Lab Part Duex Flashcards
Urinalysis screening can test and assess for…
Renal Function
Endocrine or metabolic function
Urinary tract infection
Systemic diseases
How many methods of urine collection
Two, instrumental / non-instrumental
Non instrumental collection types
First morning void
Random urine specimen
Clean catch
24 hour
Instrumental collection types
Urethral catheterization
Suprapubic needle aspiration
Cath and bladder irrigation
Urine specimens should be analyzed within
1 - 2 hours
If unable to test immediately refrigerate urine within
3 - 6 hours
Specimens left at room temperature will soon decompose due to
Presence of bacteria
Changes in pH in urine will
Dissolve any casts that are present
If glucose is present in urine bacteria may..
Use it as a source of energy resulting in false negative glycosuria
Blood and casts may..
Deteriorate if left standing without any preservatives
Advantages/disadvantages of freezing urine
Advantage: transport or storage no cost
Disadvantage: may destroy formed elements
First morning void
Most concentrated
Recommended for chemical and microscopic examination
Random urine specimen
Collected anytime
Most convenient and common
Clean catch specimen
Specimen of choice for bacterial cultures
24 hour specimen
Gives quantitative results
Urethral catheterization
Not recommended for bacterial examination
If no other way can use
Marked obese patients
Suprapubic needle aspiration
Replaces cath for single urine sample
Avoids vaginal contamination
Bladder obstruction
Infants and young children
Cath and bladder irrigation
Vigorous transcatheter agitation
50-72 mL saline inserted into bladder
Optimum cellular sample for bladder epithelium
Types of sample analysis
Physical
Chemical
Microscopic
Normal volume urine in 24 hours
600-2000 mL average is 1500mL
Urine output can be related to
Fluid intake
Temp and climate
Amount of perspiration that occurs
Normal color of urine
Straw (light yellow) to dark amber
Dark orange urine due to
Pyridium used for UTI
Milky white urine due to
Chyle
Olive green to brown black urine due to
Phenols
Yellow to brown urine due to
Presence of bile
Red or red-brown urine due to
Presence of blood
Physical characteristics of Urine
Volume Color Turbidity Odor Specific gravity
Normal urine turbidity is
Clear
Turbid alkaline due to
Amorphous phosphate or carbonate
Turbid acidic urine due to
Amorphous urates (pinkish)
Characteristic odor of urine is due to
Volatile acids (not considered to be of diagnostic importance
Sweet or fruity urine smell due to
Ketones
Pungent smell due to
Ammonia from bacteria
Maple syrup smell due to
Maple syrup urine disease
Congenital metabolic disorder
Musty or foul odor
Infant with phenylketonuria
Sweaty feet urine smell due to
Isovsleric acidemia
Specific gravity of urine
Weight of the urine / fluid intake
Random urine: 1.003 - 1.035
24 hour: 1.015 - 1.025
Chemical finding in urine analysis
Glucose Ketones Occult blood Bilirubin Urobilibogen pH Protein Nitrite Leukocyte esterase (LE)
Glucose will appear in urine once the threshold level of ________ in the blood is exceeded
160-180 mg/dL
Ketones present in the urine may indicate
Diabetes Mellitus
Starvation
Keto diet
Eclampsia
Occult blood in urine may have what color
Red and “Smokey”
Presence of blood in urine is termed
Hematuria
RBCs present in urine may be from..
