L3: CHEMICAL EXAMINATION OF URINE (1) Flashcards
1
Q
also known as Dip Stick
A
Reagent Strip
2
Q
A strip that contains one or more chemical impregnated absorbent pads.
A
Reagent Strip
3
Q
TOF: Refrigerated specimens are allowed to be tested immediately.
A
FALSE
(must reach room temp first)
4
Q
What cells will settle at the bottom of the tubes if not mixed properly?
A
RBCs and WBCs
5
Q
What results will you obtain if urine is not mixed properly?
A
False negative
6
Q
How will you report a clear colored urine specimen?
A
straw
6
Q
How will you determine the color of the urine specimen?
A
white background with good lighting
7
Q
How will you report a dark colored urine specimen?
A
amber
7
Q
How long will you dip the reagent strip to the urine tube?
A
approx. 1 second
8
Q
What results will you obtain if you read the results too early?
A
False negative
(incomplete reaction of enzymes)
8
Q
How will you remove excess urine?
A
- run the edge of the strip along the rim of the tube
- blot edges on absorbent paper
9
Q
How will you read the results of the reagent strip?
A
According to the manufacturer’s directions
or
Start from glucose to leukocytes
10
Q
TOF: Some parameters are temperature-dependent.
A
TRUE
11
Q
What will happen if you hold the reagent strip vertically while reading the results?
A
“runover” of chemicals
12
Q
What results will you obtain if you read the results too late?
A
inaccurate reading
13
Q
How will you compare the reaction color to the manufacturer’s chart?
A
- good light source
- hold strip horizontally and close to chart
14
Q
TOF: Always perform a backup test.
A
FALSE
(only when indicated or the results are positive)
15
Q
What is the backup test for proteins?
A
Heat and Acetic Acid, Exton’s
16
Q
What is the backup test for glucose?
A
Benedict’s Test
17
Q
TOF: Reagent strips are easily deteriorated by moisture, volatile chemicals, heat, and light.
A
TRUE
18
Q
TOF: The results from reagent strip is a result of physical examination that needs to be correlated with chemical and microscopic UA.
A
FALSE
(reagent strip is a chemical examination)
19
Q
Presence of air may cause _______ of the strips.
A
discoloration
20
Q
What is used to absorb the moisture in a tightly capped containers of reagent strips?
A
desiccant
21
Q
At what temperature must you store the container?
A
below 30 degree Celcius
22
TOF: Reagent strip containers are refrigerated to preserve the integrity of the strip.
FALSE
23
TOF: MT must open the container once ready to use then close immediately after.
TRUE
24
TOF: MT should touch the test area to ensure accuracy of the test.
FALSE
25
TOF: Discolored chemical pads must be compared to the negative line in the chart to know if it is still allowed to use.
TRUE
25
TOF: Reagent strip may be still used past the expiration date as long as it has the same color to the negative line in the chart.
FALSE
25
Discoloration is caused by _______ and/or the lid is _______ closed.
oxidation, not properly
26
TOF: You must not transfer used strips to another vial.
TRUE
26
What is usually the first reagent that becomes discolored in the reagent strip?
urobilinogen
27
Where can you find RBCs and WBCs in the tube? (precipitate or supernatant)
preicipate/sediment
28
TOF: Unmixed specimen will result to false positive result due to RBCs and WBCs not transferred to the test strip.
FALSE
| (false negative)
28
What will happen if the test strip stayed longer in the urine?
'leaching' of reagents to the sample
29
Enzymatic reactions are highly dependent on optimum temperature usually around __ degree Celsius.
37
30
In the test for protein, the citric acid leached to the sample. What will happen to the result?
False positive
31
Refrigerated specimen will yield _______________ enzymatic test.
false negative
32
TOF: Water can be used as a control solution for reagent strip quality control.
FALSE
32
TOF: Reagent strips must be tested with known positive and negative controls at least once a day.
TRUE
33
Water have the __________ composition with urine.
different
34
Positive control of reagent strips is a test for _________.
sensitivity
35
Negative control of reagent strips is a test for _________.
specificity
36
Positive control prevents ____________________ results.
false negative
37
Negative control prevents ____________________ results.
false positive
37
After filling the tube with water for control strip tube, how many times do you need to stir the control strip?
3 to 4 times
38
A test using different reagents or methodologies to detect the same substances as detected by the reagent strips.
