KLUBSY: PHYSICAL EXAMINATION OF URINE Flashcards
The normal urine color includes ???
pale yellow > yellow > dark yellow
The yellow color of urine is caused by the presene of what pigment?
Urochrome
The actual amount of urochrome produced on the body is dependent on what?
dependent on the body’s metabolic state
Increased urochrome production in what cases:
-thyroid conditions
-fasting
-urine stands at RT
*Increaed in OFT (old spx, fasting, thryoid conditions)
What are the additional pigments present in urine in much smaller quantities?
- Uroerythrin
- Urobilin
This is the pink pigment in the urine
Uroerythrin
this pigment is the most evident in specimens that have been refrigerated, resulting in the precipitation of amorphous urates
Uroerythrin
Uroerythrin is most evident in spx that have been refrigerated, resulting in the precipitation of what?
Amorphous urates
This additional pigment is the orange brown color
Urobilin
This is an oxidation product of the normal urinary constituent urobilinogen
Urobilin
The concentration of a normal urine specimen can be ESTIMATED by what?
urine color
How to check for urine color?
1- examine specimen under a good light source
2- read against a white background
What drug causes an orange color if the urine alkaline and becomes colorless when acidified?
PHENINDIONE
This is an anti-tuberculosis drug that causes a reddish or reddish -orange color in the urine?
Rifampin
Medtech received a smoky urine. What must be done?
Accept and check for RBCs
This drug is commonly administered for urinary tract infection and produces also a yellow foam when shaken
Phenazopyridine (Pyridium)
Phenazopyridine produces what color when shaken
Yellow foam
What color is urine in the presence of phenol when oxidized?
Green
This is associated with bilirubin and phenzopyridine
yellow foam
yellow foam is associated with what?
Bilirubin and phenazopyridine (pyridium)
What characteristic of urine is expected when you ingest an anti-UTI drug?
Yellow foam or yellow orange, and Turbid or cloudy
These interefere with copper reduction tests
phenol derivatives
This is associated with alubiminuria/proteinuria
White foam
White foam is associated with what
Albuminuria/Proteinuria
Riboflavin causes what color in the urine?
Bright yellow
Riboflavin is a.k.a
Vit b2
This causes a bright yellow color in urine
Riboflavin (multivitamins)
What characteristic of urine happens in the presence of hematuria (RBCs in urine)
Smoky urine
This is a general term that refers to the “transparency or turbidity” of a urine spx
Clarity
What is the purpose of mixing the spx in order to determine clarity?
to distribute the sediments
What container must we place the spx to see for the clarity?
clear container
this provides a key to the microscopic examination results, because the amount of turbidity should correspond with the amount of material observed under the microscope
The clarity of a specimen
T/F: Clear urine is not always normal
TRUE
This produces a faint cloud in urine after standing due to WBCs, epithelial cells and mucus
Nubecula
How to check for urine clarity?
- MIX specimen while holdng it in fron of a light source.
-View through a NEWSPAPER PRINT
What would be the result if the specimen if not mixed?
blood reagent strip becomes NEGATIVE
What parameter is affected if specimen is not mixed?
blood reagent strip (negative)
Determine the clarity: No visible particulates, transparent
clear
Determine the clarity: Few particulates, print easily seen through urine
Hazy
Determine the clarity: Many particulates, print blurred through urine
Cloudy
Determine the clarity: Print cannot be seen through urine
Turbid
Determine the clarity: May precipitate or be clotted
Milky
What is the description for a clear speciment?
No visible particulates, transparent
What is the description of a hazy specimen?
Few particulates, print really seen through urine
What is the description of a cloudy urine spx?
Many particulates, print blurred through urine
What is the description of a turid urine spx?
Print cannot be seen through urine
What is the descriptionn of a milky urine spx?
may precipitate or be clotted
What are the possible causes of a clear spx?
All solutes present are soluble (such as glucose and proteins)
What is the clarity when all solutes present are soluble?
Clear
What is the clarity when RBC and WBC are present?
Hazy
This is the urine clarity due to RBC and WBCs
Hazy
What is the clarity when there are crystals, microbes, fat (lipids, chyle), epithelial cells?
