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SAFETY & RENAL FXN, P.E Flashcards

1
Q

Chain of infection Requires a continuous link between:

A

“SMS”

 Source
 Mode of transmission
 Susceptible host

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2
Q

6 COMPONENTS OF THE CHAIN OF INFECTION?

A

“IREMES”

  1. Infectious agent
  2. Reservoir
  3. Exit (Portal of Exit)
  4. Mode of transmission
  5. Entry (Portal of Entry)
  6. Susceptible host
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3
Q

PERSONAL PROTECTIVE EQUIPMENTS?

A

 Gloves
 Fluid-resistant laboratory gowns
 Eye and face shields
 Countertop shields

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4
Q

best way to break the chain of infection ?

A

Handwashing

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5
Q

HANDWASHING

-imp step?
-time required?
-position when u rinse?
-last step?

A

-create friction
- 15 or 20 seconds
- Downward position
- Turn off faucets with a clean paper towel to prevent contaminations

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6
Q

NATIONAL FIRE PROTECTION ASSOCIATION (NFPA)

YELLOW?
WHITE?
BLUE?
RED?

A

YELLOW - Stability/Reactivity hazard
WHITE - Specific hazard
BLUE - Health hazard
RED - Flammability hazard

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7
Q

NATIONAL FIRE PROTECTION ASSOCIATION (NFPA)

YELLOW - Stability/Reactivity hazard CLASSIFICATION?

A

“SUVSM”

0 = Stable
1 = Unstable if heated
2 = Violent chemical change
3 = Shock
4 = May deteriote

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8
Q

NATIONAL FIRE PROTECTION ASSOCIATION (NFPA)

BLUE - Health hazard CLASSIFICATION?

A

“NSHED”

0 = Normal material
1 = Slightly hazardous
2 = Hazardous
3 = Extremely DANGER
4 = DEADLY

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9
Q

Degree of Hazards (Hazards Index) IN GENERAL?

A

“No SMS Ex’s”

0 = No/Minimal Hazard
1 = Slight Hazard
2 = Moderate Hazard
3 = Serious hazard
4 = Extreme/Severe Hazard

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10
Q

WHEN A FIRE IS DISCOVERED…

RACE?

A

-R (Rescue)
-A (Alarm)
-C (Contain)
-E (Extinguish/Evacuate)

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11
Q

TO OPERATE A FIRE EXTINGUISHER…

PASS?

A
  • P = Pull the pin
  • A = Aim at the base of the fire
  • S = Squeeze handles
  • S = Sweep nozzle side to side
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12
Q

TYPES OF FIRE AND FIRE EXTINGUISHER

A?
B?
C?

A

“A-WD”
“B-CDH”
“C-CDH”

A = Water, Dry chemical
B = Carbon dioxide, Dry chemical, Halon
C = Carbon dioxide, Dry chemical, Halon

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13
Q

ORDER OF URINE FORMATION?

A

“GPLDCCR”

  1. Glomerulus
  2. Proximal convoluted tubule (PCT
  3. Loop of Henle (LH)
  4. Distal convoluted tubule (DCT)
  5. Collecting duct (CD)
  6. Calyx
  7. Renal Pelvis
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14
Q

ORDER OF RENAL BLOOD FLOW?

A

‘RAGEPVR”

  1. Renal artery (blood in)
  2. Afferent arteriole (“Approaching”)
  3. Glomerulus
  4. Efferent arteriole (“Exiting)
  5. Peritubular capillaries (“Surrounding the renal tubules”)
  6. Vasa recta
  7. Renal vein (blood out)
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15
Q

Total Renal Blood Flow?
Total Renal Plasma Flow?

A
  • Total Renal Blood Flow: 1200 mL/min
  • 600 mL/min IF EACH KIDNEY
  • Total Renal Plasma Flow: 600 to 700 mL/min
  • 300-400 mL/min IF EACH KIDNEY
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16
Q

Glomerulus is non-selective filter of plasma substances with MW of?

A

<70,000 daltons

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17
Q

Protein that is negative in charged & has 69, 000 Daltons?

A

ALBUMIN

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18
Q

RENAL THRESHOLD FOR GLUCOSE?