Confirmatory Test
39
Positive and negative controls
are performed on new reagents and _________ opened bottles of reagent strips.
newly
40
A condition wherein the blood pH is less than 7.35.
Acidosis
40
TOF: Confirmatory test offer the same or even greater sensitivity or specificity.
TRUE
41
A condition wherein the blood pH is more than 7.45.
Alkalosis
42
Urine is acidic due to the release of ______________.
hydrogen ions
42
In maintaining acid-base balance, the kidneys ___________ H+ ions through the urine. in
secrete or remove
43
Blood must _________ and eliminate excess ________.
buffer, acid
43
The secreted H+ ions of kidneys in urine are found in the form of _____________.
- ammonium ions
- hydrogen phosphates
- weak organic acids
44
Acid-base balance reflects the ability of the kidneys to maintain normal [H+] in ___________ and ____________.
plasma, extracellular fluid
44
Secretion of hydrogen ions causes ___________ of bicarbonates.
reabsorption
45
The buffering capacity of blood depends on ______________.
bicarbonate ions
46
What is the pH of after meal urine specimen?
alkaline
46
Give the 5 factors that affects urine pH
1. acid-base content of blood
2. Patient's renal function
3. Urinary Tract Infection
4. Patient's dietary intake/medications
5. Age of specimen
46
What is the pH of random urine specimen?
4.5 to 8
46
What is the pH of first morning urine specimen?
5 to 6
47
If the patient have UTI, what is the pH of the urine specimen?
alkaline
| (due to bacteria)
47
When a patient have too much carbon dioxide in the body, the pH results of specimen is?
acidic
| Acidic = Respiratory Acidosis
47
If the patient have abnormal pH, what is the problem in relation with renal function?
H+ secretion and bicarbonate reabsorption
48
Increased intake of meat will result in __________ urine specimen.
acidic
48
If the sample reached a 9.0 pH, it means that the sample is _______.
stale
48
If the specimen tested is an old/stale sample, what is the pH?
alkaline
49
Increased intake of vegetables will result in __________ urine specimen.
alkaline
50
A condition wherein the lungs cannot remove enough carbon dioxide through breathing.
Respiratory Acidosis
50
A patient under treatment of calculi will have __________ urine specimen.
alkaline
| (due to ammonium chloride, methionine, and methenamine mandelate)
50
A patient with mild respiratory acidosis of sleep will have __________ urine specimen.
acidic
51
A condition wherein blood pH is decreased caused by metabolic increase in acidic elements.
Metabolic acidosis
51
A condition where there is rapid release of CO2, increasing respiration that elevates blood pH while reduction in CO2.
Respiratory Alkalosis
51
What is the pH of blood and urine of a patient suffering from Renal Tubular Acidosis?
alkaline urine, acidic blood
52
A condition wherein renal tubules cannot reabsorb bicarbonate, thus excess hydrogen ions are not
secreted.
Renal Tubular Acidosis
53
What happens in H+ ions and HCO3 - when a patient suffers from renal tubular acidosis?
Bicarbonates are secreted, hydrogen ions are reabsorbed
54
Crystals came from the precipitation of ____________ chemicals.
inorganic
| (e.g., calcium, chloride)
55
TOF: The precipitation of crystals are pH-dependent.
TRUE
55
When crystals are not excreted in the urine, they will form _______ or ___________.
stone or renal calculi
56
When a patient have UTI, the treatment will focused on ___________ the urine.
acidifying
| (bacteria makes urine alkaline)
56
The precipitation of crystals can be controlled by maintaining the urine at a pH that is ___________ with the precipitation of the particular chemicals causing the calculi formation.
incompatible
57
When a patient have calcium oxalate crystal precipitate in a acid urine, the physician will prescribe a medication that would ___________ the patient's urine.
alkalinize
| (to discourage formation of calculi)
58
ACID URINE or ALKALINE URINE
Cranberries
Acid urine
58
_____________ is used as a home remedy for UTI that will ________ urine, inhibiting bacterial growth.
Cranberries, acidify
58
If the pH of the patient reached 9.0, what must be done?
