1
Q
What does a UA detect and assess?
A
- Renal function/disorder
- Endocrine or Metabolic function/disorder
- UTI
- Systemic disease
2
Q
Clinical Reasons for performing a Urinalysis
A
- Important indicator of health
- Screening Test
- Cost effective In-vitro diagnostic test
- Non invasive procedure
- Simple to perform
3
Q
For urinalysis, it is a screening test to detect and assess
A
- Renal function/disorder
- Endocrine or metabolic disorders/functions
- UTI
- Systemic Diseases
4
Q
What are the two methods of Urine collection
A
Non-instrumented and Instrumented collection
5
Q
What are the non-instrumented collections for urine
A
- First morning void
- Random Urine specimen
- Clean Catch
- 24 hour
6
Q
What are the instrumented urine collection
A
Urethral Catheterization
Suprapubic Needle Aspiration
Catherization and bladder irrigation
7
Q
Urine specimen should be analyzed while Fresh, preferably within how many hours
A
1-2 hours
8
Q
If urine is left at room temperature, what will happen?
A
Begin to decompose and deliver inaccurate results
9
Q
How many hours do you have to refrigerate urine specimen if unable to test at the time of delivery
A
3-6 hours
10
Q
What does urea splitting bacteria produce and what happens if it combines with hydrogen ions in the urine
A
Produce ammonia; Increases pH
11
Q
What happens if the changes of pH happens in the urine
A
Dissolves any casts present
12
Q
What happens if glucose is present in the urine
A
Bacteria may use it as a source of energy resulting in false negative glycosuria
13
Q
What method of preservative has:
- Advantages: For specimen transport or storage, no cost. Simple to perform
- Disadvantages: May destroy Formed elements
A
Freezing
14
Q
Which collection of urine is:
- Most concentrated
- Increase number of abnormal elements
- Decreased deterioration of formed elements
- Recommended specimen for chemcial and microscopic exams
A
First morning Void
15
Q
Which collection of urine is:
- Collected anytime
- Most convenient for patients and most common
- Can detect abnormalities but not as sensitive as first morning void
A
Random Urine Specimen
16
Q
Which collection of urine is:
- Specimen of choice for bacterial cultures
A
Clean Catch urine specimen
17
Q
In how many hours do cultures need to be preformed after collection, only if specimen was refrigerated
A
12 hours
18
Q
Which collection of urine is:
- Gives quantitative results
- Preservatives may be needed
A
24 hour urine specimen
19
Q
Which collection of urine is:
- NOT recommended for bacteriological examination
- Use only if no other way to collect urine
- Commonly used on marked obese patients with difficulty in urine collection
A
Urethral Catherization
20
Q
Which collection of urine is:
- Choice on infants and young children
A
Suprapubic Needle Aspiration
21
Q
Which collection of urine is:
- Removing the bladder content for cytologic study
A
Catheterization and bladder irrigation
22
Q
How much mL is inserted for catheterization and bladder irrigation?
A
50-72 mL
23
Q
The normal volume of urine in a 24 hour period are in the ranges of?
A
600-2000 mL
24
Q
What is the average mL in 24 hours
A
1500 mL
25
The amount of urine is directly related to
- Fluid intake
- temperature and climate
- Amount of prespiration that occurs
26
The normal color of urine
Color straw (light yellow) to dark amber
27
What pigmentation concentration changes the color of urine
urochrome
28
What happens if the urine is Blue Green
Methylene Blue (dye or stain in diagnostic procedures)
29
What happens if the urine is Dark orange
Pyridium (used for UTI infection)
30
What happens if the urine is Milky White
Caused by Chyle (Fat or lipids in urine)
31
What happens if the urine is Olive green to brown black
Phenols (poisonous compound for antimicrobial agent)
32
What happens if the urine is Yellow to brown (turning greenish with foam when shaken)
Presence of bile
33
What happens if the urine is Red or red-brown (Smokey apperance)
Presence of Blood
34
What is the normal turbidity of urine
Clear
35
What is turbidity of urine?