A

160-180 mg/dL

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19
Q

TUBULAR REABSORPTION

It is the major site (65%) of reabsorption & secretion of plasma substances (ex. Na, Glucose)

A

PCT

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20
Q

TUBULAR REABSORPTION

Site where solute concentration is HIGHEST?

A

LH (renal medulla)

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21
Q

TUBULAR REABSORPTION

Site that is highly impermeable to water

A

ascending LH

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22
Q

TUBULAR REABSORPTION

-site that collects water?
-site that reabsorbs sodium but not water?

A
  • DLH
    -ALH
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23
Q

Explain Diabetes Insipidus

A

DI = Dami Ihi ; Pale yellow

Decreased ADH
Increased Urine vol
Increased pH (Alkaline) ; Decreased H+
Decreased SG / Osmolality

INCREASED Na
INCREASED K

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24
Q

Explain Diabetes Mellitus

A

DM= Dami Ihi ; Dark yellow
INCREASED Urine vol
Decreased pH (Acidic) ; Increased H+
Increased SG / Osmolality

Na = dec?
K = increased?

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25
Q

Explain Syndrome of inappropriate ADH secretion (SlADH)

A

SlADH
✓Increased ADH = holds too much water in the body
✓Decreased Urine vol
✓Decreased pH (Acidic) ; Increased H+
✓Increased SG / Osmolality

✓Na = Hyponatremia
✓K = Hyperkalemia

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26
Q

TUBULAR REABSORPTION

Substance in ACTIVE TRANSPORT and its location?

A

Glucose, amino acids, Salts = PCT
Sodium = PCT & DCT
Chloride = ALH

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27
Q

TUBULAR REABSORPTION

Substance in PASSIVE TRANSPORT and its location?

A

Water = PCT
Urea = PCT
Sodium = ALH

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28
Q

TUBULAR REABSORPTION

unsa dapat buhaton?

Hyponatremia
Dehydrated
Amino acids
Glucose
Urea

A
  1. Hyponatremia = ↑ Aldosterone
  2. Dehydrated = ↑ ADH
  3. AMINO ACIDS = 100% completely reabsorb back to the BL, wala OR small amount only in URINE (except for PX w/ metabolic disorders)
  4. GLUCOSE = <159 mg/dl RTG should reabsorb back to the BL, pag na abot ug 160 or >180 mg/dl RTG, glucose will appear sa urine w/c is clin.sig!
  5. UREA = 40% reabsorb back to the BL ; 60% secreted in urine
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29
Q

Explain RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM (RAAS)

A
  1. If px has ↓ BP, it will activate RAAS
  2. JG apparatus (macular dense) uutusan si JG cells to produce RENIN
  3. Renin converts Angiotensinogen to ANGIOTENSIN 1 (w/c is Inactive form)
  4. Angiotensin 1 to become ACTIVE FORM, punta ito kay LUNGS to meet Angiotensin converting enzyme (ACE)
  5. With the help of ACE, Angiotensin 1 –> Angiotensin 2
  6. Effects of Angiotensin 2:
    - Vasoconstriction (dilates Afferent arteriole; then constrict efferent)
    -Release of ADH & Aldosterone therefore ↑ Na & H2O reabsorption

OVERALL, RAAS WILL ↑ BP OR Corrects Renal Blood Flow

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30
Q

TUBULAR SECRETION

-Failure to produce an acid urine due to inability to secrete hydrogen ions
-BL pH in RTA?
-Urine pH in RTA?

A

-RENAL TUBULAR ACIDOSIS (RTA)
-BL pH in RTA = Acidic
-Urine pH in RTA = Alkaline

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31
Q

TESTS FOR GLOMERULAR FILTRATION

used to evaluate glomerular filtration

A

Clearance tests

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32
Q

TESTS FOR GLOMERULAR FILTRATION ?

A

“UCIBR”

  1. Urea
  2. Creatinine
    3 Inulin (MW: 5,200 Da)
    4 Beta2-microglobulin (MW: 11,800 Da)
  3. Radioisotopes
  4. Cystatin C (MW: 13,000 Da)
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33
Q

obsolete TEST FOR GLOMERULAR FILTRATION

A

Urea

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34
Q

MOST COMMON TEST FOR GLOMERULAR FILTRATION

A

Creatinine

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35
Q

Gold Standard; Reference method TEST FOR GLOMERULAR FILTRATION

A

Inulin

(Not routinely performed because inulin needs to be injected into the body)

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36
Q

TEST FOR GLOMERULAR FILTRATION

better marker of renal tubular function
than of GFR

A

Beta2-microglobulin

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37
Q

Alternative GLOMERULAR FILTRATION TEST if Creatinine/Inulin is N/A?