Cloudy
What is the clarity when there are mucus, mucin, pus, radiographic dye, semen, contaminants?
Turbid
What is the clarity when there are fats or lymph (lipiduria and chyluria)?
Milky
A milky urine spx is caused by?
fats or lymph
a turbid urine spx is caused by?
-mucus
-mucin
-pus
-radiographic dye
-semen
-contaminants
a cloudy urine spx is caused by what?
-crystals
-microbes
-fat (lipids, chyle)
- epithelial cells
What are the non-pathologic causes of urine turbidity?
-squamous epithelial cells
-mucus
-amorphous phosphates, carbonates, urates
-semen, spermatozoa
-fecal contamination
-radiographic contrast media
-talcum powder
-vaginal creams
What are pathologic causes of urine turbidity?
-RBCs
-WBCs
-Bacteria
-Yeast
-Non squamous epithelial cells
-Abnormal crystals
-Lymph fluid
-lipids
What are the lab correlation in urine turbidity that is soluble in dilute acetic acid?
-RBCs, amorphous phosphates, carbonates
*SRAP CARBO = Solube kapag Rbcs, Amorphous Phosphates, Carbonates
What are the lab correlation in urine turbidity that is insoluble in dilute acetic acid?
-WBCs, bacteria, yeast, spermatozoa
How to check for both clarity and color?
check urine with a white background with a good light source
how to check for the color of the urine spx?
color = good light source + white bg
How to check for the clarity of the urine spx?
Good light source + mixed urine spx
*hindi first choice ang “view sa newspaper print”
How to check for the color and clarity of a urine spx?
color and clarity = good light source + white bg
T/F: This is seldom of clinical significance and is not a part of the routine urinalysis
T
What is the normal urine odor?
Norma/Redolent/Fragrant/Odorous
Odor: Bacterial decomposition, UTI, old urine
Foul, ammonia-like, fetid, putrid
Odor: Ketones, DM, Starvation, vomiting, strenuous exercise, diarrhea
Fruity, sweet
Odor: Maple syrup urine disease, caramel sugar
Maple syrup
Odor: Phenylketonuria
Mousy odor, Barny or musty odor
Odor: Tyrosinemia
Rancid
Odor: Isovaleric academia
Sweaty feet
Odor: Methionine malabsorption
Cabbage, Hops
Odor: Contamination
bleach
Odor: Acute tubular necrosis
Odorless
Odor: Trimetylaminuria
Rotting fish
Odor: Asparagus, garlic, onion ingestion, UTI, bacteruria, increase urinary amines
Pungent or distinctive odor
What odor if wee homocystinuria?
Cabbage, hops
Odor: Hawkinsinuria
Swimming pool
Odor: Cystinuria
Sulfure or rotten egg
Odor: Phenol-containing medications
Menthol-like
Odor: Asparagus, garlic, and egg
Mercaptan odor
A purple staining may occur in catheter bags and is cused by an indicant in the urine or by a bacterial infection, frequently caused by what species of bacteria?
by Klebsiella or Providencia
This color of the urine is associated with rhabdomyolysis and in some patients taking L-dopa
cola-colored urine
a cola-colored urine is associated with what?
with rhabdomyolysis and in some patients taking L-dopa
What is formed if a normal urine specimen is shaken or agitated sufficiently?
a foam
What color of foam is formed due to bilirubin and phenazopyridine?
yellow foam
what color foam is formed due to protein mainly albumin?
white foam
a yellow foam is formed due to what?
due to bilirubin and phenazopyridine
A white foam is formed due to what?
due to protein mainly albumin
This is defined as the density of a solution compared with the density of a similar volume of distilled water at a smiliar temp
S.G
What is the S.G of distilled water?
1.000
S.G is influenced by what?
by the number of particles present and the size of the particles
What is the S.G of the plasma filtrate entering the glomerulus?
1.010
This is the term to describe urine with S.G 1.010
isosthenuric
the term to describe urine with S.G below 1.010
Hyposthenuric/Diluted urine
the term to describe urine with S.G above 1.010
Hypersthenuric/concentrated urine
What is the S.G of normal random urine?
1.002 - 1.035
Most of the random specimen falls between what S.G?
