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MLT 140 > Urinalysis & CSF > Flashcards

Urinalysis & CSF Flashcards

1
Q

Helminth forms

A

Parasitic worms

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2
Q

Causes of CSF infection

A
  • bacteria
  • viruses
  • spirochetes
  • parasites
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3
Q

CSF infections are associated with:

A
  • increased WBC counts
  • alterations in normal glucose levels
  • alterations in normal protein levels
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4
Q

Predisposing risk factors of CSF infection

A
  • young
  • elderly
  • nutritional deficiencies
  • immunologic deficiencies
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5
Q
  • low glucose

- high protein

A

Bacterial meningitis

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6
Q

What does bacterial meningitis utilize?

A

Glucose

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7
Q

Cloudy CSF fluid specimen could indicate:

A

WBCs / bacterial meningitis

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8
Q

The majority of meningitis cases affects what age?

A

Under 5 years

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9
Q

How many tubes do you collect for a CSF fluid specimen?

A

4

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10
Q

Normal CSF characteristics:

A
  • clear
  • colorless
  • sterile
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11
Q

Why should you never refrigerate CSF?

A

The organisms are sensitive to temperature

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12
Q

What media is used for CSF testing?

A
  • chocolate
  • BAP
  • thio
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13
Q

How many ml are in the CSF tubes?

A

10ml

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14
Q

A positive direct smear (gram stain) of CSF is considered:

A

An alert value, report to physician

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15
Q

CSF changes seen in bacterial meningitis:

A
  • increased turbidity
  • increased neutrophils
  • increased protein
  • decreased glucose
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16
Q

What does a cytocentrofuged gram stain do?

A

Concentrates everything (it’s hard to focus CSF on a microscope)

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17
Q

What are the protein and glucose levels in Bacterial (acute) meningitis like?

A
  • high protein

- low glucose

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18
Q

95% of bacterial (acute) meningitis is seen in:

A

Children under 5 years

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19
Q

Pathogens:

  • Haemophilis influenza B
  • Neisseria meningitidis
  • Streptococcus pneumoniae
  • GNRs
A

Bacterial (acute) meningitis

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20
Q

Most common type of meningitis

A

Viral (asceptic) meningitis

less severe

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21
Q

Pathogens:

  • Enteroviruses
  • herpes viruses
A

Viral (asceptic) meningitis

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22
Q

Causes flu-like symptoms

A

Viral (asceptic) meningitis

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23
Q

What are the glucose and protein levels like in viral (acute) meningitis?

A
  • high glucose

- low protein

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24
Q

Encapsulates yeast

A

Cryptococcus neoformans

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25
Q

Rare cause of meningitis

A

Parasitic meningitis

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26
Q

Pathogens:

  • Naegleria fowleri
  • Acanthamoeba
  • Balamuthis
  • Angiostrongylus
  • Plasmodium
  • Toxoplasma
A

Parasitic meningitis

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27
Q

Rare cause of CNS infection

A

Fungal meningitis

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28
Q

Pathogens:

  • Cryptococcus neoformans
  • Coccidiodes immititis
  • Histoplasma capsulatam
  • Blastomyces dermititidis
  • Candida
A

Fungal meningitis

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29
Q

Cryptococcus neoformans ID

A

India ink stain

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30
Q

Common in AIDS patients

A

Cryptococcus neoformans

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31
Q

Enters the body through respiratory droplets and multiplies/spreads via the blood

A

Mycobacterial meningitis

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32
Q

Pathogens:

  • M. tuberculosis
  • M. avium
  • M. bovis
A

Mycobacterial meningitis

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33
Q
  • acid-fast bacilli

- won’t stain with normal gram stain

A

Mycobacterial meningitis

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34
Q

Very thick cell wall, waxes, & has phospholipids

A

Mycobacterial meningitis

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35
Q

HIV is a risk factor

Makes you more susceptible

A

Mycobacterial meningitis

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36
Q

Slender, flexible, helically shaped bacteria

A

Spirochetal meningitis

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37
Q

Pathogens:

  • Treponema pallidum
  • Borellia burgdorferi
A

Spirochetal meningitis

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38
Q
  • spiral shaped

- gram negative

A

Spirochetal meningitis

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39
Q

Causes Lyme disease

A

Borellia burgdorferi

LYME BURGERS

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40
Q

Causes neurosyphillus

In patients with HIV

A

Spirochetal meningitis / treponema pallidum

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41
Q

What does an AFB culture look for?

