OSCE

Question 1

Leucocytes

Answer 1

These release an esterase that reacts with the reagent pad. The presence of leucocytes in the urine is an indicator of bladder or renal infection
• Send sample off for microscopy and culture

Question 2

Urobilinogen

Answer 2

Normally present in the urine; elevated levels may indicate liver abnormalities or excessive destruction of RBC’s e.g. in haemolytic anaemia. The urobilinogen test result should be considered with the bilirubin test results in order to provide differential diagnosis

Question 3

pH

Answer 3

The average urine is slightly acidic and usually is within pH 5‐6 but can vary from 4.8‐8.5.
Values are usually lowest after an overnight fast and highest after meals. Urine pH can be a helpful screening test in the diagnosis of renal disease, respiratory diseases, certain metabolic disorders and specific therapeutic regimens e.g. sodium bicarbonate
• <5: DKA, high protein diet
• >8 UTI by urea splitting bacteria (proteus spp.)

Question 4

Specific gravity

Answer 4

Urinary SG is a quick, convenient and reliable test for monitoring the concentration and diluting powers of the kidney, recognising dehydration and aiding interpretation of other tests. For example, a trace of protein result with a high SG reading may well be normal while a trace protein with low SG is usually abnormal

Question 5

bilirubin

Answer 5

Presence of bilirubin in the urine is indicative of hepatic or biliary disease. Bilirubin may appear in urine before other signs of abnormality are apparent.

Question 6

nitrates

Answer 6

Not normally present in the urine, but produced when bacteria (only gram negative) converts dietary nitrates to nitrates. Ideal specimens should be one that has been present in the bladder for four hours before voiding, to provide time for the nitrate/nitrite conversion
• Send sample off for microscopy and culture

Question 7

protein

Answer 7

Normal urine contains small amounts of albumin and globulin, but generally in amounts low enough not to give a positive reagent strip reaction. When testing for urinary protein, it is important that the urine is sufficiently concentrated, first morning is best
Presence indicative of: UTI, Hypertension, Renal tract disease
Investigations: Blood pressure monitoring, 24 hour urine collection, Look at leucocytes and nitrites

Question 8

blood

Answer 8

Presence of blood in urine suggests serious renal or urological disease and/or a urinary tract infection.

Question 9

ketones

Answer 9

Ketones are abnormal urinary constituents, being breakdown products of fatty acid metabolism. This may be caused by starvation or uncontrolled diabetes. Note it is important to test for ketones as well as glucose so not to miss ketouria without glycosuria

Question 10

glucose

Answer 10

Glucose is not normally detectable in the urine. The presence of glucose in the urine may be due to elevated blood glucose levels or reduced renal absorption and may indicate diabetes mellitus, stress, Cushing’s syndrome, post general anaesthesia, acute pancreatitis

Question 11

What is the difference between the soap and alcohol procedure?

Answer 11

∎Leave alcohol to dry ∎No need to use water to wash hands

Question 12

when do you practice hand hygiene?

Answer 12

∎Before patient contact ∎After patient contact
∎Between a clean and dirty procedure
∎Arriving on a ward esp ITU ∎Leaving a ward
∎Before food ∎after toilet
∎Before administering medication
∎Before examining a new born child
∎Before gowning in theatre

Question 13

cleaning/disinfection/sterilisation

Answer 13

∎Cleaning: Removal of organic material from a surface or medical instrument typically using detergent, hot water and physical action. The detergent surrounds the organic material and solubilises it. Need to clean before disinfecting or sterilisation because pathogens are protected by organic material.
∎Disinfecting: Removal of most pathogens, Usually chemical, Must disinfect all equipment that enters normally sterile tissue or the vascular system or through which blood flows or that touches a mucous membrane
∎Sterilisation: Removal of all pathogensm, Physical and chemical means eg steam autoclave, ethylene oxide gas, dry heat, chemicals, Autoclave operates at 134 degrees, 2.25bar, 3 minutes

Question 14

hospital acquired infection

Answer 14

An infection that arises more than 48 hours after admission (Healthcare-associated infection – due to an intervention. Not nec. in hospital)

Question 15

MRSA

Answer 15

(methycillin-resistant staphylococcus aureus) ∎Spread by hands, environment ∎Causes bacteraemia ∎Isolation ∎Handwashing ∎Careful management of cannulas etc

sensitive to vancomycin

Question 16

coliforms

Answer 16

∎Klebsiella, proteus, enterobacter, serratia ∎Spread by hands, environment ∎Cause UTI, bacteraemia
∎Handwashing ∎Isolation ∎Gloves and apron ∎Good line/catheter care

Question 17

c diff

Answer 17

∎Spread by hands, environment ∎cause diarrhoea, colitis ∎Isolation ∎handwashing ∎Environmental cleaning ∎Reduce inappropriate use of antibiotics

(sensitive to vancomysin and metronidazole)

Question 18

to avoid infection spread:

Answer 18

1. Universal precautions: Washing hands, aprons, gloves, hair back, no watch, arms bare, cover cuts, eye protection, clean spillages
2. Aseptic techniques
3. Prevent cross infection: handwashing, gloves/apron, isolation
4. Dispose waste properly
5. Disinfect equipment correctly

Question 19

main bacteria in hospitals

Answer 19

∎C. Difficile ∎MRSA ∎Klebsiella ∎Staph aureus

Question 20

what procedures lead to hospital acquired infections?

Answer 20

∎Major surgery ∎Intensive care ∎Chemotherapy ∎Placement of intravenous lines ∎Catheters

Question 21

who is at increased risk of infection?

Answer 21

Immunocompromised
Open wound
Major surgery
Cannulation

Question 22

bin bags

Answer 22

Yellow – clinical waste and body parts
Black/transparent – household
White – used linen
Red – soiled linen
Green – theatre linen
Orange – clinical waste