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Chemistry 2.0 > Urinalysis > Flashcards

Urinalysis Flashcards

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1
Q

What are three reasons urines provide testing significance in clinical setting?

A
  • diagnosis of disease
  • monitoring the progress of disease
  • monitor the effectiveness of therapy
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2
Q

What is a random urine specimen?

A

Urine sample taken at any time of the day, no fasting

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3
Q

What is a first morning urine specimen?

A

Urine sample taken when the patient wakes up, prior to any other voiding.

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4
Q

What is a timed urine specimen?

A

A urine specimen that is taken at a specific time of day.

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5
Q

What is a 24 hour urine specimen and what purpose does it serve?

A

Urine sample taken over the course of 24 hours. It measures the total volume of solutes excreted and shows diurnal variation.

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6
Q

If there is a delay in testing urine samples what should be done to maintain its integrity?

A

Refrigerate between 4-8C

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7
Q

If there is a delay in transportation of urine samples what should be done to maintain its integrity?

A

refrigerate for 24 hours prior to transportation, and place in a bacteriostatic preservative.

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8
Q

If there urine specimens are to be transported over long distances what should be done to maintain it’s integrity?

A

Refrigerate for 24 hours prior to transportation, and place in a bacteriostatic preservative.
- Dip an agar film which is sent with the urine container.

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9
Q

List three things that could deteriorate the integrity of reagent test strips?

A
  • exposure to light
  • exposure to room humidity
  • touching the reagent test pads
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10
Q

During what time frame should urines be tested in?

A

Within 2 hours

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11
Q

What two elements in a urine cannot be tested for if the urine has been refrigerated?

A
  • Bilirubin
  • Urobilinogen
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12
Q

What can two elements can precipitate due to refrigeration of urines? What interference may they cause?

A

Amorphous urates and phosphates
- cause interference when microscopically examining urine.

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13
Q

At what speed and what time are urines centrifuged for?

A

5 minutes
See SOP, or owner manual for the RCF at which urines are to be spun at.

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14
Q

When performing QC why should your positive reagent produce weak positive reactions?

A

For early detection of disease and elevated results

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15
Q

What is the preferred urine sample? For what reason?

A

First morning sample
- Concentrated (incubation)
- higher amounts of formed elements = easily detectable

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16
Q

What four things determine if a urine requires microscopic evaluation?

A
  • Protein
  • RBC
  • WBC
  • Nitrites
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17
Q

What are you looking for on low power fields, in a urine microscopic analysis ?

A
  • crystals
  • enumeration of casts
  • Elements in few fields
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18
Q

What are you looking for on high power fields, in urine microscopic analysis?

A
  • # cells
  • # bacteria
  • # crystals
  • # parasites
  • classification of casts
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19
Q

How are RBC, WBC, Epithelial cells and Casts graded during microscopic analysis?

A

Scale 0-100, >100, Packed field

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20
Q

How are Bacteria, Crystals and mucous strands graded during microscopic analysis?

A

1+
2 +
3+

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21
Q

How are Spermatozoa and yeast graded during microscopic analysis?

A

Not Present (Do not indicate)
Present

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22
Q

What is a clean catch sample? why is this the idea way of collecting urine specimens?

A
  • Midstream catch, requiring disinfection of the urethral opening prior to voiding
  • Best for non contaminated specimens as well as routine and bacteriologic evaluation.
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23
Q

What do you call a sample collected through the insertion of tubing into the bladder to facilitate voiding?

A
  • catheter specimens
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24
Q

What do you call a sample that has been collected by needle insertion into the distended bladder and for what reason would this be ordered?

A
  • Suprapubic urine collection
  • Useful for children and infants
  • avoids contamination from urethra and vagina
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25
Q

What are four common preservatives used on urines?

A
  • Boric acid
  • HCL
  • Chlorhexidine
  • Formalin
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26
Q

What kind of urine is best for the determination of pregnancy in terms of specimen preservation?

A

Un preserved

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27
Q

You’ve received a urine sample in the lab and set it down on the bench behind you, your charge tech approaches you with a list of stat orders from emerge he needs you to run immediately. After a few hours you realized you forgot to run the urine that you left on the bench. What results do you expect to see when you finally run the urine?

A

Inaccurate results because
- formed elements have deteriorated
- bilirubin and urobilinogen are unstable = untestable
- Glucose is decreased due to bacteria
- lysis of the cells
- increased pH

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28
Q

What are 3 reasons a urine might be abnormal?

A
  • Medication
  • diet
  • disease
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29
Q

What are reasons for a pale coloured urine?

A

dilute
diuretics

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30
Q

What are reasons for a red urine?

A

blood
hemoglobinuria
myoglobinuria

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31
Q

What are reasons for a brown or black urine?

A

RBC
Heme pigments
age/pH

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32
Q

What are reasons for a Yellow- green urine?

A

bilirubin metabolism

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33
Q

What does the presence of foam in a urine sample indicative of?

A

high protein

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34
Q

How do you measure the concentration of urine? which out of the two is better and why?

A
  • SG + Osmolality
  • Osmo is better bc not effected by small [glucose/protein]
35
Q

what is the normal range of SG?

A

1.003 - 1.035

36
Q

What is the purpose of testing SG and Osmo?

A

Measure the kidneys concentrating and diluting abilities.

37
Q

What may falsely increase urine concentration results when performing SG/ Osmo?

A

radiographic dyes

38
Q

What are the 9 things a urine dipstick will test for?