A
  • Acid fast bacilli

- fungal spores

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42
Q

Major organs involved in urinary systems & diseases:

A
  • bladders
  • ureters
  • kidneys
  • urethra
  • prostate

BUKUP

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43
Q

Most common nosocomial infection:

A

UTI

From catheters

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44
Q

Most common source of bacteremia:

A

UTI; urine cultures

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45
Q

Most common pathogen, E. coli:

A

UTI; urine cultures

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46
Q

Frequent pathogens, coliforms:

A

UTI; urine cultures

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47
Q

Nitrite, leukocytes, WBC and bacteria in a sediment indicate what?

A

Infection (UTI)

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48
Q

What will happen if a UTI is not treated?

A

It will spread

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49
Q

How is a UTI diagnosed?

A

By a combination of symptoms

Urinalysis -> urine culture

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50
Q

What tests certain gram negative bacteria?

A

Nitrate reductase test (Griess)

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51
Q

Urine must be in bladder for 4+ hours for this test, and it flags for a microscopic to be done

A

Nitrate reductase test (Griess)

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52
Q

Who is at risk for UTI?

A
  • Immunocompromised (elderly & children)
  • pregnant women (uterus puts pressure on bladder)
  • kidney transplant recipients (foreign object in body / immunosuppressed / scarring)
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53
Q

What is a normal cause of bacteria in a non-sterile urine specimen?

A

Epithelial cells

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54
Q

Cystitis

A

Inflammation of the bladder

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55
Q

Pyelonephritis

A

Infection of the kidney

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56
Q

Bacteriruria

A

Presence of bacteria in the urine

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57
Q

Urethritis

A

Inflammation of the urethra

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58
Q

Prostatitis

A

GU infection in males involving the prostate

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59
Q

Cervivicitis

A

Inflammation of the cervix

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60
Q

Most common non-sterile urine specimen

A

Mid-stream clean catch

Noninvasive, patient can do it themselves

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61
Q

Sterile urine culture specimens:

A
  • catheterized
  • suprapubic aspirate
  • cytoscopic
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62
Q

Suprapubic aspirate

A

Urine is aspirated through the belly into the abdominal cavity and into the bladder
(Done when there is an obstruction)

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63
Q

Cytoscopic

Urine specimen

A

Scopes through kidney

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64
Q

Deliver urine specimen to lab within ____ minutes

A

30

Refrigerate immediately if unable to process

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65
Q

What will happen if a urine culture is left sitting out?

A

Bacteria will multiply and it will affect urinalysis results

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66
Q

Urine culture setup:

A

1) mix urine thoroughly before streaking (it will settle so needs mixing)
2) inoculate with calibrated loop .001ml (calibrated to deliver a certain amount)
3) T-streak on BAP & MAC or EMB (T-streak: down middle, go to top, side to side all the way down plate)

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67
Q

Should bacteria be seen on a sterile urine specimen?

A

No

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68
Q

What is the purpose of a urine specimen count?

A

To determine actual infection from contaminating bacteria

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69
Q

> 100,000 colonies/ml of urine

A

Clinically significant

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70
Q

Over 10 colonies in urine =

A

Infection

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71
Q

A (urine) colony count greater than 10cfu is considered:

A

Significant unless sterile.

If sterile, ANY growth is considered significant.

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72
Q

What media do you do colony counts on?

A

BAP or MacConkey

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73
Q

Urine pathogens

A

1) GNRs
2) GPCs
3) GPRs
4) fungi

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74
Q

(Urine) GNR pathogens

Leading cause of UTIs

A
  • E. coli
  • pseudomonas
  • klebisella
  • acinetobacter
  • enterobacter
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75
Q

Leading cause of UTIs

A

GNRs

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76
Q

(Urine) GPC pathogens

A
  • enterococcus (in older men)
  • S. saphrophyticus
  • S. epidermidis
  • S. aureus
  • group B strep
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77
Q

(Urine) GPR pathogens

A 
Listeria monocytogenes
(Only a pathogen in rare cases)
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78
Q

(Urine) fungi pathogens

A
  • Candida albicans
  • Cryptococcus neoformans
  • Blastomyces
  • Coccidioides
  • immititis
  • Histoplasms capsulatum
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79
Q

Is bacillus in the urine considered contamination?

