UA PPT Flashcards
1) What are the agencies involved in
developing guidelines for mandated
safety policies?
2) What is the primary objective of
biological safety?
3) How does a microorganism transmit?
4) What are the infectious agents?
5) What are the reservoirs of potentially
harmful microorganisms?
6) What are the means of transmission for
microorganisms?
7) What are the potential portal of entry of
microorganisms?
8) What are examples of standard
precautions?
 Centers for Disease Control and Prevention
 Occupational Health and Safety Administration
 Clinical Laboratory Standards Institute
Preventing completion of the chain of infection
Infectious agent, reservoir, portal of exit, means of
transmission, portal of entry, susceptible host
Bacteria, fungi, parasites, viruses
Humans, animals, fomites
Airborne, direct contact, droplet, vector, vehicle
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9) Is handwashing a substitute for gloves?
10) What are the types of gloves?
11) What type of gloves if alternative for
personnel with latex allergy?
12) What is the purpose of fluid-resistant
lab coats?
13) How are the lab coats worn?
14) What are the types of face protection
for PPE?
Mucous membranes of the nose, mouth, and eyes
Breaks in the skin
Open wounds
Hand hygiene
Gloves
Mouth, nose and eye protection
Gown
Patient-care equipment – disposal or sterilization
Environmental control – clean and disinfect
surfaces
Linen – prevent exposure when handling
Occupational health and bloodborne pathogens
– no needle recapping
Patient placement – Isolation
Respiratory hygiene/cough etiquette –
prevention of droplet and fomite transmission of
respiratory pathogens
No
Sterile and nonsterile, powdered and nonpowdered,
latex and nonlatex
Nitrile or vinyl glove
Protect skin and clothing

Completely buttoned, gloves pulled over wrist
cuffs
 Wear when working with specimens, remove
when leaving lab
 Change when visibly soiled
 Discard disposable as biohazardous waste and
nondisposable in designated laundry bins
Goggles, full-face plastic shields, Plexiglas countertop
shields
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UA PPT Flashcards
15) Where does face protection as PPE help
personnel?
16) Is it OK to centrifuge uncapped
specimens?
17) What is the recommended foot
protection?
18) What is the primary method of
infection?
19) When do we sanitize our hands?
20) Who developed hand washing
guidelines to be followed for correct
hand washing?
21) Can urine be poured down the sink?
22) What are the examples of sharps?
23) Where are sharps disposed?
24) What are the steps that needs to be
done for skin/eye chemical spill?
25) What is included in the chemical spill
kit?
26) Is it OK to mouth pipet?
27) What is a chemical hygiene plan?
28) What information should an MSDS
have?
29) What are possible radioactive hazard in
labs?
30) What precautionary measures must be
done for radioactive hazards?
Splashes and aerosols caused by uncapping, pouring,
transferring, and centrifuging
No
Closed-toed and covers the entire foot
Hand contact
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CDC
Before patient contact
After gloves are removed
Before leaving the work area
At any time when hands have been knowingly
contaminated
Before going to designated break areas
Before and after using bathroom facilities
Yes
Needles, lancets, broken glassware
Puncture-resistant containers that are leak proof
 flush 15 minutes with water
 seek medical attention
 do not try to neutralize with other chemicals
Protective apparel, nonreactive absorbent material, bags
for disposal
No
Written plan required by OSHA that includes:
 appropriate work practices
 Standard operating procedures
 PPE
 Engineering controls, hoods, safety cabinets
 Employee training
 Medical consultation guidelines
Physical and chemical characteristics
Fire and explosion potential
Reactivity potential
Health hazards and emergency first aid procedures
Methods for safe handling and disposal
Primary routes of entry
Exposure limits and carcinogenic potential
Radiosotopes
Symbol on doors
Radiographers wear badges to measure exposure
Pregnancy: avoid areas with this symbol
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UA PPT Flashcards
31) How to avoid electrical hazards?
32) What to do in the event of electrical
shock accident?
33) What must be done in the event of fire?
34) How do you operate a fire extinguisher?
35) What are the general precautions of
physical hazards?
36) What is Quality Assessment?
37) What is Quality System?
38) What are the Quality Assessment
Programs?
39) What are the Guidelines published by
College of American Pathologists (CAP)
and the CLSI to provide complete
instructions for documentation?
Avoid water and fluid contact
Do not operate equipment with wet hands
Observe for frayed cords, overloads; report
Unplug and dry wet equipment
Equipment grounded with three-prong plugs
Do not touch person
Remove electrical source
Turn off circuit breaker
Unplug equipment
Move equipment using nonconductive items such as
wood or glass.
Rescue: anyone in danger
Alarm: activate
Contain: close affected area doors
Extinguish/Evacuate: if possible, or exit
Pull pin
Aim at base of fire
Squeeze handles
Sweep nozzle side to side
Avoid running in rooms and hallways
Watch for wet floors
Bend the knees when lifting heavy objects
Keep long hair pulled back
Avoid dangling jewelry
Maintain a clean, organized work area
Wear supportive, closed-toe shoes
The overall process of guaranteeing quality patient care.
The laboratory’s policies, processes, procedures, and
resources needed to achieve quality testing.
• Testing controls
– Quality control
• Preexamination variables
– Specimen collection, handling, and storage
• Examination variables
– Reagent and test performance, instrument
calibration and maintenance, personnel
requirements, and technical competence
• Postexamination variables
– Reporting of results and interpretation
Procedure manuals
Internal and external quality control
Standardization and equipment maintenance
Proficiency testing and record-keeping
Safety programs
Training, education, competency assessment
Scheduled, documented review processes
Required by accrediting agencies
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UA PPT Flashcards
40) Name the 6 Accrediting Agencies?
41) T or F, Urinalysis Manual must be
available in work area?
42) What should a Urinalysis Procedure
Manual must include?
43) How often the current methods must be
reviewed?
44) What must be done when there is a
change in the procedure manual?
45) Who must be notified of changes?
46) What are the variables before testing?
47) What is Turnaround Time (TAT)
48) What information should requisition
and computerized entry forms must
have?
Joint Commission (JC)
College of American Pathologists (CAP)
American Association of Blood Banks (AABB)
American Osteopathic Association (AOA)
American Society of Histocompatibility and
Immunogenetics (ASHI)
Commission on Laboratory Assessment (COLA)
True
Principle or purpose of the test
Clinical significance
Patient preparation
Specimen type and method of collection
Specimen acceptability and criteria for rejection
Reagents, standards, and controls
Instrument calibration and maintenance protocols and
schedules
Step-by-step procedure, calculations
Frequency and tolerance limits for controls and
corrective actions
Reference values and critical values
Interpretation of results
Specific procedure notes
Limitations of the method
Method validation
Confirmatory testing
Recording of results
References
Effective date, author, and review schedule
Annualy
Reviewed, referenced, and signed by a person with
designated authority
All personnel must be notified.
Ordering of tests
Patient preparation
Specimen collection
Specimen handling, transport, and storage
Is the amount of time required from when a test is
ordered by the health-care provider until the results are
reported to the health-care provider.
• Patient identification information
o Name, sex, age, date of birth, hospital ID
number
• Test requested
• Type of urine specimen to be obtained (voided, clean
catch, catheterized)
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UA PPT Flashcards
•
•
49) What is the acceptability of a specimen?
50) What reasons can a specimen are
rejected?
51) What processes directly affect the
testing of specimens?
52) What information reagents must have?
53) What QC must instrumentation and
Equipment must be followed?
54) What is the procedure for Testing?
Requested date and time of collection
Actual collection information (time,
storage/transport condition)
• Received and tested time
Matching patient information on specimen and
requisition
Properly labeled specimen
Timely transport or refrigeration
Adequate amount of specimen
Noncontaminated specimen
Tightly closed container
Patient misidentification
Wrong test ordered
Incorrect urine specimen type collected
Insufficient urine volume
Delayed transport of urine to laboratory
Incorrect storage or preservation of urine
Reagents
Instrumentation and equipment
Testing procedure
QC
Preventive maintenance
Access to procedure manuals
Competency of personnel performing the tests
Manufacturer, name, and chemical formula
Instructions for preparation:
Type of water used in preparation
Clinical Laboratory Reagent Water
(CLRW)
Storage requirements
Procedures for reagent quality control
Label with date of opening or preparation
Check reagent strips daily or each shift and when
a new bottle is opened
Safety and health precautions
Operation, calibration, limitations, dilution procedures,
recording
Calibration and control of refractometers, osmometers,
reagent strip readers
Temperatures of refrigerators and water baths must be
recorded daily
Calibration and disinfection of centrifuges
Prepare a routine preventive maintenance schedule
Document all routine and nonroutine maintenance
Specimen preparation: time and speed of centrifugation
Specimen and reagent stability
Calculation formulas
5
UA PPT Flashcards
55) What is Quality Control (QC)?
56) What does QC ensures?
57) What is External QC?
58) Within an external QC the verification of
accuracy and precision can also
calculate:
59) When should Corrective Actions be
taken?
60) Corrective Actions must be ________
61) What is an Internal QC?
62) What is achieved when an Internal and
Procedural QC is done?
63) What is achieved in an Electronic
Internal QC?
64) What is achieved in Proficiency
Testing/External Quality Assessment
(PT/EQA)?
65) What is the testing of unknown samples
provided by an external agency?
66) What actions follow the completion of
Proficiency Testing/External Quality
Assessment?
67) How is the evaluation and comparison
of a PT/EQA done?
68) What is the final step of a PT/EQA?
Health and safety precautions
Sources of error and interference
Clinical situations influencing test, alternate procedures
Helpful hints
Turnaround time for STATs
The materials, procedures, and techniques that monitor
the accuracy, precision, and reliability of a laboratory
test.
It ensures that acceptable standards are met during the
process of patient testing.
Patient test results not reported until the QC is verified.
• Verifies accuracy and precision such as:
– Exposed to the same condition as a patient
sample
– Medically significant
– Run two levels of control material
– Record date of opening, manufacturer’s lot
number, expiration date each time control is
run
– Same person running controls must run
patient samples
– Free of communicable disease (HIV, Hepatitis
C, Hepatitis B)
The mean, standard deviation, coefficient of variation
and range.
When the control values are outside the tolerance limits.
Documented
The internal monitoring included in the test system
Monitors addition of patient specimen and reagents,
instrument and reagent interaction and test completion.
Verifies the functional ability of electrical components of
instruments in place of liquid control medium.
Unbiased validation of the quality of patient test
results
Proficiency Testing/External Quality Assessment
(PT/EQA)
The accuracy is evaluated and compared with other
laboratories using the same method of analysis.
The vendor statistically rates answers from all
participating labs and returns the report to the lab
director.
Corrective actions performed and documented.
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UA PPT Flashcards
69) What is included in a Personnel
Assessment?
70) What is learned in Document training?
71) What must be available in Facilities?
72) The Facilities must have:
73) What must always be followed within
the facility?
74) What are Post-Examination Variables?
75) Regarding Post-Examination Variables,
what must be used in order to minimize
health-care provider confusion?
76) What are the most common type of
Post-Examination Variable?
77) What types of problems occur when
using Electronic Transmissions?
78) What must be done in order to correct
erroneous results in a timely matter?
79) What must be done when telephoning
results?
80) Why should written procedures be
available?
81) When Interpreting results you must
include _______ and _______ of tests in
the procedure manual.
82) In order to interpret results correctly a
list of what type of substances must be
documented within the manual?
83) When Interpreting results a welldocumented QA program will:
84) What is the importance of Urinalysis?
85) What is the CLSI definition of Urinalysis?
86) What are the reasons for performing
Urinalysis on patients?
87) The ultrafiltrate of plasma is used to
form _______.
88) What is an average daily urine output?
89) Urine consists of ____% water and
____% solutes.
90) What is the major organic solute in
urine?
Education and training, continuing education,
competency assessment, and performance appraisals.
The creation of Checklist of procedures
The current reference materials
A safe working area with adequate space.
Standard Precautions
Processes that affect the reporting of results and correct
interpretation of data.
The use of Standardized reporting formats which include
reference ranges.
Electronic Transmissions
Autoverification is often programmed into many
laboratory analyzers
Do not erase original result from chart and document the
errors.
Confirm that the results are being reported to the
appropriate person
For reporting of critical values
Specificity; Sensitivity
Interfering substances
Ensure quality test results and patient care
Urine contains information, which can be obtained by
inexpensive laboratory tests, to assess many metabolic
functions.
The testing of urine with procedures commonly
performed in an expeditious, reliable, safe, and costeffective manner.
The aiding of disease diagnosis, screening for
asymptomatic diseases, and monitor of disease progress
and therapy effectiveness.
urine
1200 mL
95%; 5%
Urea
7
UA PPT Flashcards
91) What consists of the inorganic solutes in
urine?
92) The identification of these components
identifies a fluid as urine.
93) The identification of these substances
within urine increases the indication of
disease.
94) The Urine volume is determined by:
95) What may influence the volume of
urine?
96) What is the usual daily volume of urine?
97) What is the normal range of urine
volume?
98) A decrease in Urine output
99) What is the definition of Anuria?
100) What is the definition of Nocturia?
101) What are the components of Polyuria?
102) Patients with Diabetes Mellitus who
are experiencing Polyuria will have:
103) Paitents with Diabetes Mellitus who
are experiencing Polyuria will also
exhibit:
104) Patients with Diabetes Mellitus will
have urine that appears:
105) Patients with Diabetes Insipidus who
are experiencing Polyuria will have:
106) The urine of a patient with Diabetes
Insipidus will appear:
107) Patients with Diabetes Insipidus will
also exhibit:
108) What information is included on a
specimen label?
109) What additional information is
included on a specimen label?
110) Where must the specimen label be
placed?
111) What must accompany the specimen/
112) What must be stamped on the
requisition form?
113) What information must be on the
requisition form?
114) A specimen is rejected if:
115) A specimen is rejected if:
116) A specimen is rejected if:
117) A specimen is rejected if:
Chloride, sodium and potassium
Urea and Chloride
Cells, casts, crystals, mucus, and bacteria
The body’s state of hyradation
Fluid intake, nonrenal fluid loss, antidiuretic hormone
(ADH) variations, excretion of large amounts of dissolved
solids (e.g., glucose)
1200-1500 mL
600-2000 mL
Oliguria
The cessation of urine flow
Increased urine excretion at night
Greater than 2.5 L of urine excreted a day.
Increased volume caused by need to excrete the excess glucose
not reabsorbed from the ultrafiltrate.
Polydipsia
Dilute with a high specific gravity
Decreased production or function of antiduretic
hormone (ADH) causing decreased reabsorption of water
from ultrafiltrate.
Dilute with low specific gravity.
Polydipsia
Patient’s name, ID number, date, time
Age, location, health-care provider’s name.
on the container not the lid.
A requisition form
Time of receipt
Type of specimen, interfering medications
The specimen is not labeled
There is non-matching labels and requisition forms
The exterior of the container is contaminated
The Specimen is sent an insufficient quantity
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UA PPT Flashcards
118) A specimen is rejected if:
119) In order to insure the proper quality of
specimen a laboratory must include:
120) In order to have the correct test
results the urine specimen must be
tested within what amount of time?
121) What must be done in order to keep
the integrity of the specimen if the
testing is delayed?
122) What causes the most problems when
trying to keep the integrity of a urine
specimen?
123) In order to keep the integrity of a
urine specimen the sample must be
refrigerated at __°C to __°C
124) What is the ideal chemical
preservative of a urine specimen?
125) The chemical preservative
bactericidal:
126) What must be true in order to use a
commercial transport tube?
