(F) Lesson 1: Non-Blood Specimen Handling and Processing Flashcards
Liquid or semi-liquid substances produced by the body and are found within various organs and body spaces
Non-blood specimens
T or F: Most non-blood specimens can be collected by a phlebotomist
False (most are only for physicians)
When a phlebotomist gives instructions regarding specimen collection, what 2 types of instruction should be given?
Oral and written (with illustrations)
T or F: You may verify proper labelling after accepting a specimen for transport
False (before accepting)
T or F: Initials of the phlebotomist are needed when labelling non-blood specimens
False
Where should the label be pasted on the container?
Body; not the lid (risk for interchanging samples as lids are removed during testing)
T or F: Phlebotomists must treat all body substances as potentially infectious
True
What is the most frequently analyzed non-blood body fluid?
Urine
How many hours before a urine sample deteriorates?
2 hours
This is the most commonly requested urine test
Routine urinalysis
T or F: Routine urinalysis is not part of a physical exam
False
This type of analysis for urine samples utilizes observation with the naked eye
Physical or macroscopic observation
This macroscopic observation tells us about the degree of hydration
Color
A darker urine color indicates what?
Concentrated sample due to dehydration
This macroscopic observation is aka transparency
Clarity
A turbid urine sample indicates the presence of what?
Bacteria, WBCs, etc.
What 2 methods measure specific gravity?
Urinometry and Refractory
What 2 macroscopic parameters measure urine concentration
Specific gravity and osmolality
High specific gravity means what in terms of concentration?
Concentrated
T or F: Odor, volume, and osmolality are considered routine urinalysis procedures
False
This macroscopic parameter is only measured if the tests are for quantitative analysis
Volume
This macroscopic parameter can also measure the degree of hydration (other than color) of the specimen as it is more preferred yet more expensive
Osmolality
T or F: Urine should be transported at room temperature
False (with ice)
T or F: Outpatient urine samples are handled by nurses
False (nurses handle inpatient samples while technicians handle the outpatient samples)
T or F: Urinalysis can be ordered during hospitalization
True
Physical or macroscopic observation is also known as?
Gross analysis
A plastic reagent strip is also known as?
Dipstick
This type of urine analysis method utilizes reagent strips to look for substances such as bacteria, bilirubin, blood glucose, ketones, leukocytes, nitrite, protein, and urobilinogen
Chemical analysis
This urine analyte is used to detect the presence of WBCs
Leukocytes
This urine analyte is used to test for bacteria
Nitrite
This analysis method in urinalysis looks for cells, crystals, and microorganisms
Microscopic analysis
T or F: Urine is centrifuged for use in microscopic analysis
True
For how long is urine centrifuged?
5 minutes
T or F: In microscopic analysis for urine, the supernatant is used while the sediments are discarded
False (supernatant is discarded while sediments are used)
WBCs in urine indicate what disorder?
Pyuria
RBCs in urine indicate what disorder?
Hematuria
WBCs and bacteria in urine indicate what condition?
UTI
How many mL of urine is centrifuged for microscopic analysis?
10-15mL
T or F: Microscopic urinalysis examines specimen under a microscope from HPO to LPO
False (from low power objective to high power objective)
T or F: Urine containers for culture and sensitivity testing should be sterile
True
T or F: Urine in containers should be kept at room temperature
True
Urine must be protected from light for up to how many hours?
2 hours
T or F: Specimens held for longer should be refrigerated as part of a preservation protocol
True
What tube must urine be collected in for bilirubin testing?
Amber tube
This urine test confirms UTIs and checks for bacterial growth
Urine culture and sensitivity (CS)
T or F: A bacterial count of over 10,000 cfu/mL means that there is significant urinary tract infection
False (> 100,000 cfu/mL)
CFU stands for?
Colony forming units
Urine for CS is measured using what nutrient medium tool?
A loop
What is the incubation period of urine swabs for CS?
18-24 hours
What is the optimal temperature for bacterial growth in urine CS?
35°-37°C
If a microorganism is identified, this test is performed to determine which antibiotics will be effective against it
Sensitivity or antibiotic susceptibility test
T or F: Culture and sensitivity utilizes a swab instead of a loop
False (a loop is used for CS while a swab is used for sensitivity testing)
T or F: The larger the zone of inhibition, the less effective the antibiotic
False (larger ZOI = more effective)
This test detects cancer, cytomegaloviruses, and other viral and inflammatory diseases of the urinary tract
Urine cytology studies
T or F: Urine cytology studies use smears not containing cell sediments from the urinary tract
False (cell-containing)
This urine stain checks for the presence of abnormal cells under a microscope
Papanicolaou (PAP) stain
How much percent of an equal volume of alcohol should be used when preserving pap smears?