A

Almost always

80
Q

Other agents of UTIs

A

1) anaerobes (when recovered from suprapubic aspirates / anaerobes don’t grow in presence of oxygen (sterile site in body = anaerobic))
2) C. trachoma & N. gonorrhoeae (these urine cultures are on BAP or MacConkey so these wouldn’t grow on either. Dr. Must be specifically looking for)
3) mycoplasma & Ureplasma (more common in neonates)
4) Gardnerella vaginalis

81
Q

Microscan and Vitek

A

Susceptibility testing (antimicrobial) antibiotics & carb/sugar

  • bacteria growing in wells = resistant to antibiotic
  • bacteria not growing = susceptible
82
Q

CSF infections can be caused by:

A
  • bacteria
  • viruses
  • fungi
  • Spirochetes
  • parasites

Can be life threatening

83
Q

95% of all bacterial meningitis occurs in:

A

Children under 5 years old

84
Q

CSF associated with bacterial meningitis has:

A
  • increased neutrophils (turbidity)
  • decreased glucose
  • increased proteins
85
Q

Bacterial meningitis pathogens in neonates

A

1) group B strep
2) GNRs (E. coli, klebsiella spp., enterobacter spp.)
3) listeria monocytogenes

86
Q

Causes bacterial meningitis in children (>2 years) and adults

A

1) streptococcus pneumoniae

2) Neisseria meningitidis

87
Q

Causes bacterial meningitis in older adults (>65 years)

A

1) streptococcus pneumonia
2) Neisseria meningitidis
3) listeria monocytogenes
4) aerobic gram negative bacilli

88
Q

Parasitic encephalitis (uncommon cause of meningitis) pathogen forms

A
  • protozoan forms (free-living amoeba)

- helminth forms (parasitic worm)

89
Q

Naegleria fowleri - protozoan form

Parasitic encephalitis

A
  • almost always fatal

- in WARM fresh WATER and moist soil

90
Q

Acanthamoeba spp. - protozoan form

Parasitic encephalitis

A

Found in solid, fresh & brackish water and sewage

91
Q

Balamuthis mandrillaris - protozoan form

Parasitic encephalitis

A

No environmental sources identified

92
Q

Protozoan forms

A

Free-living amoeba

93
Q

Helminth forms

A

Parasitic worms

94
Q

Angiostrongylus Cantonensis - helminth form

Parasitic encephalitis

A
  • Thailand, Malaysia, Vietnam

- ingestion of GREEN LEAFY VEGETABLES

95
Q

Plasmodium falciparum - helminth form

Parasitic encephalitis

A

CEREBRAL MALARIA, infected by the bite of an infected MOSQUITO, characterized by changes in MENTAL status, SEIZURES, motor deficits & COMA

96
Q

Toxoplasma gondii - helminth form

Parasitic encephalitis

A

Eating RAW, undercooked MEAT or contact with cats, organ transplants

97
Q

Fungal encephalitis pathogens

A

1) Cryptococcus neoformans
2) Coccidiodes immititis
3) Histoplasma capsulatum
4) Blastomyces dermatiditis
5) Candida spp. Including C. albicans, C. tropicalis, & C. parapsilosis

98
Q

Coccidioides immitis

Fungal encephalitis

A

SW USA, Mexico, central/South America

99
Q

Histoplasma capsulatum

Fungal infections

A

MS and Ohio river basins / patients with candidiasis (overgrowth of yeast)

100
Q

Candida spp. Including C. albicans, C. tropicalis & C. parapsilosis
(Fungal encephalitis)

A

Like Histoplasma, seen in patients with overgrowth of yeast, (disseminated yeast infection causes cerebral abcess) / acquired as nosocomial infection in patients with catheters or microbial therapy)

101
Q

Blastomyces dermatiditis

Fungal encephalitis

A

MS and Ohio river basins / spread by inhalation that results in pulmonary infection & spreads

102
Q

Griess

A

Nitrate reductase test

103
Q

Antimicrobial susceptibility testing

A

Rapid method most commonly used

104
Q

E. coli (GNR)

UTI pathogen

A

antibiotic-susceptible strains emanating from patient’s fecal flora

105
Q

Enterococcus (GPC)

UTI pathogen

A

Primarily in older men

106
Q

S. saphrophyticus (GPC)

UTI pathogen

A

Predominantly in symptomatic sexually active women younger than 40 years

107
Q

S. epidermidis (GPC)

UTI pathogens

A

Only 20% of cases, hospitalized patients >50 years, usually have had urinalysis tract surgery, indwelling catheters or chronic urinary tract disease

108
Q 
Listeria monocytogenes (GPR)
(UTI pathogen)
A

In rare cases and only considered significant after consultation with physician

109
Q

Bacillus spp. (GPR)

UTI pathogen

A

Isolation can almost always be considered contamination

110
Q 
Candida albicans (fungi)
(UTI pathogen)
A

Rare in healthy adults, common in hospitalized patients,nearly colonies can resemble CoNS