127) What influences the composition of a
urine specimen?
128) What influences the composition of a
urine specimen?
129) What is the most common type of
Specimen received?
130) When may Random Specimens be
collected?
131) What must be recorded when
collecting Random specimens?
132) What may alter the results of a
Random Specimen?
133) What is the most ideal type of
specimen for screening?
134) Why are First morning specimen’s the
most ideal for screening?
135) Why are First Morning Specimens
used?
136) Why is a First Morning Specimen more
better for testing than a random
specimen?
137) How is a first morning specimen
collected?
138) What type of specimen is collected
after the first morning specimen?
The Specimen is improperly transported
Written policies for rejection of specimens
Within 2 hours of collection
Refrigerate or chemically preserve the specimen
Bacterial multiplication
2; 8
Bactericidal
Inhibits urease and preserves formed elements
The transport tube must be compatible with the tests
The patient’s metabolic state and the timing and
procedure used for collection
Time, length, and method of collection and the patient’s
dietary and medicinal intake
Random Specimen
Random Specimens may be collected at any time
Collection time must be recorded
Dietary intake and physical activity
First Morning Specimen
The patient is in a basal state
For orthostatic protein confirmation, and urine
pregnancy tests
The urine is more concentrated
Upon rising and delivered to the lab within 2 hours
Fasting Specimen
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UA PPT Flashcards
139) This type of urine specimen does not
contain metabolites
140) What type of specimen is
recommended for glucose monitoring
141) What type of specimen will produce
accurate quantitative results?
142) What are good diurnal variation
solutes?
143) True or False
The patient must remain adequately
hydrated during short collection period.
144) True or False
The patient must be instructed on the
procedure for collecting a timed
specimen.
145) Concentration of a substance in a
particular period must be calculated
from?
146) 24-hour specimen must be thoroughly
__________ and the _________
accurately measured and recorded
147) Multiple containers of the same
collection must be _______ and
_______ thoroughly.
148) True or False
Additives should not interfere with the
tests to be performed.
149) 24-hour specimens are needed for?
150) Substances with consistent levels can
be measured with what type of
specimen?
151) What is a critical factor for accurate
results?
152) What is the procedure for a 2-hour
postprandial specimen?
153) True or False
Glucose tolerance specimens are
collected at the same intervals as the
blood samples
Fasting Specimen
Fasting Specimen
A carefully timed specimen
Catecholamines and electrolytes
True
True
The urine volume produced during that time
Mixed, volume
Combined, mixed
True
Quantitative results, measuring substances with diurnal
variation, and substances that vary with meals, activity,
and body metabolism
Shorter timed specimens
Accurate timing
1. Patient voids before eating routine meal
2. Eats meal
3. Collects next specimen 2 hours after finishing meal
4. Monitors insulin therapy
5. Results can be compared with fasting urine specimen
and blood test results
True
10
UA PPT Flashcards
154) What type of specimen is used to
correlate renal threshold with patient’s
ability to metabolize glucose?
155) What type of specimen is a sterile
specimen collected from the bladder
with a hollow tube?
156) What is the most common test for a
catheterized specimen?
157) What is an alternative to a
catheterized specimen?
158) True or False
Catheterized method is less traumatic
than midstream clean-catch specimen.
159) What type of specimen is less
contaminated than routine collection?
160) For midstream clean-catch specimen,
you must provide the patient with mild
_________ _________, a container,
and instruction.
161) True or False
For a midstream clean-catch specimen,
you should not touch or contaminate
inside of container.
162) What type of specimen is completely
free of contamination for culture ad
cytology?
163) What type of specimen is collected by
external introduction of needle for
aspiration from the bladder?
164) Which specimen is similar to
midstream clean-catch?
165) How many containers are collected for
a prostatitis specimen?
166) For a prostatitis specimen, what
sample is collected in container 1?
167) For a prostatitis specimen, what
sample is collected in container 2?
168) What needs to be done before the
third sample of a prostatitis specimen is
collected?
169) Why is the prostate massaged before
the third collection of a prostatitis
specimen?
170) What sample is collected in container
3 of a prostatitis specimen?
Glucose tolerance specimen
Catheterized specimens
Bacterial culture
A midstream clean-catch specimen
False
Midstream clean-catch specimen
Cleaning material
True
Suprapubic aspiration
Suprapubic aspiration
Prostatitis specimen
3
First urine passed
Midstream urine
Massage prostate to obtain prostatic fluid
To obtain prostatic fluid
The remaining urine and prostatic fluid
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UA PPT Flashcards
171) Which containers of a prostatitis
specimen are examined
microscopically?
172) What do these lab results indicate:
Higher WBC/hpf count in specimen 3
than specimen 1; bacterial count in
specimen 3 is 10 times higher than in
specimen 1
173) Prostatitis specimen 2 is a control for?
174) A positive culture in specimen 2
invalidates what?
175) Why does a positive specimen 2
invalidate a positive specimen 3?
176) What specimens are collected for a
pre- and postmassage test?
177) What is indicated by a quantitative
culture result in the second glass that is
10 times higher than specimen 1?
178) How is a pediatric specimen collected?
179) True or False
Clean-catch method with a sterile bag
can be used for pediatric specimens.
180) Bags with tubes to a larger container
are available for what type of
specimens?
181) What must be documented for a drug
collection?
182) Chain of custody for a drug specimen
involves:
183) Drug specimens are free of:
184) What always accompanies drug
specimens?
185) Drug specimen must withstand
________?
186) True or False
A photo ID of the urine donor does not
need to be collected
187) There is no unauthorized access to
what type of specimen?
188) Witnessed versus unwitnessed
collection is determined by?
189) True or False
For witnessed and unwitnessed
collections, the specimens must be
handed immediately to the collector.
1 and 3
Prostatic infection
Bladder or kidney infection
A positive culture in specimen 3
Because it cannot differentiate urinary tract infection
from prostate infection
First a midstream clean catch specimen, second a
postmassage specimen
Prostatitis
In a soft, clear, plastic bag, with hypoallergenic tape
applied to genital area
True
Timed specimens
Proper collection, labeling and handling
Documentation from the time of specimen collection
until the time of receipt of laboratory results
Substitution, adulteration, or dilution
Standardized form
Legal scrutiny
False
Drug specimen
Test orderer
True
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UA PPT Flashcards
190) The temperature of a drug specimen
must be taken within ____ minutes to
confirm the specimen was not
adulterated.
191) What temperature range should the
urine specimen be in?
192) What should you do if the specimen is
not within normal temperature range?
193) The labeling, packaging, and transport
of a drug specimen should follow?
194) What is the functional unit of the
kidney?
195) How many nephrons are in each
kidney?
196) What type of nephron makes up 85%
of the nephrons, the loop remains
within the cortex of the nephron, is
responsible for removal of waste
products and reabsorption of nutrients?
197) What type of nephron has longer
loops of Henle, extends deep into the
nephron medulla, and is responsible for
urine concentration?
198) What type of functions are controlled
in the nephron and include the
following: renal blood flow, glomerular
filtration, tubular reabsorption, and
tubular secretion.
199) Renal blood flow:
Renal artery, afferent arteriole, ______,
efferent arteriole, _______, vasa
recta/loops of Henle, peritubular
capillaries/distal convoluted tubule,
_____.
200) What supplies blood to the kidneys?
201) What carries the blood leaving the
glomerulus?
202) What part of the nephron is adjacent
to loops of Henle, acts as an osmotic
gradient, and exhibits major exchange
of water and salts?
203) Based on an average body size of
1.73m2 of surface, the total renal blood
flow is approximately?
204) Renal plasma flow =
4
32.5oC to 37.7oC
The temperature should be reported immediately, and
another specimen collected ASAP. The urine color should
also be inspected for possible contamination.
Laboratory instructions.
Nephron
1 to 1.5 million
Cortical
Juxtamedullary
Renal functions
Glomerulus, peritubular capillaries/proximal convoluted
tubule, renal vein
Afferent arteriole
Efferent arteriole
Vasa recta
1200mL/min
600-700mL/min
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UA PPT Flashcards
205) True or False
Correction for variance in body surface
area must be calculated.
206) How many capillary lobes are in the
glomerulus?
207) Where is the glomerulus located?
208) What type of filtration occurs in the
glomerulus?
209) Cellular structure, hydrostatic and
oncotic pressure, and renin-angiotensinaldosterone system are all factors of?
210) What 3 cellular layers make up the
glomerulus?
211) The endothelial cells of the capillaries
in the glomerulus differ from other
capillaries because?
212) True or False
The pores allow large molecules to pass
through.
213) Does the basement membrane restrict
or allow large molecules to pass
through?
214) The inner layer of Bowman’s capsule
contains what type of cells?
215) What repels molecules with a positive
charge?
216) Give an example of a molecule small
enough to pass through the three layers
of the barrier.
217) The juxtaglomerular apparatus is
responsible for?
218) How does the juxtaglomerular
apparatus maintain consistent
glomerular pressure?
219) In order to prevent decrecreased
glomerular blood flow when the
systemic blood pressure is low, the
juxtaglomerular apparatus will?
220) In order to prevent overfiltration and
glomerular damage when the systemic
blood pressure is high, the
juxtaglomerular apparatus will?
221) What does RAAS stand for?
222) The RAAS controls?
223) The RAAS reacts to what kind of
changes?
True
8
Bowman’s capsule
Nonselective
Glomerular filtration
Capillary wall, basement membrane, bowman’s capsule
inner layer
They contain pores
False
Restrict
Podocytes
Shield of negativity
Albumin
Maintaining consistent glomerular pressure
By regulating the arteriole size
Dilate the afferent arteriole and constrict the efferent
arteriole
Constrict the afferent arteriole
Renin-Angiotensin-Aldosterone System
The regulation of blood flow to and within the
glomerulus
Changes in blood pressure and plasma sodium
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UA PPT Flashcards
224) Blood pressure and plasma sodium
are monitored by?
225) The juxtaglomerular apparatus
contains different cells in each arteriole,
list the cells and which arteriole they are
found in.
226) In response to blood pressure
changes, the macula densa initiates?
227) What six factors are associated with
RAAS Cascade?
Juxtaglomerular apparatus
228) These functions are related to
_______?
Dilates afferent arteriole
Constricts efferent arteriole
Stimulates sodium reabsorption in
proximal convoluted tubule (PCT)
Triggers release of aldosterone
a. Reabsorption of sodium in distal
convoluted tubule (DCT) and collecting
duct (CD)
b. Increase in potassium excretion
Triggers release of antidiuretic hormone
(ADH)
c. Stimulates water reabsorption in CD
Angiotensin II
229) What is the normal filtrate for
Glomerular?
A. 120 mL/min of filtrate
B. 100 mL/min of filtrate
C. 80 mL/min of filtrate
D. 140 mL/min of filtrate
230) Ultrafiltrate of plasma, Same
composition minus plasma proteins,
protein-bound substances, and cells are
referring to _______Filtrate?
231) What is the ultrafiltrate specific
gravity for Gromerular?
A. 10.10
B. 1.010
C. 10.15
D. 10.09
A. 120/mL min of filtrate
Juxtaglomerular cells – afferent arteriole
Macula densa – efferent arteriole
RAAS
•
•
•
•
•
•
Renin secreted by juxtaglomerular cells
Angiotensinogen: blood substance
Angiotensin 1: passes through lungs
Angiotensin-converting enzyme (ACE)
Angiotensin II
Aldosterone
Glomerular
B. 1.010
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UA PPT Flashcards
232) Tubular reabsorption starts when the
plasma ultrafiltrate enters the proximal
convoluted tubule? True or False
233) Active transport consists of these
things? True of False
Carrier proteins and cellular energy
needed for transport back to blood,
Glucose, salts (Na is highest), amino
acids in proximal convoluted tubule,
Chloride in ascending loop of Henle,
Sodium in distal convoluted tubule.
234) Referring to tubular re-absorption,
these functions occur during what
transport?
Controlled by the differences in substance
concentration gradients on sides of a
membrane, Water reabsorption occurs
throughout the nephron, Exception is
ascending loop of Henle, Accompanies high
amount of sodium reabsorption in PCT, Urea
in PCT and ascending loop of Henle, Sodium
in the ascending loop of Henle.
A. Active
B. Passive
235) Plasma concentration of a substance
that is normally completely reabsorbed
reaches an abnormally high level is
call________ Reabsorptive
Capacity (Tm).
236) Referring to maximal reabosorptive
capacity, Renal threshold includes:
Normally reabsorbed substance appears
in urine, Glucose threshold: 160 to 180
mg/dL, Threshold distinguishes excess
filtration from tubular damage. True or
False?
237) Plasma level causing active transport
to cease is referred to as _______
_______?
238) In regards to tubular concentration,
Passive reabsorption of water into the
high osmotic gradient of the renal
medulla is referred to as?
A. Ascending loop Henle
B. Descending loop Henle
C. All the above
True
True
B. Passive
Maximal
True
Renal Threshold
B. Descending
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UA PPT Flashcards
239) Chloride actively reabsorbed, Sodium
passively reabsorbed and walls are
impermeable to water are referred to
______ loop Henle?
240) Referring to tubular concentration,
what are these functions associated
with?
a. Maintains concentration in the medulla
b. Medulla is diluted by the water from the
descending loop
c. Reconcentrated by sodium and chloride
from the filtrate in the ascending loop
241) Aldosterone-controlled Na
reabsorption if needed by body is
associated with DCT? True or False
242) Water reabsorption controlled by ADH
in response to body hydration, Osmotic
gradient in the medulla, Vasopressin
(ADH) is associated with?
243) Controls permeability of DCT and CT
walls to water, Amount of ADH
produced by hypothalamus determines
permeability is associated with?
244) The chemical balance in the body is
actually the final determinant of urine
volume and concentration is associated
with?
245) Final filtrate concentration, ADH and
The chemical balance in the body is
actually the final determinant of urine
volume and concentration is associated
with?
246) Body Hydration = ↓ADH = ↑Urine
Volume
↓Body Hydration = ↑ADH = ↓Urine
Volume
What chart is this referring to?
247) Referring to tubular secretion,
Secretion = blood peritubular capillaries
to filtrate. True or False
248) Contrast to reabsorption = filtrate to
blood is associated to Secretion?
True or False
Ascending Loop Henle
Countercurrent mechanism
True
Final filtrate concentration
ADH
Collecting Duct Concentration
Collecting Duct Concentration
Diagram of ADH Regulation
True
True
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UA PPT Flashcards
249) Eliminate nonfiltered wastes are
associated to: Protein-bound
substances, Regulate acid-base balance?
(Secrete H+ ions to return filtered
buffers to the blood, Excrete excess H+
ions). True or False
250) Normal blood pH is 7.4. True or False
251) Dietary intake and Body metabolism
are associated with Acid-Base Balance.
True or False
252) Secretion of hydrogen ions (H+) into
filtrate, 100% of bicarbonate
reabsorption and PCT are associated
with Bicarbonate (HCO3) returned to
blood. True or False
253) Rates determined by the acid-base
balance in the body are associated with
________ balance.
254) Metabolic acidosis and Renal tubular
acidosis are associated with _________
causes.
255) Referring to Renal functions tests,
Tests evaluate: Glomerular filtration,
Tubular reabsorption, Tubular secretion,
Renal blood flow. True or False
a. Measure rate at which the kidneys can
remove a filterable substance from the
blood
b. Substance analyzed cannot be
reabsorbed or secreted by the tubules
c. Stability of substance during a long urine
collection period
d. Consistency of plasma level
e. Availability to the body
f. Availability of tests to measure the
substance
256) These clearance tests are associated
with?
