GU Clin Lab Flashcards
1
Q
urinalysis
A
first line for screening/eval of GU complaints
2
Q
indications for urinalysis
A
flank pain, back pain, dysuria, frequency, hematuria, dyspareunia
3
Q
collection for urinalysis
A
preferred in the morning
clean catch or catheterized
4
Q
what time frame should urinalysis be completed in?
A
30 min to 1 hour after specimen is obtained
5
Q
what happens to urine at room temp
A
cells and casts begin to deteriorate
bacteria multiply
bilirubin, urobilirubin, ketones and glucose will decrease
pH may increase
amorphous phosphates and urates, may precipitate
6
Q
what are the 3 components of urinalysis observation
A
appearance
color
odor
7
Q
what does normal urine look like
A
pale, yellow, not odorous
8
Q
what does cloudy urine indicate
A
WBC - infection, bacteria
9
Q
what does bubbly urine indicate
A
proteinuria - foamy bubble
10
Q
what does dark yellow indicate
A
dehydration
11
Q
what does amber urine indicate
A
bilirubin metabolism issue
presence of myoglobin
12
Q
what does red urine indicate
A
blood
13
Q
what does orange urine indicate
A
use of medications - phenzopyridine (pyridium)
14
Q
what does green urine indicate
A
pseudomonas
15
Q
what does blue urine indicate
A
methylene blue
16
Q
what does a sweet odor in urine indicate
A
DKA
17
Q
what does foul smelling urine indicate
A
UTI - infection
18
Q
what does stool smelling urine indicate
A
enterovesicular fistula
19
Q
how many cells should be present in urine
A
minimal
20
Q
what do dysmorphic RBC in the urine indicate
A
glomerular membrane damage
21
Q
where would transitional cells in the urine originate from
A
bladder, ureters, renal pelvis
22
Q
what condition would renal tubular cells in the urine indicate?
A
ATN, AIN, proliferative GN
23
Q
what do hyaline casts in the urine indicate
A
may not be pathogenic
if large amounts, investigate
24
Q
what do waxy casts in the urine indicate
A
never normal!
common in CKD
25
what are the types of cellular casts
WBC, RBC, granular
26
explain what typs of casts you would see in acute tubular necrosis
granular - muddy brown casts
27
what conditions would you see uric acid crystals in the urine
gout
28
what types crystals would you expect to see in alkaline urine
calcium phosphate, magnesium ammonium phosphate (struvite or triple phosphate)
29
what types crystals would you expect to see in acidic urine
cystine
30
what is the most common crystal seen in the urine
calcium oxalate dihydrate
31
what is the normal urine pH
5-8
32
what is normal specific gravity
1.000 - 1.030
33
what is specific gravity measuring
the kidneys ability to appropriately concentrate urine
34
what does urobilinogen measuring
formed by bacterial conversion of conjugated bilirubin in the small intestine
35
what patients would you expect increased urobiliogen
increased turnover of heme, CHF w/ liver congestion
36
what conditions would you see blood in the urine
trauma, stones, menstruation, cystitis, tumor, glomerulonephritis
37
what conditions would have abnormal leukocyte esterase
UTI, sterile pyuria, acute interstitial nephritis
38
what are nitrites in the urine indicative of
UTI
- mostly gram negative, and staph species
39
what is a normal urinalysis glucose reading
negative
40
what does an abnormal glucose on urinalysis dipstick indicate
diabetes mellitus, renal tubular disease
41
what does ketones in the urine indicate
uncontrolled DM (DKA), carbohydrate free diet (keto), starvation
42
what does protein in the urine indicatie