How clear it is
36
What happens if the urine has a Sweet/Fruity smell
Ketones
37
What happens if the urine has a pungent smell
Due to ammonia produced by bacteria
38
What happens if the urine has a maple syrup smell
"maple syrup urine disease" a congenital metabolic disorder
39
What happens if the urine has a Musty or mousy smell
Infants with phenylketouria
40
What happens if the urine has a Sweaty feet smell
Isovaleric acidemia, presence of butyric or hexanoic acid in urine
41
Specific gravity of random urine and 24 hour urine and what can this be a indication for?
Specific: 1.003 - 1.035
24: 1.015 - 1.025
Dehydration
42
What will appear in the urine once the threshold level of 160-180 mg/dL in the blood is exceeded
Glucosuria/Glycosuria
43
What is glucosuria indicating?
Diabetes mellitus or any condition that causes hyperglycemia
44
What does Ketonuria indicating?
Diabetes Mellitus
45
What conditions are associated with Ketosis and what is Ketosis
Ketosis: Increase ketone in blood and urine
- > intake of carbs (Starvation)
- > Utilization of carbs (diabetes mellitus)
- Digestive disturbance or dietary imbalance ( high fat, low carb diet)
- Eclampsia
- Prolonged vomiting
- Diarrhea
46
What is hematuria
Presence of blood in urine
47
Intact RBC present in the urine may indicate:
- Damage/trauma to the kidney or urianry tract
- Renal Disease
- May aslo be due to menstrual contamination or exercise
48
Which renal diseases can cause hematuria?
- Glomerulonephritis
- Malignant HTN
- Polycystic kidney diseases
49
What is normal for bilirubin in normal urine
Negative for bilirubin
50
What condition will result in apperance of bilirubin in urine
Any condition that causes jaundice (hepatitis)
51
What is normal for urobilinogen in normal urine
Normally presented in the urine in concentrations of 1 EU or less
52
Normal range of pH for urine and the average of it
4.6 - 8.0 with the average being 6.0
53
What are some conditions that may cause acidic urine
- Respiratory and metabolic acidosis
- UTI by E. Coli*
- Uremia
- Severe Diarrhea
- Starvation
54
Pathologic conditions that cause alkaline urine are
- UTI caused by Proteus and Pseudomonas species*
| - Respiratory and metabolic alkalosis
55
How are nitrates formed?
By breakdown of nitrates by organisms that cause UTI's - E coli
56
What is considered normal for Leukocyte esterase (LE) in urine
Negative
57
What is an indication for Leukocyte esterase (LE) in urine?
Detects esterase released by the neutrophils in the urine and is an indirect test for bacteriuria
58
What test is a non-treponemal test for serologic detection of the antibody reagin, which is produced in response to an infection of syphilis caused by Treponema pallidum
Rapid Plasma Reagin
59
What is produced in patients infected with Treponema pallidum, the causative agent of syphilis, and acts like a antigen
Reagin (phospholipids)
60
Where is Reagin found in with patients with syphilis
Serum/Plasma (purple or red top tubes to draw)
61
What is the vehicle or "antigen" that is used to see results of RPR macroscopically
Carbon Charcoal particle
62
What type of diagnostic test is RPR
Screening test (Requires confirmatory)
63
What happens in a RPR if:
- Flocculation is present
- Flocculation is NOT present
Present: Reactive
| Not Present: Non Reactive
64
What is the confirmatory test for RPR and what is considered positive and negative
Fluorescent treponemal antibody-absorbed test (FTA-ABS)
Positive: Fluoresce
Negative: no fluoresce
65
Where is infectious mononucleosis commonly found in what demographic of patients
young adults and children less than 5 years of age
66
Which test is used to detect infectious mononucleosis which is a self limiting disease caused by the Epstein-Barr Virus
Monospot test
67
What antibody is formed from infectious mononucleosis
Heterophile
68
What type of bodily fluids will you be testing monospot on?
Serum/Plasma and it should be clear and non-hemolyzed
69
What is the amount of time to test the specimen if stored between 2-8 degrees Celsius for monospot
24 hours
70
The rotatory shaker should be set how much rpm for RPR
100 rpm
71
The rotatory shaker should be set how much rpm for monospot
60-100 rpm
72
How long should you rotate a RPR and a Monospot test?
