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Lab Medicine > UA and Wet Prep > Flashcards

UA and Wet Prep Flashcards

1
Q

Who should get a UA?

A
  • Anyone with urinary symptoms
  • Abdominal Pain
  • Vaginal Complaints
  • Back Pain
  • Fever
  • Dizziness
  • HTN
  • DM
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2
Q

Results of the UA will see?

A
  1. Macroanalysis (Gross Description)
  2. Chemical Analysis (Dipstick)
  3. Microanalysis
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3
Q

Results from the Macroanalysis part of the UA

A
  • Color
  • Odor (rarely reported)
  • Turbidity (clear, cloudy, opaque, etc.)
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4
Q

Results from the Dipstick Test part of the UA

A
  • Glucose
  • Bilirubin
  • Urobilinogen
  • Ketones
  • Blood
  • Leukocytes
  • Nitirie
  • Protein
  • Specific Gravity
  • pH
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5
Q

Results of the Microanalysis part of the UA

A
  • Bacteria
  • WBC
  • RBC
  • Crystals
  • Casts (Hyaline, RBC, WBC)
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6
Q

What might an abnormality indicate if seen in:

Glucose of Dipstick Analysis

A

> 180 mg/dL = Positive

Indicated Elevated Blood Sugar

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7
Q

What might an abnormality indicate if seen in:

Bilirubin of Dipstick Analysis

A

Blue or Green Colored Urine

Intrahepatic Cholestasis (or other Liver/Bile Duct issue)

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8
Q

What might an abnormality indicate if seen in:

Urobilinogen of Dipstick Analysis

A

By itself = Hemolytic Process

With Bilirubin = Cirrhosis

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9
Q

What might an abnormality indicate if seen in:

Ketones of Dipstick Analysis

A

Indicates Abnormal Carbohydrate Metabolism

  • With Glucose = DKA (DM I)
  • Starvation/Dehydration
  • No Carb Diets
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10
Q

What might an abnormality indicate if seen in:

Blood of Dipstick Analysis

A

Sensitive for Myoglobin, Hemoglobin, or RBC. Need Microanalysis for more information.

False Positive: Too much Vitamin C

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11
Q

What might an abnormality indicate if seen in:

Leukocytes of Dipstick Analysis

A

Indicates Pyuria (UTI)

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12
Q

What might an abnormality indicate if seen in:

Nitrite of Dipstick Analysis

A

Indirect Indicator of UTI

** E. coli, Enterobacter, Proteus (common UTI pathogens) convert Nitrate to Nitrite.

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13
Q

What might an abnormality indicate if seen in:

Protein of Dipstick Analysis

A
  • Sometimes caused by Fever or Exercise
  • Tubular Dz
  • Diabetic Nephropathy
  • HTN Nephropathy
  • Glomerulonephritis
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14
Q

What might an abnormality indicate if seen in:

Bacteria of Microanalysis

A

UTI

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15
Q

What might an abnormality indicate if seen in:

WBC of Microanalysis

A

Pyuria (UTI)

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16
Q

What might an abnormality indicate if seen in:

RBC of Microanalysis

A
  • Might be present during Menses
  • Kidney Stone
  • UTI
  • Bladder Cancer

Ref to Uro?

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17
Q

What might an abnormality indicate if seen in:

Casts of Microanalysis

A

Benign

Commonly seen in patients who exercise a lot.

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18
Q

What might an abnormality indicate if seen in:

WBC Casts of Microanalysis

A

Pathomnemonic for Pyelonephritis

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19
Q

What might an abnormality indicate if seen in:

RBC Casts of Microanalysis

A

Patho mnemonic for Glomerulonephritis

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20
Q

When to order Microanalysis?

A

Positive Blood, Leuks, Nitrite, and/or Protein

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21
Q

If the patient is on _____, what will happen to the Dipstick Analysis? What should you do next?

A

Azo; Alter; Move straight to Microanalysis Results

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22
Q

More Alkaline Urine would indicate:

A
  • UTI
  • Drug Use
  • Resp or Metabolic Alkalosis
  • Vegetarians
23
Q

More Acidic Urine would indicate

A
  • Drug Use
24
Q

If the urine specific gravity is high, then what are you thinking?

