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Analysis of Urine and Other Body Fluids (Laboratory) > Physical Examination of Urine | from Strasinger (6th ed.) > Flashcards

Physical Examination of Urine | from Strasinger (6th ed.) Flashcards

1
Q

What are included in the physical examination of urine?

A

Determination of urine:

1) Color
2) Clarity
3) Specific gravity

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2
Q

What are the basis of many medical decisions by early physicians?

A

Urine’s:

1) Color
2) Clarity

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3
Q

As of today, the observation of urine’s color and clarity provides preliminary info concerning disorders such as?

A

1) Glomerular bleeding
2) Liver disease
3) Inborn errors of metabolism
4) Urinary tract infection (UTI)

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4
Q

Measurement of the urine’s SG aid in what?

A

It aids in the evaluation of renal tubular fxn

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5
Q

The results of the physical examination of UA can also be used to what?

A

It can also be used to confirm / to explain findings in the chemical and microscopic areas of UA

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6
Q

True or False

The color of urine varies from almost colorless to black

A

True

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7
Q

Variations in the color of urine may be due to what?

A

May be due to:

1) Normal metabolic fxns
2) Physical activity
3) Ingested materials
4) Pathologic conditions

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8
Q

What is often the reason why a pt seeks medical advice?

A

Due to a noticeable change in the pt’s urine

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9
Q

In terms of the urine’s color, what is the responsibility of the lab?

A

To determine whether the color change is normal / pathologic

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10
Q

Answer the ff questions regarding the given color (of urine):

1) What is/are the cause/s of the color of the urine?
2) What is/are the clinical / laboratory correlations based on the color of the urine?

Given color: Colorless

A

1) Recent fluid consumption

2) Commonly observed w/ random sxs

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11
Q

Answer the ff questions regarding the given color (of urine):

1) What is/are the cause/s of the color of the urine?
2) What is/are the clinical / laboratory correlations based on the color of the urine?

Given color: Pale yellow

A

1) Polyuria or diabetes insipidus (DI)
1. 1) Diabetes mellitus (DM)
1. 2) Dilute random sx
2) Increased 24-hr volume and low SG
2. 1) Elevated SG and (+) glucose test result
2. 2) Recent fluid consumption

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12
Q

Answer the ff questions regarding the given color (of urine):

1) What is/are the cause/s of the color of the urine?
2) What is/are the clinical / laboratory correlations based on the color of the urine?

Given color: Dark yellow

A

1) Concentrated sx
1. 1) B complex vitamins
1. 2) Dehydration
1. 3) Bilirubin
1. 4) Acriflavine
1. 5) Nitrofurantoin
2) May be normal after strenuous exercise or in first morning sx
2. 2) Fever or burns
2. 3) Yellow foam when shaken and (+) chemical test results for bilirubin
2. 4) (-) bile test results and possible green fluorescence
2. 5) Antibiotic administered for UTIs

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13
Q

Answer the ff questions regarding the given color (of urine):

1) What is/are the cause/s of the color of the urine?
2) What is/are the clinical / laboratory correlations based on the color of the urine?

Given color: Orange yellow

A

1) Phenazopyridine (Pyridium)
1. 1) Phenindione
2) Drug commonly administered for UTIs
2. 1) Anticoagulant, orange in alkaline urine, and colorless in acid urine

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14
Q

Answer the ff questions regarding the given color (of urine):

1) What is/are the cause/s of the color of the urine?
2) What is/are the clinical / laboratory correlations based on the color of the urine?

Given color: Yellow green

A

1) Bilirubin oxidized to biliverdin

2) Colored foam in acidic urine and false-(-) chemical test results for bilirubin

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15
Q

Answer the ff questions regarding the given color (of urine):

1) What is/are the cause/s of the color of the urine?
2) What is/are the clinical / laboratory correlations based on the color of the urine?

Given color: Green

A

1) Pseudomonas infection

2) (+) urine culture

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16
Q

Answer the ff questions regarding the given color (of urine):

1) What is/are the cause/s of the color of the urine?
2) What is/are the clinical / laboratory correlations based on the color of the urine?

Given color: Blue-green

A

1) Amitriptyline
1. 1) Methocarbamol (Robaxin)
1. 2) Clorets
1. 3) Indican
1. 4) Methylene blue
1. 5) Phenol
2) Antidepressant
2. 1) Muscle relaxant, may be green-brown
2. 2) None
2. 3) Bacterial infections and intestinal disorders
2. 4) Fistulas
2. 5) When oxidized

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17
Q

Answer the ff questions regarding the given color (of urine):

1) What is/are the cause/s of the color of the urine?
2) What is/are the clinical / laboratory correlations based on the color of the urine?

