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Clinical Medicine LAB - Professor Sample > GU #1 > Flashcards

GU #1 Flashcards

1
Q

Reasons for obtaining urine specimens:

A

water“fluid biopsy” of the urinary tract

Quick

Economical

To diagnose renal or urinary tract disease

To monitor renal or urinary tract disease

To detect metabolic disease

**quick , noninvasive, cheap*

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2
Q

Solutes are end products of __________ and are filtered through the ________ to maintain _________ balance

A

metabolism

kidneys

acid-base - homeostasis

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3
Q

Urine collection methods?

A

Routine Void

Midstream and Clean-Catch Specimen

24-hour urine collection - big jug and collect all the urine within 24 hours

Urethral catheterization-infants

Suprapubic aspiration-surgery or prostate that is blocking urinary outlet

Pediatric collection-try not to cath them; collect it from the bag that is stuck to them in the diaper

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4
Q

What collection method is the most common?

A

Midstream and Clean-Catch Specimen

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5
Q

Indications for a UA?

A

Used as diagnosis or screening exam

screen for protein in pregnant women signifies kidney damage; looking for preeclampsia

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6
Q

UA is used to investigate?

A 
Abdominal pain / flank pain
Back pain
Dysuria - painful urinaiton
Hematuria - blood in urine 
Urinary frequency
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7
Q

Urine sampling/specimens

us only what specimens for testing for urinalysis?

A

fresh

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8
Q

Urine sampling/specimens

uses the ______ method for urinalysis?

A

Midstream clean catch

**this is the most common test - midstream clean catch *

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9
Q

For urinalysis the _______ _______ must be cleansed first with ______/_________ wipe

A

Uretheral meatus must be cleansed first with iodine/cleansing wipe

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10
Q

Urinalysis you void a small amount then ____ and then you void into ______ cup then send to lan

A

Void small amount then stop

Void into sterile specimen cup then send to lab

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11
Q

✪ best specimen for urine cultures: however they are not routinely done on everyone that you need a culture on

A

Catheterized specimen

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12
Q

Catheterized specimen

used in patients with ?

A

Dexterity issues
Bedridden
Post-op
Urinary retention

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13
Q

UA color is normally?

A

pale yellow

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14
Q

UA color: colorless means?

A

if they are very well hydrated - if kidney stone ( have them drink water until they pee clear

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15
Q

UA color: orange means?

A

pyridium

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16
Q

UA color: brown means?

A

Rhabdomyolysis

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17
Q

UA color: green means?

A

vitamins

pseudomonas

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18
Q

UA color: red means?

A

blood

hematuria

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19
Q

UA odor: fruity?

A

Diabetic (acetone)

uncontrolled Diabetes

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20
Q

UA odor: foul-smelling?

A

infections

fistulae from the intestines to the bladder

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21
Q

UA odor: fecal?

A

Enterovesicular fistula

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22
Q

UA appearance: cloudy/turbid?

A

Old specimen

Presence of pus

Ingestion of fats (large amounts)

**old or sitting around for a while it can be cloudy *

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23
Q

UA pH: alkaline causes?

A

Alkalemia
UTI
Diet high in citrus

more alkaline with infection

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24
Q

UA pH: acidic causes?

A

Acidemia
Starvation
Dehydration
Diet high in meats

**urine is normally more acidic,
more acidic if more acid in the serum, starvation, atkins diet ( ketoacidosis), paleodiet,*

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25
Q

UA: stones related to alkaline conditions?

A

Calcium carbonate,

Calcium phosphate, Magnesium phosphate

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26
Q

UA: stone related to acidic conditions?

A

Xanthine
cystine
uric acid
calcium oxalate

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27
Q

UA protein normal?

A

normally no protein present

**runner or you work out aggressively causing micro trauma to the kidney you can spill proteins *

** think inflammation, damage or infections if there is protein in the urnine*

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28
Q

if there is protein in the urine, then it is an indication of what ?

A

✪ indicator of renal disease

**glomerular capillary pores are to small to let protein through and if there is damage or inflammation then protein, mostly albumin, leaks through ( glomerular membrane is injured), when albumin leaks through you can decrease the oncotic pressure in the vascular system and cause interstitial edema

edema and proteinuria are conditions for nephrotic syndrome **

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29
Q

UA increased protein causes?

