associated with multiple myeloma?

A

Bence-Jones (present in ~50% of cases)

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16
Q

What sugar, especially in infants, is most likely indicated by a negative dipstick reaction for glucose and a positive Clinitest?

A

galactose

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17
Q

What specimen is used to detect orthostatic proteinuria, and when would you suspect this condition?

A

first morning specimen; urinary protein is excreted when the patient is erect but not when lying down, and without apparent disease (usually in children and adolescents)

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18
Q

What is the active ingredient in Ehrlich’s reagent?

A

p-dimethylaminobenzaldehyde (DMAB)

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19
Q

What is the reagent used to detect bilirubin in the Ictotest?

A

2,4-dichlorobenzenediazonium tetrachlorozincate

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20
Q

What does the reagent pad for hemoglobin detect?

A

hemoglobin, myoglobin, and erythrocytes

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21
Q

What is the action of the enzyme peroxidase?

A

pseudoperoxidase activity

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22
Q

Why is there normally no glucose in the urine?

A

the glomerulus usually filters out glucose, where it is completely reabsorbed into the blood by the proximal convoluted tubules

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23
Q

What is the advantage of using phase contrast microscopy in the examination of urinary sediment, and how does this relate to the refractive index?

A

permits more detailed visualization of translucent or low-refractive components and living cells by using a special condenser to convert variations in refractive index into variations in contrast (unstained cellular components and casts; mucus and casts have an index similar to that of urine

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24
Q

What is the use of a polarizing microscope in urinalysis?

A

it detects birefringent (anisotropic) sediment; most often used to confirm the presence of fat, especially cholesterol (Maltese cross formation); also distinguishes calcium oxalate from red cells, waxy casts from fibers, and amorphous from coccoid bacteria

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25
Q

How are cell numbers recorded and what objective is used?

A

cells/high power field (40-45x)

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26
Q

How many fields should be examined in a manual microscopic examination?

A

10

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27
Q

What is the most common type of white cell found in urinary sediment?

A

neutrophils

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28
Q

Casts in urine are usually accompanied by a positive test for what?

A

protein

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29
Q

Casts containing cells usually indicate a problem in what part of the urinary tract?

A

kidneys

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30
Q

Where are transitional epithelial cells found?

A

renal calyces, renal pelvis, ureters, bladder, and ~2/3 of the male urethra

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31
Q

Amorphous phosphates are found in urine of what pH?

A

alkaline

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32
Q

What disease is indicated when tyrosine and leucine are found in the urine?

A

aminoacidemia, and occasionally in severe liver disease

33
Q

What two kinds of urine characterize nephrotic syndrome?

A

proteinuria and lipiduria

34
Q

What kind of casts have at least two distinct components?

A

mixed casts

35
Q

How are cast numbers recorded and which objective should be used?

A

of casts/low power field (10x)

36
Q

Which white cell is likely to be found in a transplant rejection?

A

lymphocytes

37
Q

In what specific portions of the nephron are casts formed?

A

distal and collecting tubules (lumen)

38
Q

In what general type of diseases or red cell casts found?

A

intrinsic renal disease (damage to the basement membrane of the glomerulus)

39
Q

What specific type of epithelial cells are found in epithelial cell casts?

A

renal tubular epithelial cells

40
Q

Glitter cells are associated with urine of what specific gravity?

A

low

41
Q

What type of epithelial cells are indicative of vaginal contamination?

A

squamous epithelial cells

42
Q

Calcium oxalate crystals are normally found in urine of what pH?

A

acidic

43
Q

What condition is indicated by large numbers of uric acid crystals?

A

gout

44
Q

Candida albicans is often found in the urine of patients with what two conditions?

A

diabetes mellitus, or systemic yeast infection

45
Q

If flat, hexagonal, colorless crystals are found in the urine, what constituent is suggested; and what should be done before these crystals are reported?

A

cystine crystals; confirmation using the cyanide-nitroprusside reaction test

46
Q

How can red cells and yeast be differentiated?

A

yeast will not lyse in acetic acid, nor will it stain with supravital stains, whereas red cells will; yeast is also more refractile, and size can vary considerably within the same specimen

47
Q

What is the appearance of waxy casts?