257) What 6 things are associated with
measuring GFR?
True
True
True
True
Acid-base
Disruptive causes
True
Glomerular Filtration
Creatinine
Beta2 microglobulin
Cystatin C
Radioisotopes
Exogenous procedure
Requires an infused substance
Endogenous procedure
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UA PPT Flashcards
258) Substance already present in the body
and Method of choice are related to
Endogenous procedure? True or False
259) Exogenous procedure requires an
infused substance. True or False
260) Creatinine is current routine test for
what substance?
261) Referring to creatinine clearance,
Waste product of muscle destruction
found at relatively constant plasma level
and Automated chemical tests, calculate
an eGFR utilizing serum creatinine and
do not require urine testing is correlated
to?
262) Tubular secretion increases with high
blood creatinine levels
Gentamicin, cephalosporins, and cimetidine
inhibit tubular secretion
Bacteria break down creatinine if urine is
stored at room temperature
Diet heavy in meat during timed collection
increases urine creatinine
Not reliable with muscle-wasting diseases
Accurate results depend on the accurate
completing of a 24-hour collection
It must be corrected for smaller/larger body
surface area
Are these tests an advantages or
disadvantages?
263) Greatest error is improperly timed
urine specimen
Principle: to determine the amount of
creatinine (mL) completely cleared from the
plasma during 1 minute
Report in milliliters per minute
This is referred to as the glomerular
filtration rate (GFR)
These factors are associated with what?
264) Report in milliliters per minute is
correlated to procedure. True or False
265) This is referred to as the glomerular
filtration rate (GFR) in procedure.
True or False
a. Urine volume in milliliters per minute
(V)
b. Urine creatinine in mg/dL (U)
c. Plasma creatinine in mg/dL (P)
True
True
Endogenous
Advantages
Disadvantages
Procedure
True
True
Required
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UA PPT Flashcards
d. Calculation of urine volume
266) These associated with _______
measurements.
267) Milliliters in specimen/minutes
collected are associated with calculation
of urine volume. True or False
268) Referring to procedure, some
examples are: 2-hour specimen volume
= 240 mL, 2 × 60 = 120 min, 240/120 = 2
mL/min.
True or False
269) What is the Standard Clearance
Formula?
270) What are the normal values of
creatinine for both men & women?
271) How is creatinine produced?
272) Normal creatinine values are based on
what?
273) True or False: Normal reference range
of plasma creatinine is 0.5 to 1.5 mg/dL
274) Which variables does eGFR
modification of diet in renal disease
(MDRD) use?
275) What's the advantage of the MDRD
formula?
276) What's the sample formula?
277) Cystatin C is produced by___ filtered
by __ and absorbed by __
278) Beta microglobulin is removed from
the plasma by __ and measured by___
279) Beta microglobulin is sensitive
indicator of what?
280) What is an exogenous procedure that
measures plasma disappearance of an
injected isotope and provides
simultaneous visualization of the
kidneys?
281) Tubular Reabsorption Tests are a good
indicator of?
282) What's necessary for accurate results
of tubular reabsorption tests?
283) What do tubular reabsorption tests
measure?
284) How is renal concentration assessed?
285) Specific gravity includes?
286) Name the colligative properties
True
True
CP = UV and C = UV/P
107 to 139 mL/min for men
87 to 107 mL/min for women
As a result of muscle destruction
Size, the larger the person, the more creatinine is
produced
TRUE
Serum BUN, serum albumin, and ethnicity
Without weight all calculations are available from the
lab computer.
MDRD-IDMS
All nucleated cells, glomerulus, renal tubules
Kidneys, enzyme immunoassay
Decrease in GFR
Radioisotopes
Early Renal disease
Control of fluid intake
Renal Concentrating Ability
By Osmolarity
Number and Size of Molecules
Freezing point, boiling point, osmotic pressure and vapor
pressure
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UA PPT Flashcards
287) Describe what happens in
Osmometry?
288) What's the primary urine method?
289) In Renal Concentration- Osmolality,
urine depends on:
290) Controlled fluid intake has a ratio of:
291) Vapor pressure osmometers
measure?
292) What are the technical factors for
vapor pressure osmometers?
293) What's the clinical significance:
evaluating renal concentrating ability,
monitoring course of renal disease,
monitoring fluid & electrolyte therapy,
differential diagnosis of hyponatremia &
hypernatremia, evaluating secretion of
and response to ADH?
294) What happens in Diabetes Insipidus?
295) What happens after ADH injection?
296) What's free water clearance?
297) What determines if enough water is
excreted to remove wastes & the
kidney's response to body hydration?
298) True or False: Ultrafiltrate has a
different osmolarity as plasma
299) In Tubular Secretion Renal Blood Flow,
to measure secretion, the blood flow
must be adequate
300) To measure blood flow, the secretion
must be adequate
301) The tests are unrelated, because
secretion is independent on renal blood
flow
302) What is a test for renal blood flow?
303) PAH is secreted in___ , loosely bound
to __ and removed from the __
304) The PAH test normal values are based
on?
305) What's the average renal blood flow?
306) What percentage does not come in
contact with functional renal tissue?
307) Titratable Acidity/Urine Ammonia are
tests for tubular secretion of?
Measured sample is supercooled & vibrated to form
crystals, heat of fusion raises temperature to freezing
point, probe measures freezing point
Freezing point osmometers
Fluid intake or exercise
3:1
Dew point (temperature at which water vapor condenses
to a liquid)
Lipemic serum, Lactic acid, Volatile/ethanol
All of the above
Decreased ADH production, inability of tubules to
respond to ADH
1:1 ratio= no ADH receptors in CD, 3:1 ratio = inability to
produce ADH
Expands serum: urine ratio. Osmolar clearance done first
with water deprivation, timed urine & serum
Free water clearance
FALSE
TRUE
TRUE
FALSE
P-Aminohippuric Acid (PAH)
Proximal convoluted tubule, plasma proteins, blood
Normal Hct
1200 mL/min
About 8%
H+ and NH4+
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UA PPT Flashcards
308) What does physical examination of
urine include?
309) What do results provide?
310) Which disorders: Glomerular bleeding,
liver disease, inborn errors of
metabolism, urinary tract infection, or
renal tubular function does physical
characteristics of urine provide
information about?
311) What is the color of urine?
312) What are normal variations not
caused by: ingested materials,
pathologic conditions, physical activity,
hereditary disorders, or normal
metabolic functions?
313) Abnormal variations are caused by
physical activity, infection, or bleeding?
314) What are the consistent common
terminologies used within institutions to
describe normal urine color?
315) _____ is a pigment causing the yellow
color of urine.
316) Urochrome normally excretes at a
_____ rate.
317) Does urochrome increase or decrease
in thyroid disease and fasting states?
318) Does urochrome increase or decrease
when urine specimen sits at room
temperature?
319) True or False: Urochrome provides
estimate of body hydration.
320) True or False: Uroerythrin and urobilin
pigments cause color change in older
specimens.
321) _____ is a pink pigment that attaches
to amorphous urates which are formed
in refrigerated specimens.
322) _____ is an oxidation prduct of normal
urinary constituent urobilinogen which
yeilds an orange-brown color in older
specimens.
323) True or False: The following are all
common abnormal colors of urine:
dark yellow/amber/orange
red/pink/brown
brown/black, blue/green
Color, clarity, and specific gravity
Preliminary information, correlation with other chemical
and microscopic results
All of the above
Ranges from colorless to black
Hereditary disorders
Infection and bleeding
pale yellow, yellow, dark yellow
Urochrome
constant
increase
increase
True
True
Uroerythrin
Urobilin
True
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UA PPT Flashcards
324) True or False: Dark yellow, amber, or
orange urine may not always signify
normal concentrated urine but can be
caused by the presence of the abnormal
pigment bilirubin.
325) _____ in urine indicates possible
hepatitis virus present.
326) Bilirubin produces what color foam
when shaken?
327) Normal urine produces small amount
of white foam caused by _____.
328) Photooxidation of large amounts of
urobilinogen produces what color urine?
329) Photooxidation of bilirubin to
biliverdin produces what color urine?
330) True or False: Phenazopyridine
(pyridium) or Azo-Gantrisin for urinary
tract infection produces thick orange
pigment and yellow foam (no bilirubin).
331) _____ is common cause of red urine.
332) True or False: Red is the usual color
that blood produces in urine, but the
color may range from pink to brown.
333) RBCs remaining in acidic urine for
several hours produce what color urine
due to the oxidation of hemoglobin to
methemoglobin.
334) A fresh brown urine containing blood
may indicate what?
335) Cloudy red urine indicates the
presence of what?
336) Clear red urine indicates the presence
of what two substances?
337) _____ resulting from the in vivo lysis
of RBCs, patient’s plasma will be red.
338) Breakdown of skeletal muscle
produces _____, patient’s plasma will be
clear.
339) Urine specimens containing _____
may appear as a port wine color
resulting from the oxidation of
porphobilinogen to porphyrins.
340) True or False: Nonpathogenic causes
of red urine include menstrual
contamination, ingestion of highly
pigmented foods, and medications.
True
Bilirubin
yellow
protein
yellow-orange
yellow-green
True
Blood
True
brown
glomerular bleeding
RBCs
hemoglobin and myoglobin
Hemoglobin
myoglobin
porphyrins
True
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UA PPT Flashcards
341) In genetically susceptible people,
eating fresh beets causes a red color in
_____ urine.
342) Ingestion of blackberries can produce
a red color in _____ urine.
343) True or False: Additional testing is
recommended for urine specimens that
turn black after standing at room
temperature and test negative for
blood.
344) _____ is an oxidation product of the
melanogen which is produced in excess
when a malignant melanoma is present.
345) Homogentisic acid yields a black color
in alkaline urine from persons with the
inborn-error of metabolism, called
_____.
346) True or False: Medications producing
brown or black urine includes levodopa,
phenol derivatives, and flagyl.
347) True or False: Pathogenic causes of
blue/green urine color are limited to
bacterial infections, including urinary
tract infection by Pseudomonas species
and intestinal tract infections resulting
in increased urinary indican.
348) A _____ staining may occur in
catheter bags and is caused by the
presence of indican in the urine or a
bacterial infection, frequently caused by
Klebsiella or Providencia species
349) IV phenol medications causes _____
urine includes Clorets medications:
Robaxin, methylene blue, Elavil (blue).
350) True or False: Color and clarity
produces include:
Use a well-mixed specimen
View through a clear container
View against a white background
Maintain adequate room lighting
Evaluate a consistent volume of
specimen
Determine color and clarity
351) _____ refers to the transparency or
turbidity of a urine specimen.
352) What are the common terminologies
used to report clarity of urine?
alkaline
acidic
True
Melanin
alkaptonuria
True
True
purple
green
True
Clarity
clear, hazy, cloudy, turbid, milky
24
UA PPT Flashcards
353) True or False: Clarity of urine can be
determined by visual examination or
automated turbidity readings.
354) Fresh clean-catch urine is normally
_____.
355) Urine clarity reported as no visible
particulates and transparent is known
as?
356) Urine clarity reported as few
particulates and print easily seen
through urine is known as?
357) Urine clarity reported as many
particulates and print blurred through
urine is known as?
358) Urine clarity reported as print cannot
be seen through urine is known as?
359) Urine clarity reported as may
precipitate or be clotted is known as?
360) The following are considered
pathologic or nonpathologic turbidity:
hazy female specimens with squamous
epithelial cells and mucus
bacterial growth in nonpreserved
specimens
refrigerated specimens with
precipitated amorphous phosphates
(white) and urates (pink)
contamination of fecal, talc, semen,
vaginal creams, IV contrast media
361) The following are considered
pathologic or nonpathologic turbidity:
RBCs, WBCs, bacteria
nonsquamous epithelial cells, yeast,
abnormal crystals, lymph fluid, lipids
extent of turbidity should correspond to
the amount of material observed in the
microscopic examination
clarity is one of the criteria considered
in determining the necessity of
performing a microscopic examination
362) What evaluates urine concentration
and determines if specimen is
concentrated enough to provide reliable
screening results?
363) What is defined as the density of a
solution compared with the density of
an equal volume of distilled water at the
True
clear
clear
hazy
cloudy
turbid
milky
nonpathologic
pathologic
specific gravity
specific gravity
25
UA PPT Flashcards
same temperature?
364) Specific gravity of 1.010 is called
_____.
365) Specific gravity lower than 1.010 is
called _____.
366) Specific gravity higher than 1.010 is
called _____.
367) _____ measures velocity of light in air
versus velocity of light in a solution.
368) Concentration changes the _____ and
angle at which the light passes through
the solution.
369) _____ in the refractometer
determines the angle that light is
passing through the urine and converts
angle to calibrated viewing scale.
370) What are two advantages of
refractometer?
371) For each gram of _____ present, 0.003
must be subtracted from specific gravity
reading.
372) For each gram of _____ present, 0.004
must be subtracted from specific gravity
reading.
373) True or False: Protein or glucose
concentration can be determined from
the chemical reagent strip tests.
374) A specimen containing 1 g/dL protein
and 1 g/dL glucose has a specific gravity
reading of 1.030.
Calculate the corrected reading.
375) True or False: The methodology of
refractometer are as follows:
place one or two drops of urine on
prism
focus light source and read scale
wipe off prism between specimens
376) Refractometer calibration of distilled
water should read _____.
377) Refractometer calibration of 5% _____
should read 1.022 ± 0.001.
378) Refractometer calibration of 9% _____
should read 1.034 ± 0.001.
isosthenuric
hyposthenuric
hypersthenuric
Refractometer
velocity
Prisms
Temperature compensation is not needed.
Only small volume of specimen is needed (1-2 drops).
protein
glucose
True
1.030 – 0.003 (protein) – 0.004 (glucose) = 1.023
True
1.000
NaCl
Sucrose
26
UA PPT Flashcards
379) True or False: Abnormally high results
of specific gravity >1.040 can be caused
by the following:
excretion of the injected radiographic
contrast media (IVP)
patients receiving dextran and other IV
plasma expanders
380) True or False: Reagent strip readings
and osmometry are not affected by
high-molecular-weight substances.
381) In _____, a more representative
measure of renal concentrating ability
can be obtained.
382) True or False: Specific gravity depends
on the number of particles present in a
solution and the density of these
particles, whereas osmolality is affected
only by the number of particles present.
383) The substances of interest for
osmolality include small molecules of
what?
384) _____ is defined as 1 g molecular
weight of a substance divided by the
number of particles into which it
dissociates.
385) Glucose has a molecular weight of
_____ g/osm.
386) NaCl has a molecular weight of _____
g/osm.
387) What unit of measure is used in the
clinical laboratory?
388) _____ of a solution can be determined
by measuring a property that is
mathematically related to the number
of particles in the solution
389) Lower freezing point, higher boiling
point, increased osmotic pressure, and
lower vapor pressure are all changes in
_____ properties
390) What is measured in the urinalysis
laboratory with an osmometer?
391) The additional step to the routine
urinalysis procedure is:
392) What does an automated osmometer
utilize to measure osmolality?
393) What change is the reagent strip
reaction based on?
True
True
osmolality
True
sodium, chloride, and urea
Osmole
180
58.5
milliosmole (mOsm)
osmolality
colligative
Osmolality.
Measuring osmolality with an osmometer.
Freezing point depression.
The change in pka (dissociation constant) of a
polyelectrolyte in an alkaline medium.
