final Flashcards
- What are dysmorphic red blood cells? What do they indicate if found in the urine?
RBCs with abnormal morphology
-suggests glomerulonephritis
- Does a positive pregnancy test always indicate a patient is pregnant? Explain your answer.
no. a number of conditions can cause elevated hCG levels.
-trophoblastic disease and certain non-trophoblastic neoplasms (testicular tumors, prostate cancer, breast cancer & lung cancer)
- A urine was done on a pediatric patient, 3 months old, with a positive bile, negative glucose, and Clinitest of 3+.
a. what is the possible pathological condition?
b. what test would you need to check the bile result with?
a. galactosemia
b. an Icto test
- UA results from routine physical
pH- 6.0
protein- 2+
glucose, ketone & blood- neg
RBC- 50-200/hpf
ascorbic acid- 40 mg
a. abnormal results?
b. explain discrepancies
a. protein 2+, RBCs 50-200/hpf
b. positive RBCs in microscopic but neg blood chemistry result
-ascorbic acid may cause a false neg blood result
- Identify any abnormal result(s) in the following urinalysis done on the Velocity. Explain the most likely cause, and the tech follow-up:
pH- 7.0
protein- trace
glucose, blood & ketones- neg
SG- 1.060
-SG of 1.060
-x-ray contrast media may falsely elevate SG
-repeat urine on clinitek to check SG result
- A family practice resident doing her nephrology rotation ordered a urinalysis on a patient who came in for her afternoon appointment, and is suspected of having glomerulonephritis. The results were as follows:
pH- 7.5
protein- 1+
glucose & ketones- neg
blood- 1+
SG- 1.005
microscopic- normal
a. why was she disappointed? what was she expecting to find?
b. what type of urine specimen would give her a satisfying result?
a. no results indicating glomerulonephritis. dysmorphic RBC, RBC in micro, RBC casts
b. first morning urine- most concentrated
- Identify two possible causes for a clear red urine from a trauma patient having a 4+ dipstick reaction for blood and no RBCs microscopically.
hemoglobin or myoglobin
- The following results were obtained on a urine from a 30 year old female
color- brown
clarity- cloudy
pH- 5.5
blood- 2+
urobilinogen- 1+
SG- 1.027
nitrite- positive
bile, glucose & ketone- neg
indicate whether or not you would expect to see the following in a microscopic analysis & why
a. RBC
b. WBC
c. tri phos crystals
d. hyaline casts
e. bacteria
a. yes, positive blood
b. yes, nitrite result
c. no bc of acidic pH
d. yes, protein result
e. yes, nitrate result
- Why is it necessary to identify the type of epithelial cells in a female patient who has a large number of these cells in her urine microscopic?
Squamous epithelial cells suggest contamination during collection (not a clean catch specimen). Transitional epithelial cells may suggest serious conditions.
hyaline clinical significance
strenuous exercise, dehydration, emotional stress, kidney issues, congestive heart failure
RBC cast clinical significance
acute glomerulonephritis, lupus nephritis, subactute bacterial endocarditis
WBC cast clinical significance
pyelonephritis
granular cast clinical significance
damaged glomeruli, cellular degeneration, strenuous exercise, stress, dehydration, fever
waxy cast clinical significance
prolonged sepsis & tubular obstruction
-transplant rejection, chronic renal rejection
bilirubin crystals
pathological conditions- Bilirubinuria associated with liver disease or obstruction. Severe liver disease, and jaundice
visual description- fine needles that form clusters
leucine crystals
pathological conditions- severe liver disease, maple syrup disease & amino aciduria
visual description- spheres with concentric circles or striation
tyrosine crystals
pathological condition- liver disease & amino aciduria
visual description- fine delicate needles with in clusters or sheaves
cholesterol crystals
pathological condition- lipiduria, found in proteinuria, nephrotic syndrome, renal tubular disease
visual description- flat rectangular plated with notched corners
cystine crystals
pathological conditions- cystinosis, cystinuria, cysteine metabolic disorders
visual description- hexagonal plates
- One morning, a mission partner was pouring the QC reagents for the Velocity into the QC rack. The phone started ringing right as she finished, so she left the QC rack there and answered the phone call that ended up taking her 20 minutes to resolve, because there was a missing specimen. She came back to the UA aisle and ran the Velocity QC. She noticed that the QC failed for CA—it is supposed to have a positive bilirubin result, but the result was negative. What did the mission partner do wrong, and what is the next step she should take to get a passing QC result?