RPR: 8 minutes
Monospot: 3 minutes
73
What is considered for a positive and negative monospot test
Positive: Shows Agglutination
Negative: Smooth, homogenous solution. No agglutination
74
What is a parasitic infection caused by the introduction of the protozoan organisms into the blood by the bite of a female anopheles mosquito
Malaria
75
Where do the pre-erythrocytic cycle start?
In the liver
76
What happens during the exoerythrocytic cycle?
Further development in the liver after RBC invasion
77
What are macrogametocyte (females)
Curved sausage/banana shaped with central large chromatin dot covered
78
What are microgametocyte (male)
Short and wider than female with rounded ends
79
Which malaria has:
- Malignant tertian
- Fever every 48 hours or every 2nd day
- Most fatal: likely to caused intravascular hemolysis (destruction of RBC)
- Fever is prolonged and intensified
Plasmodium Falciparum
80
Which malaria is:
- Benign Tertian
- Fever every 48 hours or every 2nd day
- Most common
Plasmodium Vivax
81
Which malaria is:
- Benign tertian
- Fever q48h or every 2nd day
Pplasmodium Ovale
82
Which Malaria is:
- Benign quartan
- Fevery every 72 hours or every 3rd day
Plasmodium Malariae
83
If drawing a blood sample for malaria, how many days can it be stored and what temp
3 days; 2-30 degrees C (36-86 degrees F)
84
Which one is positive by itself for malaria?
T1: Plasmodium Falciparum
85
When will a test be considered non-valid for malaria
If the Control "C" line does not appear
86
What are some rapid malaria kit limitations
- Sample aquired when patient is febrile
- Only detects antigens
- Must be confirmed with a thick and thin smear for confirmation, sent to NEPMU
87
What are the false positive results in patients with the following conditions
- Rheumatoid arthritis
- Chronic Viral infections - HEP C
- Patient with other blood parasite - Babesia
88
Smears should be done frequently but no more than:
hourly
89
What is a highly contagious, acute, viral infection of the respiratory tract
Influenza
90
How can influenza be transmitted
Coughing and sneezing of aerosolized droplets containing live virus
91
Which influenza is more common and produces more serious illness
Influenza A
92
The best diagnoses of influenza is during?
the first 2-3 days
93
Benefits of doing the influenza test
- Enable appropriate therapy
- Facilitate prompt treatment
- Some antivirals are only effective if adminstered within 48 hours of symptoms onset
- Reduce healthcare cost
94
When will a false-positive may occur for influenza
When disease prevelance in the community is low (beginning and end of the season)
95
When will a false-negative may occur for influenza
When disease prevalence is high in the community (at the height of the season)
96
Over time, What does the metabolic panel provide?
An important baseline of a patient's basic physiology
97
What is hyponatremia and what can it indicate
Low sodium; over hydration
98
What is hypernatremia and what will it indicate
high sodium; need for water
99
What can a low BUN (urea nitrogen) indicate
Sign of overhydration or liver disease
100
What is the body's total percentage of calcium located in bones and teeth and in the blood
99% bones and teeth
| 1% in blood
101
90% of hypercalcemia is caused by:
Eithera malignancy or hyperthyroidism
102
High levels of CO2 is seen in
Respiratory acidosis and low levels are associated with respiratory alkalosis
103
Hyperchloremia is seen in:
Dehydration and acidemia
104
Hypochoremia may be the result of
Vomiting, over hydration, and alkalemia
105
Low magnesium (MG) can cause
refractory hypokalemia
106
Elevated levels of bilirubin are responsible for:
Jaundice
107
What nutrient when decreased leads to malnutrition, liver diseases and severe skin disease
Total protein
108
What is recommended for lipids for adults over 20
Fasting lipids screening every 5 years
109
Measurement of A1C is indicative of
Glucose control during the preceding 2-3 months
110
What is A1C
A component of the hemoglobin molecule, during the 120 lifespan of RBC
111
What are cardiac markers used for
Biomarkers that measure the damage to the heart and the functions
Ongoing Meical Care
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