Given color: Pink

A

1) RBCs

2) Cloudy urine w/ (+) chemical test results for blood and RBCs visible microscopically

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18
Q

Answer the ff questions regarding the given color (of urine):

1) What is/are the cause/s of the color of the urine?
2) What is/are the clinical / laboratory correlations based on the color of the urine?

Given color: Red

A

1) Hgb
1. 1) Myoglobin
1. 2) Beets
1. 3) Rifampin
1. 4) Menstrual contamination
2) Clear urine w/ (+) chemical test results for blood; intravascular hemolysis
2. 1) Clear urine w/ (+) chemical test results for blood; muscle damage
2. 2) Alkaline urine of genetically susceptible persons
2. 3) TB medication
2. 4) Cloudy sx w/ RBCs, mucus, and clots

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19
Q

Answer the ff questions regarding the given color (of urine):

1) What is/are the cause/s of the color of the urine?
2) What is/are the clinical / laboratory correlations based on the color of the urine?

Given color: Port wine

A

1) Porphyrins

2) (-) test for blood, may require additional testing

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20
Q

Answer the ff questions regarding the given color (of urine):

1) What is/are the cause/s of the color of the urine?
2) What is/are the clinical / laboratory correlations based on the color of the urine?

Given color: Red-brown

A

1) RBCs oxidized to methemoglobin
1. 1) Myoglobin
2) Seen in acidic urine after standing; (+) chemical test result for blood

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21
Q

Answer the ff questions regarding the given color (of urine):

1) What is/are the cause/s of the color of the urine?
2) What is/are the clinical / laboratory correlations based on the color of the urine?

Given color: Brown

A

1) Homogentisic acid (alkaptonuria)

2) Seen in alkaline urine after standing; sp tests are available

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22
Q

Answer the ff questions regarding the given color (of urine):

1) What is/are the cause/s of the color of the urine?
2) What is/are the clinical / laboratory correlations based on the color of the urine?

Given color: Black

A

1) Malignant melanoma
1. 1) Melanin or melanogen
1. 2) Phenol derivatives
1. 3) Argyrol (antiseptic)
1. 4) Methyldopa or levodopa
1. 5) Metronidazole (Flagyl)
2) Urine darkens on standing and reacts w/ nitroprusside and ferric chloride
2. 2) Interfere w/ copper reduction tests
2. 3) Color disappears w/ ferric chloride
2. 4) Antihypertensive
2. 5) Darkens on standing, intestinal and vaginal infections

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23
Q

True or False

The terminology used to describe the color of normal urine may differ slightly among labs but should be consistent within each lab

A

True

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24
Q

What are the common descriptions of normal color of urine?

A

1) Pale yellow
2) Yellow
3) Dark yellow

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25
Q

What is the proper way of examining the color of pt’s urine?

A

The sx should be examined under a good light source, looking down through the container against a white bg

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26
Q

What pigment is the cause of the yellow color of the urine?

A

Urochrome

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27
Q

Who coined the name urochrome?

A

Thudichum

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28
Q

When did Thudichum coined the name urochrome?

A

1864

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29
Q

What is urochrome?

A

It is a product of endogenous metabolism

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30
Q

What is the characteristic of the production of urochrome if the body is in normal condition?

A

Urochrome is produced at a constant rate under normal conditions of the body

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31
Q

The actual amt of urochrome produced is dependent on what?

A

It is dependent on the body’s metabolic state

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32
Q

At what states / conditions does increased amts of urochrome are produced?

A

In thyroid conditions and fasting states

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33
Q

Does urochrome also increase in urine w/c stands at room temp?

A

Yes

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34
Q

True or False

Because urochrome is excreted at a constant rate, the intensity of the yellow color in a fresh urine sx can give a rough estimate of urine conc

A

True

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35
Q

What is the color of a dilute urine?

A

Pale yellow

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36
Q

What is the color of a concentrated sx?

A

Dark yellow

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37
Q

True or False

Owing to variations in the body’s state of hydration, the differences in the yellow color of urine can be normal

A

True

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38
Q

Aside from urochrome, what are the other 2 additional pigments?

A

1) Uroerythrin

2) Urobilin

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39
Q

True or False

Both uroerythrin and urobilin are present in much bigger quantities in the urine

A

False, because both uroerythrin and urobilin are present in much smaller quantities in the urine

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40
Q

True or False

Both uroerythrin and urobilin contribute little to the color of normal, fresh urine

A

True

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41
Q

What is the characteristic of uroerythrin in terms of color?

A

It is a pink pigment

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42
Q

At what type of sxs is uroerythrin most evident?

A

It is most evident in sxs that have been refrigerated

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43
Q

What will happen (/ what will be the result) if the urine sx is refrigerated?

A

The amorphous urates will precipitate

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44
Q

What is the action of uroerythrin to refrigerated sxs?

A

Uroerythrin attaches to the urates, producing a pink color to the sediment

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45
Q

What is urobilin?

