Clin Path 1: Lab Final

Where do band aids go after being used?

a) Regular trash

b) SHARPS container

c) Drain

d) Biohazard (red) Bins

a) Regular trash

Where do blades go after being used?

a) Regular trash

b) SHARPS container

c) Drain

d) Biohazard (red) Bins

b) SHARPS container

Where does blood go after being examined?

a) Regular trash

b) SHARPS container

c) Drain

d) Biohazard (red) Bins

c) Drain

Where does Glass Capillary Tubes (contaminated) go after being used?

a) Regular trash

b) SHARPS container

c) Drain

d) Biohazard (red) Bins

b) SHARPS container

Where does Culturette Swabs go after being used?

a) Regular trash

b) SHARPS container

c) Drain

d) Biohazard (red) Bins

d) Biohazard (red) Bins

Where do Gloves (visibly soiled w/ blood) go after being used?

a) Regular trash

b) SHARPS container

c) Drain

d) Biohazard (red) Bins

d) Biohazard (red) Bins

Where do Gloves (unsoiled) go after being used?

a) Regular trash

b) SHARPS container

c) Drain

d) Biohazard (red) Bins

a) Regular trash

Where do Lancets go after being used?

a) Regular trash

b) SHARPS container

c) Drain

d) Biohazard (red) Bins

b) SHARPS container

Where do Needles go after being used?

a) Regular trash

b) SHARPS container

c) Drain

d) Biohazard (red) Bins

b) SHARPS container

Where does Paper / Towels / Mats / Kimwipes (contaminated with blood) go after being used?

a) Regular trash

b) SHARPS container

c) Drain

d) Biohazard (red) Bins

d) Biohazard (red) Bins

Where does Paper / Towels / Mats / Kimwipes (contaminated with urine) go after being used?

a) Regular trash

b) SHARPS container

c) Drain

d) Biohazard (red) Bins

a) Regular trash

Where do Pipettes – Plastic (contaminated) go after being used?

a) Regular trash

b) SHARPS container

c) Drain

d) Biohazard (red) Bins

d) Biohazard (red) Bins

Where do Tubes (culture, vacutainer, microfuge) go after being used?

a) Regular trash

b) SHARPS container

c) Drain

d) Biohazard (red) Bins

d) Biohazard (red) Bins

Where do Urine Samples go after being examined?

a) Regular trash

b) SHARPS container

c) Drain

d) Biohazard (red) Bins

c) Drain

Where do Urine Transfer Pipettes / Specimen Containers / Test Strips go after being used?

a) Regular trash

b) SHARPS container

c) Drain

d) Biohazard (red) Bins

a) Regular trash

Where does a Hematocrit tube go after being used?

a) Regular trash

b) SHARPS container

c) Drain

d) Biohazard (red) Bins

b) SHARPS container

Where do ESR Tubes go after being used?

a) Regular trash

b) SHARPS container

c) Drain

d) Biohazard (red) Bins

b) SHARPS container

Where do HemoCue microcuvettes go after being used?

a) Regular trash

b) SHARPS container

c) Drain

d) Biohazard (red) Bins

b) SHARPS container

Where do Fecal Occult Tests go after being used?

a) Regular trash

b) SHARPS container

c) Drain

d) Biohazard (red) Bins

d) Biohazard (red) Bins

A normal urinalysis consists of what 3 examinations?

Physical

Chemical

Microscopic

All urine specimens must be labeled properly with what 3 things?

patient's name

DOB

date of collection

What is the clinical significance of urine being straw/pale in color?

normal

What is the clinical significance of urine being red in color?

hematuria

What is the clinical significance of urine being brown/Coca-Cola in color?

acute glomerular nephritis

What is the clinical significance of urine being greenish in color?

bilirubinuria

What is the clinical significance of urine having a sweet/fruity odor?

ketonuria (DM 1)

What is the clinical significance of urine having a ammonia odor?

urine retention

What is the clinical significance of urine having a foul odor?

UTI (e.g. cystitis)

What is the clinical significance of urine having a turbid appearance?

white blood cells, bacteria, yeast, protein

What is the clinical significance of urine having a clear appearance?

normal

What is a confirmatory test for ketonuria?

ketostix

What is a confirmatory test for glucosuria?

diastix

What is a confirmatory test for proteinuria?

albustix

What is the confirmatory test for bilirubinuria?

ictotest

What is a confirmatory test for hematuria?

hemastix

What is a confirmatory test for pyuria?

microscopic examination

What is a confirmatory test for nituria?

microscopic examination

What does a squamous reading >10 LPF signify?

contamination

What is the normal WBC reading in a microscopic urine examination?

0-5/hpf

What is the normal RBC reading in a microscopic urine examination?

0-2/hpf

What is the specific gravity range for urine? What does it mean if its low? High? Fixed @ 1.010?

1.003-1.030

Low: excessive hydration (diabetes insipidus)

High: dehydration (diabetes mellitus, fever)

Fixed @ 1.010: advanced kidney failure

What is the pH range for urine? What does it mean if its low? High?

4.5-8.0

High: alkalosis, cystitis

Low: acidosis, fever, high protein diets.

What is the most likely location of a lesion for an individual experiencing frequency, urgency, and painful urination. As well as suprapubic discomfort with a temperature of 98.4 degrees. Would this be cystitis or pyelonephritis?

bladder (based on location)

cystitis - lack of systemic findings, pain level low, NL temp

What are 2 reasons that a patient could have stix negative for nitrites and still have a UTI?

