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What effect will prolonged standing at room temp have on urine
nitrite, ph, and turbidity will increase
glucose, ketones, bilibrubin, urobilinogen, cells and cast will decrease
Ketone bodies are in the urine as a result of what process taking place in the body
Fat Catabolism
What would be indicated if you have a pos glucose oxidase (dipstick) and a neg copper reduction (clinitest) test for urine glucose?
small quantity of glucose. Remember that glucose oxidase is specific for glucose and the clinitest is not specific but will detect glucose and other NGRS.
What effect will the consumption of a meal have on a patients urine pH?
It will become more alkaline
Which cast found in the urine is indicative of bleeding from nephron and is diagnostic for glomerulonephritis?
RBC cast
An increased urine urobilinogen is suggestive of what two diseases?
Liver damage (hepatitis, cirrhosis) and hemolytic disease
Give the color produced by the following substances:
Porphyrin-
melanin-
homogentisic-
biliverdin-
red/ port wine
brown or black
black
yellow-green
Name the clinically significant crystals found in urine
Bilirubin, leucine, tyrosine, cystine, and cholesterol
What stains are used to confirm the presence of fat or triglyceride?
Sudan III or Oil Red O
Using the descriptive terms, give the name of the following crystals found in the urine.
Coffin Lid-
Envelope-
Dumb Bell-
triple phosphate
calcium oxalate
calcium carbonate
What is the significance of the waxy cast in the urine sediment?
indicates prolonged urinary stasis and if broad, is considered a renal faillure cast
Which findings are suggestive if the clinitest is pos and the dipstick for glucose is negative?
sugars other than glucose such as glactose and lactose
Name three conditions in which polyuria occurs
Diabetes mellitis, Diabetes insipidus, excess fluid intake
Give three microscopic indicators of a UTI?
Bacteria, WBC and cast
Erythropoietin is produced by what organ
Kidney
Patient has increased intake of vit C. This may give a false neg for what substances in the urine?
glucose, ketones, blood, bilirubin, nitrite
What crystal does a pink and cloudy urine indicate?
amorphous urates
RBC might be confused with what other sediment in the microscopic urine? What may be used to aid in differentiation?
yeast; drop of acetic acid will dissolve RBC
Cast are mostly composed of what?
Protein
If you have a pos urine glucose, what else should you test for?
ketones
What test is specific for glucose
Glucose oxidase on dipstick
What are glitter cells
Polymorphonuclear (neutrophil) cells with browian movement of the granules
What is the principle of protein on the dipstick?
Protein error of indicators
Where is glucose reabsorbed in the kidney?
in the proximal convoluted tubules
What could cause the urine dipstick to be inactivated?
leaving the lid off the dipstick can and removing the desiccant
Where are casts formed?
in the distal concoluted tubules
What is the most probable cause of jaundice if the patients lab results were as followed:
urine: bili neg
blood: increased unconjugated bili
feces: increased urobilinogen
Hemolytic Jaundice
How would you get rid of amorphous urates?
By heating
How would you get rid of amorphous phosphates
by adding acid
What is the average 24 hour urine excretion from a normal- adult?
1200-1500 ml
What would it mean if you had a pos occult blood on a dipstick, but no RBC were seen microscopically?
Presence of myoglobin and/or hemoglobin in urine
What has a maltest cross appearance when viewed with polarized microscopy?
oval fat bodies (cholesterol), starch, cholesterol crystals
In what condition are oval fat bodies seen in?
Nephrotic syndrome
What could cause urine to turn black upon standing?
homogenistic acid or melanin
What gives urine its natural color?
urochrome
What happens to the volume and specific gravity of urine in a patient that has diabetes insipidus?
specific gravity is decreased and volume is increased
To do quantitative tests on urine what kind of specimen is preferred?
24 hour
Do you have a increased or decreased urine output in diabetes mellitus?
increased (polyuria)
Urinary cast are best found under what microscopic condition?
low power with dim illumination
What may be confused with leukocytes in a urine microscopic?
Renal epithelial cells
Name 8 acid and 5 alkaline crystals
Acid- uric acid, calcium oxalate, amorphous urates, calcium sulfate, hippuric acid, sodium urates, cystine, leucine
Alkaline- triple phosphate, calcium carbonate, ammonium birurate, amorphous phosphates, calcium phosphate
What is the functional unit of the kidney?
Nephron
What is the glucose renal threshold?
glucose will be spilled over into the urine when the blood glucose exceeds 160 to 180 mg/dl
What is the preferred specimen for routine UA?