1.015 - 1.030
What is the S.G abnormally high S.G?
above 1.040
This S.G result is seen in patients who have recently undergone an intravenous pyelogram
above 1.040
S.G: Physlologically impossible-same as pure water; suspect adulteration of urine specimen
1.000
What is the indication/cause of an S.G of 1.000?
Physlologically impossible-same as pure water; suspect adulteration of urine specimen
S.G: Dilute urine
1.001-1.009
S.G: associated with increased water intake or water diuresis (e.g., diuretics, diabetis insipidus, inadequate secretion/action of ADH)
1.001-1.009
An S.G of 1.001 - 1.009 is indicative/caused by?
Dilute urine; assoclated with increased water intake or water diuresis (e.g., diuretics, Diabetes
insipidus, inadequate secretion/action of ADH)
S.G: Indicates average solute and water intake and excretion
1.010-1.035
An S.G of 1.010-1.025 is indicative/caused by?
Indicates average solute and water intake and excretion
S.G: Concentrated urine
1.025-1.035
S.G: associated with dehydration, fluid restriction, profuse sweating, osmotic diuresis
1.025-1.035
SG: associated with dehydration
1.025-1.035
SG: associated with fluid restriction
1.025-1.035
SG: associated with profuse sweating
1.025-1.035
SG: associated with osmotic diuresis
1.025-1.035
S.G: suspect adulteration of urine specimen
1.000
S.G: Physiologically impossible; indicates presence of iatrogenic substance (e.g., radiographic contrast
‘media, mannitol)
> 1.040
S.G: indicates presence of iatrogenic substance (e.g., radiographic contrast
‘media, mannitol)
> 1.040
An S.G of 1.025 - 1.035 is indicative/caused by?
concentrated urine
An S.G of >1.040 is indicative/caused by?
indicates presence of iatrogenic substance (e.g., radiographic contrast
‘media, mannitol)
What are the methods for detection urine S.G?
-direct mtds
-indirect mtds
What are the direct mtds for detection of urine s.g?
-hydrometer
-harmonic oscillation densitometry
-falling drop
what are the indirect mtds for detection of urine s.g?
-refractometer
-reagent strip
What method of detection of urine s.g is this?
-Hydrometer
-harmonic oscillation densitometry
-falling drop
what methods of detection of urine s..g is this?
-refractometer
-reagent strip
A hydrometer is a.k.a?
Urinometer
This consists of a weighted float attach to a scale that has been calibrated in terms
of urine specific gravity
Urinometer
When using urinometer, an adequate amount of urine is poured into a proper-size
container and the urinometer is added with ….
with a spinning motion.
How to read a scale of a urinometer?
at the bottom of the urine meniscus
What is the MAJOR disadvantage of using a urinometer?
is that it requires a 10-15 mL specimen
This method of detection of urine s.g is less accurate than other methods and is not recommended by the CLSI
Urinometer
What is the calibrated temperature printed on the instrument?
about 20C
How to correct for the S.G in a urinometer?
- Add 0.001 for every 3C ABOVE the calibration temp (20C)
- Subtract 0.001 for every 3C BELOW the calibration temp
- Subtract 0.004 for every 1 gram of glucose (4G)
- Subtract 0.003 for every 1 gram of protein (proTHREEin)
What are the two calibrating fluids when using a urinometer?
-potassium sulfate
-Water
With potassium sulfate as a calibrating fluid, the S.G should be read at ???
1.015
With water as a calibrating fluid in a urinometer, the S.G should be read at ???
1.000
This calibrating fluid should be read at 1.015 when using a urinometer
potassium sulfate
With this calibrating fluid, the S.G should be reat at 1.000
water
A refractometer is a.k.a?
TS meter
It determines the concentration of dissolved particles in a specimen.
Refractometer
This method determines concentration of dissolved particles by measuring refractive index
Refractometer
*REFRACtive index = REFRACtometer
A refractometer determines what?
determines the concentration of dissolved particles in a spx
How does a refractometer determine the concentration of dissolved particles?
by measuring refractive index
This is a comparison of the velocity of light in air with the
wvelocity of light in a solution(urine).