A

It is an oxidation product of the normal urinary constituent urobilinogen

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46
Q

What is the action of urobilin?

A

It imparts an orange-brown color to urine that is not fresh

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47
Q

True or False

Certain abnormal colors of urine are seen more frequently and have a greater clinical significance than do others

A

True

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48
Q

What are abnormal urine colors?

A

1) Dark yellow / amber / orange
2) Red / pink / brown
3) Brown / black
4) Blue / green

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49
Q

Does dark yellow or amber urine may always signify a normal concentrated urine?

A

No, these abnormal colors of urine may not always signify a normal concentrated urine

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50
Q

What can be the cause of dark yellow or amber urine?

A

It can be caused by the presence of bilirubin

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51
Q

Is bilirubin an abnormal or normal pigment?

A

It is an abnormal pigment

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52
Q

How to detect bilirubin if it is present in the urine sx?

A

It will be detected during the chemical examination of urine

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53
Q

When should the presence of bilirubin be suspected?

A

Its presence should be suspected if yellow foam appears when the sx is shaken

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54
Q

What is the characteristic of a normal urine when shaken?

A

It produces only a small amt of rapidly disappearing foam

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55
Q

What is the indication if there is a large amt of white foam in the pt’s urine?

A

It indicates that there is an increased conc of protein

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56
Q

A urine sx that contains bilirubin may also contain what virus?

A

Hepatitis virus

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57
Q

What is needed to be done if the pt’s urine (w/c contains bilirubin) also contains hepatitis virus?

A

Std precautions should be followed

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58
Q

What is the color of the pt’s urine if there is a photo-oxidation of large amts of excreted urobilinogen to urobilin

A

Yellow-orange urine

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59
Q

Is yellow foam present in a pt’s urine w/c has photo-oxidation of large amts of excreted urobilinogen to urobilin when the sx is shaken?

A

No

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60
Q

What is the color of the urine imparted by the photo-oxidation of bilirubin and what is the cause of the presence of this color?

A

Yellow-green color due to the presence of biliverdin

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61
Q

What is the color of pt’s urine that is frequently encountered in the lab?

A

Yellow-orange sx

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62
Q

What are the causes of yellow-orange sx?

A

Administration of:

1) Phenazopyridine
2) Or azo-gantrisin compounds

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63
Q

To whom are phenazopyridine or azo-gantrisin compounds administered?

A

To pts who have UTIs

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64
Q

What is the brand name of phenazopyridine?

A

Pyridium

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65
Q

What are the actions of the thick orange pigment?

A

1) It obscures the natural color of the sx

2) It also interferes w/ chemical tests that are based on color rxns

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66
Q

Is it impt to recognize the presence of phenazopyridine in a sx?

A

Yes

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67
Q

Why is it impt to recognize phenazopyridine in a sx?

A

For the labs to use an alternative testing procedures

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68
Q

What is the action of sxs containing phenazopyridine when shaken?

A

Sxs containing phenazopyridine produces a yellow foam when shaken

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69
Q

What is the issue to the yellow foam produced when the pt’s urine (w/c contains phenazopyridine) is shaken?

A

The yellow foam produced could be mistaken for bilirubin

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70
Q

What is 1 of the most common causes of abnormal urine color?

A

Presence of blood

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71
Q

What is the usual color that blood produces in urine?

A

Red

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72
Q

What is the characteristic of red color (that is the usual color that blood produces in urine)?

A

It may range from pink to brown

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73
Q

The range of red color in the pt’s urine (w/c is the usual color that blood produces in urine) depends on what?

A

It depends on:

1) Amt of blood
2) pH of the urine
3) Length of contact

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74
Q

What is the color of the urine produced if RBCs remain in acidic urine for several hrs?

A

Brown

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75
Q

What is the cause of the production of brown urine (if RBCs remain in an acidic urine for several hrs)?

A

Oxidataion of hgb to methemoglobin

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76
Q

A fresh brown urine containing blood may also indicate what condition?

A

Glomerular bleeding

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77
Q

What is the cause of glomerular bleeding (in a fresh brown urine)?

A

Conversion of hgb to methgb

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78
Q

Aside from RBCs, what are the other 2 substances that produce a red urine and result in a (+) chemical test for blood?

A

1) Hgb

2) Myoglobin

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79
Q

What is the flow of differentiation of red urine testing chemically (+) for blood?

A

Red urine -> clear; cloudy

  • > clear -> hgburia -> red plasma
  • > clear -> myoglobinuria -> clear plasma

-> cloudy -> RBCs present (hematuria)

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80
Q

What are the characteristics of the pt’s urine if RBCs are present?

A

The pt’s urine are:

1) Red
2) Cloudy

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81
Q

What are the characteristics of the pt’s urine if hgb or myoglobin is present?

A

The pt’s urine are:

1) Red
2) Clear

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82
Q

How to distinguish between hemoglobinuria and myoglobinuria?

