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Urinalysis > Physical Examination Of Urine > Flashcards

Physical Examination Of Urine Flashcards

1
Q

Why do Urinalysis (4)

A
  1. Diagnose infections
  2. Diagnose metabolic disorders (diabetes)
  3. Aid in diagnosis of renal function
  4. If treatments for above are effective
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2
Q

Route in Microscopic includes looking for..?

A
  1. Physical - colour, clarity and odour

2. Chemical - specific gravity

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3
Q

Microscopic examination of ..?

A

Cells, sediment, crystals and casts (cylindrical structures formed in tubules)

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4
Q

Chemical examination of urine..?

A

PH, glucose, ketones, proteins, specific gravity, red blood cells or by products, white cells, bilirubin, urobilonigen and nitrites using strip and table reagents

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5
Q

Pink Urine causes

A

Blood, menstrual contamination, renal calculi, trauma, acute glomerlunophritis, pyelonephritis, severe cystitis

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6
Q

Pink urine confirmation

A

Microscopic, blood reagent +

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7
Q

Red urine causes

A

Blood, hemoglobin, menstrual contamination, beets, rhubarb, rifampin (TB med)
Same as pink

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8
Q

Red Urine confirmation

A

Microscopic, blood reagent +

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9
Q

Tan- Brown Urine causes

A

Myoglobin, muscle damage/ breakdown due to MI (heart attack), muscular dystrophy, ALS, extreme exertion

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10
Q

Tan- Brown urine confirmation

A

Blood +

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11
Q

Orang urine causes

A

Pyridium (phenazo)- analgesic for UTI pain, excess carrot ingestion (beta carotene)

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12
Q

Orange urine confirmation

A

Persistent yellow foam on shaking

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13
Q

Amber urine causes

A

Bilirubin, liver disease, excess intravascular hemolysis - transfusion reaction or sickle cell

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14
Q

Dark brown / Black urine causes

A

Melanin, metronidazole (Flagyl), Melanoma, anaerobic/ parasitic infection treatment, levodopa

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15
Q

Amber Urine confirmation

A

Persistent yellow foam on shaking, bilirubin reagent +

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16
Q

Dark brown / Black urine confirmation

A

N/A

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17
Q

Green Urine causes

A

Closets/ chlorophyll gum in excess. Pseudomonas aeruginosa infection

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18
Q

Green urine confirmation

A

In Ps. aeruginosa will have rotting fruit smell, bacteria, WBC’s in microscopic and leukocyte eateries reagent +

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19
Q

Blue urine causes

A

Amitriptyline (sleep aid, anti-depressant), robaxin (muscle relaxant), oral gentian violet for thrush

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20
Q

Blue urine confirmation

A

N/A

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21
Q

Yellow, Amber, Orange Urine

A

Can indications concentration due to dehydration, first morning specimen or post exercise

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22
Q

Bright Yellow Urine Causes

A

Vitamin C or Vitamin B12

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23
Q

Unochrome

A

Norma pigment colour of urine

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24
Q

What should you always do with a sample if you think it contains bilirubin?

A

Wrap it in an opaque substance such as aluminum foil to prevent the bilirubin from being destroyed

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25
Q

Hemoglobinuria

A

Hemoglobin in urine due to hemolytic anemia or trauma (lysed red cells), intravascular hemolysis, transfusion reactions, burns, infections or hemolysis of red. Cells in dilute, alkaline urine

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26
Q

Hematuria

A

Blood present in urine

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27
Q

Myoglobin

A

Due to the breakdown of muscle tissues (ALS, heart attack, muscular dystrophy)
Transport oxygen in bloodstream

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28
Q

What does Flagyl treat?

A

Trichomonas vaginellas

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29
Q

What does levodopa treat?

A

Parkinson’s disease

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30
Q

Clarity of Urine

A

How well can you see through the urine

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31
Q

Normal turbidity of urine

A

Clean if it’s a proper clean catch mid stream

- should be able to read print on paper

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32
Q

Benign turbidity of urine

A

Cloudy due to presence of epithelial cells, mucus, semen, fecal presence, talcum powder, vaginal creams and lubricants, radiographic contrast dyes and if specimen is chilled (precipitation of crystals that should redissolve at 20*)

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33
Q

A Brno all turbidity of urine

A

Due to presence of white blood. Cells and bacteria but may indicate abnormal excretion of lipids and lymph fluid

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34
Q

Odour of urine

A

Not always part of normal exam

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35
Q

Ammonia smell is due to

A

Due to old, non-refrigerated samples or bacterial infections

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36
Q

Where should you process urine

A

In a bio safety cabinet or behind a splash shield, allows you to smell urine
Waft gasses towards face, holding container 12 inches from face

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37
Q

Ketones smell like..?