intrinsic renal disease (glomerulonephritis, nephrotic syndrome, DM nephropathy)
preeclampsia
multiple myeloma
43
diabetes mellitus dipstick
+ glucose, - ketones
44
diabetes ketoacidosis dipstick
+ glucose, + ketones
45
starvation/low glucose dipstick
negglucose, + ketones
46
developing kidney disease dipstick
+ protein, later stages - specific gravity ~ 1.01 repeatedly
47
acute tubular necrosis dipstick
+ muddy brown casts, +/- renal tubule cells
48
acute interstitial nephritis dipstick
+ wbcs, + wbc casts, + leukocyte esterase, - nitrites, no bacteria
49
acute cystitis dipstick
+ wbcs, + leukocyte esterase, +/- nitrites, +bacteria, +/- triple phosphate
50
pyelonephritis dipstick
+wbcs, +wbc clump, + bacteria, + leukocytes esterase, +/- nitrites, +/- wbc casts
51
glomerulonephritis dipstick
+blood, + rbcs, +dysmorphic rbcs
52
cancer dipstick
+ blood, +rbcs, +/- cells
53
nephrolithiasis, ureterolithiasis
+blood, +rbcs, no dysmorphic cells, +/- crystals
54
hemolytic anemia dipstick
increased urobilinogen, no bilirubin
55
hepatocellular inflammation (hepatitis) dipstick
+bilirubin, increased urobilinogen
56
biliary obstruction dipstick
+ bilirubin, low urobilinogen
57
rhabdomyolysis dipstick
+blood, no rbcs
58
nephrotic syndrome dipstick
+++ protein
59
when to order urine culture
not first line
recurrent UTI/failure of treatment
complicated UTI
pregnancy
60
what are the most common UTI microorganisms
most common - E coli
gram positive - staph, enterococcus
proteus, psuedomonas
61
what colony count in a urine culture would you consider to be infection
>100,000 CFU/mL
62
microalbumin
good screening test for diabetes progression
monitor response to treatment
63
albumin/creatinine ratio
quantitative
looks at the amount of the albuminuria present
64
protein/creatinine ratio
helps to quantify amount of protein present
helps to r/o conditions like multiple myeloma
65
when do order a 24 hour urine
most accurate proteinuria and renal function
66
urine sodium range
20 - 200 mEq/L
67
what conditions would you expect with a low urine sodium
dehydration, kidney disease, adrenal insufficiency
68
what conditions would you expect with a high urine sodium
diuretic use, salt-losing nephropathy, hypernatremia
69
what sample would you use to perform a urine protein electrophoresis
24 hour urine
70
BUN/Creatinine
best indicators of kidney functions
71
increased BUN without increased creatinine
corticosteroid use, GI bleed
72
eGFR
best way to assess renal function
73
what type of sample should you use for a creatinine clearance
24 hour urine
74
FENa
functional excretion of sodium
75
what is FENa calculating
what is filters through the glomerulus vs what is excreted in the urine
76
FENa <1
cause of AKI is likely due to underperfusion
77
FENa > 2
cause of AKI from tubular damage
78
AKI Workup
complement
ANCAs
Anti-GBM
SPEP and UPEP
Streptococcal testing
Renal biopsy
79
complement
screens for hereditary deficiencies of complement peptides
monitors autoimmune
80
ANCA
associated with vasculitides
81
Anti-GBM antibodies
indicative of autoimmune induced nephritis
82
what syndrome are Anti-GBM associated with?
Goodpasture
83
what is Goodpasture disease
autoimmune disorder against the glomerular basement membrane
84
what is the pathognomonic triad
presence of circulating bodies, glomerulonephritis (hematuria), and pulmonary hemorrhage (hemoptysis)
85
SPEP and UPEP
evaluation of kidney disease when etiology is unknown/uncertain
86
what abnormality is SPEP and UPEP looking for?