50%
These are used by athletes to enhance performance as these are also detected under urine drug screening
Anabolic steroids
T or F: Urine drug screening procedures are not random
False (are random)
These documents are needed when performing urine drug screening
Chain of custody and control forms
T or F: If the SG of urine is less than 1.003, ask for another sample
False (more than)
T or F: The urinals in drug screening are waterless and the sinks are separated from the toilet area
True
What temperatures indicate that the urine is freshly collected?
32.5°-37°C
T or F: Concentrated urine can give false negative results
False (diluted)
T or F: Dilute urine specimen has increased creatinine
False (decreased creatinine)
These 2 chemicals are ALWAYS paired together when testing urine
Glucose and Ketone
High glucose in BOTH blood and urine indicate what condition?
Diabetes mellitus
Normal blood glucose but high glucose levels in urine indicate what condition?
Renal disease
T or F: Traces of glucose can be found in urine once glucose levels lie within the renal threshold which is 140-160mg/dL
False (must exceed the renal threshold in order to detect glucose in urine; passing the threshold means the kidneys can no longer absorb glucose and therefore expel it in the urine)
Ketones found in urine indicate what condition?
Diabetic ketoacidosis
T or F: Ketones are created when the body breaks down fat for energy because one’s diet is sufficient in carbohydrates
False (deficient)
T or F: Ketones are created when the body breaks down fat for energy because it does not metabolize glucose properly
True
During ketoacidosis, what chemical is absent which triggers the blockage of glucose?
Insulin (therefore glucose is not metabolized properly)
A pregnancy test is able to detect what hormone
Human chorionic gonadotropin hormone
HCG is produced commonly in what part of a pregnant woman’s body?
Developing placenta
How many days after conception is HCG detectable in serum and urine?
8-10 days
What urine specimen is preferred for taking a pregnancy test to avoid false negatives?
First morning specimen
T or F: HCG only appears in pregnant women as this can only be found in a placenta
False (can also appear in the urine of male patients with certain types of cancer and trophoblastic diseases)
This urine specimen is collected at any time and is most commonly analyzed
Random
This urine sample is collected in the morning after 8 hours of sleep and is the most concentrated sample
First morning/8-hour specimen
This urine specimen is the most recommended for routine urinalysis and pregnancy tests due to its high specific gravity
First morning/8-hour specimen
T or F: In a first morning urine specimen, you void the first sample in the toilet
False (you keep the first void)
This urine specimen involves voiding the second specimen after fasting to be used for glucose monitoring and glucose testing
Fasting (fasting second morning)
T or F: You void the first sample in the toilet for a fasting urine sample because it has remnants of the food taken from the last meal
True
This urine specimen is collected at specific times or collected and pooled throughout a specific time period
Timed
This subtype of timed urine specimen is collected serially at specific times that correspond with the timing of blood collection
Tolerance test specimen
T or F: The interval for tolerance test specimen collection is: fasting, 1 hour, and 2 hours
False (fasting, 1/2 hour, 1 hour, 2 hours)
T or F: Glucose levels before a meal should be higher than 100mg/dL as urine is more concentrated
False (lower than 100mg/dL)
How many mg/dL of glucose is expected after 2 hours of collecting a tolerance test specimen?
140
This subtype of timed urine specimen is collected 2 hours after a meal and tested for glucose to monitor insulin therapy of patients with diabetes mellitus
2-hours postprandial
T or F: When conducting a 2-hour postprandial urine test, the patient must start with an empty bladder after consuming a meal
False (void shortly BEFORE consuming a meal then collect 2 hours later)
T or F: You are to compare glucose results on fasting urine and fasting blood specimen
True
This subtype of timed urine specimen is used for quantitative analysis (volume) and collected and pooled for an entire day
24-hour specimen
T or F: 24-hour specimen can only be collected in a wide-mouthed container provided by the hospital
False (patients may use large clean soda bottles as an alternative)
T or F: There are no preservatives present in the wide-mouthed containers prior to 24-hour urine specimen collection
False (preservatives are added prior to collection)
T or F: 24-hour urine specimens are not to be refrigerated throughout collection period
False (refrigerate)
T or F: You void the first sample into a container for a 24-hour urine specimen
False (void in a toilet as this will not be counted within the 24 hours due to it being the urine that was building up in the body the night before)
T or F: Collect urine before anticipated bowel movement
True
T or F: A patient must drink excessive amounts of fluid when testing for 24-hour specimen
False (drink normal amount of fluid unless instructed otherwise)
T or F: The last specimen you void after 24 hours should be voided in the toilet
False (keep it)
T or F: 24-hour specimen should be transported to the laboratory ASAP
True
This subtype of urine specimen requires emptying the bladder and then waiting for a specific amount of time before collecting the specimen
Double-voided specimen
How many minutes should you wait before voiding another specimen for use in a double-voided specimen?