27
UA PPT Flashcards
394) Releasing H+ions in
proportion
to the number of ions in the solution.
395) What effect will an increased number
of H+ ions on pH?
396) What indicator on the reagent pad
measures the change in pH?
397) What is the range of the
bromothymol-LS blue indicator?
398) What has no effect on reagent strip?
399) What is not routinely reported in
urinalysis?
400) How does fresh urine smell?
401) What does older urine smell like?
402) Maple syrup urine disease is caused
by a:
403) What causes a fruity odor to urine?
404) What smell permeates with an
infection?
405) What foods cause an odor in urine?
406) Why can’t all people smell asparagus
in urine?
407) If urine smells mousy, you may
suspect the patient has:
408) What odor does urine emit with
tyrosinemia?
409) What does Isovaleric academia cause?
410) What malabsorption causes urine to
smell like cabbage?
411) Bleach odor in a urine sample
indicates:
412) What routine chemical tests on urine
is simple and fast?
413) What two types of reagent strips are
available?
414) Is there significance in the brand and
number of reagent strip test?
415) What to reagent strips consist of?
416) What occurs when the absorbent pads
of the reagent strips come in contact
with urine?
417) How is the reagent strips reaction
interpreted?
418) What information do the charts
supplied by the manufacturer?
Direct
It will lower the pH.
Bromothymol-LS blue
From blue (1.00 [alkaline]) through shades of green to
yellow (1.030 [acid])
Non-ionizing substances
Odor
Faintly aromatic
Ammonia
Metabolic disorder
Ketosis
Unpleasant ammonia smell
Garlic, onions, and asparagus
Genetically not all people are capable.
Phenylketonuria.
Rancid.
Urine with a sweaty feet smell.
Methionine.
Contamination.
Reagent strips.
Single and multitest varieties.
No, it is based on laboratory preference.
Chemical-impregnated absorbent pads on a plastic strip.
A color-producing reaction.
By comparing the color produced on the pad within the
required time frame with a chart supplied by the
manufacturer.
Several degrees of color comparison to provide semiquantitative
readings of neg, trace, 1+, 2+, 3+, 4+, and occasionally estimates
of mg/dL for the test areas.
28
UA PPT Flashcards
419) What is the proper technique for a
reagent strip test?
420) What errors occur with improper
technique?
421) The following requirements are
necessary for?
 Store below 300C in a tightly sealed
container with desiccant.
 Remove strips immediately prior to
use.
 Do not expose to volatile fumes.
 Do not use past expiration date.
 Visually inspect for
discoloration/deterioration.
422) How often should quality control be
done on reagent strips?
423) When should additional controls be
run on reagent strips?
424) Why should distilled water not be
used as a negative control?
425) Are there manufactured positive and
negative controls available?
426) True or False:
All control results must be recorded.
427) True or False:
All negative control readings should be
negative.
1. Dip strip into well-mixed specimen at room
temperature.
2. Remove excess urine by touching edge of strip to
container as strip is withdrawn.
3. Blot edge of strip on absorbent pad.
4. Wait specified amount of time.
5. Read using a good light source.
1. Formed elements, such as red and white blood
cells, sink to the bottom of the specimen and will
not be detected in an unmixed specimen.
2. Leaching of reagent from the pads by allowing
the strip to remain in the urine for an extended
period of time.
3. Distortion of the color between chemicals on
adjacent pads occurs when excess urine remains
on the strip.
4. Not following manufacturer’s stated time.
5. Accurate interpreatation of color reactions
requires a good light source.
6. Using the appropriate manufacturer color charts.
7. Refrigerated specimens not allowed to come to
room temperature.
Proper handling and storing for reagent strips.
Run positive and negative controls at least once per 24
hours
1. New bottle of strips is opened.
2. Results are questionable.
3. Concerns over strip integrity.
Reactions are designed for urine ionic concentration.
Yes.
True.
True.
29
UA PPT Flashcards
428) What should positive control readings
agree with?
429) What should you be aware for quality
control of reagent strips?
430) True or False:
Chemical readings should correlate with
each other and physical and microscopic
readings.
431) What uses different reagents or
methodologies to detect the same
substances as reagent strips with the
same or greater sensitivity or
specificity?
432) What may be used when questionable
results are obtained in confirmatory
testing?
433) What must be checked using positive
and negative controls?
434) Lungs and kidneys are major
regulators of acid-based content in:
435) The normal urine pH range is:
436) True or False:
Absolute values are assigned to urine pH.
437) First morning urine is:
438) Postprandial urine is more:
439) What makes urine pH vary from
patient to patient?
440) What pH level is associated with aged,
improperly preserved specimen, and a
new specimen should be obtained?
441) What clinical significance does urine
pH provide?
442) What measures pH between 5.0 and
9.0 in one half or one unit increments?
443) How does the double-indicator system
reaction indicate pH?
Published control values.
Manufacturer-stated limitations and interfering
substances.
True.
Confirmatory testing.
Non-reagent strip testing procedures using tablets and
liquid chemicals.
Chemical reliability.
Urine pH.
4.5 to 8.0.
False.
Slightly acidic at 5.0 to 6.0.
Alkaline.
1. Acid-based content of the blood.
2. Patient’s renal function.
3. Presence of a urinary tract infection.
4. Patient’s dietary intake.
5. Age of specimen.
pH of 8.5 or above.
 Respiratory or metabolic acidosis/ketosis
 Respiratory of metabolic alkalosis
 Renal tubular acidosis
 Renal calculi formation
 Treatment of UTI
 Precipitation/identification of crystals
 Determination of unsatisfactory specimens
pH-Reagent Strip Reactions
Methyl red for 4 to 6 with red/orange to yellow color.
Bromthymol blue for 6 to 9 with green to blue color.
30
UA PPT Flashcards
444) True or False:
There are no known substances that
interfere with urinary pH measurements
performed by reagent strips.
445) The most indicative substance of renal
disease in urine is:
446) When is proteinuria present in renal
disease?
447) Normal urine protein levels are:
448) Low-molecular-weight serum proteins
are:
449) What is the primary protein of
concern in urine?
450) What other urine proteins are
examined?
451) Presence of protein in urine requires:
452) What urine protein levels indicate
proteinuria?
453) What causes protein in the urine?
454) How does prerenal proteinuria
develop?
455) Where does prerenal proteinuria
occur?
456) Where is prerenal proteinuria rarely
seen?
457) How is multiple myeloma
confirmation done?
458) Bence Jones Protein (BJP) can be
indicative of:
459) What is Bence Jones Protein (BJP)?
460) Renal proteinuria is indicative of:
461) What other conditions can cause
glomerular or tubular damage?
462) What causes glomerular proteinuria?
463) What immune substances deposit on
the membrane?
464) What immune disorders result in
glomerular proteinuria from immune
complex formations?
465) What causes increased pressure on
the kidney filtration mechanism?
466) Strenuous exercise, high fever,
dehydration, and exposure are causes of:
True.
Protein.
Early renal disease.
<10mg/dL or 100mg/24hr
Filtered and reabsorbed.
Albumin.
Vaginal, prostatic, seminal, and Tamm-Horsfall
(uromodulin)
Determination of normal or pathological condition
30mg/dL, 300mg/24hr
Prerenal, renal, and postrenal.
Transient low-molecular-weight plasma proteins acute
phase reactants increase and exceed the reabsorptive
capacity.
The plasma.
Reagent strip.
Serum electrophoresis.
Multiple myeloma (plasma myeloma)
Immunoglobulin light chains in urine.
Glomerular or tubular damage
Glomerular proteinuria, microalbuminuria, Orthostatic
(postural) proteinuria, and tubular proteinuria
Damage to glomerular membrane from impaired
selective filtration from increased protein filtration.
Amyloids and other toxins.
Lupus erythematosus and streptococcal
glomerulonephritis
Hypertension
Strenuous exercise
Dehydration
Pregnancy, especially Preeclampsia
Benign proteinuria (transient)
31
UA PPT Flashcards
467) What causes diabetic nephropathy in
type 1 and type 2 diabetes mellitus with
reduced glomerular filtration and
eventual renal failure?
468) Microalbuminuria is associated with
an increased risk of:
469) Orthostatic (postural) proteinuria
appears when there is:
470) What are the collection instructions
for a postural proteinuria?
471) Why are two specimens required for a
postural proteinuria test?
472) Acute tubular necrosis is caused by:
473) Fanconi syndrome is a:
474) What malignancy does tubular
proteinuria?
475) Extended tubular proteinuria may
lead to:
476) True or False:
Same amounts of urine protein are
found in glomerular disorders and
tubular disorders.
477) Postrenal proteinuria can be caused
by:
478) What are the traditional principles for
a protein-reagent strip reactions?
479) What overrides the acid buffer
system?
480) What gives false-positive results?
481) What is the confirmatory test for
protein?
482) What type of specimen is needed for
Sulfosalicylic Acid?
Microalbuminuria
Cardiovascular disease
Increased pressure on the renal vein when in the vertical
position, but disappears in horizontal position.
1. Empty bladder before bed.
2. Collect specimen immediately on arising
The first morning specimen will show negative, and the
second specimen will be found positive.
Toxic substances, heavy metals, viral infections, Fanconi
syndrome.
Generalized convoluted tubule defect.
Tubular damage affecting reabsorptive ability.
Acute tubular necrosis.
False.

Protein added in the lower urinary and
genitourinary tract.
 Microbial infections causing inflammations and
release of interstitial fluid protein.
 Menstrual contamination.
 Semen/ prostatic fluid.
 Vaginal secretions.
 Traumatic injury.
a. protein error of indicators
b. certain indicators change color in the presence of
protein at a constant pH
c. Protein accepts H+ from the indicator, increased
sensitivity to albumin due to more amino groups
to accept H+ than other proteins
Highly buffered alkaline urine
a. highly pigmented urine
b. high specific gravity
c. quaternary ammonium compounds, detergents,
antiseptics, chlorhexidine
Sulfosalicylic Acid Precipitation
Centrifuged specimen to remove any extraneous
contamination
32
UA PPT Flashcards
483) What is the semiquantitative testing
for patients at risk for renal disease?
484) What measures creatinine to produce
an albumin:creatinine ratio?
485) What specimen is recommended for
microalbuminuria?
486) What technique is used for
Immunodip Test?
487) How does Immunodip Test work?
Microalbuminuria
Microalbuminuria
First morning specimens
Immunochromographic technique
•
•
•
•
•
•
488) How does Micral-Test work?
•
•
•
•
•
•
•
•
489) What strips are used for microalbumin
tests?
490) How does Clinitek microalbumin
reagent strips and Multistix Pro reagent
strips work?
491) What is albumin strip dye?
492) How does creatinine reagent strip
work?
493) What is the purpose of creatinine
reagent strip?
Place container in controlled amount of
specimen for 3 min, urine enters container
Albumin binds to blue latex particles coated with
antihuman albumin antibody
Bound and unbound migrate up strip
Unbound encounters area of immobilized
albumin on strip—forms blue band
Bound continues migrating to an area of
immobilized antibody and forms blue band
Color of band is compared with chart
Dip strip in urine to marked level for 5 seconds
Albumin binds to antibody
Bound and unbound conjugates move up strip
Unbound removed in captive zone containing
albumin; bound continues up strip
Reaches enzyme substrate, reacts
Colors from white (neg) to red (varying degrees)
Compare color to chart
Results read from 0 to 10 mg/dL
Clinitek microalbumin reagent strips and Multistix Pro
reagent strips
• Simultaneous measurement of albumin and
creatinine
• Provide an estimate of the 24-hour albumin
concentrations from random urine
• Albumin pad uses dye-binding reaction for
specific albumin testing
It is specific for albumin. It has a sensitivity of 8 to 15
mg/dL. It is highly buffered alkaline urine interference,
which is controlled by treated paper.
 Creatinine combines with copper sulfate to form
copper-creatinine peroxidase
 Peroxidase reacts with DBDH, releases oxygen
ions that oxidized TMB
 Colors change from orange to green to blue
To correlate creatinine with albumin results to determine
the albumin:creatinine ratio
33
UA PPT Flashcards
494) What strips measures creatinine?
495) What methods does Bayer Multistix
Pro 10 strips measure?
496) What are not included on Bayer
Multistix Pro 10 strips?
497) How are Albumin:Creatinine Ration
reported as?
498) What is the most frequent chemical
analysis performed on urine?
499) What is the major screening test for
diabetes mellitus?
500) What is the renal threshold for
glucose?
501) What is renal glycosuria?
502) How does glucose oxidase reaction
work?
503) Is glucose oxidase reaction specific for
glucose?
504) What are the reasons for falsepositive results?
505) What are the reasons for falsenegative results?
506) How does Copper Reduction Test
work?
507) What is the procedure of clinitest?
508) Pass through clinitest procedure
include________.
509) What is Reducing substances test
mean?
Bayer Mutistix Pro 10
 Protein-high is protein error of indicators
method
 Protein-low is dye-binding method
Urobilinogen and bilirubin
Results are reported as Normal or Abnormal
Glucose
Glucose test
160 to 180 mg/dL
Tubular reabsorption disorder
 Glucose oxidase catalyzes a reaction between
glucose and oxygen
 Peroxidase catalyzes the reaction between
peroxide and chromogen to form an oxidized
colored compound
True
Only peroxide, oxidizing detergents
 Ascorbic acid and strong reducing agents
 High levels of ketones
 High specific gravity and low temperature
 Greatest source of error is old specimens
Reduction of copper sulfate to cuprous oxide with alkali
and heat
• Pass through
• Hygroscopic tablets: strong blue color and excess
fizzing = deterioration
-High levels of reducing substance
-Color from blue through red back to green-brown: rapid
reaction
-Repeat with two-drop procedure
•
•
•
•
Not a specific test for glucose
Clinitest does not provide a confirmatory test for
glucose
Interference from reducing sugars
Major use is quick screen for “inborn error of
metabolism” in children up to 2 years old
34
UA PPT Flashcards
510) What is Ketones?
511) Three intermediate products of fat
metabolism are_____________.
512) What is the clinical significance of
Ketones?
513) What is Diabetic Ketoacidosis, and
what is its cause?
514) Clinical significance of Ketonuria
unrelated to diabetes are__________.
515) What is the primary reagent strip
reaction of Ketone?
516) What dose sodium nitroprusside
measure primarily?
517) Acetoacetic acid assumes________.
518) The reagent strip reaction result
is______.
519) Identify the four reaction interference
of Ketone?
520) What is Acetest?
521) What is the difference between
Hematuria and hemoglobinurea?
522) The clinically significant of blood urine
considered_________.
523) Chemical tests for hemoglobin is
provide_______.
•
•
products of fat metabolism
Appear in urine when body stores of fat must be
metabolized to supply energy
-Acetone: 2%
-Acetoacetic acid: 20%
-β-hydroxybutyrate: 78%
• Increased fat metabolism
• Primary causes
• Diabetes mellitus
• Vomiting (loss of carbohydrates)
• Starvation, malabsorption, dieting (↓
intake
• Ketonuria shows insulin deficiency
• Diabetic ketoacidosis
-increased accumulation of ketones in the blood
-Electrolyte imbalance, dehydration, and diabetic coma
– Inadequate intake/absorption of
carbohydrates
– Vomiting
– Weight loss
– Eating disorders
– Frequent strenuous exercise
• sodium nitroprusside
– (Nitroferricyanide)
• acetoacetic acid
-the presence of β-hydroxybutyrate and acetone
acetoacetate (and acetone) + sodium nitroprusside
Alkaline
+ (glycine) ——————> purple color
• Levodopa in large dosage
• Medications containing sulfhydryl groups
• False-positive results from improperly timed
readings
• Falsely decreased values in improperly preserved
specimens
• Not a urine confirmatory test
• Tablet = sodium nitroprusside, glycine,
disodium phosphate, lactose (gives better color)
• Hematuria: intact RBCs
– Cloudy red urine
• Hemoglobinuria: product of RBC destruction
– Clear red urine
• Any amount of blood greater than five cells per
microliter of urine.
the most accurate means for determining the presence
of blood
35
UA PPT Flashcards
524) Why we used the microscopic
examination in blood urine?
