UNIT 1: Specimen Collection and Handling Flashcards
1
Q
Types of UTIs (5)
A
Cystitis
Urethritis
Pyelonephritis
Pyelitis
Glomerulonephritis
2
Q
Etiologic Agents
Enterics (3)
A
Proteus
Enterobacter
Klebsiella
3
Q
Etiologic Agents in Urine (6)
A
E. coli
Enterics
Enterococcus faecalis
Pseudomonas aeruginosa
Staphylococcus aureus
S. saprophyticus
4
Q
Preferred specimen used in Urine
A
Clean catch midstream
5
Q
Other specimens used in urine (3)
A
Straight catheterized urine
Suprapubic aspirates
Collection during cystoscopy
6
Q
Avoid collecting these 2 specimens in urine:
A
Random voided urine
Foley catheters
They are prone to contamination
7
Q
T/F: The first portion of the urine stream in clean catch method is the most concentrated, thus it is the preferred portion
A
False
It contains organisms in the urethra; Midstream is preferred
8
Q
UTIs
Inflammation of the bladder
A
Cystitis
9
Q
UTIs
Inflammation of the kidney
A
Pyelonephritis
10
Q
UTIs
Inflammation of the renal pelvis
A
Pyelitis
11
Q
UTIs
Inflammation of the glomeruli
A
Glomerulonephritis
12
Q
Specimens collected for urine (6)
A
First Morning
Random
Clean Catch Midstream Urine Specimen
Catheterized
Plastic Bag Collection
Suprapubic Aspiration
13
Q
Urine specimen collection method for newborns
A
Plastic Bag Collection
14
Q
T/F: First Morning Urine Specimen is the most concentrated
A
True
15
Q
Urine
The direct collection of uncontaminated urine from the bladder with the use of a syringe
A
Suprapubic Aspiration
16
Q
T/F: Suprapubic Aspiration is used for aerobic culture
A
False
Anaerobic culture
17
Q
The amount of urine left in the bladder after urination
A
Residual urine
18
Q
T/F: Females are less prone to bladder infections
A
False
19
Q
Colony count that indicates UTI
A
100,000 CFU/ml and above
20
Q
Urine culture
Incubation temperature and duration
A
35° for 18-24 hours
21
Q
Specimen used for the diagnosis of lower respiratory tract infections
A
Sputum
22
Q
Specimen used to diagnose bacterial pneumonia and pulmonary tuberculosis (PTB)
A
Sputum
23
Q
Essential volume of collected sputum specime
A
5-10 ml
24
Q
Sources of sputum sample (3)
A
Expectorated
Induced
Gastric contents
25
Source of sputum sample for **children**
Gastric contents
26
How many sputum samples should be collected for PTB?
2
27
Other specimens for **PTB** (3)
| Besides sputum
Trastracheal aspirate
Bronchioalveolar Lavage (BAL)
Bronchial washings
28
Sputum sample for other infections
Early morning specimen
29
T/F: Prior to **culture and sensitivity** examination, **pre-examine** the submitted sputum
True
30
Stain used in th microscopic examination of **sputum**
Gram Stain
31
Used to assess the quality of **sputum** as it takes into account the ratio of WBCs to squamous epithelial cells as well as the presence of mucus in the specimen
Bartlett's Classification
32
Bartlett's Classification for sputum (2)
...> 25 leukocytes/LPF
...< 10 epithelial cells/LPF
33
The **specimen of choice** for the diagnosis of **gastrointestinal pathogens**
Stool
34
T/F: **Rectal swabs** may be used if stool is present on the swab during sample collection
True
35
Stool pathogens (9)
C. jejuni
Salmonella
Shigella
E. coli (EHEC, ETEC, EPEC, EIEC)
Vibrio
Y. enterolitica
L. monocytogenes
C. difficile
Mycobacterium Avium Complex (MAC)
36
# Stool
EHEC stands for
Entero**hemorrhagic** Escherichia coli
37
# Stool
ETEC stands for
Entero**toxigenic** Escherichia coli
38
# Stool
EPEC stands for
Entero**pathogenic** Escherichia coli
39
# Stool
EIEC stands for
Entero**invasive** Escherichia coli
40
T/F: E. coli is a **non-pathogenic** normal flora
True
41
Stool pathogen detected in **water analysis** for fecal contamination
E. coli
42
**Blood** is used in the diagnosis of (5)
Fever of unknown origin (FUO)
Septicemia
Bacteremia
Typhoid Fever
Subacute Bacterial Endocarditis (SBE)
43
Blood should be collected before or after **fever spike**?