A

Glomerulonephritis

SLE

Kidney trauma

Multiple myeloma- Bence joyce

Preeclampsia

Polycystic kidney dz

Malignant HTN

Pyelonephritis

Goodpasture syndrome - AI condition where body attacks the kidneys and the fail

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30
Q

UA increased protein causes cont…?

A 
CHF
Orthostatic proteinuria
Bladder tumors
Urethritis
Amyloidosis
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31
Q

Glucose is ___ normally found in the urine?

A

NOT

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32
Q

What is the number one cause of glucose in the urine?

A

diabetes

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33
Q

Other causes of glucose in the urine?

A

Renal glycosuria - lower threshold for secretion of glucose

Fanconi syndrome - transport defect in the proximal renal tubule

Nephrotoxic chemicals

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34
Q

If there is glucose in the urine then it indicates an ________ serum glucose , > ___.

A

elevated

> 180

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35
Q

Specific Gravity range?

A

1.005-1.030

36
Q

Specific Gravity is a measurement of _____________.

A

concentration

37
Q

SG compares with ?

A

water

**usually more solutes in urine than in water ( SG of urine is really close to the SG of water)*

38
Q

SG is used to evaluate the _____________ and __________ power of the kidneys

A

concentrating and excretory power

**SG - how well our kidney can concentrate the urine *

39
Q

Low specific gravity causes?

A

decreased conc.

over hydration - peeing clear

Diabetes insipidus

Renal failure - cause more water secretion

Diuretics

40
Q

High specific gravity causes?

A

dehydration

SIADH

renal ischemia

fever

glycosuria

proteinuria

41
Q

UA: leukocyte esterase normal ?

A

Normal: none

but we do see it with UTI so its positive

42
Q

Leukocyte esterase is a screening test to detect what?

A

leukocytes

43
Q

Leukocyte esterase positive with ?

A

Pyuria

UTI

44
Q

Leukocyte esterase falsely increased with ?

A

WBC normal not in urine and it is false increase if sample has external inflammation or vaginal discharge ( got a special with external WBCs)

45
Q

UA: nitrites normal urine level?

A

none

46
Q

UA nitrites is an ________ test for detecting ________.

A

indirect

bacteria

**nitrites are made by bacteria so we can assume we having infection*

47
Q

bacteria reduce ________ to _________ by producing _________

A

nitrates

nitrites

reductase

48
Q

+nitrites and +leuks = ?

A

UTI

49
Q

UA normal ketone level?

A

none

50
Q

Causes of ketonuria?

A

Metabolic conditions
Dietary conditions
Increased metabolic states
anything that causes ketoacidosis

**what ever raises ketone is the serum with raise it in the urine *

51
Q

conjugated bilirubin is ____________.

A

water soluble

52
Q

Bilirubin in the urine suggests process affecting ____________________

A

excretion of bilirubin

** excreted through the kidney system into the urine so anything that raises conjugated bili it will raise urine bili*

53
Q

Urobilinogen: means conjugated bilirubin is broken down in the bowel into ___________

A

Urobilinogen

54
Q

Bilirubin has to be __________ to be in the kidneys so …..?

A

Infectious hepatocellular disease

Obstructive process

55
Q

Urobilinogen is increased with ?

A

Hemolysis
Hemorrhage
Hepatic damage

56
Q

Urobilinogen is decreased with ?

A

Obstructive disease

**obstructive process - high bilirubin but low urobilinogen ( cause it is not going though the bile duct and small intestine - it is going start to the vascular system),

Galls tone - high bili but uronbilinogen is not elevated cause there is obstruction

elevated bilirubin and a decreased to NL urobili = obstructive process*

57
Q

Blood in the urine indicates some type of damage in the __ tract

A

GU

58
Q

Hematuria causes?

A 
UTI/Cystitis
Stones
Cancer
Trauma (MVC, athletes)
Blood thinners 
Menstruation - female 
Traumatic catheterization

Myoglobin- gives cherry red appearance without blood!
muscle damage - skeletal muscle

**kidney sensitive to an inflammation in the body or micro trauma so they will leak protein and blood in small amount - this is NL only larger amount we are worried about *

59
Q

UA micro: WBCs: >5 per LPF = ?