A

pH
Protein
Glucose
Ketones
Occult Blood
Bilirubin
Urobilinogen
Nitrites
Leukocyte esterase

39
Q

What organ is responsible for the pH of urine?

A

Kidney maintains the a constant pH of the blood stream by compromising the pH of the urine.

40
Q

What is the normal range of urine pH?

A

4.6 - 8.0

41
Q

What does high protein levels in urine indicate?

A

renal disease

42
Q

What protein is not normally secreted into urine?

A

Albumin

43
Q

What is the urine dipstick sensitive for when test for proteins in urine?

A

Albumin

44
Q

What do you have to keep in mind when testing solutes in urines. ( ex. pale urines vs dark amber urines)

A

Should correlate the physical results from the dipstick with the macroscopic of the urine.
A dilute urine with trace amounts of protein is significant.

45
Q

What are two things that can falsely increase protein in urine analysis?

A

Alkaline pH
Leaving dipstick in urine too long

46
Q

What are two things that can falsely decrease protein in urine analysis?

A

Dilute urines
Other proteins other than albumin

47
Q

What are three in vivo factors that can affect glucose levels?

A
  • blood glucose levels
  • GFR
  • tubular reabsorption
48
Q

What kind of reaction happens on the dipstick for glucose?

A

Enzymatic reaction that is continuous must be checked at specified time.

49
Q

What are two reason glucose may be falsely decreased when testing urines?

A
  • cold temp (decrease enzymatic activity)
  • High SG + High pH
50
Q

What are two reason glucose may be falsely increased when testing urines?

A

peroxide / bleach
high urobilinogen

51
Q

What are the 4 reducing substances that can be tested?

A

Galactose
Lactose
Fructose
Maltose

52
Q

How are reducing substances tested for?

A

Copper reduction test

53
Q

What glucose reducing substance that cannot be tested for is?

A

Sucrose

54
Q

What are two reason reducing agents may be falsely decreased when testing urines?

A

high protein
x-ray contrast media

55
Q

What are two reason reducing agents may be falsely increased when testing urines?

A

high Vit.C
Formalin

56
Q

What are the three forms of ketones? which one is reagent test strips sensitive for in urines?

A

Acetone, Diacetic acid, B-hydroxybutyrate
- Diacetic acid

57
Q

What ketone is most definitely not tested for?

A

B-hydroxybutyrate

58
Q

What are two reason ketones may be falsely increased when testing urines?

A

high levels of pigment
high SG with low pH

59
Q

What is a false negative for ketones?

A

The presence of acetone

60
Q

What is hematuria?

A

Presence of blood in the urine

61
Q

What is myoglobinuria?

A

presence of heme protein from striated muscle, due to injury of the skeletal muscles/ tissue.

62
Q

What are two reason occult blood may be falsely decreased when testing urines?

A

failure to mix sample
high Vit.C

63
Q

What are two reason occult blood may be falsely increased when testing urines?

A

bleach
bacteria

64
Q

What is the presence of bilirubin in the urine indicative of?

A

obstructive/ hepatic jaundice
hemoglobin breakdown with the inability to convert it to urobilinogen.

65
Q

How is urobilinogen formed?

A

Bacterial decomposition of bilirubin in the GI that is reabsorbed into circulation and brought to the liver then to the kidneys to filtrate out into the urine.

66
Q

What are two reason bilirubin may be falsely decreased when testing urines?

A

Vit.C
Light

67
Q

What are two reason bilirubin may be falsely increased when testing urines?

A

wait to long to read
metabolites (drugs)

68
Q

What are two reason urobilinogen may be falsely decreased when testing urines?

A

High nitrite
formalin

69
Q

What is one reason urobilinogen may be falsely increased when testing urines?

A

high bilirubin

70
Q

If nitrites come back positive, what do you expect to find microscopically?

A

Bacteria

71
Q

What are two reason nitrites may be falsely decreased when testing urines?

A

Vit.C
high SG

72
Q

What are two reason nitrites may be falsely increased when testing urines?

A

urine is allowed to stand
red urines

73
Q

The increased presence of what WBC with give off a positive result for leukocyte esterase?

A

Neutrophils

74
Q

What are two reason leukocyte esterase may be falsely decreased when testing urines?

A

high SG
Glucose + protein

75
Q

What are two reason leukocyte esterase may be falsely increased when testing urines?

A

vaginal discharge
detergents

76
Q

What are ghost cells?

A

RBC that have been lysed

77
Q

What are two reasons you might see ghost cells under the microscope?

A
  • Alkaline urine
  • dilute / hypotonic urine
78
Q

What might you see in hypertonic urines?

A

RBC crenation

79
Q

What might you see under the microscope in a patients urine presenting with an acute infection?

A

Lots of WBC and WBC clumping

80
Q

What are three different kinds of epithelial cells you might see under the microscope?

A

Renal tubular
Transitional
Squamous

81
Q

What microorganism might you see in urines?

A
  • Bacteria
  • Yeast
  • Parasites
82
Q

What are the most common crystal found in acidic urines? and which ones polarizes light?

A

Uric acid - PL
Calcium Oxalate
amorphous urates

83
Q

What crystals might you see in alkaline urines? and which ones polarize light?

A

triple phosphate - PL
amorphous phosphate
calcium carbonate
calcium phosphate
ammonium biurate

84
Q

What are the 7 casts that can be seen in urines?

A

Hyaline
RBC
WBC
Epithelial cell
granular
waxy
Fatty

Chemistry 2.0 (5 decks)

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