Around 30 minutes
T or F: A 24-hour specimen measures exact amounts of analytes such as cortisol
True
This urine collection method involves the patient voiding or urinating into a clean container
Regular void (from senior transes)
This urine collection method involves the patient voiding both initial and final urine flow into the toilet
Midstream
Why is initial urine flow not collected?
May be contaminated with cells and bacteria
How many mL should be collected for a midstream method?
10-15
This method uses a sterile container for microbial analysis or CS testing and where special genital cleaning is required
Midstream clean catch specimen
T or F: In midstream collection, make sure that the labia is separated for females
True
This urine collection method is collected from a sterile tube inserted through the urethra into the bladder and is used for patients having trouble urinating or those who already have a tube attached to them
Catheterization
This urine collection method aspirates urine directly from the bladder using a needle and is guided by an ultrasound; usually done for infants and young children
Suprapubic collection
What testing areas in the laboratory are suprapubic specimens used for?
Microbial analysis or cytology studies
What tests are catheterization samples usually used for?
Urine cultures
This urine collection method uses a plastic collection bag with hypoallergenic skin adhesive
Pediatric urine collection
T or F: An adult patient’s genital area is cleaned and dried before taping the collection bag to the skin
False (infants/neonates)
A special collection bag with a tube attached that allows the bag to be emptied periodically is used for what urine specimen?
24-hour specimen
The urine collection bag for pediatric urine collection is also called as?
Wee bag
A clear, colorless to pale-yellow fluid that surrounds and cushions a fetus in the uterus
Amniotic fluid
Amniotic fluid is collected using what tool aided with an ultrasound?
Transabdominal amniocentesis (needle and syringe)
After how many weeks of gestation is amniotic fluid usually collected?
15 weeks
T or F: Amniotic fluid can be collected by both a physician and medical technologist
False (only a physician)
How many mL of amniotic fluid is usually collected?
10mL
Testing amniotic fluid for use in chromosome studies is able to detect what?
Genetic disorders/screening abnormalities
Testing amniotic fluid for bilirubin levels is able to detect what?
Hemolytic diseases
Hemolytic diseases occur between babies and their mothers during pregnancy if the baby develops what?
A different blood type than that of the parents making the mother’s body attack the baby’s immune system
Amniotic fluid creatinine levels indicate what?
Gestational age
T or F: Testing amniotic fluid is more accurate than ultrasounds in determining how far along a pregnancy is
False (ultrasounds are more reliable for OB-GYNEs)
This protein is observed during fetal development
Alpha-fetoprotein (AFP)
High AFP indicates what developmental defect to the baby?
Neural tube defects
Low AFP indicates what developmental defect to the baby?
Down’s syndrome
In this amniotic fluid test, phospholipids act as surfactants to keep the alveoli inflated
Fetal lung maturity (FLM)
What substance act as surfactants (decreases surface tension) in FLM?
Phospholipids
T or F: High phospholipids mean immature lungs
False (mature lungs)
When handling amniotic fluid specimen for bilirubin testing, this must be handled with what specific procedure?
Protection from light
When handling amniotic fluid specimen for chromosome analysis, this must be handled with what specific procedure?
Keep at room temperature
When handling amniotic fluid specimen for FLM testing, this must be handled with what specific procedure?
Keep on ice/refrigerate
How long should amniotic fluid be delivered to the laboratory?
Within 1 hour
This clear, colorless fluid surrounds the brain and spinal cord
Cerebrospinal fluid (CSF)
A yellowish CSF is not considered normal, it is also called as what?
Xanthochromic CSF
T or F: Only physicians are allowed to collect CSF
True
CSF is collected using what procedure?
Lumbar puncture (spinal tap)
For adults, between what lumbar vertebrae can a spinal tap be done?
L3 and L4
For babies, between what lumbar vertebrae can a spinal tap be done?
L4 and L5
CSF should be analyzed within how much time?
Within 1 hour
T or F: Routine tests for CSF include cell counts, chloride, glucose, and total protein
True (Additional note: cell counts are for determining bacterial infections)
What position should the patients be in when performing a spinal tap?
Fetal position
Tube 1 for CSF is used for what sections in the laboratory?