525) What is the cause of Hematuria?
526) What is the cause of Hemoglobinuria?
527) Hemoglobinuria may result
from______.
528) What is hemosiderin?
529) What is Myoglobinuria?
530) What is Rhabdomyolysis?
531) What cause Rhabdomyolysis?
532) What is the reagent strip reactions of
blood urine?
533) False –positive of reaction
interference is_______.
534) False –negative reaction interference
is_______.
535) What is bilirubin?
to differentiate between hematuria and hemoglobinuria
•
Damage to renal system
– Renal calculi
– Glomerular disease
– Tumors
– Trauma
– Pyelonephritis
– Exposure to toxic chemicals
– Anticoagulants
– Transfusion reactions
– Hemolytic anemias
– Severe burns
– Infections/malaria
– Strenuous exercise/RBC trauma
– Brown recluse spider bites
The lysis of red blood in dilute, alkaline urine.
yellow brown granules in sediment
• heme-containing protein in muscle tissue; clear,
red/brown urine
muscle destruction
• Muscular trauma/crush syndromes
• Prolonged coma
• Convulsions
• Muscle-wasting diseases
• Alcoholism
• Drug abuse
• Extensive exertion
• Cholesterol-lowering statin medications
• Principle pseudoperoxidase activity of
hemoglobin
• Catalyze a reaction between the heme
component
• Two charts corresponding to different reactions
• Free hemoglobin shows uniform color
• Intact RBCs show a speckled pattern on pad
-Menstrual contamination, strong oxidizing agents,
bacterial peroxidases
– Ascorbic acid >25 mg/dL
– High SG/crenated cells
– Formalin
– Captopril
– High concentrations of nitrite
– Unmixed specimens
• Normal degradation product of hemoglobin
• Body recycles iron, protein
36
UA PPT Flashcards
•
•
536) Early urine bilirubin indicate_______.
537) Unconjugated bilirubin is ________.
538) Conjugated bilirubin is_________.
539) What are forms of conjugated
bilirubin?
540) What is clinical significance of
bilirubin?
541) The reagent strip reactions of bilirubin
is_______.
542) What is the reaction interference?
543) What is Ictotest?
544) What is Urobilinogen?
545) What is the difference between
Urobilinogen and Stercobiliogen?
Protoporphyrin is broken down into bilirubin
Bilirubin is bound to albumin
– Kidneys cannot excrete
• Unconjugated bilirubin
• Conjugated bilirubin
• Unconjugated bilirubin to the liver
• Forms conjugated bilirubin
• Excreted in feces
-Liver disease.
Water insoluble.
Water soluble.
– From liver to intestines
– Reduced to urobilinogen,
stercobilinogen, and urobilin by
intestinal bacteria
• Conjugated bilirubin appears in urine with bile
duct obstruction
• Obstruction
• Hepatitis, cirrhosis
• Hemolytic disease
• Principle is a diazo reaction
• Report: neg, small (1+), moderate (2+), large (3+)
• Colors may be difficult to interpret
– Easily influenced by other pigments
present in the urine
• Atypical colors can be problem for automated
readers
• False-positive
– Urine pigments
– Pyridium (phenazopyridine)
– Drugs indican, iodine
• False-negative
– Old specimens (biliverdin does not react)
– Ascorbic acid >25 mg/dL
– Nitrite
• Combine with diazonium salt and
block bilirubin reaction
• Confirmatory for bilirubin
• Use specified mat for test; mat keeps bilirubin on
surface for reaction
• Positive reaction = blue-to-purple color
• Interfering substances are washed into the mat,
and only bilirubin remains on the surface
Is when bilirubin in intestine converted to Urobilinogen
and Stercobilinogen.
Urobilinogen is reabsorbed into circulation.
Stercobilinogen is not reabsorbed into circulation.
37
UA PPT Flashcards
546) Is Urobilinogen filtered by the Kidney?
547) What are clinical significance of
Urobilinogen?
548) What clinical significance exhibit
urobilinogen in 1% of nonhospitalized
and 9% of hospitalized population?
549) What is the result of urobilinogen in
the urine with bile duct obstruction?
550) What are the principles for Multistix Ehrlich’s aldehyde reaction?
551) What are the principles for Chemstrip
– diazo (azo-coupling)reaction?
552) What are the reaction interferences
with Ehrlich reactive compounds?
553) What are the reaction interferences
for both tests?
554) What are the reaction interferences
for Chemistrip>
555) Rapid screening test for the presence
of urinary tract infection (UTI)whith the
presence of nitrie are:
556) Why is the reagent strip reaction for
nitrite done?
557) What is the Greiss reaction result?
•
Yes, There is always a small amount of
urobilinogen filtered by the kidneys and is found
in the urine <1 mg/dL
• Early detection of liver disease, greater than 1
mg/dL
• Liver disorders, hepatitis, cirrhosis, carcinoma
• Hemolytic disorders
– Excess bilirubin being converted to
urobilinogen and ↑ urobilinogen
recirculated to liver
• Negative bilirubin and strong positive
urobilinogen are seen in hemolytic disorders
Elevated results which is frequently caused by
constipation
No urobilinogen is seen; strip will give a normal result;
reagent strips cannot report a negative reading
- p-dimethylaminobenzaldehyde (Ehrlich reagent); report
in Ehrlich units (EU) 1 EU = 1 mg/dL
- Normal readings 0.2 to 1, abnormal 2, 4, 8
- Light to dark pink
urobilinogen + p-dimethylaminobenzaldehyde -acid→
red color
- 4-Methoxybenzene-diazonium-tetrafluoroborate; more
specific than Ehrlich reaction; report in mg/dL
- White to pink
urobilinogen + diazonium salt-acid→red azodye
- porphobilinogen, indican, sulfonamides, methyldopa,
procaine, chlorpromazine, p-aminosalicylic acid
- urobilinogen is highest after meals (increased bile salts),
old specimens and formalin preservation decrease
results
- false-negative with high nitrite interferes with diazo reaction
- Pyelonephritis (tubules)
- Evaluation of antibiotic therapy
- Monitoring of patients at high risk for urinary tract
infection
- Cystitis (initial bladder infection)
- Screening of urine culture specimens (in combination
with LE test)
To test ability of bacteria to reduce nitrate (normal
constituent) to nitrite (abnormal)
-nitrite reacts with aromatic amine to form a diazonium
salt that then reacts with tetrahydrobenzoquinoline to
form a pink azodye
38
UA PPT Flashcards
558) Reagent strip reaction correspond
with what?
559) What are the interference for nitrite
test that give false-negative reactions?
560) What are the interference for nitrite
test that give false-positive reactions?
561) Leukocyte Esterase (LE) provides:
562) What is the purpose of Leukocyte
Esterase (LE)?
563) What is the advantage of Leukocyte
Esterase (LE)?
564) Is Leukocyte Esterase (LE) a
quantitative test?
565) What is the clinical significance for
Leukocyte Esterase (LE)?
566) What test is better predictor than
nitrite test for screening of urine culture
specimens?
567) With what other infections is the LE
present?
568) What are the reagent strip reactions
with LE?
569) What is the longest time of all the
reagent strip reactions for LE?
570) How are the results reported?
571) Is trace reading significant for LE test?
a quantitative bacterial culture criterion of 100,000
organisms/mL
- Insufficient contact time between bacteria and urinary
nitrate
- Lack of urinary nitrate
- Large quantities of bacteria converting nitrite to
nitrogen
- Presence of antibiotics
- High concentrations of ascorbic acid
- Nonreductase-containing bacteria
- High specific gravity
- Negative results in the presence of even vaguely
suspicious clinical symptoms should always be repeated
or followed by a urine culture
- Highly pigmented urine
- Pink edge or spotting on reagent strip is considered
negative
- Old specimens (bacterial multiplication)
- Check automated readers manually for color
interference
Standardized means for the detection of leukocytes
LE test detects the presence of esterase in the
granulocytes and monocytes
detects presence of lysed leukocytes
No; must to do microscopic test if positive
It is positive in:
- Bacterial and nonbacterial urinary tract infection
- Inflammation of the urinary tract
Leukocyte Esterase (LE) test
Trichomonas, Chlamydia, yeast, interstitial nephritis
LE catalyzes hydrolysis of acid esterase on pad to
aromatic compound and acid; aromatic compound reacts
with diazonium salt on pad for purple color
2 minutes
- Negative
- Trace
- Small: 1+
- Moderate: 2+
- Large: 3+
Trace readings may not be significant and should be
repeated on a fresh specimen
39
UA PPT Flashcards
572) What are the interference for LE test
that give false-positive reactions?
573) What are the interference for LE test
that give false-negative reactions?
574) What is specific gravity based on?
575) How does specific gravity work?
576) What indicator measures pH change
and what colors can we see?
577) What are the reaction interference for
specific gravity?
578) What is other interference reaction
from large molecules, glucose and urea
and radiographic dye and plasma
expanders?
579) Macroscopic screening is performed
based on what results?
580) List the performed macroscopic tests.
581) List special population for the
macroscopic screening in urine.
582) Clinical and Laboratory Standards
Institute (CLSI) states that all decisions
should be based on the needs of:
583) Why specimen preparation should be
examine when fresh or preserved?
584) What happens when urine specimen is
refrigerated ?
585) Less contamination (epithelial cells)
from comes from specimen that is a:
586) Before decanting to the centrifuge
tube
587) specimen must be:
588) What is the requirement for the urine
specimen volume?
- Formalin
- Strong oxidizing agents
- Highly pigmented urine, nitrofurantoin
- High concentrations of protein, glucose, oxalic acid,
ascorbic acid
- Crenation from high specific gravity
- Inaccurate timing: must have 2 min
- Presence of the antibiotics; gentamicin, cephalosporins,
tetracyclines
It is based on pKa (dissociation constant) of a
polyelectrolyte in alkaline medium
- Polyelectrolyte ionizes releasing H+ in relation to
concentration of urine
- ↑concentration = more H+ released
bromthymol blue; blue (alkaline) through green to yellow
(acid)
- Slight elevation from protein
-Decreased readings: urine pH 6.5 or higher
*Interferes with indicator; add 0.005 to the reading;
readers automatically add this
difference in refractometer reading
physical and chemical
Color, clarity, blood, protein, nitrite, leukocyte esterase,
and possibly glucose
pregnant women; pediatric, geriatric, diabetic,
immunocompromised, and renal patients
- Requested by the physician
- Laboratory-specified population
- Any abnormal physical or chemical result
- RBCs, WBCs, casts disintegrate in dilute, alkaline urine
Refrigeration precipitates crystals, also can obscure other
elements
midstream clean-catch specimen
thoroughly mix
- Centrifuge 10 to 15 mL urine (reagent strips fit into 12
mL)
- Quantities <12 mL should be documented
- Too little volume = fewer formed elements
- Some laboratories correct for volume
40
UA PPT Flashcards
589) Standardized speed and time, and
capped specimen is required for:
590) What are the specifications for
centrifugation?
591) What are the characteristics of
sediment standardization?
592) Commercial systems: KOVA in
sediment standardization includes:
593) What postcentrifuge sediment
include?
594) What is the concentration factor of
postcentrifuge sediment?
595) What is important in postcentrifuge
sediment?
596) What include glass slide method of
volume and sediment examination?
597) Chambers capable of containing a
standardized chamber volume, size of
the viewing area, and approximate
number of low-power and high-power
viewing areas are part of:
598) Commercial systems are based on:
599) Commercial systems are
recommended together with
standardization of all phases of the
methodology by what organization?
600) What commercial systems require?
601) Commercial systems include slides
that:
602) Examination of sediment require:
603) What can be seen under low power of
sediment examination?
centrifugation
- 5 min at relative centrifugal force (RCF) of 400 is ideal
- RCF corrects for variations in the diameter of centrifuge
heads; revolutions per minute does not
- RCF = 1.118 × 10−5 × radius in centimeters × RPM2
- Preparation of sediment
- Volume of sediment examined (0.5 to 1.0 mL)
- Methods of visualization
- Reporting of results
Calibrated centrifuge tubes, special slides to control
volume, decanting pipettes, grids for better quantitation
0.5 to 1.0 mL of sediment after decantation
volume of urine centrifuged/sediment volume with the
probability of detecting low quantities of formed
elements
- Aspirate rather than pour off urine (pipettes available
for this)
- Mix sediment gently, not vigorously
- 20 μL in 22 × 22 glass cover slip
- Do not overflow cover slip; heavier elements (casts)
flow outside
Commercial systems
the area of the field of view using a standard
microscope
CLSI
- Capped, calibrated centrifuge tubes
- Decanting pipettes to control sediment volume
- Control the amount of sediment examined
- Produce a consistent monolayer of sediment for
examination
- Provide calibrated grids for more consistent
quantitation
- Minimum 10 low (10×) and 10 high (40×) fields
- Use fine adjustment continuously for best view
casts, general composition; scan edges for casts with
glass slide method
41
UA PPT Flashcards
604) What can be seen under high power
of sediment examination?
605) How is the initial focusing performed?
606) Reporting the microscopic
examination must be:
607) How do we report casts results?
608) How do we report epithelial cells,
crystals, etc., in semiquantitative terms?
609) Converting the average number of
elements per lpf or hpf to elements per
mL is done by:
identification of type of the sediment
Use low power, reduced light and focus on epithelial cell,
not artifacts that are in a different plane
Consistent within laboratory
average per lpf
- Few, moderate, many
- 1+, 2+, 3+, 4+
- Follwed by /lpf or /hpf
1. Calculating the area of an lpf or hpf for the microscope
in use using the manufacturer-supplied field of view
diameter and the formula πr2 = area
Diameter of hpf = 0.35 mm
3.14 × 0.1752 = 0.096 mm2
2. Calculating the maximum number of lpfs or hpfs in the
viewing area; area under a 22 mm × 22 mm cover slip =
484 mm2
484 = 5040 hpfs
.096
3. Calculating the number of hpfs per milliliter of urine
tested using the concentration factor and the volume of
sediment examined
5040____ = 5040
0.02 mL x 12 .24
610) How does sediment appear in the
sediment examination techniques?
611) What is often difficult to see under
bright-field microscopy?
612) Describe the reaction of SternheimerMalbin stain in the sediment.
613) What includes Sternheimer-Malbin
stain?
614) What enhances nuclear detales of the
sediment?
= 21,000 hpf/mL of urine
4. Calculating the number of formed elements per
milliliter of urine by multiplying the number of hpfs per
milliliter by the average number of formed elements per
field
4 WBC/hpf × 21,000 = 84,0 WBC/mL
- Cells and casts in various stages of development and
degeneration
- Distortion of cells and crystals by the chemical content
of the specimen
- The presence of inclusions in cells and casts
- Contamination by artifacts
Low refractive index elements
- Increases refractive index
- Stains nuclei, cytoplasm, inclusions
- crystal violet /Safranin O
- Sedi-Stain, KOVA stain, etc.