recollection is a must
59
ACID URINE or ALKALINE URINE
Diet Rich in Fruits and Vegetables
Alkaline urine
59
ACID URINE or ALKALINE URINE
High Protein and Meat Diet
Acid urine
60
ACID URINE or ALKALINE URINE
Acid-Producing bacteria
Acid urine
61
ACID URINE or ALKALINE URINE
Citrus
Alkaline urine
61
ACID URINE or ALKALINE URINE
Urine after meal
alkaline urine
| (aka Alkaline Tide)
62
ACID URINE or ALKALINE URINE
Starvation
Acid urine
63
ACID URINE or ALKALINE URINE
Renal Tubular Acidosis
Alkaline urine
64
ACID URINE or ALKALINE URINE
diarrhea
acid urine
65
ACID URINE or ALKALINE URINE
Dehydration
acid urine
66
ACID URINE or ALKALINE URINE
urease-producing bacteria
alkaline
67
Diet Rich in Fruits and Vegetables causes formation of _______ resulting in alkaline urine.
bicarbonates
68
ACID URINE or ALKALINE URINE
diabetes mellitus
acid urine
69
Dehydration, starvation, diarrhea, and diabetes mellitus results in the formation of ___________.
ketone bodies
| (diacetic or acetoacetic acid, beta-hydroxybutyric acid, etc.)
70
ACID URINE or ALKALINE URINE
Hyperventilation
alkaline urine
| (due to rapid release of CO2)
71
Give the 3 tests for pH.
1. Reagent Strip Method
2. pH electrode
3. Titrable acidity
71
ACID URINE or ALKALINE URINE
Old specimen
alkaline urine
72
Bromthymol Blue will transition to what color?
yellow to blue
72
What is the principle used for Reagent Strip Method?
Double Indicator System
73
Methyl red will transition to what color?
red to yellow
74
**Methyl Red**
RED at pH = ____
ORANGE at pH = ____
YELLOW at pH = ____
4, 5, 6
75
**Bromthymol Blue**
YELLOW at pH = ____
GREEN at pH = ____
BLUE at pH = ____
6, 7.5, 9
76
What is the reading time of reagent strip after dipping into the sample?
60 seconds
77
It uses pH meter with glass electrode
pH electrode
77
What is the pH range that can be measured by Reagent Strip Method?
5.0 to 8.5
78
What is the colometric transition that can be observed in Reagent Strip Method?
orange - green - blue
79
pH electrode measures the voltage caused by ________ in urine.
H+ ions
80
TOF: pH Electrode is used in diagnosis and treatment of patients with disturbances of acid-base balance.
TRUE
81
pH electrode is used in monitoring urine alkalinization in patients receiving high-dose of ________ therapy.
methotrexate
82
pH electrode is used in monitoring urine alkalinization in patients undergoing treatment for __________.
nephrolithiasis
83
The pH of the urine is largely dependent on the amounts of ____________ and ____________ present.
monobasic and dibasic phosphate
83
ph Electrode must be standardized with ____________ of known pH immediately after use.
three buffers
84
Titrable Acidity is measured by titrating an aliquot of 24-hr urine with ____ with pH ____ as an end point.
0.1 N of NaOH. 7.4
85
Sources of error or interference in pH reagent strip
1. no known interfering substances
2. runover from adjacent pads
3. old specimens
4. bacterial growth
86
a very important renal marker
proteins
86
What are the correlations of pH reagent strip with other tests?
1. Nitrite
2. Leukocytes
3. Microscopic
86
What are the normal values of protein?
in 24 hrs, avg in random urine specimen
<100 mg/24 hrs
<10 mg/dL avg
| 150 mg in Henry's
86
Proteins that have low molecular weights are filtered by ___________
glomerulus
| <66,000 MW (Bishop)
<70,000 MW (Strasinger)
87
GBM is called the ________ since it repels negative molecules.
Shield of Negativity
| same signs = repel
87
TOF: Albumin is a positively-charged molecule repelled by GBM.
FALSE
| negatively-charged
88
Clinical Proteinuria have ____________ amount of protein.
> 30 mg/dL
| measured by reagent strip
89
TOF: Filtered albumin from glomerulus will go to the urine.
FALSE
| must be reabsorbed in tubules
## Footnote
if glomerulus have problem, it will be seen in urine
90
What are other proteins seen in urine (in very small amounts)?
microglobulins and uromodulin
91
Uromodulin is also known as ________ that lines the matrix of all casts.
Tamm-Horsfall Glycoprotein
92
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