111
Q

Cryptococcus neoformans, Blastomyces dermatiditis, Coccidioides immitis, Histoplasma capsulatum (fungi)
(UTI pathogen)

A

Recovery of any of these in urine culture is considered highly significant and indicates a disseminated (spread) infection

112
Q

Anaerobes

UTI

A

Significant when recovered from suprapubic aspirates

113
Q

C. trachomatis and N. gonorrhoeae

UTI

A

Can cause:

  • urethritis
  • cystitis
  • prostatitis
114
Q

Mycoplasma & Ureaplasma

UTI

A

Neonates from lower socioeconomic groups

115
Q

Gardnerella vaginalis

UTI

A

Commonly reflects vaginal contamination but also is an emerging UT pathogen. Repeated cultures with this organism as the primary isolate should be considered significant

116
Q

What does CFU stand for?

A

Colony forming units

117
Q

What is considered a significant colony count from a urine culture from a clean catch specimen?

A

Greater than 10 cfu

118
Q

Why are UTIs the most common cause of nosocomial infections?

A

Because of patients with catheters

119
Q

Why are UTIs more common in women than in men?

A

Because women have shorter urethral and their urethral openings are closer to the anus

120
Q

Name two conditions that would make an individual more susceptible to an infection of the CSF:

A
  • extremities of age (older young)

- nutritional & immunologic deficiencies

121
Q

What percentage of bacterial meningitis cases occur in children

A

95%

122
Q

What action should be taken by the MLT if bacteria is observed on the CSF gram stain? Why?

A

Call the physician if positive because it is considered an alert value

123
Q

Cervicitis

A

A GU infection seen in females only

124
Q

Cystitis

A

Inflammation of the bladder

125
Q

Pyelonephritis

A

Infection of the kidney

126
Q

Urethritis

A

Inflammation of the urethra

127
Q

Prostatitis

A

A GU infection seen in males only

128
Q

Bacteriuria

A

Presence of bacteria in the urine

129
Q

If a urine specimen cannot be immediately processed, what action should be taken to preserve the specimen?

A

Refrigerate immediately and process within 2 hours

130
Q

What urine pathogen is seen primarily in older men?

A

Enterococcus

131
Q

Name three gram negative rods that are known to cause encephalitis in neonates:

A

E.coli, klebsiella, enterobacter

132
Q

How do neonates acquire encephalitis?

A

Vertical transmission from mother to infant

133
Q

What will the chemistry results be in a patient who has viral encephalitis?

A

Increased glucose, decreased proteins

134
Q

Name four conditions that would make an individual more susceptible to contracting a UTI:

A
  • extremities of age (elderly & children)
  • pregnant women
  • catheterized patients
  • kidney transplant patients
135
Q

Name the CSF pathogen that is associated with eating raw or undercooked meat, contact with cats and organ transplants:

A

Toxoplasma gondii

136
Q

Causative agent for lyme’s disease

A

Borrelia burgdorferi

137
Q

Causes cerebral malaria

A

Plasmodium falciparum

138
Q

Found in soil, fresh & brackish water, sewage

A

Acanthamoeba

139
Q

Found in MS & OH river basins

A

Blastomyces

140
Q

Associated with war,, natural bodies of water

A

Naegleria fowleri

141
Q

Causes neurosyphillis

A

Treponema pallidum

142
Q

Associated with HIV patients

A

M. tuberculosis

143
Q

Green leafy vegetables, snails & slugs

A

Angiostrongylus

144
Q

What type of encephalitis causes mild, flu-like symptoms and will usually resolve on its own?

A

Viral

145
Q

What urinary pathogen is mainly seen in women

A

S. saphrophyticus

146
Q

How are most diarrheal pathogens acquired?

A

By ingesting a contaminated food or beverage

147
Q

Name four host defenses of the GI tract and explain the role each one plays in the host defense process:

A

Normal flora - fights off pathogens
Stomach acidity - low pH kills organisms
Mucous layer - constant motion reduces chances for adherence
Colon / IgA fights off some organisms

148
Q

What is the most common cause of diarrheal illness in children

A

Rotavirus

149
Q

What diarrheal pathogen is associated with infectious outbreaks on cruise ships?

A

Calcivirus

150
Q

What is the specific strain of diarrheal pathogen that produces shiga-like toxins?

A

E.coli 0157:H7

151
Q

What is the most common cause of bacterial gastroenteritis in the world and is associated with contaminated poultry?