A

Via examining the pt’s plasma

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83
Q

What is the cause of hemoglobinuria?

A

In vivo breakdown of RBCs

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84
Q

What is the characteristic of the pt’s plasma if hemoglobinuria is present?

A

The pt’s plasma is color red

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85
Q

What is the cause of the production of myoglobin?

A

Breakdown of skeletal muscle

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86
Q

What is the difference between myoglobin and hgb?

A

Myoglobin is more rapidly cleared from the plasma than is hgb

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87
Q

Since myoglobin is more rapidly cleared from the plasma than hgb, does myoglobin affect the color of the plasma?

A

No

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88
Q

What is the characteristic of a fresh urine containing myoglobin?

A

It frequently exhibits a more reddish-brown color than urine containing hgb

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89
Q

True or False

The possibility of hgburia being produced from the in vitro lysis of RBCs should not be considered because the only cause of hgburia is in vivo lysis of RBCs

A

False, because the possibility of hgburia being produced from the in vitro lysis of RBCs must also be considered

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90
Q

What is the characteristic if the urine sx contains porphyrins?

A

It may also appear red

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91
Q

What is the cause of urine sxs (containing porphyrins) appearing red?

A

Oxidation of porphobilinogen to porphyrins

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92
Q

What is the color often referred for urine sxs (containing porphyrins) being color red?

A

They are often referred to as having the color of port wine

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93
Q

What are the nonpathogenic causes of red urine?

A

1) Menstrual contamination
2) Ingestion of highly pigmented foods
3) Medications
a. Rifampin
b. Phenolphthalein
c. Phenindione
d. Phenothiazines

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94
Q

What is the color of the urine (specifically alkaline urine) of genetically susceptible pts if they eat fresh beets?

A

Red color

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95
Q

What is the color of the urine (specifically acidic urine) if pts ingest black berries?

A

Red color

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96
Q

What is recommended to be done to urine sxs that turn brown / black on standing and have (-) chemical test results for blood?

A

Additional testing

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97
Q

What are the components that urine sxs (that turn brown / black on standing and have [-] chemical test results for blood) may contain?

A

1) Melanin

2) Or homogentisic acid

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98
Q

What is melanin?

A

It is the oxidation product of the colorless pigment, w/c is melanogen

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99
Q

When is melanin produced in excess?

A

When a malignant melanoma is present

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100
Q

What is homogentisic acid?

A

It is a metabolite of phenylalanine

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101
Q

What is the action of homogentisic acid to alkaline urine from persons w/ the inborn-error of metabolism called alkaptonuria?

A

It imparts a black color

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102
Q

What are the medications producing brown / black urines?

A

1) Levodopa
2) Methyldopa
3) Phenol derivatives
4) Metronidazole (Flagyl)

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103
Q

What are the pathogenic causes of blue / green urine?

A

These are limited to bacterial infections including:

1) UTI by Pseudomonas spp
2) Intestinal tract infections (resulting in increased urinary indican)

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104
Q

Can ingestion of breath deodorizers such as Clorets result in a green urine?

A

Yes

105
Q

What are the medications that may cause blue urine?

A

1) Methocarbamol (Robaxin)
2) Methylene blue
3) Amitriptyline (Elavil)

106
Q

What can be done w/c frequently reveals abnormally colored urine (in connection to blue / green colored urine)?

A

Observation of sx collection bags from hospitalized pts

107
Q

What may the abnormal color of urine (as observed in the sx collection bags from hospitalized pts) signify?

A

It may signify either:

1) A pathologic condition w/c requires the urine to stand for a period of time before color development
2) Presence of medications

108
Q

True or False

Phenol derivatives found in certain intravenous medications does not produce green urine on oxidation

A

False, because phenol derivatives found in certain intravenous medications produce green urine on oxidation

109
Q

Can a purple staining may occur in catheter bags?

A

Yes

110
Q

What are the causes of purple staining in catheter bags of pts?

A

1) Indican (w/c is present in the pt’s urine)

2) Bacterial infection (w/c is frequently caused by Klebsiella or Providencia spp)

111
Q

What is clarity?

A

It is the general term that refers to the transparency or turbidity of a urine sx

112
Q

How is clarity determined in routine UA?

A

It is determined in the same manner that ancient physicians used w/c is via visually examining the mixed sx while holding it in front of a light source

113
Q

Where should the sx be placed when examining for its clarity?

A

It should be placed in a clear container

114
Q

True or False

Color should be routinely determined 1st prior to determination of clarity

A

False, because both color and clarity are routinely determined at the same time

115
Q

What are the common terminologies used to report urine’s clarity?

A

1) Clear
2) Hazy
3) Cloudy
4) Turbid
5) Milky

116
Q

True or False

The terminology (when it comes to clarity) should be consistent within a lab

A

True

117
Q

What is the term (/ explanation) for the given clarity?