A

Dehydration

25
Q

If a kidney stone is less than _____ cm, then we expect it to pass on its own.

A

7

26
Q

Benefit of the CT Scan for Kidney Stones

A
  • Size of stone

- Hydronephrosis?

27
Q

How do you treat a pt with Kidney Stones?

A

Treat Pain and Nausea!!

  • Toradol
  • Narcotics (Morphine, Dilaudid)
  • Fluids
28
Q

If a CT Scan is completed and there is an obstructed Kidney Stone, what should we order/check?

A

Creatinine Levels to see how the Kidney is doing

29
Q

When a geriatric patient comes in with acutely altered mental status with or without fever, what should you think?

A

UTI

30
Q

How do you treat a geriatric patient with UTI?

A
  • Nitrofurantin
  • Bactrim
  • Macrobid
  • Fluoroquinolones
31
Q

Teenage patient presents with markedly elevated glucose and large ketones with acidic urine. What are you thinking?

A

DKA

32
Q

What other Physical Exam Findings are present with DKA?

A
  • Sweet Breath
  • Tachypnea (compensate for Metabolic Acidosis)
  • Rigid Abdomen
  • Vomiting
33
Q

What other labs would be abnormal on a patient with DKA?

A
  • Electrolytes (Inc. K+ and Dec. Na+) very abnormal

- HbA1C abnormal

34
Q

How do you treat DKA?

A
  1. IV Fluids (2L bolus)
  2. IV Insulin

**You may have to give K+ if it’s excessively high extracellularly

35
Q

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?

A

Pyelonephritis

36
Q

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?

A

Creatinine levels, because we need to check the health of the single kidney remaining. We are thinking pyelonephritis, we cannot compromise this kidney.

37
Q

This is the term for a slide prepared with normal saline and/or KOH to look for possible vaginal infection.

A

Wet Prep

38
Q

Who needs to get a wet prep?

A
  • 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.
39
Q

How to perform a Wet Prep?

A
  1. Specimen is collected with a swab or spatula
  2. Add normal saline and/or KOH
  3. Evaluate slide under the microscope
40
Q

What are you looking for in a wet prep?

A
  • Candida/Yeast
  • Trichomonas
  • Bacterial Vaginosis
  • WBC
  • RBC
41
Q

This is the term for an epithelial cell that is covered in bacteria.

A

Clue Cell

42
Q

What makes a person susceptible to a vaginal yeast infection?

A
  • DM
  • Immunosuppression
  • Recent Abx Use
43
Q

Common Vaginal Yeast causing Infection

A

Candida Albicans

44
Q

Clinical Presentation of Candida/Yeast Infections

A
  • Vulvar Pain
  • Vaginal Pain
  • Swelling
  • Pruritus
  • Thick, white discharge (Cottage Cheese)
  • Vulvar Erythema
  • Edema
  • Excoriations?
45
Q

How is a yeast (candida) infection best seen?

A
  • Wet Prep with KOH

- Budding Yeast and Hyphae

46
Q

Treatment of Candida/Yeast Infection

A
  1. Topical Antifungals
    - - Myconazole
    - - Terconazole
    - - Clotrimazole
  2. Oral Antifungals
    - - Fluconazole
47
Q

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.

A

Trichomonas

48
Q

Clinical Presentation of Trichomonas

A
  • 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.
49
Q

How is a trichomonas infection best seen?

A
  • Normal Saline Preparation
  • Flagellated, Mobile Protozoa
  • Oval, Slightly Larger than a WBC

*Best seen in less than 30 minutes from discharge collection

50
Q

Treatment of Trichomonas

A
  • Oral Metronidazole

- ? Metrogel Vaginal

51
Q

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).

A

Bacterial Vaginosis (BV, Gardnerella)

52
Q

Clinical Presentation of BV

A
  • Malodorous Vaginal Discharge
  • Unremarkable External Exam
  • Speculum Exam may or may not reveal discharge
53
Q

How is a BV infection best seen?

A
  • 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)

54
Q

Treatment of BV

A
  • Oral Metronidazole
  • Topical Metronidazole
  • Topical Clindamycin

Lab Medicine (7 decks)

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