0.5% solution of toluidine blue
42
UA PPT Flashcards
615) What enhances WBC nuclei and lyses
RBC’s?
616) What stains lipids (triglycerides and
neutral fats; cholesterol polarizes)?
617) What stain identifies bacterial casts?
618) What stain identifies urinary
eosinophils?
619) What stain identifies hemosiderin
granules seen with hemoglobinuria?
620) What is the purpose of Cytodiagnostic
urine testing?
621) Preparation of permanent slides using
what technique?
622) Papanicolaou stain is use to stain
what?
623) What microscope is the most
commonly used microscope?
624) How does Brightfield microscope help
in urinalysis?
625) What other variety of microscopy are
in the field?
626) What distinguishes Phase-contrast
microscopy from other?
627) What distinguishes Polarizing
microscopy from others?
628) What distinguishes Interferencecontrast from others?
629) What makes up the Compound brightfield microscope?
630) The two-lens system has what use?
Acetic acid
Oil Red O and Sudan III
Gram stain
- Hansel stain
- Methylene blue and eosin Y: better than Wright stain
Prussian blue stain
Purpose is frequently performed to detect and monitor
renal disease/malignancies.
Cytocentrifugation
– Transplant rejection
– Viral, fungal, and parasitic infections
– Cellular inclusions
– Pathologic casts
Inflammatory conditions
Brightfield
It allows..
–
–
–
Reduced light is essential
Magnification is 10× and 40×
Par focal means minimal adjustment
when changing objectives (use fine
adjustment)
– Lower light using the rheostat
– Condenser can be raised up and down
– Do not use the aperture diaphragm
Others include phase contrast, polarizing, dark field,
fluorescence, and interference contrast
– Increases refractive index
–
–
–
–
–
Crystals and lipids
Ability to split light into two beams
Crystals are multicolored
Cholesterol produces Maltese cross
formations
Three-dimensional images
–
–
–
–
–
–
Two-lens system
Illumination system
Body consisting of
Mechanical stage
In the oculars, the objectives
The coarse- and fine-adjustment knobs
43
UA PPT Flashcards
631) The Illumination system has what use? Light source, condenser, and field and iris diaphragms
632) The body of the microscope consist
– Base
of?
– Body tube
– Nosepiece
Mechanical stage
633) Binocular is use for what purpose?
Adjusts for interpupillary distance
634) Field of view is determined by what?
The eyepiece and is the diameter of the circle of view
when looking through the oculars.
635) What objective lens is use for UA
Magnifications of 10x (low power,dry) and 40x (high
sediment examination?
power, dry).
636) Final magnification of an object is the
The objective magnification times the ocular
product of?
magnification.
637) Name the objective characteristics of – Type of objective, magnification, numerical aperture,
the microscope?
microscope tube length, and cover-slip thickness to
be used
– Length of the objectives attached to the nosepiece
varies with magnification
– Changing the distance between the lens and the slide
when they are rotated
638) What is parfocal?
Only minimum adjustment when switching among
objectives.
639) The distance between the slide and
Controlled by the coarse and fine focusing knobs.
the objective is?
640) Coarse focus does what?
Initial focusing
641) Fine focus does what?
Sharpen image, focusing after changing magnification.
642) The microscope is consist of what?
– Base
– Equipped with rheostat
– Regulates intensity
– Filters vary illumination and wavelength
– Diaphragm contained in the light source
controls the diameter of the light beam
– Condenser located below the stage to
focus the light
– All have adjustments for optimal lighting
643) What is Köhler illumination?
Provide optimal viewing of the illuminated field.
644) Steps for care of the microscope
1. Carry microscope with two hands, supporting the
base with one hand.
2. Always hold the microscope in a vertical position.
3. Only clean optical surfaces with a good quality lens
tissue and commercial lens cleaner.
4. Do not use the 10× and 40× objectives with oil.
5. Clean the oil immersion lens after use.
6. Always remove slides with the low-power objective
raised.
7. Store the microscope with the low-power objective
in position and the stage centered.
44
UA PPT Flashcards
645) Urine sediment constituents consist
of?
•
•
•
•
646) What the identification of yeast?
647) What the identification of oil
droplets?
648) What the identification of air bubbles?
649) What the identification of starch?
650) What are the characteristics of RBC?
651) What does Dysmorphic RBCs cause?
652) How does Dysmorphic RBCs help
doctor?
653) Damage to glomerular membrane
cause damage to what?
654) Number of cells represents what?
655) What is the normal value?
656) Macroscopic versus microscopic
hematuria?
657) What the normal size of WBCs?
658) What WBC is normal most abundant?
659) WBCs are identify under what power?
660) What are characteristics of glitter
cells?
661) What conditions are eosinophils
associated with?
662) What special about Hansel stain?
Small amounts of constituents can be normal or
pathogenic based on the clinical picture
Many urines have just a rare epithelial cell
Some constituents are easily distorted
– Concentrations, pH, and presence of
metabolites
Normals are not clearly defined
Look for buds
Refractility
Refractility and possibly in a different plane
Refractile, polarizes
• Smooth, nonnucleated, biconcave disks ~7 µm
• Crenated in hypersthenuric urine
• Ghost cells in hyposthenuric urine
• Identify using high power
– Glomerular bleeding
– Strenuous exercise
– Acanthocytic, blebs
Fragmented, hypochromic
Aid in diagnosis
Vasular injury to the genitourinary tract
Extent of damage
0-3 to 5/hpf
– Cloudy, red urine, advanced disease,
trauma, acute infection, coagulation
disorders
Clear urine, early glomerular disease,
malignancy, strenuous exercise, renal
calculi confirmation
12 µm
Neutrophils
High power
– Hypotonic urine
– Brownian movement
– Swell; granules sparkle
– Pale blue if stained
Nonpathologic
– Drug-induced interstitial nephritis
Renal transplant rejection
– Percent per 100 to 500 cells
– >1% significant
Concentrate sediment, centrifuge, or
cytocentrifuge
45
UA PPT Flashcards
663) What are mononuclear cells?
664) What lymphocytes resemble?
665) Mononuclear may need to refer to
what testing?
666) What is the normal hpf in female?
667) Increased WBCs in urine is known as?
668) What symptoms does infection cause?
669) What clinical finding can you?
670) What must you report in clinical
significance?
671) What are three types of epithelial
cells?
672) What are classification of epithelial
cells?
673) What are some significance of
squamous epithelial cells?
674) Clue cells are what type of cell?
675) An example of vaginal infection?
676) Coccobacillus species are commonly
found in?
677) What are the three form of
Transitional Epithelial cells?
678) Transitional epithelial cells are
differentiate from RTE how?
679) What does syncytia mean?
680) What causes syncytia?
681) What are the shapes of the renal
tubular epithelial cells and where are
they found?
–
Lymphocytes, monocytes, macrophages,
histiocytes are rare
– Differentiate from renal tubular
epithelial (RTE) cells
• Staining
May resemble RBCs; seen in early transplant rejection
cytodiagnostic
<5 hpf
Pyuria
Cystitis, pyelonephritis, prostatitis, and urethritis.
Glomerulonephritis, lupus erhthematosus, interstitial
nephritis, tumor.
Report presence of bacteria.
1.
2.
3.
–
Squamous
Transitional (urothelial)
RTE
Squamous: vagina, male and female
urethra
– First structures observed
– Transitional: bladder, renal pelvis,
calyces, ureters, upper male urethra
RTE: renal tubules
• Largest cell in urine
• Good for focusing microscope
• Rare, few, moderate, many
• lpf or hpf per laboratory
• Normal sloughing
Contamination if not midstream clean-catch
Squamous cell with pathologic significance
Gardnerella vaginalis
Seen in urine but more common in vaginal wet
preparation
1. Spherical: absorb water in bladder and become large
and round
2. Caudate: appear to have a tail
3. Polyhedral: multiple sides
Centrally located nucleus
Syncytia = clumps
Catheterization
Malignancy
Columnar = proximal convoluted tubule (PCT)
Round, oval = distal convoluted tubule (DCT)
Cuboidal = collecting duct
46
UA PPT Flashcards
682) What are the characteristics of the
PCT cells?
683) What are the characteristics of the
DCT cells?
684) What are the characteristics of the
collecting duct RTEs?
685) Which renal tubular cells are the most
clinically significant and why?
686) What are Oval Fat Bodies?
687) What conditions are associated with
Oval Fat Bodies?
688) If bacteria if found in the urine, which
type is more common: rods or cocci?
689) What urine conditions are ideal for
yeast growth?
690) What is the most common parasite
found in urine?
691) What is the significance of
spermatozoa in urine?
692) What are some characteristics of
mucus in urine?
693) What are the characteristics of casts
in the urine?
Larger than other RTEs
Columnar, convoluted, rectangular
May resemble casts
Coarsely granular cytoplasm
Notice presence of nucleus
Round or oval shaped, smaller
May resemble WBCs or spherical transitional cells
Observe the eccentrically placed nucleus to differentiate
from spherical transitional
Cuboidal, never round
-At least one straight edge
-Eccentric nucleus
Three or more cells in clump is renal fragment; often
large sheets
RTE cells are the most clinically significant urine
epithelial cells; indicate tubular necrosis; fragments
indicate severe destruction
-Heavy metals, drug toxicity, hemoglobin, myoglobin, viral infections, pyelonephritis, transplant rejection,
salicylate poisoning
RTE cells that have absorbed lipid in the filtrate
Lipiduria: nephrotic syndrome, acute tubular necrosis,
diabetes, crush syndromes
Rods are most common
Diabetic urine: ↑ glucose and acid ideal for yeast growth
Most common: Trichomonas vaginalis
Pear-shaped flagellate
Swims across field rapidly
infertility: sperm expelled into bladder instead of urethra.
May cause positive protein
Protein from RTE, glands, squamous cells
Threadlike, low refractive index
Confuse with casts
Irregular, composed of uromodulin protein
Female specimens, no clinical significance
Elements unique to the kidney
Formed in DCT and collecting duct
Parallel sides, rounded ends, inclusions
Detect under low power, ID high power
Scan edges of glass cover slip
Low light is essential
Report number per lpf
Many pathologic and nonpathologic causes
47
UA PPT Flashcards
694) What is Uromodulin Protein?
695) How is Uromodulin formed?
696) What are the physical characteristics
of hyaline casts?
697) What pathologic conditions are
associated with hyaline casts?
698) How can RBC casts be differentiated
from RBC clumps?
699) What is the clinical significance of RBC
casts?
700) How is tubular necrosis confirmed?
701) What is mostly seen in WBC casts?
702) When are WBC casts seen?
703) What are bacterial Casts?
704) What do bacterial casts resemble?
705) How do you look for bacterial cells?
706) Where are bacterial cells seen?
707) What are mixed cellular casts?
708) How do you look for mixed cellular
casts?
709) Where are epithelial casts formed?
710) What pulls from damaged tubules in
epithelia casts?
711) Where are the majority of cells on in
epithelial casts?
712) In epithelia casts a stain is done to
differentiate from WBC. Why?
Uromodulin protein secreted by RTE of DCT and
collecting duct
Consistent excretion normally
-↑ stress and exercise
Formation of protein fibrils into matrix
Urine stasis, acid pH, Na, and Ca
Uromodulin protein not detected by reagent strips
↑ protein is from renal disease
Aggregated uromodulin fibrils attached to RTEs
Interweaving to loose network, traps elements
More interweaving to form solid matrix
Attachment of elements to matrix
Detachment of fibrils from RTEs
Excretion of cast
Normal parallel sides or convoluted, wrinkled, cylindroid,
occasional adhering cell or granule
glomerulonephritis, pyelonephritis, chronic renal disease,
congestive heart failure
Look for cast matrix
Bleeding within the nephron, casts are more specific than free
RBCs in urine
Glomerular damage or nephron capillary damage
Glomerular damage: dysmorphic RBCs and elevated
protein
May be seen following strenuous exercise
Look for RTE cells
Mostly neutrophils and lobed nucleus and granules
WBC casts are seen with infection and inflammation of
the tubules
Pyelonephritis: WBC casts, bacteria
Acute interstitial nephtitis: WBC casts, no bacteria
Pure bacteria or mixed with WBCs
Granular casts
By looking for free WBCs and bacteria, and by confirming
with gram stain
In pyelonephritis
Glomerular nephritis: RBCs and WBCs
By looking for predominant type of cell
In DCT
Fibrils forming cast
On the cast matrix
to show single nucleus
48
UA PPT Flashcards
713) What are the clinical significance in
epithelial casts?
714) What kind of stain does the epithelial
casts might appear as?
715) In epithelial casts what do you want to
look for to distinguish fragments?
716) What are fatty casts seen with?
717) Oval fat bodies may attach to matrix
and are:
718) What kind of stain does fatty casts
look like?
719) How do fatty casts look like under a
microscope?
720) Nephritic syndrome, diabetes, crush
trauma, and tubular necrosis are all
associated with:
721) In mixed cellular casts where are RBC
and WBC casts located?
722) In mixed cellular casts where are the
WBC and bacterial casts located?
723) What aids in identifying mixed cellular
casts?
724) What do granular casts look like?
725) Granule origin is in RTE lysosomes,
excreted in normal metabolism, more
after exercise and activity, and
disintegration of cellular casts and free
cells. True or False
726) What power are granular casts
detected under?
727) What power are granular casts ID
under?
728) Granules are disintegrated to form:
729) Where do you want to look when
differentiating granular casts from
clumps of debris and crystals.
730) Waxy casts are:
731) When are waxy casts well seen?
732) What are waxy casts?
733) Extreme urine stasis and renal failure
are associated with:
734) What are broad casts?
735) All types of casts are broad.
True or false
Tubular damage, heavy metals, viral infections, drug
toxicity, graft
Bilirubin stained
The Matrix
Oval fat bodies (OFBs) and fat droplets
Highly refractile
Lipid stains
Polarized
Fatty casts
In the glomerulonephritis
In the pyelonephritis
Staining or phase microscopy
Coarse and finely granular
True
Low power
High power
Waxy casts
Look for matrix
Brittle, highly refractile, and fragmented with jagged ends
and notches.
With staining
Degenerated hyaline and granular casts
Waxy casts
The destruction and widening of the DCTs formed in the
upper collecting duct
True
49
UA PPT Flashcards
736) What are the most common broad
casts?
737) In broad casts where is the bilirubin
stained from.
738) Renal failure casts is associated with:
739) What is caused by medications or
treatments in urinary crystals?
740) Urinary crystals are not clinically
significant but are reported.
True or False
741) How are urinary crystals reported?
742) What are urinary crystals?
743) What must urinary crystals
differentiate from?
744) What do urinary crystals indicate?
745) In urinary crystal formation what are
the precipitation of urine solutes?
746) What are urinary crystal formation
based on?
747) What temperature are urine crystal
specimens kept.
748) What is needed in fresh specimens?
749) What do most urinary crystals have
when identifying them?
750) What is the most valuable ID for urine
crystals?
751) What are the classifications of urine
crystals?
752) Where are all abnormal crystals
found?
753) Polarized microscopy characteristics
for urine crystals are valuable in:
754) What do temperature and pH
contribute to for urine crystals?
755) What forms in refrigerated acid urine?
756) Amorphous urates will_____ with
heat.