A

infection

60
Q

UA micro: epithelial cells in urine means?

A

Cells lining the hollow organs and the skin.

If present, can indicate contamination.

**microscopic analysis - looks for WBC and gives you a count, more then 5 per low power field - infection!, if there are many squamous epithelial cells then it means the sample is contaminated *

61
Q

What frequently causes kidney stones?

A

Ca oxalate

62
Q

Casts are what?

A

mold or renal tubules - slugging off of the inside of the renal tubule - different casts mean different things

63
Q

RBC casts indicate?

A

infection

64
Q

Hyaline casts indicate?

A

can be normal they are just hyaline cells

** not everyone makes casts - *

65
Q

Hyaline casts indicate?

A

can be normal they are just hyaline cells

** not everyone makes casts*

66
Q

Urine C & S indications?

A

+ dipstick or micro results

67
Q

Urine C & S normal ?

A

no growth

68
Q

Urine C & S abnormal?

A

single organism

multiple organism

69
Q

Urine C & S >100,000 bacteria/ mL = ?

A

infection ( Klebsiella or E.coli)

70
Q

Urine C&S 10,000-100,000 = ?

A

consider clinical presentation

71
Q

Urine C&S <10,000 bacteria / mL = ?

A

no infection

(maybe if they are immunocompromised or something then yeah we want to treat this number)

72
Q

Urine C&S: multiple organisms?

A

Probably contaminated

73
Q

Urine stone analysis?

A

Strain urine of patient with stone

74
Q

Urinary stone analysis: calcium oxalate / phosphate stones = ?

A

80%

75
Q

Urinary stone analysis: Ammonium phosphate stones = ?

A

10%

76
Q

Urinary stone analysis: Urice acid stones = ?

A

9%

77
Q

Urinary stone analysis: Cystine stones = ?

A

1%

78
Q

Urine cytology indications?

A

Gross or microscopic hematuria

79
Q

Urine cytology is the initial screening test for?

A

✪ initial screening test for bladder cancer

**sometimes they will have negative cytology*

80
Q

Urine cytology is a good test for screening for but a __ is diagnostic?

A

CA

CT is dx

81
Q

Urine Microalbumin (MA) refers to protein not __________ by routine protein testing from __?

A

detectable

UA

**protein that is smaller ( smaller amount) then what we test for with UA*

82
Q

Urine Microalbumin (MA) can ID _____________ 5 years prior to routine testing.

A

diabetic nephropathy

**why we looking for minute amount of protein? it is a good indication or early kidney disease or damage in DM patients before they start spilling over bigger proteins *

** order a UA and MA*

83
Q

MA: Annual screening test for diabetics?

A

3 tests: If 2 or more are positive than 24-hour urine for microalbumin should be completed

84
Q

Urine Microalbumin (MA) is a early indicators of what?

A

✪ early indicator of damage to renal system from diabetes ( so we can start duo do things to save them - like pt them on an ACE )

85
Q

42 yo female with left flank pain radiating into the LLQ of the abdomen since this morning. Waxes and wanes. Rates it 10/10.

VS: HR 108 BP 165/76 T 37.0C SPO2 96%

UCG: negative

A

glucose, protein(idk), nitrite

if pilo - we will have WBC

run a serum glucose test, CT scan of kidneys

maybe some kidney inflammation ( looks a little larger)

stone down in the LLQ

right pic - level of the hips

UVJ is the most common place for a stone to get stuck ( uretevesticular junction)

HURTS LIKE THE DICKENS

86
Q

21 yr old female presents with dysuria, frequency, and urgency x 2 days.

VS: all WNL

UCG: negative
UA: +leuks, +blood, +nitrites,
Micro: many epithelials, >25 WBC

Next test?

A

UTI!
epithelial - we should get another specimen

treat her empirically and send specimen for culture

3 days of bactrim or cipro for uncomplicated UTI for healthy immune system 1 tab BID x 3 days most common for UTI
( same ABS for pilo but we treat for 7 days )
but if they are pregnant then marcobid ( bacteriostatic) or nitrofurantoin

Clinical Medicine LAB - Professor Sample (36 decks)

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