A

Cystatin C

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38
Q

used to evaluate tubular reabsorption (assess the ability of the kidney to concentrate or dilute urine)

A

Concentration tests

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39
Q

TESTS FOR TUBULAR REABSORPTION : Concentration tests?

A

Obsolete test:
Fishberg test
Mosenthal test

Recently used tests :
(S.G.) & Osmolality

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40
Q

TESTS FOR TUBULAR SECRETION & RENAL BLOOD FLOW

most commonly used reference method ?

A

P-aminohippuric acid (PAH) test

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41
Q

TESTS FOR TUBULAR SECRETION & RENAL BLOOD FLOW

obsolete; results are hard to interpret?

A

phenolsulfonphthalein (PSP) test

OTHERS:
pH
Acidity
Ammonia

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42
Q

URINE COMPOSITION ?

A
  • 95-97% water
  • 3-5% solids (60 grams= Total Solids in 24 hours)
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43
Q

COMPOSITION OF TOTAL SOLIDS IN URINE?

A
  1. 35 grams’ ORGANIC
    *Urea (major)
    *Creatinine (2nd)
    *others: hippurate, uric acid, CHO, pigments, fatty acids, mucins, enzymes, hormones
  2. 25 grams’ INORGANIC
    *Chloride (major) > Sodium > Potassium
    *NaCl - Sodium chloride (principal salt)
    *others: Sulfate, phosphate, ammonium, magnesium, calcium
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44
Q

TYPES OF URINE SPECIMEN

-For routine and qualitative urinalysis
-Ideal for cytology studies (ONLY IF with prior hydration, & exercise 5 mins. before collection!)

A

Random/ Occasional/ Single

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45
Q

TYPES OF URINE SPECIMEN

-Ideal specimen for routine screening/urinalysis
-hCG pregnancy test
-OFTEN preferred for cytology studies
-most ACIDIC
-orthostatic proteinuria

A

First morning

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46
Q

TYPES OF URINE SPECIMEN

  • 2nd voided urine after a period of fasting
  • For glucose/SUGAR determination
A

2nd morning/ Fasting

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47
Q

TYPES OF URINE SPECIMEN

-MOST preferred for testing GLUCOSE
-For diabetic screening or monitoring (DM px)

A

2-hour postprandial

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48
Q

TYPES OF URINE SPECIMEN

Optional with blood samples in glucose

A

Glucose tolerance test

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49
Q

TYPES OF URINE SPECIMEN

  • At least 2 voided collection
  • Series of blood and urine samples are collected at specific time intervals to compare concentration of a substance in urine with its concentration in the blood
  • Used in the diagnosis of diabetes
A

Fractional specimen

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50
Q

TYPES OF URINE SPECIMEN for detecting SUGAR/GLUCOSE?

A

“22GF”

  1. 2nd morning/ Fasting
  2. 2-hour postprandial
  3. Glucose tolerance test
  4. Fractional specimen`
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51
Q

TYPES OF URINE SPECIMEN

-MOST CONVENIENT
- routine screening and bacterial culture (OPD)
- Patient should thoroughly cleanse his glans penis or her urethral meatus before collection (not that sterile)

A

midstream clean-catch

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52
Q

TYPES OF URINE SPECIMEN

-for bed ridden px
-for bacterial culture
-urethral or ureteral (not that sterile)

A

catheterized

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53
Q

TYPES OF URINE SPECIMEN

  • MOST STERILE
  • also bed ridden px
  • disad : extremely invasive
  • anaerobic bacterial culture and urine cytology
  • Abdominal wall is punctured, and urine is directly aspirated from the bladder
A

Suprapubic aspiration

54
Q

TYPES OF URINE SPECIMEN

-Use of soft, clear plastic bag with adhesive (wee bag)
- Sterile specimen obtained by catheterization or
suprapubic aspiration
- Urine collected from diapers is NOT recommended for testing

A

pediatric spx

55
Q

TYPES OF URINE SPECIMEN used for Bacterial culture?