A

Fruity smell, or like someone who has been drinking

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38
Q

Ketones in urine are caused by

A

Ketoacidosis, or insufficient caloric intake (anorexia)

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39
Q

Maple syrup urine disease

A

Smells like maple syrup

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40
Q

Other things that can cause smells in urine

A

Ingestion of pungent foods - garlic, onions, asparagus, or coffee

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41
Q

Specific Gravity

A

Measures the density of a solution compared to a similar volume of distilled water at a similar temperature
Measures the density or amount of dissolved particles in the urine

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42
Q

Two ways to measure specific gravity

A
  1. Urinometer

2. Refractometer

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43
Q

Urinometer

A

Consists of a weighted float that has been designed to sink to a level marked 1.0 in distilled water at 20*C
- when allowed to float in a similar volume of urine, will indicate specific gravity by the level at which it floats
Done when colour does not correlate with reading

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44
Q

Urinometer must be corrected for

A

Temperature (if not 20*C) , glucose and protein if present

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45
Q

Volume needed for urinometer?

A

Large volume

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46
Q

Urineometer is..

A 
Less easy to disinfect
Less accurate
Cheap
Less safe due to mercury it in 
Tests buoyancy
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47
Q

Normal specifics gravity range

A

1.010 (pale yellow)-1.025 (dark yellow)

>1.025 = dehydrate 
<1.010 = over hydrated
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48
Q

Refractometer

A

Measures refractive index of urine to determine density and therefore specific gravity

  • concentration of dissolved particles
  • determines the angle that light will travel through urine specimens
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49
Q

Refractometer uses how much of a sample?

A

One drop

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50
Q

Refractometer is..?

A 
Easy to disinfect (alcohol wipe)
More accurate
more expensive
Easily calibrated using a jewellers screwdriver to adjust internal prism
Testing the change of light
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51
Q

Refractometer needs to be corrected for

A

Glucose and protein if present using standard solutions

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52
Q

Chemical examination of urine is done using..?

A

Done with reagent test strips, tablets and precipitation tests

53
Q

Reagent Strips

A

Chemical impregnated pads attached to a plastic strip
- reactions produce colour changes that are compared to a chart - strip is dipped into urine completely but briefly and excess is removed
Can be done automatically or manually

54
Q

Errors in using Reagent Strips

A
  1. Improper/insufficient mixing of specimen
    - may leave large molecules at bottom (WBC,RBC) false -
  2. Allowing strip to remain in sample too long
    - leaching of reagent, false -
  3. Not draining/ blotting - causes run over
  4. Not testing at room temp (20*C)
    - false -
  5. Not timing properly (short time -, long +)
  6. Do not use expired strips
55
Q

Handling and storage of strips

A
  1. Do not expose to light, moisture, volatile chemicals
  2. remove strips from container just prior to testing, container should be tightly sealed
  3. Strips should not be open near volatile compounds such as alcohol, acetone or formalin)
  4. Only used if not expired
56
Q

Do not expose strips to

A
  1. Light
  2. Moisture
  3. Extreme heat, cold - keep at 20*C
  4. Volatile chemicals
57
Q

Quality control is done when

A
  1. At the start of each shift & or
  2. Each new shift & or
  3. Each new lot # (not each bottle)
  4. Minimum once each day
58
Q

PH test is done

A

To determine systemic acid base balance disorders -> metabolic acidosis or respiratory alkalosis

59
Q

What can cause pH shifts?

A

High protein diets (meats) - make urine acidic
Vegetarians - alkaline urine (bicarbonate production)
Cranberry juice - acidifies urine

60
Q

Normal and abnormal urine pH

A

Normal: 4.5-8
Average: 6-6.5
No one will ever reach pH of 9-14 (old sample if it reads 9+)

61
Q

PH reagents

A 
Methylene red (4-6)
Bromothymol Blue (6-9)
62
Q

Protein in urine can indicate

A

Early renal disease

63
Q

Benign cause for proteinuria

A

Orthostatic proteinuria: due to long periods spent in vertical position

64
Q

How do they test for proteinuria?