Given clarity: Clear

A

No visible particulates, transparent

118
Q

What is the term (/ explanation) for the given clarity?

Given clarity: Hazy

A

Few particulates, print easily seen through urine

119
Q

What is the term (/ explanation) for the given clarity?

Given clarity: Cloudy

A

Many particulates, print blurred through urine

120
Q

What is the term (/ explanation) for the given clarity?

Given clarity: Turbid

A

Print cannot be seen through urine

121
Q

What is the term (/ explanation) for the given clarity?

Given clarity: Milky

A

May precipitate or be clotted

122
Q

What is the urine color and clarity procedure?

A

1) Evaluate an adequate volume of sx
2) Use a well-mixed sx
3) View the urine through a clear container
4) View the urine against a white bg using adequate room lighting
5) Maintain adequate room lighting
6) Evaluate a consistent volume of urine
6. 1) Determine the urine color
6. 2) Describe the urine clarity

123
Q

What is the characteristic of a freshly voided normal urine?

A

It is usually clear

124
Q

What type of urine sx (freshly voided normal urine) is usually clear?

A

Midstream clean-catch sx

125
Q

Precipitation of amorphous phosphates and carbonates may cause what?

A

It may cause a white cloudiness

126
Q

The presence of squamous epithelial cells and mucus in sxs from women can result in what?

A

It can result in a hazy but normal urine

127
Q

Sxs that are allowed to stand or are refrigerated also may develop what?

A

It may also develop turbidity that is nonpathologic

128
Q

Improper preservation of a sx results in what?

A

Bacterial growth

129
Q

What is the action of bacterial growth (being present in sxs)?

A

It increases sx turbidity (but is not representative of the actual sx)

130
Q

Refrigerated sxs frequently develop what?

A

These frequently develop a thick turbidity

131
Q

What are the causes of development of a thick turbidity in refrigerated sxs?

A

Precipitation of amorphous phosphates, carbonates, and urates

132
Q

What is the action of amorphous phosphates and carbonates?

A

These produces a white ppt

133
Q

At what type of urine sx does amorphous phosphates and carbonates produce a white ppt?

A

In urine w/ an alkaline pH

134
Q

What is the action of amorphous urates?

A

It produce a ppt

135
Q

At what type of urine sx does amorphous urates produce a ppt?

A

In acidic urine

136
Q

What is the characteristic of the ppt produced by amorphous urates (in acidic urine)?

A

It resembles pink brick dust

137
Q

Why does the ppt produced by amorphous urates resemble pink brick dust?

A

Due to the presence of uroerythrin

138
Q

What are the nonpathologic causes of urine turbidity?

A

1) Squamous epithelial cells (in sxs from female pts)
2) Mucus (in sxs from female pts)
3) Amorphous phosphates, carbonates, and urates
4) Semen, spermatozoa
5) Fecal contamination
6) Radiographic contrast media
7) Talcum powder
8) Vaginal creams

139
Q

What are the most commonly encountered pathologic causes of turbidity in a fresh sx?

A

1) RBCs
2) WBCs
3) Bacteria (cause by infection or a systemic organ disorder)

140
Q

What are the less frequently encountered causes of pathologic turbidity?

A

1) Abnormal amts of nonsquamous epithelial cells
2) Yeast
3) Abnormal crystals
4) Lymph fluid
5) Lipids

141
Q

What are the pathologic causes of urine turbidity?

A

1) RBCs
2) WBCs
3) Bacteria
4) Yeast
5) Nonsquamous epithelial cells
6) Abnormal crystals
7) Lymph fluid
8) Lipids

142
Q

The clarity of a urine sx certainly provides a key to what results of examination in UA?

A

Microscopic examination results

143
Q

Why does the clarity of a urine sx certainly provides a key to the microscopic examination results?

A

Because the amt of turbidity should correspond w/ the amt of material observed under the microscope

144
Q

True or False

Clear urine is always normal

A

False, because clear urine is not always normal

145
Q

With the increased sensitivity of the routine chemical tests, can most abnormalities in clear urine be detected prior to the microscopic analysis?

A

Yes

146
Q

What are included in the current criteria w/c are used to determine the necessity of performing a microscopic examination on all urine sxs?

A

These include both clarity and chemical tests for:

1) RBCs
2) WBCs
3) Bacteria
4) Protein

147
Q

What is 1 of the kidney’s most impt fxns?

A

The kidney’s ability to concentrate the glomerular filtrate by selectively absorbing essential chemicals and H2O from the glomerular filtrate

148
Q

Is the evaluation of urine conc included in the routine UA?

A

Yes

149
Q

How does the evaluation of urine conc in routine UA done?

A

Via measuring the SG of the sx

150
Q

What is the help provided if SG is included in the routine UA?