Chemistry and Serology
Tube 1 for CSF is preserved how?
By freezing
Tube 2 for CSF is used for what section in the laboratory?
Microbiology
Tube 2 for CSF is preserved how?
By keeping at room temperature
Tube 3 for CSF is used for what section in the laboratory?
Hematology (cell count)
Tube 3 for CSF is preserved how?
By refrigerating
This is what you call when you perform a spinal tap and there is presence of blood
Traumatic tap
T or F: All laboratories have a 4th tube for CSF
False (not all)
Tube 4 for CSF is used for what tests in the laboratory?
- Microbiologic tests
- Cytologic studies
- Additional tests
T or F: In CSF sample collection, perform microbiologic tests first to avoid contamination
True (then hematology and lastly is chemistry)
T or F: If you are using only 1 tube to collect CSF and pressure drops, you may still continue with the procedure
False (stop immediately if the pressure drops)
This specimen uses an evacuated tube inserted through the nose or mouth to measure the degree of acid in the stomach
Gastric fluid/stomach fluid
This process has replaced gastric fluid analysis, it visually examines the upper GI tract with a tiny camera on the end of the long flexible tube
Endoscopy
This analysis examines stomach contents for abnormal substances and evaluates stomach acid production
Gastric analysis
This sample is obtained by aspirating gastric fluid by means of a tube passed through the nose or mouth after fasting
Basal sample
What region of the pharynx are we referring to when we talk about the mouth and throat?
Oropharynx
What region of the pharynx are we referring to when we talk about the nose and throat?
Nasopharynx
What 2 chemicals during gastric fluid stimulation allows patients to produce more acid?
Histamine or pentagastrin (intravenously)
This swab test collects samples from the nasal cavity and pharynx
Nasopharyngeal swab
What is a safe stopping point when performing NP swab?
When resistance is felt
How many degrees back is recommended for a patient to tilt their head when performing a swab test?
70 degrees
T or F: You use calcium aglinate swabs or swabs with wooden shafts in NP swabbing
False (may contain substances that inactivate viruses and may inhibit molecular tests)
T or F: The collection of gastric samples is only done prior to stimulation of stomach acid
False (before and after)
T or F: CDC recommends only using the OP specimen when swabbing
False (NP swab)
T or F: If both NP and OP specimen are collected, separate them in specific tubes
False (combine them in a single tube to maximize test sensitivity and limit the use of testing resources)
This swab collects samples from the throat and diagnoses streptococcal (strep) infections
Oropharyngeal Swab
T or F: You may depress the tongue of the patient undergoing an OP swab using fingers of a gloved hand
False (use a tongue depressor)
T or F: Streptococcus is a virus
False (bacteria)
What happens when the patient makes an “ahh” sound during OP swab?
Raises the uvula
T or F: During OP swab, avoid touching the lips, tongue, and uvula
True
How many mL of viral transport media is contained in OP and NP vials?
2mL
T or F: You may cut or break applicator sticks off near the swab tip to permit tightening of the cap
True
If swab samples can be transported within 72 hours, at what temperature must they be kept in?
4 degrees Celsius (ship on wet ice or refrigerant gel-packs)
If swab samples will be transported beyond 72 hours, at what temperature must they be kept in?
-70 degrees Celsius (ship on dry ice)
This refers to fluid secreted by the glands inside the mouth
Saliva
T or F: Drugs in saliva indicate chronic drug use
False (only recent drug use)
T or F: Aaliva for hormone tests are typically warmed to ensure stability
False (frozen)
This is a sperm-containing thick, yellowish-fluid
Semen
T or F: A yellowish color of semen indicates no prolonged abstinence of sexual activity
False (there is prolonged abstinence)
T or F: A pearly white color of semen indicates prolonged abstinence of sexual activity
False (no prolonged abstinence)
What is the preferred collection method of semen?
Masturbation
How long must semen samples be brought to the lab?
30 minutes
T or F: Semen samples must be kept warm at body temperature
True (do not expose to extreme temperatures)
T or F: Semen can be exposed to light, it will not affect the test results
False (must be protected from light)
Sperm concentration is also known as?
Sperm count
Refers to sperm movement and what percentages are swimming
Motility
Refers to the physical appearance of the sperm (e.g. head size and shape)
Morphology
A pale-yellow, watery, serum-like fluid found between the visceral and parietal membranes enclosing some cavities
Serous fluid
Pleural refers to what body part?
Lungs
Pericardial refers to what body part?
Heart
Peritoneal refers to what body part?
Abdomen
Serous fluid is normally present in small amounts, but volume increases whenever there is what?
