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Diagnostic M.'s Sara Peer mentor > Urinalysis > Flashcards

Urinalysis Flashcards

1
Q

What are the types of Urine specimens that can be collected?

A 
Random or spot urine 
Clean catch urine
Straight catheter specimen
Indwelling catheter specimen
Suprapubic specimen
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2
Q

What do we evaluate when performing Urinalysis (UA)?

A

Physical examination of urine
Chemical testing of urine
Microscopic examination of urine

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3
Q

What other tests can be performed on urine?

A

Urine culture and sensitivities (C&S)

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4
Q

What are the indications for urinalysis?

A

Diagnostic screening
Monitoring or renal disease or metabolic disease
S/S of urinary tract diseases
S/S of urinary tract infection = abdonminal pain, back pain, dysuria, hematuria, urinary frequency
S/S of infection including fever and leukocytosis

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5
Q

What is looked at on physical examination of urine?

A

Color
Appearance
Specific gravity

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6
Q

What is normal urine color due to?

A

Urochrome

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7
Q

What can cause urine to be red?

A 
Beets
Hemoglobinuria
Blood
Propofol
Chemotherapy
Ex-lax
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8
Q

What can cause urine to be orange?

A

Vitamin C
Rifampin
Phenazopyridine

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9
Q

What can cause urine to be green?

A

Asparagus
Propofol
Utis
Methylene Blue

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10
Q

What can cause urine to be blue?

A

Methylene blue
Indomethacin
Blue diaper syndrome

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11
Q

What can cause urine to be purple?

A

Utis in patient with catheters

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12
Q

What can cause urine to be brown?

A

Fava bean
Levodopa
Metronidazole
Hepatobiliary disease

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13
Q

What can cause urine to be black?

A

Alkaproteinuria

Melanoma

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14
Q

What is the specific gravity of urine and what is it measured by?

A

Density of urine

A Refractom eter test

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15
Q

What does a urine dipstick test?

A 
Specific Gravity
pH
Leukocyte esterase
Blood
Nitrate
Ketones
Bilirubin
Urobilinogen
Protein
Glucose
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16
Q

At what level of blood glucose will a positive glucose test be seen on urine dipstick?

A

> 180

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17
Q

What are the normal findings on a urine dipstick?

A 
Clear
Yellow
Aromatic odor
4.6-8.0 pH
0.8 protein
1.005-1.030 specific gravity
neagtive leukocyte esterase
None nitrates, ketones, bilirubin, or glucose
0.01-1 urobilinogen
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18
Q

Proteins in urine…

A

proteinuria

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19
Q

WBCs in urine…

A

pyuria

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20
Q

Blood/RBCs/hemoglobin in urine…

A

hematuria vs. hemoglobinuria

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21
Q

Ketones in urine…

A

ketonuria

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22
Q

Bilirubin in urine…

A

bilirubinemia

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23
Q

Glucose in urine…

A

glycosuria

24
Q

What can be seen within urine specimens?

A 
Urine sediment including:
Cells
Casts
Crystals
Other
25
Q

What cells may possibly in urine?

A

RBCs
WBCs
Squamous epithelial cells

26
Q

What are squamous epithelial cells in urine an indication of?

A

contamination of specimen

27
Q

What are casts?

A

Cylindrical particles formed from coagulated proteins in renal tubules

28
Q

What are the types of casts?

A 
Hyaline cast
RBC cast
WBC cast
Waxy cast
Muddy-brown granular cast
Fatty cast
29
Q

What are hyaline casts associated with?

A

Non-specific
Heavy exercise
Diuretics

30
Q

What are RBC casts associated with?

A

Glomerulonephritis

Vasculitis

31
Q

What are WBC casts associated with?

A

Acute pyelonephritis

Tubule interstitial nephritis

32
Q

What are waxy casts associated with?

A

Advanced renal failure

33
Q

What are muddy-brown granular casts associated with?

A

nephrotic syndrome

34
Q

What are normal urine microscopic findings?

A 
No crystals or casts
0-4 per low power field WBCs
< 3 RBCs
No RBC casts
Less than 15-20/hpf squamous epithelial cells
35
Q

What are urinalysis indicators of infection?