Both (before AND after)
44
T/F: **Blood** is used in both **aerobic** and **anaerobic** culture
True
45
Collection method for **blood** sample
Venipuncture
46
How many sites are used in blood collection?
2-3 different sites
| Left and right hands/feet
47
Volume of blood that should be collected in **adults**
20 ml
48
Volume of blood that should be collected in **pediatrics**
1-20ml (1-5ml)
49
Blood:Media Ratio
1:10
| 1 blood:9 medium
50
**Media of choice** for blood samples (2)
**Broth** (Brain Heart Infusion, Biphasic Media, Thioglycollate Broth, Commercially available bottles)
**Isolator system**
51
**Preferred anticoagulant** for blood samples
Sodium polyanethole sulfonate (SPS)
(0.025-0.030%)
52
Other anticoagulants used for **blood samples** (3)
Heparin
Sodium amylosulfate
Sodium citrate
53
T/F: EDTA is **antibacterial** and should not be used in blood cultures
T
54
**Body fluids** include (7)
Abdominal fluid
Amniotic fluid
Ascitic fluid
Bile
Synovial fluid
Pleural fluid
Pericardial fluid
55
Body fluids are collected by?
Needle aspiration
| (done by doctors only)
56
**Gastric tubes** used in collection of **gastric specimens** (2)
Levine Tubes
Rehfuss Tubes
57
Specimen used in the diagnosis of **meningitis** or **meningoencephalitis**
Cerebrospinal Fluid (CSF)
58
T/F: CSF specimen must be placed in a **biosafety cabinet**
T
| Because meningitis can be airborne (in droplets)
59
T/F: CSF specimen must be processed ASAP
T
60
Causative agents of **Meningitis** (5)
H. influenzae
N. meningitidis
S. pneumoniae
S. agalactiae
Listeria
61
Collection method for **CSF specimen**
Lumbar Tap
| 3rd-4th Lumbar Vertebra
62
CSF is placed in how many sterile tubes?
3
63
# CSF
Which tube is used for microbiology if there are 3 sterile tubes?
2nd tube
64
# CSF
Which tube is used for microbiology if there are 4 sterile tubes?
4th tube
65
Volume of CSF sample that should be collected
≥ 1 ml
66
T/F: If there is only 1 sterile tube of CSF collected for testing, then the sample must be rejected.
F
67
T/F: If there is 1 sterile tube of CSF collected for testing, you must use it for C&S **first** before other sections
T
68
# CSF
Accidental tapping of artery can lead to
RBC contamination
69
# Tissue Specimens
2 Types of biopsy
Excisional
Incisional
70
Collection method for **tissue specimens**
Biopsy
71
Tissue biopsy where the **entire** lesion is removed
Excisional biopsy
72
Tissue biopsy where only a **portion** of the lesion is removed
Incisional biopsy
73
T/F:
Aspirates - Anaerobic bacteria
Swabs - Aerobic bacteria
F
74
Transport of specimen to the laboratory is **ideally**:
30 minutes
75
Transport of specimens to the laboratory is preferably up to how many hours?