A

Compare urine samples after being in vertical position to lying horizontal
Ie. daytime vs first morning test

65
Q

Bense Jones Protein

A
  • produced in multiple myeloma
    Coagulate at 40-60C and dissolve again at 100C
    + if they coagulate and dissolve at these temps or electrophoresis
66
Q

Microalbuminuria is produced in what condition?

A

Produced and filtered as a complication of diabetes melatus

Indicates eventual renal failure

67
Q

Microalbuminura is found in

A

Semen, mucus, prostatic fluid, vaginal fluid,

  • all are contaminants
  • indicates not a clean catch midstream
68
Q

Protein reagent

A

Tetra x 2

Indicators with really long names

69
Q

Protein false +

A

Highly alkaline pH

Phenazo (overrides buffers)

70
Q

Protein false -

A

Non-albumin proteins

71
Q

Protein confirmation

A

SSA -sulfosalicylic acid
Bense Jones
microalbumin protein

72
Q

Renal threshold

A

The threshold or blood level at which tubular reabsorption stops

  • stops the absorption of glucose if its met
  • thus glucose will be excreted in urine
73
Q

Reagent for glucose

A
  1. Glucose peroxidase

2. Peroxidase and a dye

74
Q

Glucose reagent equations

A
  1. Glucose + O2 -> glucose oxidase –> gluconic acid +peroxide (H2O2)
  2. Peroxide + peroxidase with a dye –> H2o + O with dye makes colour
75
Q

Glucose false +

A

Peroxide contamination

76
Q

Glucose false -

A

Vitamin C

Improper preservation

77
Q

Glucose Confirmation test

A

Clinitest

Ketones +

78
Q

Clinitest (monosaccharide / reducing sugar test)

A
  • used to check for all three simple sugars

- glucose, galactose, fructose

79
Q

Reagent in a clinitest

A

Copper sulfate

- results in a colour change (blue) if positive

80
Q

How clinitest works

A

Urine added to clinitest tablet in a test tube

  • heat is created
  • colour changes from blue to orange to red
  • reaction may go through a pass through if high amounts of reducing sugars are present
81
Q

2 cautions when doing a clinitest

A
  1. Dont hold in hands - produces heat

2. Watch for full 2 mins as it may go through a pass through and you can miss the positive reaction colour change

82
Q

Ketones are produces through?

A

Produced as a results of breaking down adipose and muscle for energy

83
Q

What condition are ketones present it?

A

Diabetics melatus and calorie reduced diets (anorexia and Dr.Bernstein)
Carb and insulin insufficiency

84
Q

What smell to ketones cause?

A

Sweet smelling , fruity, or like someone has been drinking

85
Q

Ketone Reagent

A

Sodium Nitroprusside - produces a purple colour

86
Q

Ketone False +

A

Medications

87
Q

Ketones false -

A

Leaving container open - ketones evaporate quickly

88
Q

Blood

A

Looking for presence of hemoglobin (doesn’t have to be intact) and peroxidase (enzyme attached to myoglobin and hemoglobin)

89
Q

Blood reagent

A

Peroxide and a dye

Peroxide + dye –> peroxidase H2O + O = dye changes colour

90
Q

Blood false +

A

Menstruated contamination

Peroxidase producing bacteria

91
Q

Blood false -

A

high SG
Vitamin C
Poor mixing

92
Q

Blood confirmation test

A

Microscopic (RBC’S)

Colour

93
Q

Hematuria indicates ?

A

Renal calculus, renal diseases, trauma, pyelonephritis, chemical exposure, and anticoagulant therapy

94
Q

Benign condition of hematuria is?

A

Menstruation or strenuous exercise

95
Q

Myoglobinuria

A

Presence or myoglobin in urine

  • red-brown in colour
  • present in crush injuries, trauma, alcoholism, heroin abuse, muscle wasting disease (MI) and extensive exertion
96
Q

bilirubin

A

Produced in liver disease a or hemolytic anemias

  • when rbc’s are broken down the bilirubin is released into circulation and bound to albumin and send to the liver
  • will appear in urine when there is damage or a blockage in bile duct, liver is allowing leakage or water solvable bilirubin (hepatitis or cirrhosis)
97
Q