Inflammation or infection
This term refers to fluid buildup
Effusion
T or F: The main function of plasma is to allow the membranes to pass through each other with minimal friction
False (serous fluid)
Serous fluids in EDTA tubes are used for what?
Cell counts and smears
Serous fluids in Heparin or Sodium Fluoride tubes are used for what?
Chemistry tests
Serous fluids in non-anticoagulated tubes are used for what?
Biochemical tests
Serous fluids in sterile heparinized tubes are used for what?
Culture
This refers to mucus and phlegm ejected from the trachea, bronchi, and lungs via deep coughing
Sputum
What type of specimen is used to collect sputum?
First morning
How many slow and deep breaths must the patient perform before coughing up the sputum?
3-4
How many mL of sputum is required for transport at room temperature?
3-5
This analyte contains chloride and is expelled through the skin
Sweat
Collection of sweat involved a drug that stimulates sweating called?
Pilocarpine
What do you call the process of sticking electrodes on the skin of the forearm or thigh during sweat collection?
Iontophoresis
T or F: Serous fluid collection can be done by phlebotomists
False (physician only)
High levels of chlorine are seen in patients suffering with this illness
Cystic fibrosis (a problem in the chlorine channels which affects the lungs in the form of excessive mucus production)
It is an exocrine gland disorder commonly tested using sweat
Cystic fibrosis
How many times higher are chloride levels in CF patients compares to normal humans?
2-5x higher
This is aka joint fluid which is a clear, pale-yellow, viscous fluid that lubricates and decreases friction in movable joints which normally occurs in small amounts
Synovial fluid
Synovial fluid increases in the presence of what?
Inflammation
What is the difference between serous fluid and synovial fluid?
Serous fluid is watery while synovial fluid is viscous
Synovial fluid for cell counts, crystal analysis, and smear preparation is placed in what tubes?
EDTA and Heparin
Synovial fluid for culture and sensitivity is placed in what tube?
Sterile
Synovial fluid for macroscopic appearance, chemistry, and immunology tests (to observe clot formation) are placed in what tubes?
Non-additive
The process wherein synovial fluid can identify and differentiate arthritis, gout, and other inflammatory conditions
Arthrocentesis
A less invasive, painless alternative to blood collection for obtaining cells for DNA analysis wherein you massage the mouth on the inside of the cheek with a special swab
Buccal sample
This substance is found on the site of blood cell production; used to detect and identify blood and blood production diseases
Bone marrow aspirate
During bone marrow aspiration, physicians insert a special large-gauge needle into the bone marrow in what 2 areas?
Iliac crest (hip) and sternum (breast)
T or F: During bone marrow aspiration, hematology technologists make special slides while EDTA tubes are for other laboratory studies
True
T or F: The remaining excess bone marrow aspirate is thrown out
False (it is allowed to clot and is placed in formalin for histology examination)
Biopsy specimen and several slides are sent to what department?
Histopathology department
This is a a rapid, non-invasive technique to detect Helicobacter pylori (H. pylori bacteria)
Urea breath test
What is the invasive option for a urea breath test?
Endoscopy
What isotope does the patient ingest in a urea breath test?
Nonradioactive Carbon 13
How many mL of bone marrow aspirate is required for testing?
1-1.5
What chemical does H. pylori release that hydrolyzes urea into ammonia and CO2?
Urease
What is an indicator for a positive presence of H. pylori in a patient via a urea breath test?
CO2 labeled with Carbon 13
This is the most accurate lactose tolerance test
as it diagnoses problems with digestion of lactose and fructose; it detects bacterial overgrowth in the small intestine
Hydrogen breath test
T or F: The only samples collected for a hydrogen breath test are those after the introduction of a special drink
False (collect baseline breath sample before the special drink)
Additional samples of the hydrogen breath test are taken at what time interval?
Every 30 minutes for 3 hours
This specimen can be used to evaluate lower GI disorders
Feces or Stool
T or F: Lactose is called fruit sugar while fructose is called milk sugar
False (reverse)
Occult or hidden blood in stool is an indicator of a GI bleed which could screen for?
Colorectal cancer
How many grams of feces specimen are needed for testing?
5g (routinely it could be pea sized)
T or F: Feces samples should not be contaminated with urine
True
This is used for trace and heavy metal analysis as it can show evidence of chronic drug use rather than recent use
Hair
How many days can traces of drugs be detected in hair?
90 days
These are collected from biopsies and preserved in formalin or other suitable solutions
Tissue specimens
T or F: You may use formalin on tissues for genetic analysis
False (this could deteriorate the sample)