A

To determine whether sx conc is adequate to ensure the accuracy of chemical tests

151
Q

What is the SG of the plasma filtrate entering the glomerulus?

A

1.010

152
Q

What is isosthenuric?

A

It is used to describe a urine w/ a SG of 1.010

153
Q

What is hyposthenuric?

A

These are sxs w/ an SG below 1.010

154
Q

What is hypersthenuric?

A

These are sxs that have a SG above 1.010

155
Q

True or False

1 would expect urine that has been concentrated by the kidneys to be hyposthenuric, but this is not always true

A

False, because 1 would expect urine that has been concentrated by the kidneys to be hypersthenuric, but this is not always true

156
Q

What may be the range of SG of normal random sxs?

A

Approx 1.002 - 1.035

157
Q

The SG of normal random sxs depends on what?

A

It depends on the pt’s amt of hydration

158
Q

Are sxs having a measurement of SG lower than 1.002 probably urine?

A

No, these sxs are probably not urine

159
Q

What is the range of SG of most random sxs?

A

Between 1.015 - 1.030

160
Q

What is SG?

A

It is defined as the density of a solution compared w/ the density of a similar volume of distilled H2O at a similar temp

161
Q

What is the density (/ SG) of distilled H2O?

A

1.000

162
Q

Because urine is actually H2O that contains dissolved chemicals, the SG of urine is a measure of what?

A

It is a measure of the density of the dissolved chemicals in the sx

163
Q

What are the factors that influences the urine’s SG (as a measure of sx density)?

A

1) # of particles present

2) Size of particles present

164
Q

In relation to the concept of the factors that affect the urine’s SG, does large molecules contribute more to the reading than do the small molecules?

A

Yes

165
Q

What is required to be done in relation to the concept that large molecules contribute more to the reading than do the small molecules?

A

This may require the need to correct for the presence of substances that are not normally seen in urine

166
Q

What are the substances (w/c are not normally seen in urine) w/c may be required to be corrected (in relation to the principle of large molecules contributing more than small molecules in the SG of the urine)?

A

1) Glucose

2) Protein

167
Q

Currently, what is the only method in use in routine UA that requires correcting?

A

Refractometer

168
Q

What are the other 2 methods in use in routine UA?

A

1) Chemical rgnt strips

2) Osmolality

169
Q

What are the different methods of current urine SG measurements?

A

1) Refractometry
2) Osmolality
3) Rgnt strip

170
Q

What is the principle of the given method (in current urine SG measurements)?

Given method: Refractometry

A

Refractive index

171
Q

What is the principle of the given method (in current urine SG measurements)?

Given method: Osmolality

A

Changes in colligative properties by particle number

172
Q

What is the principle of the given method (in current urine SG measurements)?

Given method: Rgnt strip

A

pKa changes of a polyelectrolyte by ions present

173
Q

What is refractometry?

A

It determines the conc of dissolved particles in a sx by measuring refractive index

174
Q

What is RI?

A

It is a comparison of the velocity of light in air w/ the velocity of light in a solution

175
Q

The conc of dissolved particles present in the solution determines what?

A

It determines the velocity and angle at w/c light passes through a solution

176
Q

How does clinical refractometers make use of the principles of light?

A

Via using a prism to direct a specific (monochromatic) wavelength of daylight against a manufacturer-calibrated SG scale

177
Q

The conc of the sx determines what?

A

It determines the angle at w/c light passes through the sx

178
Q

What is the distinct advantage provided by the refractometer?

A

Determining the SG using a small volume of sx

179
Q

How many drops of sx are needed (as a distinct advantage of determining the SG via the use of refractometer)?

A

1 / 2 drops

180
Q

Are temp corrections necessary if refractometer is used? Why or why not?

A

No, because the light beam passes through a temp compensating liquid prior to being directed at the SG scale

181
Q

The temp is compensated between what temp (in the refractometer)?

A

Between 15 DC - 38 DC

182
Q

True or False

Corrections for glucose and protein (if refractometer is used) must be calculated

A

True

183
Q

How are corrections for glucose and protein calculated?

A

These are calculated via subtracting 0.003 for each gram of protein present and 0.004 for each gram of glucose present

184
Q

Where can the amt of protein or glucose present be determined?

A

These can be determined from the chemical rgnt strip tests

185
Q

How is the refractometer used?

A

1) A drop of urine is placed on the prism
2) The instrument is focused at a good light source
3) The reading is taken directly from the SG scale
4) The prism and its cover should be cleaned after each sx is tested

186
Q

What are the steps (/ complete procedure) in the use of urine SG refractometer?

A

1) Put 1 / 2 drops of sx on the prism
2) Close the daylight plate gently
3) The sx must spread all over the prism surface
4) Look at the scale through the eyepiece
5) Read the scale where the boundary line intercepts it
6) Wipe the sx from the prism clean w/ a tissue paper and H2O

187
Q

How is refractometer calibrated?