A

“MS.CP”

  1. midstream clean-catch
  2. catheterized
  3. Suprapubic aspiration
  4. pediatric spx
56
Q

TYPES OF URINE SPECIMEN used for URINE CYTOLOGY?

A

“RuFa iS Pretty”

  1. Random
  2. First morning
  3. Suprapubic aspiration
  4. Pediatric spx
57
Q

TYPES OF URINE SPECIMEN

  • For prostatic infection
    o First portion of voided urine
    o Middle portion of voided urine
    o Urine after prostatic massage
  • Examine the 1st and 3rd specimen microscopically, then compare the # of WBC and bacteria
  • Prostatitis = if the # of WBC and bacteria in the 3rd specimen is 10x GREATER than that of the 1st
  • 2nd specimen
    o CONTROL, for bladder & kidney infection
    o If control is (+) for WBCs and bacteria, the results from the 3rd specimen are considered invalid
A

Three-glass technique

58
Q

TYPES OF URINE SPECIMEN

reporting of Three-glass technique?

o First portion of voided urine
o Middle portion of voided urine
o Urine after prostatic massage

A
  1. Compare the # of WBC and bacteria of 1st and 3rd specimen microscopically
  2. Prostatitis = if the # of WBC and bacteria in the 3rd specimen is 10x GREATER than 1st
  3. 2nd specimen = CONTROL for bladder & kidney infection
    *If control is (+) for WBCs and bacteria, the results from the 3rd specimen are considered invalid
  4. UTI = ALL spx contains bacteria!
59
Q

TYPES OF URINE SPECIMEN

  1. (VB1) - initial voided urine = Urethral infection/inflammation
  2. (VB2) - midstream urine = urinary bladder infection
  3. (EPS) - expressed prostatic secretions
  4. (VB3) - post- prostatic massage urine

*EPS & VB3 are cultured for WBC (10-20wbc/HPF = abnormal)

A

STAMEY-MEARS TEST FOR PROSTATITIS

60
Q

TYPES OF URINE SPECIMEN

12 hr urine?

A

Addis count

61
Q

TYPES OF URINE SPECIMEN

4 hr urine/1st morning urine?

62
Q

TYPES OF URINE SPECIMEN

afternoon urine (2-4 pm)?

A

urobilinogen

UBG peaks in afternoon (diurnal variation)
*also bile pigments

63
Q

paramaters used to check if urine is adulterated?

64
Q

DRUG SPECIMEN COLLECTION

  1. process providing documentation of
    proper sample ID from the time of collection to the receipt of laboratory results
  2. Required urine volume?
  3. Container capacity:?
  4. Temperature?
  5. Added to the toilet water reservoir to prevent specimen adulteration?
A
  1. chain of custody
  2. 30-45 mL
  3. 60 mL
  4. 32.5-37.7oC – (checked within 4 minutes)
    5 . Blueing agent (dye)
65
Q

SPECIMEN INTEGRITY

Following collection, urine specimens should be delivered to the laboratory promptly and tested within _____ (Strasinger, Harr); ideally within ______ (Turgeon)

A

2 hrs; 30 mins

66
Q

CHANGES IN UNPRESERVED URINE

INCREASED?

A

“pBaON”

pH
Bacteria
Odor
Nitrite

67
Q

CHANGES IN UNPRESERVED URINE

DECREASED?

A

“TRUCKBGP”

Trichomonas - immotile
RBC/WBC/Cast - disintegrate
UBG - oxidized to urobilin
Color - ↑ urobilin
Ketones - volatized
Bilirubin - light exposure
Glucose - Glycolysis
Protein - least affected

68
Q

URINE PRESERVATIVES

-Precipitates amorphous phosphates and
urates
- routine urinalysis and urine culture
-Prevents bacterial growth for 24 hrs

A

Refrigeration

69
Q

URINE PRESERVATIVES

-Preserves glucose and sediments well

70
Q

URINE PRESERVATIVES

-Preserves protein
-For culture transport, C&S
-Does not interfere w routine analyses