A

Campylobacter jejuni

152
Q

Can migrate to liver

A

Entamoeba histolytica

153
Q

Toxins have cytotoxic & neurotoxic effects

A

Shigella sonnei

154
Q

Travelers returning from endemic areas

A

Cyclospora

155
Q

Associated with AIDS patients

A

Microsporidia

156
Q

Associated with hikers, mountain streams

A

Giardia lamblia

157
Q

Resistant to chlorine

A

Cryptosporidium

158
Q

Only known host is human, intracellular

A

Salmonella typhi

159
Q

Resistant to refrigeration

A

Yersinia enterocoligica

160
Q

Associated with fried rice

A

Bacillus cereus

161
Q

Peptic ulcer disease

A

Helicobacter pylori

162
Q

Antibiotic associated diarrhea

A

Clostridium difficile

163
Q

Produces “rice-water” stools

A

Vibrio cholerae

164
Q

Name two complications of Campylonacter infection:

A

Guillain-Barré syndrome and relative arthritis

165
Q

Why will treatment with antibiotics delay the clinical improvement of patients with a Shigella infection?

A

If the antibiotic breaks down the cell wall, the organism releases the toxins and makes the patient sicker

166
Q

Name two types of media that could be inoculated for the recovery of Salmonella in a stool specimen:

A

GN broth and Selenite

167
Q

What temperature should media intended for the recovery of Campylobacter be incubated at?

A

42 degrees Celsius

168
Q

What temperature should media intended for the recovery of Yersinia be incubated at?

A

Room temperature

169
Q

What is the mortality rate of newborns that acquire bacterial meningitis?

A

20%

170
Q

If a patient had viral meningitis, what will be seen on the gram stain of the CSF collected from this patient?

A

Nothing - viruses are not seen on gram stains

171
Q

Name two common organisms known to cause meningitis in both adults AND children:

A

N. meningitidis

S. pneumoniae

172
Q

1) Name the media used for urine culture setup:

2) Which of these is the colony count performed on?

A

1) BAP, MAC, or EMB

2) BAP

173
Q

Name two sterile urine collection methods and a non-sterile collection method for urine cultures.

A

Sterile: suprapubic aspirate and cytoscopic

Nonsterile: mid-stream clean catch

174
Q

On a direct gram stain of a CSF a yeast is observed. The yeast has a large halo around it on an India ink stained slide. What is the organism?

A

Cryptococcus neoformans

175
Q

The primary etiologic agent for UTI is:

A

E.coli

176
Q

Name a parasite that can cause encephalitis:

A

Naegleria fowleri

177
Q

What is cystitis?

A

Inflammation of the bladder

178
Q

Why should CSFs never be refrigerated before the culture has been set up?

A

Potential pathogens are sensitive to temperature

179
Q

What are the expected chemistry results on a CSF in a patient with bacterial meningitis?

A

Increased proteins, decreased glucose

180
Q

What is the name of the rapid screening test done on urines to determine the presence of a possible UTI?

A

Griess test

181
Q

What is the Griess test detecting?

A

Nitrate reduction to nitrite

182
Q

Loeffler media

A

Corynebacterium

183
Q

BYCE

A

Legionella

184
Q

Lowenstein-Jensen

A

Mycobacteria

185
Q

Bordet-Gengou

A

Bordatella

186
Q

A cytoscopic urine is collected and inoculated with a .001ml loop and after 24 hours of incubation it has 4 colonies counted from the BAP plate. Is this clinically significant? Explain:

A

Yes, because a cytoscopic urine is sterile, so any growth is significant

187
Q

Name the 5 major organs of the urinary tract that are involved with infections of the UT:

A

BUKUP

1) bladder
2) urethra
3) kidneys
4) ureters
5) prostate

188
Q

What media is used for CSF cultures?

A

Chocolate, thio, BAP

189
Q

The expected colony count in a suprapubic urine specimen from a healthy individual is:

A

0 CFU/mL

190
Q

Why are urine colony counts performed?

A

To determine if there is an infection

191
Q

What is the primary population that acquires bacterial meningitis?

A

Children younger than 5 years old

192
Q

Name a change seen in the physical characteristics of a CSF sample if a bacterial infection is present:

A

Increased turbidity (from WBCs/neutrophils)

193
Q

Recovery of any of these in a urine culture is considered highly significant and indicates a disseminated infection:

A
  • Cryptococcus neoformans
  • Blastomyces dermatidis
  • Coccidiodes immitis
  • Histoplasma capsulatum
194
Q

What is a disseminated infection?

A

Spread infection

195
Q

Anaerobes are significant when:

A

Recovered from suprapubic aspirates

MLT 140 (3 decks)

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