A

It is calibrated via the use of distilled H2O that should read 1.000

188
Q

When calibrating the refractometer, what should be done if necessary?

A

The instrument contains a zero setscrew to adjust the distilled H2O reading

189
Q

How is the calibration of refractometer further checked?

A

It should be further checked via the use of 5% NaCl (w/c as shown in the refractometer conversion tables should read 1.022 +/- 0.001, or 9% sucrose that should read 1.034 +/- 0.001)

190
Q

When should urine control sxs be run?

A

These should be run at the beginning of each shift

191
Q

What should be done to calibration and control results?

A

These should always be recorded in the appropriate quality control records

192
Q

Abnormally high results of SG (above 1.040) are seen in whom?

A

These are seen in pts who have recently undergone an intravenous pyelogram

193
Q

What is the cause of abnormally high results (1.040 >) of SG?

A

Excretion of the injected radiographic contrast media

194
Q

Who are the pts who also produce urine w/ an abnormally high SG?

A

Pts who are receiving dextran or other high-molecular-weight intravenous fluids (plasma expanders)

195
Q

What happens to the pt’s SG once the foreign substance has been cleared from the body?

A

The SG returns to normal

196
Q

How the urine conc be measured if pts receives dextran or other high MW IV fluids?

A

The urine conc of these pts can be measured via the use of:

1) Rgnt strip chemical test
2) Osmometry

197
Q

Why are rgnt strip chemical test and osmometry be used in terms of measuring their urine conc (for pts who are receiving dextran or other high MW IV fluids)?

A

Because these pts are not affected by such high MW substances

198
Q

SG depends on what components?

A

1) # of particles present in a solution

2) Density of these particles (w/c are present)

199
Q

Osmolality is only affected by what?

A

By the # of particles present

200
Q

What are the substances of interest when evaluating renal concentrating ability?

A

Small molecules

201
Q

What are the primary molecules w/c are the substances of interest when evaluating renal conc ability?

A

Primarily:

1) Sodium
2) Chloride

202
Q

What is the molecular weight of Na?

A

23

203
Q

What is the MW of Cl?

A

35.5

204
Q

Does urea have an importance in the evaluation of renal conc ability?

A

None

205
Q

Does urea contribute more to the SG than Na and Cl molecules?

A

Yes

206
Q

What is the MW of urea?

A

60

207
Q

True or False

Na, Cl, and urea all contribute equally to the osmolarity of the sx

A

True

208
Q

True or False

Because Na, Cl, and urea all contribute equally to the osmolarity of the sx, a more representative measure of renal concentrating ability can be obtained by measuring osmolarity

A

True

209
Q

What is an osmole?

A

It is defined as 1 g molecular weight of a substance divided by the # of particles into w/c it dissociates

210
Q

What is the characteristic of glucose?

A

It is an nonionizing substance

211
Q

How many grams per osmole does glucose contain?

A

180 g per osmole

212
Q

What is the MW of glucose?

A

180

213
Q

What is the MW of NaCl?

A

58.5

214
Q

How many grams per osmole is NaCl if it is completely dissociated?

A

29.25 g per osmole

215
Q

Does osmolality and osmolarity differ from each other?

A

Yes

216
Q

What is the content of an osmolal solution of glucose?

A

It has 180 g of glucose dissolved in 1 kg of solvent

217
Q

What is the content of an osmolar solution of glucose?

A

It has 180 g of glucose dissolved in 1 L of solvent

218
Q

What is the unit of measure used in the clinical lab?

A

Milliosmole (mOsm)

219
Q

Why is mOsm the unit of measure used in the clinical lab?

A

Because it is not practical when dealing w/ body fluids to use a measurement as large as the osmole (23 g of Na per kg)

220
Q

How to determine the osmolarity of a solution?

A

It can be determined by measuring a property that is mathematically related to the # of particles in the solution (colligative property) and comparing this value w/ the value obtained from the pure solvent

221
Q

What are the changes in colligative properties caused by solute dissolved in solvent?

A

1) Lower freezing point
2) Higher boiling point
3) Increased osmotic pressure
4) Lower vapor pressure

222
Q

Answer the ff questions w/ regards to the given property:

1) What is the normal pure H2O point?
2) What is the effect of 1 mole of solute?

Given property: Freezing point

A

1) 0 DC

2) Lowered 1.86 DC

223
Q

Answer the ff questions w/ regards to the given property:

1) What is the normal pure H2O point?
2) What is the effect of 1 mole of solute?

Given property: Boiling point

A

1) 100 DC

2) Raised 0.52 DC

224
Q

Answer the ff questions w/ regards to the given property:

1) What is the normal pure H2O point?
2) What is the effect of 1 mole of solute?