A

Boric acid

71
Q

URINE PRESERVATIVES

-Excellent sediment preservative
- For Addis count

72
Q

URINE PRESERVATIVES

  • Floats on urine surface; clings to pipettes &
    testing materials
  • Best all-around preservative
A

Toluene (Toluol)

73
Q

URINE PRESERVATIVES

  • Prevents glycolysis
  • Good preservative for drug analysis
A

Sodium fluoride / Sodium benzoate

74
Q

URINE PRESERVATIVES

  • Causes an odor change
75
Q

URINE PRESERVATIVES

  • Used for cytology studies (50 mL urine)
  • Preserves cellular elements
A

Saccomanno fixative

76
Q

URINE PRESERVATIVES

composition of Saccomanno fixative

A

Saccomanno fixative (50% ethanol + 2%
carbowax)

77
Q

Variables in the creatinine clearance formula by
Cockgroft and Gault:

A

” SAWS “

sex
age
weight
serum creatinine

78
Q

Variables in the creatinine clearance formula by MDRD system:

MDRD = Modification of Diet in Renal Disease

A

“RAGS” or “BEA”
✓Race
✓Age
✓Gender
✓Serum Crea

5th Stras: “BEA”

✓BUN
✓Ethnicity
✓Albumin

79
Q

URINE VOLUME

Normal range (24 hours)?

A

600 to 2,000 mL OR 0.6 to 2 L

80
Q

URINE VOLUME

Average (24 hours)?

A

1,200 to 1,500 mL OR 1.2 - 1.5 L

81
Q

URINE VOLUME

Night urine output?

82
Q

URINE VOLUME

Day: Night ratio?

A

2-3:1

2-3 x a day : 1 x a nght

83
Q

URINE VOLUME

-Container capacity (UA) ?
-Required for routine UA ?

A

-50 mL
-10 to 15 mL; average: 12 mL (for urinometry and reagent strip)

84
Q

URINE VOLUME TERMINOLOGIES

-many
-Increased urine volume - >2,000 mL/24 hrs
-causes:
Increased fluid intake
Diuretics, nervousness
Diabetes mellitus = ↑ SG
Diabetes insipidus = ↓ SG

85
Q

URINE VOLUME TERMINOLOGIES

-few
-decreased urine volume - <500 mL/24 hrs.
-causes:
Dehydration
Renal diseases
Renal calculi or tumor

86
Q

URINE VOLUME TERMINOLOGIES

-absent
- complete cessation of urine flow <100mL/24hrs
-causes:
Complete obstruction (stones, tumors)
Toxic agents
Decreased renal blood flow

87
Q

URINE VOLUME TERMINOLOGIES

-night
-Excretion of more than 500 mL of urine at night - S.G.<1.018
-causes:
Pregnancy
Renal diseases
bladder stones
Prostate enlargement

88
Q

URINE VOLUME TERMINOLOGIES

-taod2 ihi
-Any increase in urine excretion
-causes:
Excessive water intake (polydipsia)
Diuretic therapy
hormonal imbalance
Renal dysfunction
drug ingestion

89
Q

Rough indicator of the degree of hydration
Should correlate with urine S.G.

A

Urine color

90
Q

Urine COLOR determination uses what?

A

good light source
against white BG

91
Q

Urine CLARITY determination uses what?

A
  • thoroughly mix spx
  • best: use printed paper
  • use good light source & can use against white BG but not best
92
Q

Clarity

-NO visible particulates, transparent

93
Q

Clarity

-Few particulates, print EASIly seen through urine

94
Q

Clarity

  • Many particulates, print BLURRED through urine
95
Q

Clarity

  • Print cannot be seen through urine
96
Q

Clarity

  • May precipitate or be clotted
97
Q

NORMAL PIGMENTS IN URINE

Major pigment (yellow)

98
Q

NORMAL PIGMENTS IN URINE

-Pink (or red)
- amorphous urates and uric acid crystals

A

Uroerythrin

99
Q

NORMAL PIGMENTS IN URINE

-Dark yellow/orange-brown
-old spxs

100
Q

NORMAL PIGMENTS IN URINE

colorless unless it is oxidized

101
Q

URINE COLOR

dark yellow

A

carotene/carrots/ royal

102
Q

URINE COLOR

  1. orange with yellow foam ; “Tea-colored urine”
  2. orange & viscous urine w/ orange foam
A
  1. Biliribun
  2. Phenazopyridine (Pyridium) - tx for UTI
103
Q

