UA and Wet Prep Flashcards
Who should get a UA?
- Anyone with urinary symptoms
- Abdominal Pain
- Vaginal Complaints
- Back Pain
- Fever
- Dizziness
- HTN
- DM
Results of the UA will see?
- Macroanalysis (Gross Description)
- Chemical Analysis (Dipstick)
- Microanalysis
Results from the Macroanalysis part of the UA
- Color
- Odor (rarely reported)
- Turbidity (clear, cloudy, opaque, etc.)
Results from the Dipstick Test part of the UA
- Glucose
- Bilirubin
- Urobilinogen
- Ketones
- Blood
- Leukocytes
- Nitirie
- Protein
- Specific Gravity
- pH
Results of the Microanalysis part of the UA
- Bacteria
- WBC
- RBC
- Crystals
- Casts (Hyaline, RBC, WBC)
What might an abnormality indicate if seen in:
Glucose of Dipstick Analysis
> 180 mg/dL = Positive
Indicated Elevated Blood Sugar
What might an abnormality indicate if seen in:
Bilirubin of Dipstick Analysis
Blue or Green Colored Urine
Intrahepatic Cholestasis (or other Liver/Bile Duct issue)
What might an abnormality indicate if seen in:
Urobilinogen of Dipstick Analysis
By itself = Hemolytic Process
With Bilirubin = Cirrhosis
What might an abnormality indicate if seen in:
Ketones of Dipstick Analysis
Indicates Abnormal Carbohydrate Metabolism
- With Glucose = DKA (DM I)
- Starvation/Dehydration
- No Carb Diets
What might an abnormality indicate if seen in:
Blood of Dipstick Analysis
Sensitive for Myoglobin, Hemoglobin, or RBC. Need Microanalysis for more information.
False Positive: Too much Vitamin C
What might an abnormality indicate if seen in:
Leukocytes of Dipstick Analysis
Indicates Pyuria (UTI)
What might an abnormality indicate if seen in:
Nitrite of Dipstick Analysis
Indirect Indicator of UTI
** E. coli, Enterobacter, Proteus (common UTI pathogens) convert Nitrate to Nitrite.
What might an abnormality indicate if seen in:
Protein of Dipstick Analysis
- Sometimes caused by Fever or Exercise
- Tubular Dz
- Diabetic Nephropathy
- HTN Nephropathy
- Glomerulonephritis
What might an abnormality indicate if seen in:
Bacteria of Microanalysis
UTI
What might an abnormality indicate if seen in:
WBC of Microanalysis
Pyuria (UTI)
What might an abnormality indicate if seen in:
RBC of Microanalysis
- Might be present during Menses
- Kidney Stone
- UTI
- Bladder Cancer
Ref to Uro?
What might an abnormality indicate if seen in:
Casts of Microanalysis
Benign
Commonly seen in patients who exercise a lot.
What might an abnormality indicate if seen in:
WBC Casts of Microanalysis
Pathomnemonic for Pyelonephritis
What might an abnormality indicate if seen in:
RBC Casts of Microanalysis
Patho mnemonic for Glomerulonephritis
When to order Microanalysis?
Positive Blood, Leuks, Nitrite, and/or Protein
If the patient is on _____, what will happen to the Dipstick Analysis? What should you do next?
Azo; Alter; Move straight to Microanalysis Results
More Alkaline Urine would indicate:
- UTI
- Drug Use
- Resp or Metabolic Alkalosis
- Vegetarians
More Acidic Urine would indicate
- Drug Use
If the urine specific gravity is high, then what are you thinking?
Dehydration
If a kidney stone is less than _____ cm, then we expect it to pass on its own.
7
Benefit of the CT Scan for Kidney Stones
- Size of stone
- Hydronephrosis?
How do you treat a pt with Kidney Stones?
Treat Pain and Nausea!!
- Toradol
- Narcotics (Morphine, Dilaudid)
- Fluids
If a CT Scan is completed and there is an obstructed Kidney Stone, what should we order/check?
Creatinine Levels to see how the Kidney is doing
When a geriatric patient comes in with acutely altered mental status with or without fever, what should you think?
UTI
How do you treat a geriatric patient with UTI?