A

high refractive index; sharp, blunt, or uneven ends; homogenous, irregular shape; characteristic cracks or fissures on lateral margins or along the axes

48
Q

What organisms can indicate contamination if found in the urine?

A

bacteria (especially Gram-negative), yeast (usually Candida albicans), sperm, Trichomonas vaginalis, Gardnerella vaginalis, parasites/ova (pinworm or blood/bladder fluke)

49
Q

What is the order for the aging process of casts?

A

cellular, coarse granular, fine granular, waxy

50
Q

What is the term for the presence of elevated numbers of casts in urine?

A

cylinduria

51
Q

How can a precipitate of amorphous phosphates be removed?

A

they are soluble in dilute acetic acid

52
Q

How can a precipitate of amorphous urates be removed?

A

they can be dissolved in alkali or by heating to ~60*C with warm saline

53
Q

Can Multistix be used to detect a negative urobilinogen?

A

no; they only have a sensitivity of 0.2

54
Q

How would a negative nitrite alongside a positive bacteria be interpreted?

A

urinary tract infection caused by bacteria that do not have the ability to convert nitrates to nitrites; urine has not been in the bladder long enough for conversion; dietary nitrates are absent; bacterial population is so high that they reduce nitrates to N2; increased specific gravity; antibiotic therapy; ascorbic acid is present (can cause a false negative)

55
Q

How would red cells appear in hypertonic urine?

A

crenated

56
Q

What happens if the dipstick is dipped too many times?

A

reagents on the individual pads may start to run together

57
Q

What type of cast may be found in urine of normal pH?

A

hyaline

58
Q

What are shadow cells?

A

red cells that swell in hypotonic solution, release their hemoglobin, and appear as colorless, empty circles; also called ghost cells

59
Q

What is the significance of the size and shape of a cast?

A

the degree of damage done to the renal tubules; clues to cast identification

60
Q

At what temperature should urine used for testing be?

A

room temperature

61
Q

Why is the refractometer used for specific gravity rather than the dipstick?

A

requires a small sample size; auto-compensates for specimens between 15-37*C; calibrated for both specific gravity and protein determinations; can be used with both ionic and non-ionic solutes (dipsticks can only use ionic)

62
Q

How does the Watson-Schwartz test differentiate between urobilinogen and prophobilinogen?

A

modified Ehrlich’s test based on the different solubility characteristics of prophobilinogen and urobilinogen with regard to pH and solvent type; urobilinogen is soluble in chloroform and butinol, porphobilinogen remains in the aqueous layer

63
Q

What is the principle of the automated instruments for dipstick reading?

A

utilize reflectance photometry method - when light strikes reagent pad, some light is absorbed and the remaining light is scattered; it is performed at a specific wavelength depending on the color of the reagent pad

64
Q

What two terms are used to refer to glucose in the urine?

A

glucosuria, glycosuria

65
Q

What are the two different forms of blood in the urine described as?

A

hematuria (red cells) and hemoglobinuria

66
Q

What reagent is used to differentiate between precipitated urinary hemoglobin and myoglobin?

A

ammonium sulfate

67
Q

What is the normal range for urinary urobilinogen?

A
68
Q

What test is the most sensitive for bilirubin?

A

Ictotest

69
Q

What is ketonuria?

A

presence of ketone bodies in the urine

70
Q

What are the two equations for the detection of glucose?

A

glucose + O2 —glucose oxidase–> gluconic acid + H2O2, and H2O2 + chromagen —peroxidase–> oxidized chromogen + H2O

71
Q

What reagent is used to detect ketones?

A

sodium nitroprusside

72
Q

What reagent is used to detect urobilinogen?

A

p-dimethylaminobenzaldehyde

73
Q

What reagent is used to detect protein?

A

tetrabromphenol blue

74
Q

What reagent is used to detect pH?

A

bromthymol blue, methyl red

75
Q

What reagent is used to detect nitrites?

A

1,2,3,4-tetrahydrobenzo(h)quinolin-3-ol

76
Q

What reagent is used to detect bilirubin?

A

2,4-dichloroaniline diazonium salt

77
Q

What reagents are used to detect glucose?

A

glucose oxidase, horseradish peroxidase, potassium iodide

78
Q

What reagent is used to detect blood?

A

3,3’,5,5’-tetramethylbenzidine

Urinalysis (4 decks)

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