2 hours
| Except for **CSF specimens**
76
T/F: If specimens cannot be transported to the lab immediately, specimens must be added with preservatives, anticoagulants, or placed in transport/culture media
T
77
2 **preservatives** for specimen preservation
Boric Acid
Refrigeration
78
# Preservatives
**Boric Acid** and **Refrigeration** are bacteriostatic/bactericidal
Bacteriostatic
79
Maintains the viability of the specimen during transport to the lab
Transport Media/Holding Media
80
Transport Mediums (4)
Cary Blair
Stuart's or Amie's
JEMBEC Media
Gonopak
81
Antiphagocytic, anticomplementary anticoagulant that may inhibit some antimicrobials and certain bacteria
Sodium polyanethol sulfonate (SPS)
82
**Sodium polyanethol sulfonate (SPS)** inhibits certain bacteria, such as: (4)
Neisseria
Gardnerella vaginalis
Streptobacillus moniliformis
Peptostreptococcus anaerobius
83
2 **anticoagulants** used in preservation, storage, and transport of specimens
0.025%-0.03% Sodium polyanethol sulfonate (LIQUIOID)
Heparin
84
# Storage Temperature and Application
CSF for **viruses**
Refridgerator temperature
85
Refridgerator temperature
4 degree Celcius
86
Ambient/Room temperature
22 degree Celcius
87
Body temperature
37 degree Celcius
88
Freezer temperature
-20 or -70 degree Celcius
89
# Storage temperature and Application
Outer ear swab
Refridgerator temperature
90
# Storage temperature and Application
**Feces** for isolation of *Clostridioides difficile toxin*
Refridgerator temperature
91
# Storage temperature and Application
Sputum
Refridgerator temperature
92
# Storage temperature and Application
Catheter tips
Refridgerator temperature
93
# Storage temperature and Application
CSF for **bacteria**
Ambient/Room temperature
94
# Storage temperature and Application
Abcess, lesion, wounds
Ambient/Room temperature
95
# Storage temperature and Application
Body fluids
Ambient/Room temperature
96
# Storage temperature and Application
**Preserved** urine and stool
Ambient/Room temperature
97
# Storage temperature and Application urine and stool
**Unpreserved** urine and stool
Refridgerator temperature
98
# Storage temperature and Application urine and stool
Nasal specimens
Ambient/Room temperature
99
# Storage temperature and Application urine and stool
Tissue samples
Refridgerator temperature
100
# Storage temperature and Application urine and stool
CSF
Body temperature
101
# Storage temperature and Application urine and stool
Serum for Serology
Freezer temperature
(-20 C)
102
# Storage temperature and Application urine and stool
Long term storage
Freezer temperature
(-70 C)
103
T/F: Difficult samples can be rejected
F
| Confirm with the physician first
104
Examples of difficult specimens (2)
CSF
Surgical biopsies
105
# Specimen Priority
Critical/Invasive
Level 1
106
# Specimen Priority
Unpreserved
Level 2
107
# Specimen Priority
Quantitation required
Level 3
108
# Specimen Priority
Preserved
Level 4
109
# Specimen Priority
Batch Processing
Level 5
110
# Specimen Priority
Level 1 (4)
CSF
Amniotic fluid
Blood
Pericardial fluid
111
# Specimen Priority
Level 2 (3)
Feces
Sputum
Tissue
112
# Specimen Priority
Level 3 (2)
Urine
Tissue for quantification
113
# Specimen Priority
Level 4 (3)
Feces in preservative
Urine in preservative
Swabs in holding/transport medium
114
# Specimen Priority
Level 5
Sputum/AFB culture
115
Which specimen level should be the priority?