Refractive index
Refractive index is a comparison between what?
velocity of light in air with the velocity of light in a solution (urine)
This provides the distinct advantage of determining specific gravity using a small volume of specimen (one or two drops)
Refractometer
T/F: Temperature corrections are necessary in the refractometry method
F.
NOT necessary
In a refractometer, the temperature is compensated between what???
between 15C and 38C
How to correct glucose in a refractometry?
subtract 0.004 for each gram
How to correct protein in refractometry?
subtract 0.003 for each gram
Calibration of a refractometer is performed using a what?
Using a calibration screw
What are the calibrating fluids using in refractometry?
- Water
- 3% NaCl
- 5% NaCl
- 9% Sucrose
In refractometry, the S.G of the calibrating fluid WATER should be read at ????
1.000
In refractometry, the S.G of this calibrating fluid should be read at 1.000?
Water
In refractometry, the S.G of calibrating fluid 3% NaCl should be read at ???
1.015 +/- 0.001
In refractometry, the s.g of the calibrating fluid 5% NaCl should be read at ????
1.022 +/- 0.001
In refractometry, the s.g of the calibrating fluid 9% sucrose should be read at ????
1.034 +/- 0.001
This method is based on the principle that the frequency of a sound wave entering a solution changes in proportion to the density of the solution
Harmonic oscillation densitometry
Swollen RBCs and glitter cells are due to?
HYPOsthenuria
*HYPO = HIPPO (swollen mataba)
Crenated RBCs are seen in ???
HYPERRRRRRRsthenuria
Harmonic oscillation densitometry is based on what principle?
based on the principle that the frequency of sound waves entering a solution changes in proportion to the density of the solution
S.G of triple distilled water
1.000
Where to read if the solution is colored?
BELOW the meniscus
What is used to calibrate the baseline of a urinometer?
WATER
The most commonly used method for detecting uring s.g?
Rgnt strip
This mtd to detect urine s.g is rarely used today despite its ability to accurately and precisely determine urine s.g
Harmonic Oscillation Densitometry
What is the s.g linearity in a harmonic oscillation densitometry
linearity up to 1.080
This method was initially used on a semiautomated urinalysis workstation known as the Yellow IRIS
Harmonic oscillation densitometry
HOD was initially used on a semiatuomated urinalysis workstation known as the ???
YELLOW IRIS
During a testing in HOD, a portion of the urine sample is held how?
in a U-shpaed glass tube that has an electromagnetic coil on one end and a motion detector on the other end
in HOD, this is applied to the coil generates a sound wave of fixed frequency
an electric current
in HOD, this is transmitted through the specimen and the frequency attenuation is measured
sonic oscillation
This is observed directly proportionate to the sample density, and a microprocessor converts the frequency to a corresponding specific gravity value
the frequency or the oscillating cycle period
In HOD, the frequency observed is directly proportionate to the what?
directly proportionate to the sample density
In HOD, converts the frequency to a corresponding specific gravity value
microprocessor
in HOD, a microprocessor converts the frequency to what?
to a corresponding specific gravity value
This is based on the change in the pKa of a polyelectrolyte in an alkaline medium
The rgnt strip reaction
The reagent strip reaction is based on what?
based on the change in the pKa (dissociation constant)
the reagent strip reaction is based on the change in the pKa of what?
change in the pKa of a polyelectrolyte in an akaline medium
T/F: Using a rgnt strip, S.G reading is NOT affected by radiographic contrast dye, protein, and glucose.
TRUE
In a rgnt strip, S.G reading is not affected by what?
not affected by radiographic contrast dye, protein, and glucose
In a rgnt strip, what is NOT affected by radiographic contrast dye, protein, and glucose
S.G reading
What factors must be corrected in a urinometer?
- correction for temp
- correction for glucose
- correction for protein
What factors must be corrected in a refractometer?
- correction for glucose
- correction for protein
what factors must be corrected in a rgnt strip?
- NO CORRECTIONS NEEDED
What is the formula for S.G dilution?
S.G x DILUTION = ACTUAL S.G
A specimen diluted 1:5 with a reading of 1.010 would have an actual S.G of:
1.015
*no need to include the WHOLE number (1) in multiplying