She left it out and the bilirubin degraded in the light. She should pour off a new tube of CA reagent.
- What is the purpose of the color compensation field on the strips?
The color compensation pad assesses urine color and modifies the test results by subtracting the urine color from the color change obtained on the test reaction pads.
- What pigment gives urine its characteristic yellow color?
urochrome
- What are the two critical values in the urinalysis department that must be called within 20 minutes?
4+ glucose and 3+ ketones, positive legionella
- A 24 year old obese diabetic woman had the following blood and urine test results from specimens obtained at the same time. Her blood glucose result was 275 mg/dl (Normal range 60-120 mg/dl).
pH 7.5
protein 1+
glucose, bili, blood, nitrite- neg
ketone- moderate
urobilinogen- 1.0
SG- 1.008
epis- occasional
bacteria & yeast- low amount
amorphous crystals- moderate
ascorbic acid- 40.0
a. identify discrepant results
b. explain them
a. blood glucose high & urine glucose neg
b. ascorbic acid is giving a false neg glucose result (decreased glomerular filtration rate)
- Does a negative nitrite result rule out a UTI?
No. Not all bacteria reduce nitrates, it may not have sat in the bladder long enough, ascorbic acid may be interfering, and nitrates may not be in diet
- Does a negative Legionella Urinary Antigen Test rule out a Legionella infection? Explain your answer.
No. The test only will detect legionella pneumophilia sero group 1 (unlike the serology test that will detect 1-6)
- When interpreting a Vaginitis Affirm test, if the spot next to Gardnerella is blue, this indicates bacterial vaginosis. Explain why an increase in Gardnerella indicates bacterial vaginosis.
In a bacterial vaginosis infection, the lactobacillus population decreases, so the environment is not as acidic, therefore allowing the overgrowth of Gardnerella vaginosis and other anaerobic bacteria.
- Why must one result a positive leuko on a one year old baby as an unconfirmed positive?
False positives can occur in breast fed babies.
- Round, refractile globules, noted during bright light microscopy of a urinary sediment, were birefringent with polarized light and appeared as perfect Maltese crosses. These urinary globules are most likely:
c. oval fat bodies
- A two hour old urine specimen, submitted for routine urinalysis and culture, yielded the following results:
pH- 7.5
SG- 1.008
nitrite- neg
culture- strep faecalis
Factors that may account for the negative nitrite result include:
1. pH of the urine
2. Species of the bacteria
3. Specific gravity
4. Retention time in the bladder
b. only 2 and 4 are correct
- A 28 year old woman is taking an antibiotic for a urinary tract infection and was told that the antibiotic would be most effective if her pH was acidic. The woman should be on a diet rich in:
b. protein
- Colorless, clear, hexagonal crystals were found in a urine specimen. The patient is most likely to have which of the following clinical conditions?
d. cystinosis
- A urine specimen with an elevated urobilinogen and a negative bilirubin may indicate:
d. hemolytic disease of the newborn
- The method of choice for performing a specific gravity measurement of urine from a patient who was administered x-ray contrast dye for an x-ray earlier that afternoon would be:
a. reagent strip
- A patient with Multiple myeloma has a protein result of 3+ on the Velocity. This elevated protein result is due to a large amount of Bence Jones proteins in the urine. What type of proteinuria is this?
a. prerenal proteinuria
- All of the following are ketone bodies that appear in urine, except:
b. acetophenone