- Nitrofurantin
- Bactrim
- Macrobid
- Fluoroquinolones
Teenage patient presents with markedly elevated glucose and large ketones with acidic urine. What are you thinking?
DKA
What other Physical Exam Findings are present with DKA?
- Sweet Breath
- Tachypnea (compensate for Metabolic Acidosis)
- Rigid Abdomen
- Vomiting
What other labs would be abnormal on a patient with DKA?
- Electrolytes (Inc. K+ and Dec. Na+) very abnormal
- HbA1C abnormal
How do you treat DKA?
- IV Fluids (2L bolus)
- IV Insulin
**You may have to give K+ if it’s excessively high extracellularly
Patient presents with CVA Tenderness, Suprapubic Tenderness and Shivering. Has a hx of single kidney removal and partial hysterectomy.
UA Dipstick shows large blood, markedly elevated leuks.
What are you thinking?
Pyelonephritis
Patient presents with CVA Tenderness, Suprapubic Tenderness and Shivering. Has a hx of single kidney removal and partial hysterectomy.
UA Dipstick shows large blood, markedly elevated leuks.
What else should be evaluated in this patient?
Creatinine levels, because we need to check the health of the single kidney remaining. We are thinking pyelonephritis, we cannot compromise this kidney.
This is the term for a slide prepared with normal saline and/or KOH to look for possible vaginal infection.
Wet Prep
Who needs to get a wet prep?
- Women with symptoms
- Women that are preggo
- Women that are found to incidentally have discharge or cervicitis on exam.
- Women with recurring UTIs that are not responding to abx.
How to perform a Wet Prep?
- Specimen is collected with a swab or spatula
- Add normal saline and/or KOH
- Evaluate slide under the microscope
What are you looking for in a wet prep?
- Candida/Yeast
- Trichomonas
- Bacterial Vaginosis
- WBC
- RBC
This is the term for an epithelial cell that is covered in bacteria.
Clue Cell
What makes a person susceptible to a vaginal yeast infection?
- DM
- Immunosuppression
- Recent Abx Use
Common Vaginal Yeast causing Infection
Candida Albicans
Clinical Presentation of Candida/Yeast Infections
- Vulvar Pain
- Vaginal Pain
- Swelling
- Pruritus
- Thick, white discharge (Cottage Cheese)
- Vulvar Erythema
- Edema
- Excoriations?
How is a yeast (candida) infection best seen?
- Wet Prep with KOH
- Budding Yeast and Hyphae
Treatment of Candida/Yeast Infection
- Topical Antifungals
- - Myconazole
- - Terconazole
- - Clotrimazole - Oral Antifungals
- - Fluconazole
This is a parasitic gynecological infection. It may also infect urethra and urinary bladder in both men and women. It is a common STD in the US.
Trichomonas
Clinical Presentation of Trichomonas
- Commonly asymptomatic
- Green/Yellow, Foul, Thin Vaginal Discharge
- Dysuria
- Dyspareunia
- Pruritus
- Vulvar Erythema
- Speculum - Thin, Malodorous Discharge of Green or Yellow Color
- Strawberry Petichiae may be present alone the vaginal walls and on the cervix.
How is a trichomonas infection best seen?
- Normal Saline Preparation
- Flagellated, Mobile Protozoa
- Oval, Slightly Larger than a WBC
*Best seen in less than 30 minutes from discharge collection
Treatment of Trichomonas
- Oral Metronidazole
- ? Metrogel Vaginal
This is an abnormal overgrowth of an anaerobic species within the vagina (Gardnerella, mycoplasma, etc.). It is also assc with a reduction of the normal vaginal flora (lactobacillus).
Bacterial Vaginosis (BV, Gardnerella)
Clinical Presentation of BV
- Malodorous Vaginal Discharge
- Unremarkable External Exam
- Speculum Exam may or may not reveal discharge
How is a BV infection best seen?
- Saline Prep most helpful in identifying “clue cells,” which are reliable indicators of the presence of BV
- Add KOH to get a positive “whiff test.”
May also test pH: >4.5 for BV
(Normal pH: < 4.5)
Treatment of BV
- Oral Metronidazole
- Topical Metronidazole
- Topical Clindamycin