1) urine needs be in the bladder for 4 hours before nitrate gets converted to nitrite

2) could be caused by a bacteria that doesn't do the conversion of nitrate to nitrite (not E.coli)

How can you tell functional from organic (renal)?

• pathologies come with signs and symptoms

• excessive exercise, high protein diet, not having been exposed to cold can all contribute to a function proteinuria (otherwise consider orthostatic proteinuria)

47-year-old man complaining of an acute onset of left sided, intermittent flank pain radiating down into his left testicle of four hours’ duration as well as nausea. Physical examination reveals tenderness at left costovertebral angle.

Vital signs: temperature: 98.5 degrees F; PR: 110 bpm; BP: 188/92 mm Hg; RR: 20 bpm; pain level: 9/10

What organ is the most likely source of his problems? What is causing his BP & PR to be abnormal? Why is it not an infection? Most likely diagnosis

Kidney

His pain is causing BP & PR to be abnormal, and there is not elevated temperature of other signs of fever

Nephrolithiasis

If a patient had negative blood on a chemstrip but microscopic examination finding of hematuria, what would be the most probable reason for this discrepancy?

Vitamin C

What does oliguria mean?

decreased urination

Daphne Harrison is a 28-year-old woman complaining of nausea, vomiting and diarrhea of 3 days duration. She believes it is due to food poisoning as others in her family have the same complaint after attending a family reunion. She is also complaining of thirst and oliguria.

UA: dark amber, aromatic, cloudy, specific gravity 1.039, pH 5.5, trace ketones, moderate squamous epi

What is the most likely diagnosis?

Dehydration. No polyuria or polydipsia (diabetes) present. Thirst, oliguria, and increased specific gravity point to this diagnosis. Ketones can be present with dehydration, and there is no glucose in urine so we know this isn't diabetes.

Angie Parkson is a 29-year-old woman complaining of an acute onset of severe low back and right-sided flank pain. She was previously diagnosed with mechanical low back pain. PE reveals tenderness at the right costovertebral angle.

Vital signs: temperature: 101.5 degrees F; PR: 66 bpm; BP: 108/72 mm Hg; RR: 16 bpm; pain level: 8/10

CBC = WBC - 14,400/ul, RBC - 5.1 million/ul, Hb – 13.5 gm/dl, Hct - 39%

Differential WBC: N: 87%, L: 10%, M: 3%, E: 0%, B: 0%

What organ is most likely the source of her problems? What is the most likely diagnosis and why?

Kidney

Pyelonephritis. Due to location, and pain level (would be milder for cystitis), systemic findings such as fever, leukocytosis, and neutrophilia.

If a patient had acute glomerulonephritis (AGN), what pathognomonicformed cellular element is most likely seen in a microscopic examination of urine?

RBC cast

The real threshold in the kidneys for glucose is ________ milligrams per deciliter

180

will not start dumping it at a high rate until the blood glucose hits this amount

44-year-old woman complaining of an acute onset of severe, colicky RUQ abdominal pain as well as nausea, vomiting, fever and chills. She has not been out of the country recently, denies drug use or exposure to anyone with hepatitis. PE exam revealed tenderness in the RUQ, involuntary guarding of upper abdominal muscles on the right side, and temperature 100 degrees F.

CBC = RBC – 5.1 million/ul, Hb – 14.5.0 g/dl, Hct - 42%, WBC –15,400/ul, Differential WBC - N = 88%, L =12%, M = 0%, E = 0%, B = 0%.

What organ is most likely the source of her problems? What is the most likely diagnosis and why? What is the most likely sign of referral for this patient?

Liver & Gallbladder

Cholecystitis

R shoulder

If bilirubin is in the urine is it conjugated or unconjugated? Water-soluble or insoluble? Direct or indirect?

conjugated

water-soluble

direct

Bill Porter is a 68-year-old man complaining of a fever, mucopurulent cough, pleuritic chest pain and exertional dyspnea. Physical exam revealed crackles on auscultation. Chest x-ray revealed multi-lobar infiltrates. Vital signs: temperature: 102.1 degrees F; PR: 86 bpm; BP: 100/78 mm Hg; RR: 20 bpm; VAS: 6/10

CBC = RBC – 6.1 million/ul, Hb – 14.5.0 g/dl, Hct - 42%, WBC –24,100/ul, Differential WBC - N = 98%, L = 2%, M = 0%, E = 0%, B = 0%.

What is the most likely diagnosis? What would ESR be?

Bacterial Pneumonia based on WBC count with neutrophilia and lower respiratory signs present. ESR would be increased.

Nate Rue is a 12-year-old boy brought in by his mother for an adjustment. His mother states he has had nasal congestion and a cough for 3 weeks. He has had these symptoms seasonally for about 2 years.

CBC: Hb - 14.8 g/dl, Hct - 45%, RBC - 5.4 mil/ul, WBC - 8,400/ul

Differential = N - 53%, L - 28%, M - 7%, E - 12%, B - 0%.

What is the most likely diagnosis?

Eosinophilia, and with that being around 10% and considering the symptoms allergies is the most likely diagnosis

Eosinophils of _______________ would be indicative of parasitic infection

25-30%