URINE COLOR

Yellow-green

A

Biliverdin

104
Q

URINE COLOR

Green

A

Pseudomonas infection

105
Q

URINE COLOR

Blue-Green

A

phenol; indican

106
Q

URINE COLOR

  1. hematuria (rbc) /renal lithiasis
  2. hemoglobinuria/intravascular hemolysis
  3. myoglobinuria/rhabdomyolysis
  4. rifampin & fuchsin
  5. beets (alk) & blackberries (acidic)
A
  1. cloudy/smoky red
  2. clear red
  3. clear red
  4. red
  5. red
107
Q

URINE COLOR

portwine

108
Q

URINE COLOR

  1. black & acidic urine?
  2. black & alkaline urine?
  3. black upon air exposure?
  4. milk white?
  5. bright yellow?
A
  1. methemoglobin
  2. homogentisic acid/alkaptonuria
  3. melanin (albinism)
  4. WBCs
  5. Riboflavin (multivitamins)
109
Q

LABORATORY CORRELATIONS IN URINE TURBIDITY

what can you see in Acidic Urine?

A

amorphous Urates
Radiographic contrast media

110
Q

LABORATORY CORRELATIONS IN URINE TURBIDITY

what can you see in Alkaline Urine?

A

amorphous Phosphates
Carbonates

111
Q

LABORATORY CORRELATIONS IN URINE TURBIDITY

crystals soluble w/ heat?

A

amorphous Urates
Uric acid crystals

112
Q

LABORATORY CORRELATIONS IN URINE TURBIDITY

SOLUBLE in acetic acid?

A

“PRC”

amorphous Phosphates
Rbc
Carbonates

113
Q

LABORATORY CORRELATIONS IN URINE TURBIDITY

INsoluble in Acetic Acid?

A

WBCs
bacteria
yeasts
Spermatozoa

114
Q

LABORATORY CORRELATIONS IN URINE TURBIDITY

Soluble in Ether?

A

Lymphatic fluid
lipids
chyle

115
Q

CAUSES OF URINE TURBIDITY (Pathologic)?

A
  1. rbc
  2. wbc
  3. bacteria
  4. yeast
  5. non-squamous EC
  6. abnormal crystals
  7. lymph fluid
  8. lipids
116
Q

URINE ODOR

Aromatic, faintly , fragrant

A

Normal (due to presence of volatile acids from food)

117
Q

URINE ODOR

Odorless

A

Acute tubular necrosis (acute renal failure)

118
Q

URINE ODOR

Foul, ammoniacal , pungent

A

UTI (ex. Proteus vulgaris)
old urine

119
Q

URINE ODOR

Fruity, sweet

A

Diabetes Mellitus
Ketones
starvation
vomiting

120
Q

URINE ODOR

Caramelized sugar, curry, maple syrup

A

Maple syrup urine disease (MSUD)

121
Q

URINE ODOR

Mousy, musty, barny

122
Q

URINE ODOR

Rancid butter

A

Tyrosinemia

123
Q

URINE ODOR

Sweaty feet, acrid

A

Isovaleric acidemia, glutaric acidemia

124
Q

URINE ODOR

Menthol-like

A

Phenol-containing medications

125
Q

URINE ODOR

Cabbage, hops (pampa-pait sa beer)

A

Methionine malabsorption (Oasthouse syndrome)

126
Q

URINE ODOR

Bleach

A

Specimen adulteration or container contamination

127
Q

URINE ODOR

Sulfur, rotten eggs

A

Cystine disorder

128
Q

URINE ODOR

Rotting fish; galunggong fish

A

Trimethylaminuria

129
Q

URINE ODOR

Pungent, fetid

A

Ingestion of onions, garlic, & asparagus
(methylmercaptan), UTI (Brunzel)

130
Q

URINE ODOR

Swimming pool (amoy chlorine)

A

Hawkinsinuria

131
Q

URINE ODOR

Cat urine

A

3-hydroxy-3-methylglutaric aciduria

132
Q

URINE ODOR

Tomcat urine

A

Multiple carboxylase deficiency

DL-CM (6 decks)

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