Given property: Vapor pressure

A

1) 2.38 mm/Hg at 25 DC

2) Lowered 0.3 mm/Hg at 25 DC

225
Q

Answer the ff questions w/ regards to the given property:

1) What is the normal pure H2O point?
2) What is the effect of 1 mole of solute?

Given property: Osmotic pressure

A

1) 0 mm/Hg

2) Increased 1.7 x 10^9 mm/Hg

226
Q

What is the solvent in urine?

A

H2O

227
Q

True or False

Because H2O is the solvent in urine, the # of particles present in a sx can be determined by comparing a colligative property value of the sx w/ that of pure H2O

A

True

228
Q

What is the special equipment that is required to measure osmolality in the UA?

A

Osmometer

229
Q

True or False

The use of an osmometer is not an additional step in the routine UA procedure

A

False, because the use of an osmometer is an additional step in the routine UA procedure

230
Q

True or False

The term “molality” is the most commonly used because the solute and the solvent are both expressed in the same units of measure

A

True

231
Q

What is the meaning of A2O?

A

Advanced Automated Osmometer

232
Q

What is the action of A2O?

A

It uses freezing point depression to measure osmolality, providing a more automated method for measuring both urine and serum osmolality

233
Q

What is the help provided by the addition of a SG testing to UA chemical rgnt strips?

A

It has provided a convenient way to perform the routine UA by eliminating the need for an additional procedure

234
Q

The rgnt strip rxn is based on what?

A

It is based on the change in pKa (dissociation constant) of a polyelectrolyte in an alkaline medium

235
Q

What is the action of polyelectrolyte?

A

It ionizes, releasing hydrogen ions in proportion to the # of ions in the solution

236
Q

True or False

The higher the conc of urine, the lesser hydrogen ions are released, thereby lowering the pH

A

False, because the higher the conc of urine, the more hydrogen ions are released, thereby lowering the pH

237
Q

What is the indicator used on the rgnt pad (/ in the rgnt strip for SG)?

A

Bromthymol blue

238
Q

What is the action of bromthymol blue on the rgnt pad (/ on the rgnt strip for SG)?

A

It measures the change in pH

239
Q

What is the color change of the indicator (in the rgnt pad [in the rgnt strip for SG]) as the SG increases?

A

The indicator changes from blue (1.000 [alkaline]), through shades of green, to yellow (1.030 [acid])

blue (1.000 [alkaline]) -> green -> yellow (1.030 [acid])

240
Q

What is the interval used when reading results from the rgnt strip for SG?

A

0.005 intervals (accompanied w/ careful comparison w/ the color chart)

241
Q

Is urine odor a noticeable physical property?

A

Yes

242
Q

Is urine odor clinically significant?

A

Yes, seldomly

243
Q

Is urine odor a part of the routine UA?

A

No

244
Q

What is the odor of a freshly voided urine?

A

Faint aromatic odor

245
Q

What is the odor that becomes more prominent as the urine sx stand?

A

The odor of ammonia

246
Q

What is the cause of the characteristic ammonia odor (when the urine sx stands)?

A

Breakdown of urea

247
Q

What are the causes of unusual odors?

A

1) Bacterial infections (w/c causes a strong, unpleasant odor similar to ammonia)
2) Diabetic ketones (w/c produce a sweet or fruity odor)

248
Q

What is maple syrup urine disease (MSUD)?

A

It is a serious metabolic defect results in urine w/ a strong odor of maple syrup

249
Q

What are the foods (when ingested) that can cause an unusual or pungent urine odor?

A

1) Onions
2) Garlic
3) Asparagus

250
Q

True or False

Studies have shown that although everyone who eats asparagus produces an odor, only certain genetically predisposed people can smell the odor

A

True

251
Q

What is/are the possible cause/s of the given urine odor?

Given urine odor: Aromatic

A

Normal

252
Q

What is/are the possible cause/s of the given urine odor?

Given urine odor: Foul, ammonia-like

A

Bacterial decomposition, UTI

253
Q

What is/are the possible cause/s of the given urine odor?

Given urine odor: Fruity, sweet

A

Ketones (DM, starvation, vomiting)

254
Q

What is/are the possible cause/s of the given urine odor?

Given urine odor: Maple syrup

A

MSUD

255
Q

What is/are the possible cause/s of the given urine odor?

Given urine odor: Mousy

A

Phenylketonuria

256
Q

What is/are the possible cause/s of the given urine odor?

Given urine odor: Rancid

A

Tyrosinemia

257
Q

What is/are the possible cause/s of the given urine odor?

Given urine odor: Sweaty feet

A

Isovaleric acidemia

258
Q

What is/are the possible cause/s of the given urine odor?

Given urine odor: Cabbage

A

Methionine malabsorption

259
Q

What is/are the possible cause/s of the given urine odor?

Given urine odor: Bleach

A

Contamination

Analysis of Urine and Other Body Fluids (Laboratory) (9 decks)

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