Level 1 - Critical/Invasive
116
# Selection of Appropriate Culture Medium
Isolation of **gram-positive** and **gram-negative anaerobes**
Anaerobic phenylethyl alcohol agar
117
# Selection of Appropriate Culture Medium
Isolation of **gram-negative anaerobes**
Anaerobic kanamycin-vancomycin agar
118
# Selection of Appropriate Culture Medium
Isolation of **Bordetella pertussis** (2)
Bordet-Gengou media
Regan-Lowe agar
119
# Selection of Appropriate Culture Medium
**Enrichment** used to isolate **Legionella**
Buffered charcoal yeast extract (BCYE)
120
# Selection of Appropriate Culture Medium
Isolation of **Campylobacter**
Campy blood agar
121
# Selection of Appropriate Culture Medium
Enriched, nonselective medium to isolate fastidious organisms
Chocolate agar
122
# Selection of Appropriate Culture Medium
Isolation of **Neisseria** and **Haemophilus**
Chocolate agar
123
# Selection of Appropriate Culture Medium
Isolation of **Yersinia species**
Cefsulodin-Irgasan-novobiocin agar (CIN agar)
124
# Selection of Appropriate Culture Medium
Isolation of **gram-positive bacteria**
Colistin-nalidixic acid agar
125
# Selection of Appropriate Culture Medium
Differential: isolation of **gram-negative bacilli** and differentiation of l**actose fermenters** from **non-lactose fermenters** (2)
Eosin-methylene blue agar
MacConkey agar
126
# Selection of Appropriate Culture Medium
Enrichment broth to enhance recovery of **stool pathogens** and inhibit normal flora coliforms (3)
Gram-negative broth
Selenite broth
Tetrathionate broth
127
# Selection of Appropriate Culture Medium
**Selective:** isolation of stool pathogens through inhibition of normal flora coliforms (2)
Hektoen enteric agar
Salmonella-Shigella agar
128
# Selection of Appropriate Culture Medium
Primary isolation medium for Mycobacterium
Löwenstein-Jensen medium
Middlebrook medium
Petragnani's medium
129
# Incubation Conditions
Usual incubation time for most bacteria
18-24 hours
37 degrees C
130
# Incubation Conditions
Pseudomonas aeruginosa
Campylobacter jejuni
42 degrees C
131
Listeria monocytogenes
Yersinia enterocolitica
4 degrees C
(Cold enrichment medium)
132
# Incubation Conditions
**Aerobic bacteria** e.g. P. aeruginosa
Ambient air
(21% oxygen)
133
# Incubation Conditions
**Anaerobic bacteria** e.g. Fusobacterium, Bacteroides, Clostridium
Use of **anaerobic jars**
(Gas-Pak, Brewer Jar, Glove Box method, Biobag System)
134
# Incubation Conditions
Enterics
Facultative anaerobes
135
# Incubation Conditions
Capnophiles
Candle Jar
136
# Incubation Conditions
Requires **5-10% carbon dioxide** to grow
Capnophiles
137
# Incubation Conditions
Requires **reduced oxygen (5-6%)**
Microaerophiles eg. Campylobacter jejuni, Helicobacter pylori
138
# Incubation Conditions
21% Oxygen, 0.03% CO2
Aerobic Bacteria
139
# Incubation Conditions
0% oxygen
Anaerobe
140
# Incubation Conditions
5-10% CO2; 15% Oxygen
Capnophiles
141
# Incubation Conditions
5-6% or 5-10% Oxygen
Microaerophiles
142
**Critical results** that should be reported immediately
Panic Values
143
# Enumeration
Panic Values
Positive:
Blood Culture
CSF Gram Stain or Culture
**S. pyogenes** in surgical wound
Gr Staining suggestive of **gas gangrene**
Blood Smear for **Malaria**
Cryptococcal Antigen Test
AFS
Detection of select agents such as **Brucella** or other significant pathogen
144
A protein that can only be killed via incineration; causes CJD
Prions
145
# Selection of Appropriate Culture Medium
Isolation and differentiation of **Vibrio**
Thiosulfate-citrate-bile salts-sucrose agar
146
# Selection of Appropriate Culture Medium
Isolation of **Neisseria gonorrhoeae** (2)
Martin-Lewis medium
Modified Thayer-Martine agar
147
# Selection of Appropriate Culture Medium
**All-purpose** isolation media; **subculture** from primary plate
Trypticase soy agar
148
# Selection of Appropriate Culture Medium
Enriched broth that permits growth at **various oxygen levels**
Thioglycolate broth