A. Increase
B. Decrease
C. Dissolve
D. Form
Granular and waxy
Viral hepatitis
Broad casts
Latrogenic
True
Rare few, moderate, many
True geometrically formed structures or as amorphous
material
Few abnormal crystals
Liver disease, inborn errors of metabolism, and damage
to tubules
Salts, organic compounds and medications
Temperature, solute concentration, and pH
Refrigerated
High specific gravity
Characteristic shapes and colors
Urine pH
Normal acid, normal alkaline
In acid urine
ID
Formation and solubility
Amorphous urates
C. dissolve
50
UA PPT Flashcards
757) Amorphous phosphates form in
refrigerated alkaline urine will ____ in
acetic acid and so will ___
A. Increase, urine
B. Decrease, crystals
C. Dissolve, RBCs
D. Form, crystals
758) What has yellow-brown granules,
clumpy, and resemble casts?
759) What is the pH in amorphous urates?
760) Why does the urine sediment have a
pink color in amorphous urates?
761) What do uric acid crystals look like?
762) Uric acid crystals resemble cystine
crystals but they are always:
763) What increases in uric acid crystals?
764) Uric acid crystals are chemotherapy
for what disease?
765) What is a major component of calcium
oxalate?
766) An example that has Monohydrate
calcium oxalate crystals is:
767) What appears to be similar to
amorphous phosphates?
768) What happens to the amorphous
phosphates after being refrigerated?
769) How does normal crystals look like in
alkaline urine?
770) What do normal crystals in alkaline
urine have?
771) What does normal crystals in alkaline
urine cause?
772) Normal crystals in alkaline urine are:
773) What does calcium phosphate look
like?
774) What does calcium carbonate look
like?
775) What is produced with addition of
acetic acid in calcium carbonate?
776) What do ammonium biurate crystals
look like?
777) Ammonium Biurate Crystals are:
778) Where do ammonium biurate crystals
form in?
779) What do cystine crystals look like?
780) What are cystine crystals similar to?
C. dissolve, RBCs
amorphous urates
5.5
The pigment uroerythrin attaching on surface of granules
Yellow-brown color, rhombic, whetstones, wedges,,
rosettes
Polarized
Purines
Leukemia
Renal calculi
Antifreeze poisoning
Amorphous urates
Alkaline pH and heavy white precipitate forms
Colorless, prism, coffinlid shape
Triple phosphate
High alkaline urine, UTIs
Polarized
Flat rectangles and thin prisms in rosettes
Small, dumbbell, spherical shapes
Gas
Yellow-brown, spicule covered spheres, thorny apples
only urates in alkaline urine
in old specimens and with urea splitting bacteria
Hexagonal, thin and thick plates
Uric acid
51
UA PPT Flashcards
781) UA polarizes but only thick cystine
crystals:
782) What is seen in cystinuria?
783) What does cystine crystals confirm?
784) What do cholesterol crystals look like?
785) What temperature must cholesterol
crystals specimens be kept at?
786) What accompanies nephritic
syndrome?
787) What is radiographic dye crystals
similar to?
788) Is radiographic dye crystals polarized
or not polarized?
789) What does radiographic dye crystals
have?
790) What does tyrosine crystals look like?
791) What are tyrosine crystals seen with?
792) What disorder does tyrosine crystals
inherited from?
793) What does Leucine crystals look like?
794) Crystals that are clumped needles or
granules and has characteristic yellow
color is:
795) What crystal has a positive reagent
strip for bilirubin?
796) What is bilirubin crystals?
797) Sulfonamide crystals can cause
tubular damage if crystals are formed
where?
798) What are the characteristics of
sulfonamide crystals?
799) Which crystals appear as colorless
needles that tend to form bundles after
refrigeration?
800) Name the types of Urinary Sediment
Artifacts that can be seen when
performing a Microscopic Examination?
801) What is ‘Renal Disease”
Polarizes
Inability to reabsorb cystine
Cyanide nitroprusside
Rectangular plates with characteristic notched corners
Refrigerated
Fatty casts and OFBs
Cholesterol crystals
Polarized
High SG with refractometer
Fine yellow needles in clumps or rosettes
Leucine crystals
Amino acid disorders
Yellow-brown spheres with concentric circles and radial
stirations
Bilirubin crystals
Bilirubin crystals
Viral hepatitis with tubular damage
Nephron
Needles, rhombics, whetstones, sheaves of wheat,
rosettes with colors ranging from colorless to yellow
brown
Ampicillin crystals
•
•
•
•
802) Name the 3 classifications renal
disease?
•
•
•
•
Material fibers, meat and vegetable fibers, and hair
Starch, oil droplets, air bubbles, pollen grains,
vegetable fiber, hair, diaper fiber
Disorders throughout the body can affect renal
function and produce abnormalities in the urinalysis
The kidneys are consistently exposed to potentially
damaging substances
Glomerular disorders
Tubular disorders
Interstitial disorders
52
UA PPT Flashcards
803) What are the two types of Glomerular
disorders?
804) Name the immunologic disorders.
805) Name the Nonimmunologic
806) General term for sterile, inflammatory
process affecting the glomerulus that
causes blood, protein, and casts in
urine.
807) What are the 4 types of
glomerulonephritis that progress
through various disorders?
808) What test can be performed to
diagnose Acute Poststreptococal
Glomerulonephritis (AGN)?
809) What are some of the indications of
AGN?
810) What is the more serious acute form
that can cause renal failure and
Systemic immune disorders such as:
a. Macrophages damage capillary walls
b. Fibrin = permanent damage to capillary
tufts
Urinalysis similar to AGN progresses to
more abnormal, elevated protein, low
glomerular filtration rate (GFR)
May have increased fibrin degradation
products (FDP), cryoglobulins and IgA
immune complex depositions
811) What disorder causes:
Morphological changes resembling
crescentric GN
•
•
–
Majority are of immunologic disorders
Nonimmunologic
Immune complexes from immunologic reactions
throughout the body
– Increased serum immunoglobulins are deposited on
the glomerular membranes
– Immune system mediators: complement migrate and
produce change and damage to membranes
– Chemicals and toxins, deposition of amyloid material
and acute phase reactants, electrical charge
interference, membrane thickening
Glomerulonephritis
Acute glomerulonephritis to chronic
glomerulonephritis to nephrotic syndrome to renal
failure.
• Rapid anti–group A streptococcal enzyme tests
– Ease in diagnosis
– Decline in incidence
• Group A streptococcal infections from organisms
with M protein in the cell wall
• Fever, edema around the eyes, oliguria, and
hematuria
• Immune complexes deposit on glomerular
membranes
• Hematuria, proteinuria, oliguria
– Red blood cell (RBC) casts, dysmorphic RBCs
– Hyaline and granular casts
– White blood cells
– Anti–group A streptococcal enzyme tests
Rapidly Progressive (Crescentic) Glomerulonephritis
Goodpasture’s Syndrome
53
UA PPT Flashcards
812) Autoimmune disorder against
glomerular and alveolar basement
membranes
813) Cytotoxic antibody following viral
respiratory diseases
814) Antiglomerular basement membrane
antibody
815) Hemoptysis, hematuria, proteinuria,
RBC casts
816) Chronic glomerulonephritis to endstage renal failure is common
817) What causes the immune response,
producing granulomas in Wegener’s
Granulomatosis?
818) What is the disease process of
Wegener’s Granulomatosis?
819) What antibody is key to diagnosing
Wegener’s Granulomatosis?
820) What test can be performed to
diagnose Wegener’s Granulomatosis?
821) This disease is seen in children
following upper respiratory infections
who’s symptoms include:
822) Raised, red patches on skin
823) Blood in sputum and possibly stools
824) Renal involvement is the most serious
complication of the disorder
825) Proteinuria and hematuria, RBC casts
826) 50% complete recovery
827) Follow patients for more serious renal
problems
828) Name the types of Urinary Sediment
Artifacts that can be seen when
performing a Microscopic Examination?
829) Systemic lupus erythematosus,
Sjögren’s syndrome, secondary syphilis,
hepatitis B, gold and mercury
treatments, malignancy can aid in the
diagnosis of….
830) What type of immunoglobulin
immune complexes cause pronounced
thickening of glomerulare basement
membrane?
Neutrophils initiate the immune response.
•
Inflammation and granulomas in small blood vessels
of kidney and respiratory system
• Pulmonary symptoms first, then hematuria,
proteinuria, RBC casts, elevated BUN and creatinine
levels
Antineutrophilic cytoplasmic antibody (ANCA)
Immunofixation for p-ANCA/c-ANCA
Henoch-Schönlein Purpura
•
•
Material fibers, meat and vegetable fibers, and hair
Starch, oil droplets, air bubbles, pollen grains,
vegetable fiber, hair, diaper fiber
Systemic lupus erythematosus, Sjögren’s syndrome,
secondary syphilis, hepatitis B, gold and mercury
treatments, malignancy can aid in the diagnosis of….
What type of immunoglobulin immune complexes cause
pronounced thickening of glomerulare basement
membrane?
54
UA PPT Flashcards
831) Name the disorder:
832) Type 1: increased cellularity in the
subendothelial cells of the mesangium
a. Thickening of capillary walls
833) Type 2: extremely dense deposits in
the glomerular basement membrane
a. Poor prognosis
834) Hematuria, proteinuria, ↓
complement
835) Autoimmune disorders, infections,
malignancies
836) What is the disorder that progresses
into:
837) Fatigue, anemia, hypertension,
edema, oliguria gradually worsening
838) Hematuria, proteinuria, glycosuria
(tubular damage), many types of casts
including broad and waxy casts
839) Markedly decreased GFR
840) What is Berger’s disease? What is the
other name for this disease?
841) Acute onset from systemic shock (low
blood pressure) or glomerulonephritis
complication causes…
842) Name the causes of Nephrotic
Syndrome
843) A patient with proteinuria would have
how many g/day of protein in the urine?
844) What are the clinical findings for
Minimal Change Disease
(Lipid Nephrosis)?
845) This disease is similar to nephritic
syndrome but affects only certain
numbers and areas of glomeruli;
podocytes are damaged
846) IgM and C3 immune deposits
847) Moderate to heavy proteinuria;
microscopic hematuria
848) Heroin and analgesic abuse, HIV
849) This is an inherited sex-linked and
autosomal disorder affecting basement
membrane.
850) Males more severely affected
851) Macroscopic hematuria with
respiratory infections by age 6 years
852) Membrane laminated with thinning;
no immune complexes
Name the disorder:
•
Type 1: increased cellularity in the subendothelial
cells of the mesangium
– Thickening of capillary walls
•
Type 2: extremely dense deposits in the
glomerular basement membrane
– Poor prognosis
•
Hematuria, proteinuria, ↓ complement
•
Autoimmune disorders, infections, malignancies
What is the disorder that progresses into:
• Fatigue, anemia, hypertension, edema, oliguria
gradually worsening
• Hematuria, proteinuria, glycosuria (tubular
damage), many types of casts including broad and
waxy casts
• Markedly decreased GFR
What is Berger’s disease? What is the other name for this
disease?
Acute onset from systemic shock (low blood pressure) or
glomerulonephritis complication causes…
Name the causes of Nephrotic Syndrome
A patient with proteinuria would have how many g/day
of protein in the urine?
What are the clinical findings for Minimal Change Disease
(Lipid Nephrosis)?
This disease is similar to nephritic syndrome but affects
only certain numbers and areas of glomeruli; podocytes
are damaged
•
•
IgM and C3 immune deposits
Moderate to heavy proteinuria; microscopic
hematuria
• Heroin and analgesic abuse, HIV
This is an inherited sex-linked and autosomal disorder
affecting basement membrane.
• Males more severely affected
• Macroscopic hematuria with respiratory infections
by age 6 years
• Membrane laminated with thinning; no immune
complexes
• Mild to persistent hematuria, later nephrotic
55
UA PPT Flashcards
853) Mild to persistent hematuria, later
nephrotic syndrome, renal failure for
some
854) Patients with this disease have
elevated serum uric acid and gout at an
early age, occurs before renal
symptoms.
855) Formerly Tamm-Horsfal protein is the
only protein produced by the kidney
856) Inherited disorder that results in an
abnormal buildup of uromodulin in the
tubular cells causing their destruction
857) This is the most common cause of
end-stage renal disease.
858) Glomerular basement membrane
thickening
859) Increased proliferation of mesangial
cells
860) Increased deposition of cellular and
acellular material within matrix of
Bowman’s capsule and around capillary
tufts
861) Deposition associated with
glycosylated proteins from poorly
controlled diet
862) Sclerosis of vascular structure
863) Reason for early microalbumin testing
864) Describe Ischemia
865) Ischemia and Nephrotoxic agents such
as aminoglycosides, amphotericin B,
ethylene glycol, heavy metals,
mushroom poisoning, hemoglobin,
myoglobin can cause this___________.
866) This Hereditary and Metabolic
disorder have these symptoms:
867) Generalized proximal convoluted
tubule reabsorption failure
a. Inherited with cystinosis and Hartnup
disease
b. Acquired: heavy metals, outdated
tetracycline
c. Complication of multiple myeloma,
renal transplant
d. Glycosuria and electrolyte imbalance
868) What are the two types of
Nephrogenic Diabetes Insipidus
syndrome, renal failure for some
•
•
•
Patients with this disease have elevated serum uric
acid and gout at an early age, occurs before renal
symptoms.
Formerly Tamm-Horsfal protein is the only protein
produced by the kidney
Inherited disorder that results in an abnormal
buildup of uromodulin in the tubular cells causing
their destruction
This is the most common cause of end-stage renal
disease.
• Glomerular basement membrane thickening
• Increased proliferation of mesangial cells
• Increased deposition of cellular and acellular
material within matrix of Bowman’s capsule and
around capillary tufts
• Deposition associated with glycosylated proteins
from poorly controlled diet
• Sclerosis of vascular structure
• Reason for early microalbumin testing
Describe Ischemia
Ischemia and Nephrotoxic agents such as
aminoglycosides, amphotericin B, ethylene glycol, heavy
metals, mushroom poisoning, hemoglobin, myoglobin
can cause this___________.
This Hereditary and Metabolic disorder have these
symptoms:
– Generalized proximal convoluted tubule
reabsorption failure
– Inherited with cystinosis and Hartnup disease
– Acquired: heavy metals, outdated tetracycline
– Complication of multiple myeloma, renal transplant
– Glycosuria and electrolyte imbalance
What are the two types of Nephrogenic Diabetes
Insipidus
56
UA PPT Flashcards
869) Urine: pale yellow, low specific gravity
(SG), possible negative results for other
tests describes wheat disease?
Urine: pale yellow, low specific gravity (SG), possible
negative results for other tests describes wheat disease?
870) This affects only the reabsorption of
glucose
871) Inherited as autosomal recessive
872) Decreased number of glucose
transporters in tubules
873) Decreased affinity of transporters for
glucose
874) Glycosuria with normal blood glucose
level
875) In tubulointerstitial disease infections
and inflammations affecting what?
876) What is the most common renal
disease?
877) Urinary tract infection (UTI) is
associated with
878) Is cystitis (bladder infection) common
in tubulointerstitial disease?
879) Cystitis untreated progresses where?
880) What are the lab findings in cystitis?
•
•
•
•
•
This affects only the reabsorption of glucose
Inherited as autosomal recessive
Decreased number of glucose transporters in tubules
Decreased affinity of transporters for glucose
Glycosuria with normal blood glucose level
the interstitium and the tubules
urinary tract infection (UTI)
tubulointerstitial diseases
Yes, it is very common
to upper urinary tract
Many WBCs, bacteria, increased pH, mild proteinuria,
hematuria
881) WBSs in urine are called
pyuria
882) In acute pyelonephritis ascending emptying of bladder
movement of bacteria affecting
883) In acute pyelonephritis ascending Calculi, pregnancy, reflux of urine from bladder to
movement of bacteria is associated with ureters
884) What are the clinical signs of the acute Rapid onset, urinary frequency, burning, lower back pain
pyelonephritis?