Bilirubin reagent

A

Diazo (diazonium salt)

colour change reaction from pink to purple

98
Q

Bilirubin false +

A

Phenazo or medications

99
Q

Bilirubin false -

A

Vitamin C
High nitrites
Exposure to light
Not a fresh sample

100
Q

bilirubin confirmation

A
  • Ictotest
  • colour
  • yellow foam on shaking
101
Q

Ictotest

A

Ravioli test

  • preformed on filter paper that removes affecting substances (ex. Phenazo)
  • tablet on paper
  • colour reaction is blue to purple with all other colour considered negative
102
Q

Urobilinogen

A

Bile pigment resulting from hemoglobin breakdown

  • product of bacteria action on bile in intestines
  • produces brown colour in feces
  • Less than 1mg/do are considered normal
103
Q

Too much urobilinogen is indicative of

A

Liver disorders and disease and hemolytic disorders

104
Q

Reagents for urobilinogen

A

Multistix - Erlich’s - light to dark pink colour

Chemstrip - diazo -white - pink colour

105
Q

Urobilinogen False +

A

Multistix - Medications

Chemstrip- Phenazo

106
Q

Urobilinogen False -

A

Chemstrip - High nitrites and vitamin C

Multistix - nothing

107
Q

Urobilinogen Confirmation test

A

+ bilirubin

108
Q

Nitrites

A
  • Broken down from nitrates by bacteria in bladder
  • Some break down further into N2 gas
  • byproduct of digestion of green leafy vegetables
109
Q

Nitrites can indicate..?

A

Bacterial UTI infection and can help determine if treatment is effective
- untreated UTI can lead to pyelonephritis - permanent damage

110
Q

Nitrite reagent

A
  • diazo
  • Any indication of pink is positive
  • Test only reported as + or -
    Colour reaction are set to only occur if 100,000 bacteria /ml are present - infection is present
111
Q

Nitrite false +

A

Phenazo

Improper preservation

112
Q

Nitrites false -

A

Vitamin C
Non-nitrite reducing bacteria
Nitrite to N2 reducing bacteria
No veg in diet (all meat)

113
Q

Nitrite confirmation test

A

Microscopic : WBC’s, bacteria, leukocyte esterase +

114
Q

Leukocyte esterase

A
  • Indicates presence of enzyme in WBC’s (whole/ lysed blood)
  • cells must lyse on pad to have enzyme detected
  • cant determine how many are present, just that they are
  • can be used with nitrite to determine UTI before culture done
115
Q

Leukocyte esterase reagent

A

Diazo - produce a purple colour

116
Q

Leukocyte esterase false +

A

Phenazo, formalin, pigments, antibiotics

117
Q

Leukocyte esterase false -

A 
High nitrites
High SG
Vitamin C
Poor mixing 
High protein and glucose
118
Q

Leukocyte esterase confirmation test

A

Microscopic: WBC’s, bacteria, yeast, parasites

119
Q

Specific Gravity

A

-Measuring the concentration of your urine

120
Q

Specific gravity reagent

A

Polyelectrolyte- releases H+ ions in the same proportion as ions present in urine
- change in H+ ions results in change in pH which causes colour change in indicator Bromothymol blue which changes from blue (alkaline) to green (neutral) to yellow (acid)
Bromothymol blue

121
Q

Specific gravity false +

A

None

122
Q

Specific gravity false -

A

Low urine
PH 6
Less interferes with indicator

123
Q

How to maintain consistancy in microscopic analysis

A
  1. Always use same volume of sample
  2. Centrifuge all samples at same speed for same time
  3. Decant all specimens to same volume
  4. Give same drop of urine on each slide (micropipette, calibrated unalysis pupette or slide with calibration built in)
  5. Always use 2x22mm coverslip
  6. Look for 10 fields of material (5 from centre, 5 from peripheral)
124
Q

Supernatent

A

Fluid part of urine after centrifugation (plasma)

125
Q

Sediment

A

Solid portion of urine after centrifugation (formed elements)

126
Q

Microscopic urinalysis

A

Used to see physical structures in urine under microscope

- RBC’s WBC’s, bacteria, parasites, contaminants

127
Q

What type of cells are pelvis, ureters, bladder, urethra

A

Transitional epithelium (anywhere you find urine)

128
Q

What type of cells are tubes made from?

A

Simple cuboidal

129
Q

What type of cells are the vaginal canals made of?

A

Stratified squamous

Urinalysis (1 decks)

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