Damage to kidneys or urinary tract
Renal diseases
Menstrual contamination or exercise
Bilirubin may appear in urine in patients who have conditions that cause
Jaundice
Bilirubin color of urine
Yellow to brown (green with foam when shaken)
Bilirubinuria indicates
Hepatocellular disease
Infra or extra-hepatic biliary obstruction
Urobiligen is present in urine in concentrations of
1 EU or less. Amounts up to 1mg/dL is normal
pH range of urine
4.6 to 8.0. Average is around 6.0
Conditions that may cause acidic urine
Respiratory or metabolic acidosis l UTI E. Coli Uremia Severe diarrhea Starvation
Conditions that cause alkaline urine
UTIs caused by proteus or pseudomonas
Respiratory or metabolic alkalosis
Protein in urine is a good indicator of
Renal disease
Mechanisms of proteinuria
Glomerular damage
Defect in reabsorption process
Nitrite is formed by the breakdown of nitrates by organisms that cause
UTIs
Bacteria presence in urine indicates UTI
Esterase is an
Enzyme
Inflammatory process in or around the urinary tract
Leukocyturia
Minimal proteinuria value
< .5g/day
Moderate proteinuria value
.5 - 3.5g/day
Significant proteinuria value
> 3.5g/day
A dipstick can detect as few as _____ RBCs HPF (High Power Field)
1-2 RBCs HPF
Presence of greater than 3 RBCs is considered
Abnormal
Persistent RBCs in urine may indicate
Glomerulonephritis
Kidney Stones
Cancer
Infection
Myoglobin is highly suggestive of
Rhabdomyolysis
A non-treponemal test for serologic detection of the antibody Reagin
Rapid Plasma Reagin
Treponema pallidum is
The causative agent of syphilis
Reagin is found in the ______ of patients with syphilis
Serum/plasma
Flocculation present the test is
Reactive (positive)
Flocculation is NOT present, the test is
Non-reactive (negative)
The confirmatory test for RPR testing
Fluorescent treponemal antibody-absorbed (FTA-ABS)
Positive FTA-ABS will show _______ if positive
Fluorescence
Venous blood for RPR should be collected in
Blood tube without anticoagulant for serum (Red/SST) and with anticoagulant (purple top) for plasma
RPR antigen suspension should be shaken vigorously for
10-15 seconds
Test card and controls should be on the rotator for how long
8 minutes at 100rpm
Reactive test flocculation ranges
Slight but definite
Minimum to moderate
Marked and intense
RPR controls should be run…
With each batch of tests
Antigen needle should be calibrated to
60 drops per 1mL
Purpose of monospot testing
To detect infectious mononucleosis
Mononucleosis which is a self limiting disease caused by
The Epstein-Barr Virus
Mono is typically seen in
Young adults and children less than 5
Collect monospot samples in
Blood tubes with or without anticoagulant
Test monospot sample within
24 hours if stored between 2-8 degrees C
Latex reagent should reach ______ temperature
Room temperature (20-30 C)
Positive monospot shows
Agglutination
Negative monospot shows
Smooth, homogenous solution, no agglutination
Parasitic infection caused by the introduction of protozoan organisms into the blood by the female anopheles mosquito
Malaria
Plasmodium is the parasite in
Malaria
Female anopheles inject _______ into humans
Sporozoites
Sporozoites enter parenchymal cells of the liver and become
Schizonts
Further sporozoite development in the _______ after RBC invasion
Liver
Merozoites develop to form
Immature (ring stage) trophozoites
Mature trophozoites develop into
Schizonts
Gametocytes are derived from
Merozoites
________ ingested by mosquito
Gametocyte
Beginning of sexual reproduction, production of
In the Gametocyte and produces zygote
Fertile zygote penetrates midgut wall of mosquito forming
Oocyst
Oocyst matures, ruptures and releases
Sporozoites
Sporozoites migrate to the salivary gland and then
Injected into new host
How many species of malaria
Four
Species of malaria
Plasmodium Falciparum
Plasmodium Vivax
Plasmodium Ovale
Plasmodium Malariae
Characteristics of plasmodium Falciparum
Erythrocytic cycle (malignant teritan) Fever every 48 hours or every 2nd day
Most fatal (intravascular hemolysis)
Characteristics of plasmodium vivax
Eeythrocytic cycle (benign teritan) Fever every 48 hours or every 2nd day
Most common
Characteristics of plasmodium ovale
Erythrocytic cycle (benign teritan) Fever every 48 hours or every 2nd day
Characteristics of plasmodium malariae
Erythrocytic cycle (benign quartan) Fever every 72 hours or every 3rd day
Capillary collection for malaria
Lancet and collect in EDTA capillary tube
Collection for venous blood for malaria
EDTA (purple top)
Venous blood for malaria may be stored at 2-30 C for up to
3 days. If refrigerated allow warming to room temp (15-30 C)
What must be present for malaria test to be valid
“C” control line
Test result of T1 for malaria
Positive for P. Falciparum
T2 result for malaria
Positive for P. Vivax, Malariae, or Ovale
T1 and T2 result for malaria
Positive for P. Falciparum and other types of malaria
Malaria test is negative if
Only the “C” line results
Malaria samples must be obtained when
The patient is febrile
Rapid malaria kit limitations
Patient must be febrile
Will only detect antigens
Must be confirmed by the NEPMU
Not used to monitor treatment
Highly contagious, acute, viral infection of the respiratory tract
Influenza A and B
Most common type of influenza
Influenza A
Symptoms of Influenza
Fever Cough Sore throat Runny nose Muscle/body aches Headaches Fatigue Double dragon
Negative flu results show
Blue control line in the bottom third turns pink/purple. No other lines appear
Flu A positive shows
Pink/purple control line AND second pink/purple line in middle third window
Flu B positive test shows
Pink/purple control line AND second pink/purple in top third window
When flu disease prevalence is low in a community what may occur
False positives
When flu disease is high in the community what may occur
False negatives
Basic Metabolic panel provides what?