First morning void
What hormone regulates the absorption of water in the distal portion of the nephron
ADH antidiuretic hormone
What is the best chemical preservative for urinary sediment?
formalin
Odors of urines are important- identify the following;
Sweet or fruity smell-
ammonia-
musty or mousy odor-
maple syrup-
ketones
bacteria
phenylketonuria
maple syrup disease
Name three functions of the kidney
maintain acid base balance
excretion of nitrogenous waste products
maintain electrolyte balance
Name the chemical tests performed in routine urinalysis
pH, protein, glucose, ketones, blood, bilirubin, urobilinogen, nitrite, leukocytes, and specific gravity
Name the single most important test that may indicate renal diease.
Protein
Give a list of contaminants which may be found in urines
sperm, pinworms, trichomonas, yeast
Define hematuria
intact red cells in urine
why do you need to screen infants for nonglucose reducing substances? What test is performed
Because the presence of non glucose sugar may be indicative of a carbohydrate disorder such as galactosemia. Do the clinitest
What percent of plasma glucose is CSF glucose?
60 to 70%
Nitrite in a urine specimen suggests the presence of?
Gram negative bacteria
The final phase of degeneration that granular casts undergo is represented by which of casts?
waxy cast which implicates there is urinary stasis
What is the titer in tube 8 if tube 1 is undiluted and dilutions are doubled?
128 titer
What test measures IgE levels against a specific allergen?
RAST (Radioallergosorbent)
What type of immunity do you get when you are given an immunization shot? Ex: Rubella vaccine
Active
What disease is indicated by a high titer of anti-Sm (anti smith) antibody?
Systemic Lupus Erythematosus (SLE)
What type of test are performed to detect lyme disease and what is the causative agent?
Serologic testing is done to detect antibodies. Borrelia burgdorferi, a spirochete, is transmitted to humans by the bite of the deer tick
What is an immediate hypersensitivity reaction and give some examples.
Type one anaphylatic is IgE mediated. Antigen binds to IgE sensitized mast cell which releases histamine. Examples are bee sting, hay fever, and asthma
Define titer
The reciprocal of the highest dilution in which a pos reaction occurs
What can activate the alternate pathway of complement?
non antibody initiated pathway. Polysaccharide complexes from yeast cells, bacterial and endotoxins
What is the lineage and function of a plasma cell?
Activated B lymphocytes; produce antibodies
Which antibody is associated with speckled nuclear pattern on the ANA test?
ENA antibody
What can cause a false pos glucose on a dipstick
bleach
A urine specimen has a occult blood of 2+ and 0 RBC microscopically, what is the probable cause?
Hemoglobinuria
What structure connects the bladder to the exterior of the body?
urethra
Name the flat colorless plate, notched on one corner, and what is it soluble in?
Cholesterol, soluble in chloroform
What are oval fat bodies?
Renal tubule epi cells with fat or lipids
Name this casts- homogenous, opaque, notched edges, broken ends
waxy casts
Name crystal that is colorless dumbbell or sphere shaped and soluble in acetic acid?
calcium carbonate
A 17 year old girl has been on a starvation diet for a week. What substance would you expect to see in the urine?
Ketones from fat catabolism
Name two primary functions of the complement system.
Cell lysis and promote inflammation
What test would be pos on the reagent strip when a patient is suffering from dehydration due to diarrhea or vomiting?
Ketones
The serum hemolytic complement level is
A measure of total complement activity
Urine sediment that contains RBC, RBC cast, and protein is characteristic of
Acute glomerulonephritis
The finding of WBC cast in urine sediment has been linked with what condition?
Pyleonephritis
What type of urine specimen is used to evaluate whether a patient has a UTI?
Midstream clean catch
What routine urine test may be used to assess the kidney ability to concentrate urine
Specific gravity
Which specimens are usually not infectious unless visibly bloody?
Urine, feces, sputum, nasal secrection, sweat, tears, and vomitus
Explain the concept of Universal/ Standard Precautions
All specimens should be handled as if they are infectious
Name four categories of chemicals that pose health hazards
irritants, corrosives, toxic agents, and carcinogens
What are proficiency test
Samples sent from an outside agency that are tested as unknown by the lab. Results obtained are compared to those of other participating labs reference labs.
Which federal agency issues regulations to ensure employee safety.
The Occupational Safety and Health Administration (OSHA)
Which federal agency regualtes blood banks
The food and drug administration (FDA)
What is the federal legislation that regualtes almost all clinical lab in the US
The clinical lab improvement amendments of 1988 (CLIA '88)
What is the role of the centers for disease control and prevention (CDC)
It issues standards and guidelines for hospitals and lab, primarily related to infection control and safe work practices. Its role is advisory; it is not a regulatory agency and does not have enforcement authority