A 
Bacteria
Leukocyte esterase positive
WBCs > 10
Nitrate positive
RBCs
pH increased
36
Q

What are the two categories of urine culture?

A 
Quantitative = colony count evaluation
Qualitative = presence of bacteria
37
Q

What are the diagnostic indications for lumbar puncture?

A

CNS infections
Inflammatory processes
Subarachnoid hemorrhage
Cytologic and protein analysis

38
Q

What are therapeutic indications for lumbar puncture?

A

Deliver medications

Relieve symptoms of a few specific causes of increased ICP

39
Q

What are the Contraindications for Lumbar puncture?

A 
Local skin infection
Suspected mass lseion
Raise ICP
Bleeding Diathesis
Coagulopathy = platelet count less than 50,000; platelet dysfunction; INR greater than 1.4
Poor patient cooperation
40
Q

What is in a Lumbar puncture kit?

A

Sterile procedure

Four tubes collected labeled 1-4 and order of collection is important

41
Q

Where would you do a lumbar puncture?

A

L3-L4 or L4-L5

42
Q

What are the four tubes for CSF testing?

A

Tube 1 = Collect Cell Count and differential

Tube 2 = Glucose and protein

Tube 3 = Culture and gram stain

Tube 4 = Cell count and diferential

43
Q

Why are there two tubes that collect for cell count and differential?

A

Because RBCs would be higher due to trauma from puncture at beginning of procedure

Last tube would be more correct for RBC count

44
Q

What must the patient do after lumbar puncture and why?

A

Lay flat so fluid can normalize and so they don’t get a spinal HA

45
Q

If a CSF infection is suspected, what would you get?

A

Cell count and differential
Glucose
Protein
Gram stain, culture, PCR

46
Q

What must you consider if CSF infection suspected?

A 
AFB or TB PCR
Cryptococal antigen and india ink
Fungal culture
VDRL
Lyme Antibody
PCR for viruses (EBV, HSV, CMV, VZV, HHV6
47
Q

What would you find on CSF analysis if the infection is bacterial?

A 
> 30 pressure
Turbid appearance
> 1 protein
< 2.2 Glucose
60-90% positive gram stain
< 0.4 Glucose-CSF: Serum ratio
> 500 WCC
90% PMN
48
Q

What would you find on CSF analysis if infection if viral?

A 
Normal or mildly increased pressure
Clear appearance
< 1 protein
Normal Glucose and Gram stain
> 0.6 Glucose-CSF: Serum ratio
< 1000 WCC
Monocytes: 10% have > 90% PMN and 30% have > 50% PMN
49
Q

What would occur if traumatic puncture happens?

A 
Low CSF pressure
Duration of bleeding with decrease when CSF is withdrawn
Clotting will be present
Repeat lumbar puncture is not bloody
Clear fluid when centrifuged
50
Q

What would occur if Subarachnoid hemorrhage happens?

A 
High CSF pressure
No change in color when CSF is wthdrawn
Absent clotting
Blood if repeated lumbar puncture
Xanthochromia if centrifuged
51
Q

What are the indications for synovial fluid analysis?

A

Joint pain
Joint swelling
Joint Effusion

Must take context of clinical history and presentation

52
Q

What is looked at on synovial fluid analysis?

A 
Appearance
Viscosity
Cell count
Cell differential
Crystal analysis
Culture and sensitivity (infection)
Cytology (if malignancy suspected)
53
Q

What are the characteristics of normal synovial fluid?

A 
Transparent
Clear
High viscosity 
< 200 WBC.mm3
< 25% Polys
54
Q

What are the characteristics of non-inflammatory synovial fluid?

A 
Transparent
Yellow
High viscosity 
100-2000 WBC/mm3
< 25% polys
55
Q

What are the characteristics of Inflammatory synovial fluid?

A 
Transparent
Yellow
Low viscosity 
2000-10000 WBC/mm3
> 50% polys
56
Q

What are the characteristics of Septic Synovial fluid?

A 
Opaque
Yellow/Dirty 
Variable viscosity 
> 80000 WBC/mm3
> 75% Polys
57
Q

What are the characteristics of Hemorrhagic synovial fluid?

A 
Bloody
Red
Variable viscosity 
200-2000 WBC/mm3
50-75% polys

Diagnostic M.'s Sara Peer mentor (27 decks)

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