Important baseline of patients basic physiology
Hyponatremia may indicate
Over hydration
Hypernatemia may indicate
Dehydration and need for water
Low Urea nitrogen may indicate
Over hydration or liver disease
Elevated urea nitrogen may indicate
Impairment of renal function (50-150 mg/dL)
99% of the bodies calcium is located where?
Bones and teeth
High and low CO2 levels made associated with
High: respiratory acidosis
Low: respiratory alkalosis
How long do you shake the antigen suspension for monospot
10-15 seconds
What is creatinine
Byproduct of creatine and produced in muscle. Can be used to measure renal insufficiency
Most abundant extra cellular anion
Chloride
Second most prevalent intercellular cation
Magnesium
If low can cause refractory hypokalemia
What is involved in normal metabolism and energy production and needed for muscle contractility and neurologic functions
Phosphorous
ALT and AST measure what
Hepatocellular damage
What does albumin help maintain
Oncotic pressure
Alkaline phosphates refer to
A group of enzymes. Can indicate biliary disease or liver damage
What are bilirubin
A byproduct of breakdown of heme pigments in RBC
Can cause jaundice
If the AST is twice the ALT and AST is rarely over 300… may indicate?
Alcoholic hepatitis
Almost all prescription drugs can increase
ALT/AST levels
Total protein is a screening for
Nutritional deficiencies and gammopathies
What does a lipid panel measure
Total cholesterol
High density lipoprotein (HDL) cholesterol
Low density lipoprotein (LDL) cholesterol
Triglycerides
How often should adults over 20 get a fasting lipid screening
Every 5 years
Thyroid function tests check the function of what
Thyroid
Free thyroxine (FT4) measures
Unbound T4 in serum
What is the most accurate reflection of thryrometabolic status
Free thyroxine (FT4)
Thyroid Stimulating Hormone (TSH)
Glycoprotein secreted by anterior pituitary gland.
Assesses true metabolic status
Hypo is high tsh
Hyper is low tsh
A1C gives the big pictures of
2-3 months average glucose due to the 120 day life cycle of RBC
Glucose normal value
70-100mg/dL
4-6% A1C
Critical glucose levels
Low: < 40
High > 500
What is the best indication of glucose homeostasis
Fasting glucose
Major cause of high glucose
Type 1 and 2 diabetes
Major cause of low glucose
Insulin overdose. Sulfonylureas and hypoglycemic agens
An A1C of greater than 6.5% suggests
Poor control of glucose
What are cardiac markers
Bio markers measured to evaluate heart function and cardiac muscles
What is troponin
Protein located in the cardiac muscles
Increase in troponin is indicative of
Myocardial infarction
Troponin levels begin to rise within
3-12 hours and peak in 24 hours
What is CK-MB
Enzyme found in cardiac muscles
CK-MB begin to rise in
3-12 hours and peak in 24 hours
Once Schizonts rupture, they release______
Merozoites
Ring form of P. Falciparum color
Light blue circular structure with red chromatin dot
Gametocyte (macro) of P. Falciparum of female look like
Curved sausage/banana with central large chromatic dot
Gametocyte (micro) of male look like
Shorter and wider than female with rounded ends, diffused chromatin
How is the flu transmitted
Coughing sneezing of aerosolized droplets
Benefits of flu testing
Enable correct treatment
Reduce costs
Decrease inappropriate antibiotic use
Read influenza test results how many minutes
15 minutes
Test for flu within how many days
2-3 days
Antivirals can be used for flu if within how long
48 hours
What organ does malaria affect
Liver
How does malaria travel through the body
Bloodstream / RBC
Most deadly type of malaria
P. Falciparum, destroys RBCs
Gold standard for confirming malaria
Thin and thick smear
Hyperchloremia is seen in
Dehydration and acidemia
Hypochloremia may result from
Vomiting or over hydration and alkalemia
Hypokalemia is seen with…
Alkalosis, diuretic, alcoholism and fluid loss
Potassium is the primary cation in
Intracellular space
Low magnesium can cause
Refractory hypokalemia
What is required for all urine tests
Confirmation test
What gives urine its color
Urachrome
Blue green urine due to
Methylene Blue
What is the vehicle or antigen used to see the result of RPR
Carbon charcoal
Mono causes increase of lymphocytes and monocytes causing the formation of
Heterophile antibody
Malaria fevers coincide with the rupture of what
RBCs
Most common malaria
Vivax
How many microliters of blood used for malaria test
15
How is Malaria Reagin added to test kit
2 drops on first pad, 4 on second pad
What would constitute an invalid test
Control line not present
malaria False positives could be caused from
Rheumatoid arthritis
Hep C
Babesia
Smears should be done no more than
Hourly
Flu pipette should have how many microliters
100
If low potassium what do you need to fix first
Magnesium
Total protein what levels will you see with malnutrition
Low