M-spike - Multiple Myeloma
87
streptococcal testing
Antistreptolysin O (ASO)
Anti DNase-B (ADB)
streptococcus group B
Streptozyme
88
Renal biopsy
diagnose cause of renal disease
evaluate possible malignancy if patient is not a surgical candidate
evaluate a transplant rejection
89
what type of test of SPEP
blood test
90
stone analysis
stone sent to pathology
- helps to identify cause of neprholithiasis
91
stone panel
used when no stone is present but able to use 24 hour urine to determine risk factors of development
92
testosterone
evaluate ambiguous sex characteristics
precocious puberty
male infertility
female virilizing syndrome
93
female virilizing syndrome
development of male secondary sex characteristics
94
semen analysis
evaluate quality of sperm of infertility eval
document adequacy of vasectomy
95
antispermazodal Ab
infertility screening to detect antibodies against sperm
96
KUB x-ray indications
useful in visualizing calcifications
97
Normal KUB
98
Abnormal KUB - stone in the left ureter
99
pyelography
evaluation of urinary tract
100
what are the indications for pyelography
proposed pelvic surgery
trama to the urinary system
concern for urinary outlet obstuction
101
possible findings with pyelography
ureteric obstruction
upper tract tumor
papillary necrosis
anatomical variants (horseshoe kidney)
course of the ureters
102
Normal Pyelogram
103
Abnormal Pyelogram
104
cystography
evaluation of the bladder
105
indications of when to order cystography
recurrent UTI
dysuria
dysfunction voiding
hydronephrosis/hydroureter
hematuria
trauma - not acute
neurogenic dysfunction of the bladder
congenital anomalies of GU tract
Post Op eval of GU tract
106
normal cystography
107
abnormal cystography - retrograde flow of contrast into ureters indicating issue
108
where is the contrast introduced in a retrograde pyelography
catheter passed into ureter and contrast is introduced
109
how is contrast introduced in cystography
catheter is placed in the bladder and filled with contrast
then the patient voids
110
preferred exam for kidney stones
CT abd/pelvis without contrast
111
preferred exam for masses and lesions in the GU tract
CT abd/pelvis with contrast
112
when to order CT urography
hematuria
urothelial mass
obstructive uropathy
urothelial CA surveillence
stricture
congenital collecting system abnormality
113
what is triple phase CT urography
without contrast
with contrast in nephrons
with contrast in the renal pelvis/ureters
114
when to perform CT angiography
to look at the renal arteries
115
kidney stone in right ureter
116
Renal Mass
117
renal artery stenosis
118
pyelonephritis
119
polycystic kidney
120
horseshoe kidney
121
when to order MRI
evaluate of masses
patients who cannot have iodinated contrast
122
what should you be concerned about when giving gadolinum contrast with MRI
nephrogenic systemic fibrosis
123
when to order NM renogram
assessing perfusion, function, and structure of the kidney
presence of obstruction
presence of renovascular hypertension
monitor renal function in patients with known renal disease
124
right kidney dysfunction
125
renal ultrasound
safe
no contrast
study of choice for general GU
126
what test to order for renal artery stenosis
US w/ doppler
127
testicular imaging
ultrasound is first choice
128
what imaging for testicular torsion
testicular ultrasound
129
cystoscopy indications
suspected pathogen of GU tract
hematuria
recurrent UTI
variety of GU complaints
130
what is the only GU imaging test that is therapeutic and diagnostic
cystoscopy
131
cystoscopy diagnostic
direct visualization
identify stone location
identify source of hematuria
132
cystoscopy therapeutic
stone retrieval
removal or treatment of small bladder tumors
dilation of urethra and ureters
stent placement
133
urodynamics
a series of tests to evaluate bladder function
134
post-void residual
pre and post void measurement
should be less than 50 mL
135
what are the complications and CI of urodynamics
UTI
136
bladder cancer diagnostics
no diagnostic serum marker available
cystoscopy w/ biopsy +/- cytology
137
renal cancer
no screening test
138
testicular cancer
no diagnostic serum marker available
testicular ultrasound is confirmatory
139
prostate cancer screning
recommended ages 55-69 with informed consent
140
free PSA
will be decreased in prostate cancer
141
Prostate Health Index (PHI)
higher PHI is associated with increased risk of prostate cancer
142
prostate and rectal ultrasound
used to eval of prostate CA in patients with elevated PSA
- can be used to guide biopsy
143
ProstaScint
staging of prostate CA
NM study
144
3 step method for ABG
1. assess primary disorder
2. calculate anion gap
3. calculate excess anion gap
145
what is the normal pH of blood
7.35 - 7.45
146
what is the normal pCO2
>45 - <35
147
what is the normal HCO3
<22 - >26
148
what is the equation to calculate anion gap
Na - (Cl + HCO3)
149
what is the equation to calculate excess anion gap
(AG - 12) + HCO3
150
what is the expected anion gap
12 +/- 4
151
high anion gap metabolic acidosis
>20
152
excess AG >30
metabolic alkalosis
153
excess AG <23
nonanion gap metabolic acidosis