885) Differentiation between cystitis
WBC casts.
and pyelonephritis is aided by the
( In acute pyelonephritis WBC casts are present)
presence of
886) Characteristics:
more
serious, Chronic pyelonephritis
permanent damage to renal tubules,
chronic renal failure, most often
diagnosed in children:
887) Renal disorder that can affect Chronic pyelonephritis
emptying of collecting ducts
888) Early urinalysis is similar to acute Chronic pyelonephritis
pyelonephritis in
889) Microscopic results in chronic Later granular, waxy, and broad casts; increased protein,
pyelonephritis are characterized by :
hematuria, ↓ SG
890) Allergic reaction causing inflammation Acute interstitial nephritis
of interstitium and tubules
891) Medication allergy to penicillin, Acute interstitial nephritis
57
UA PPT Flashcards
methicillin, ampicillin, cephalosporins,
NSAIDs, thiazide diuretics are associated
with
892) Treatment for acute interstitial
nephritis:
893) Urinalysis: Pyuria (pus: neutrophils),
eosinophiluria,
hematuria,
proteinuria,↑ WBCs, WBC casts, no
bacteria are the clinical manifestations
of
894) In acute interstitial nephritis the stain
used for eosinophils is
895) Renal failure can have two forms:
896) Chronic renal failure is
897)
898) Renal function tests: GFR <25 mL/min,
↑↑ BUN and creatinine levels,
electrolyte imbalance, isosthenuria,
proteinuria, and renal gycosuria are
typically found in
899) In chronic renal failure urinalysis
findings are characterized by
900) Acute renal failure is characterized by
901) Causes of acute renal failure:
steroids
Acute interstitial nephritis
Hansel stain
Acute and chronic forms
progression from original disorders to end-stage renal
disease
chronic renal failure
↑ granular, waxy, broad casts
Sudden onset, and often is reversible
Decreased blood flow (prerenal), acute disease (renal),
renal calculi and tumors (postrenal)
902) Urinalysis related to cause acute renal RTE cells = decreased blood flow
failure:
RBCs = glomerular damage
WBCs and casts = infection/inflammation
Urothelial cells = possible bladder tumor
903) Prerenal causes of acute renal
Decreased blood pressure/cardiac output, hemorrhage,
failure:
burns, surgery, septicemia
904) Renal causes of acute renal failure:
Acute glomerulonephritis, acute tubular necrosis,
acute pyelonephritis, acute interstitial nephritis
905) Postrenal causes of acute renal Renal calculi, tumors, crystallization of ingested
failure:
substances
906) What is renal lithiasis?
Renal calculi (kidney stones) in calyces and pelvis of
kidney, ureters, bladder
907) What are the general characteristics Staghorn, round and smooth, barely seen
of the renal calculi in renal lithiasis?
908) What are the clinical manifestations of Severe back pain radiating from lower back to legs when
renal lithiasis?
passing
909) How is renal lithiasis treated?
By lithotripsy or surgical removal
910) What is lithotripsy?
High-energy shock waves break up stones
911) How are the stones formed in renal Formation conditions similar to crystals; affected by
lithiasis?
pH, concentration, urine stasis. No exact cause of
58
UA PPT Flashcards
formation is known
912) When is the occurrence of renal Increased in the summer because of dehydration
lithiasis increased?
913) What types of stones are related to 75% calcium oxalate or phosphate
renal lithiasis?
Magnesium ammonium phosphate (stuvite)
 UTI and ↑ pH, like triple phosphate crystals
Uric acid: increased purine diet
Cystine: hereditary cystinosis
914) What neurotransmitter is produced
from tryptophan?
915) Where is serotonin produced from
tryptophan?
916) How is serotonin carried to muscles in
the body?
917) What happens to excess serotonin in
the body?
918) What would be an indicator of a
tumor in the argentaffin cells of the
intestine?
919) What kind of urine specimen can be
used to test for 5-Hydroxyindoleacetic
acid?
920) What foods should a patient avoid
72hours prior to a urine test for 5Hydroxyindoleacetic acid?
921) How should a 24-hour urine sample
for 5-Hydroxyindoleacetic acid be
preserved?
922) What is common of all cystine
disorders?
923) What is an inherited disorder affecting
renal reabsorption?
924) What amino acids are affected by
cystinuria?
925) When are calculi formation seen in
Cystinuria?
926) What is usually the only amino acid
found during analysis of calculi from
Cystinuria patients?
927) What urine screening test is used to
screen for cystinuria?
928) What color is present if a cyanidenitroprusside urine screening test is
positive?
929) What does a positive cyanidenitroprusside urine screening test
Serotonin
Intestinal argentaffin cells
Platelets
Excreted in the urine as 5-Hydroxyindoleacetic acid (5HIAA)
Increased 5-HIAA in urine from excess serotonin
production
Random specimen
Bananas, pineapples, tomatoes, phenothiazines, and acetanilids
In HCl or boric acid
noticeable sulfur odor
Cystinuria
Cystine, lysine and possibly arginine and ornithine
Early in life
Cystine
cyanide-nitroprusside
red-purple color
excess cystine is present
59
UA PPT Flashcards
indicate?
930) What are two possible causes of falsepositives on cyanide-nitroprusside urine
screening?
931) What is the purpose of sodium
cyanide in the cyanide-nitroprusside
urine screening test?
932) What is the purpose of sodium
nitroprusside in the cyanidenitroprusside urine screening test?
933) Which cystine disorder ranges in
severity from a fatal disorder developed
in infancy to a benign form appearing in
adulthood?
934) What two categories can Cystinosis be
broken down into?
935) What is the defect in Cystinosis?
936) Where can crystalline cystine deposits
be found in cystinosis?
937) What causes Fanconi syndrome in
cystinosis patients?
938) What are the symptoms of Cystinosis
in a non-nephropathic patient?
939) What laboratory results would be
consistent with Cystinosis?
940) What is the treatment option for
patients with Cystinosis?
941) Which amino acid is affected in
Homocystinuria?
942) What is the cause of Homocystinuria?
943) What symptoms can be seen in
patients with Homocystinuria?
944) Which Cystine disorder is included in
newborn screening programs?
945) What is the name for intermediate
compounds in the production of heme?
946) What are the primary porphyrins?
947) What are a-aminolevulinic acid (ALA)
and porphobilinogen precursors of?
948) Disorders in what stage of the heme
pathway can be seen in urine?
949) In porphyrin disorders, where can
coproporphyrin and protoporphyrin be
detected?
ketonuria and homocystinuria
It reduces cystine
color indicator
cystinosis
Nephropathic and non-nephropathic
cystine cannot pass lysosomal membrane to be released
into cytoplasm forming crystalline cystine deposits in the
body
cornea, bone marrow, lymph nodes and organs
crystalline cystine deposits in renal tubules
some ocular problems, otherwise benign
aminoaciduria, reducing symptoms and cystine crystals
Renal transplant and cystine-depleting medications
Methionine
a defect in metabolism of methionine, causing excess
methionine
failure to thrive, cataracts, mental retardation,
thromboemboli, death
Homocystinuria
porphyrin
uroporphyrin, coproporphyrin, protoporphyrin
Porphyrins
precursors; ALA, porphobilinogen, urobilinogen
feces/bile
60
UA PPT Flashcards
950) If a patient has free erythrocyte
protoporphyrin disorders from lead
poisoning, where would this be
detected?
951) What is the collective term for
porphyrin disorders?
952) Which type of porphyria is caused by a
missing gene in the metabolic pathway?
953) What clinical symptoms are seen in
inherited porphyrias?
954) What are common ways that
porphyrias can be acquired?
955) What can be seen on the diaper of a
baby with a porphyria disease?
956) What test helps detect ALA and
porphobilinogen in urine?
957) What happens to ALA during an
Ehrlich reaction?
958) What is the name of a group of
inherited disorders preventing the
metabolism of glycoaminoglycans in the
connective tissue?
959) What happens to polysaccharides in
mucopolysaccharide disorders?
960) What substances found in urine are
indicators of a mucopolysaccharide
disorder?
961) What family of disorders do Hurler
syndrome, Hunter syndrome and
Sanfilippo syndrome fall under?
962) What is the treatment for
mucopolysaccharidoses?
963) Which mucopolysaccharidosis causes
corneal damage?
964) Which mucopolysaccharidosis is
inherited as a sex-linked recessive trait?
965) What is a urinary screening test for
Mucopolysaccharidoses?
966) What is a positive result on
Metachromatic staining of a urine
sample?
967) How long after adding
Cetytrimethylammonium bromide to
urine sample is the turbidity read?
968) For Mucopolysaccharide Paper test,
what is filter paper dipped into before
adding urine?
In blood
porphyrias
inherited porphyria
neurologic/psychiatric, cutaneous/photosensitivity or
both
lead poisoning, alcoholism, iron deficiency, chronic liver
and renal disease
port wine color after air exposure
Ehrlich reaction
It reacts with acetyl acetone to form porphobilinogen
mucopolysaccharide disorders
they are incompletely metabolized and accumulate in
connective tisue
dermatan sulfate, keratan sulfate, heparin sulfate
Mucopolysaccharidoses
bone marrow transplantation and gene therapy
Hurler syndrome
Hunter syndrome
acid-albumin and cetyltrimethyammonium bromide
turbidity test
a blue color that cannot be washed away with dilute
acidified methanol
5 minutes
0.59% azure A dye in 2% acetic acid
61
UA PPT Flashcards
969) Name a purine disorder.
970) What are the symptoms of Leschnyhan disease?
971) What is a symptom normally seen in
the diaper of a baby with Lesch-nyhan
disease?
972) What is the term for carbohydrate
disorders that result in carbohydrates in
urine?
973) Most meliturias do not cause
problems except for?
974) Disorders in galactose-1-phosphate
uridyl transferase (GALT) cause which
carbohydrate disorder?
975) What disorder causes failure to thrive,
severe mental retardation, cataracts
and liver disorders?
976) What changes to diet can help
sufferers of galactosuria?
977) When is Lactosuria usually
discovered?
978) Fructosuria can be detected by which
screening test?
979) When is Pentosuria usually
discovered?
980) Overflow
981) Overflow can be described as
Lesch-Nyhan disease
motor defects, mental retardation, self-destruction,
gout, renal calculi
orange sand in diaper
melituria
galactosuria
galactosuria
Galactosuria
removal of lactose
During pregnancy or lactation
Resorcinol screening test
after ingestion of large amounts of fruit
Disruption of a normal metabolic pathway
over production of a normal or abnormal substance to
the point that the tubules are not able to prevent it from
escaping into the urine
982) Overflow is caused by
inherited lack of specific enzyme for protein, fat, or
carbohydrate metabolism—inborn error of metabolism
983) What happens in renal disorders?
tubules fail to reabsorb substance
984) Overflow vs. renal disorders
Overflow: increased levels in blood and urine
Renal disorders: Increased levels seen in urine only
985) What is renal disorder?
Malfunctions in the tubular reabsorption mechanism
986) Renal disorders classified by
Inherited overflow
functional defect:
Acquired metabolic overflow
Renal
987) Disorders caused by inherited overflow Phenylketonuria
Tyrosinemia
Maple syrup urine disease
Organic acidemias
Cystinosis
Porphyria
Mucopolysaccharidoses
Galactosemia
Lesch-Nyhan disease
62
UA PPT Flashcards
988) Disorders caused by acquired metabolic InfantileTyrosinemia
overflow
Melanuria
5-Hydroxyindole-acetic acid
Porphyria
989) Disorders caused by renal defect
Hartnup disease
Cystinuria
990) Current state-mandated screening
30 or more
detects how many inborn errors of
metabolism?
991) What can Phenylalanine/Tyrosine
Disorders can cause abnormal urinalysis results
disorders cause?
992) What are the primarily follow-up tests Urine tests
for inborn errors of metabolism?
993) Specimen collected for newborn
heel stick blood
screening is performed on
994) When is the newborn screening
before infant leaves hospital at age of >24 hrs
performed?
995) What appear first in the blood?
Metabolites
996) How is the newborn screening
by tandem mass spectrophotometry, MS/MS
analyzed?
997) Phenylketonuria, tyrosyluria and
Amino Acid Disorders (Aminoacidurias)
alkaptonuria are
998) How often does Phenylketonuria
1 in 10,000 to 20,000 births
(PKU) occur?
999)
1000) Phenylketonuria (PKU) is genetically
Inherited autosomal recessive; heterozygotes normal
classified as
(must inherit 2 defective genes)
1001) What happens if phenylalanine is not
Severe brain damage and mental retardation can occur
reduced in the diet early in life?
1002) Milk contains what?
Phenylalanine
1003) PKU management of disease
Diet to eliminate phenylalanine (aspartame)
1004) In amino acid disorders such as PKU,
Phenylalanine hydroxylase is missing
there is an absence or deficiency of
what enzyme?
1005) What are the testing methods for
Urine test; Urine and 5% ferric chloride produces a
phenylketonuria?
permanent green-blue color
1006) Tyrosyluria causes what kind of
Inherited or transiently acquired (metabolic defect)
defect?
1007) How can newborns acquire
Newborns may acquire tyrosyluria as their livers may be
tyrosyluria?
underdeveloped (Premature transient tyrosinemia)
1008) Hereditary defects are classified as
Type 1, Type 2 and Type 3
1009) What enzyme deficiency is Type 1
Fumarylacetoacetate acid hydrolase
defect?
1010) What are the clinical manifestations of Renal tubular disease and liver failure in infants
Type 1 defect?
1011) What enzyme deficiency is Type 2
Enzyme deficiency is tyrosine aminotransferase
defect?
63
UA PPT Flashcards
1012) What are the clinical manifestations of
Type 2 defect?
1013) What enzyme deficiency is Type 3
defect?
1014) What are the clinical manifestations of
Type 3 defects?
1015) What is used for tyrosyluria screening
test?
1016) What is the second pathway for
tyrosine?
1017) What is melanin?
1018) Melanin deficiency results in what?
1019) Increased levels of melanin are
strongly suggestive of
1020) What is 5,6-dihydroxyindole?
1021) What is alkaptonuria?
1022) Black alkaline urine, possible blackstained diapers suggest
1023) How does alcaptonuria manifests later
in life?
1024) How is alkaptonuria diagnosed?
1025) Branched chain amino acid disorders
are
1026) What are the two groups of branched
chain amino acid disorders?
1027) The newborn patients with branched
chain amino acid disorders have what?
1028) What is the genetic classification of
Maple syrup urine disease (MSUD)?
1029) What amino acid levels are elevated in
blood and urine in MSUD?
1030) Characteristic odor to urine in maple
syrup urine disease (MSUD):
1031) In MSUD, dietary regulation by day
___ shows good outcomes
Corneal erosion and lesions on hands and feet
Enzyme deficiency is p-hydroxyphenylpyruvate oxidase
Mental retardation if no dietary restrictions (milk)
Screening tests using MS/MS, and are available for
tyrosinemia types 1, 2, and 3
Melanuria
-Melanin, thyroxine, epinephrine, protein, and tyrosine
sulfate
Pigment for dark hair, skin
Albinism
malignant melanoma
Dark urine; Initially a colorless precursor produced which
is oxidized to melanogen (also colorless) and further
oxidized to melanin (brown-black)
Third major defect in the phenylalanine-tyrosine
pathway. Enzyme deficiency, caused by a failure to
inherit the gene to produce the enzyme homogentisic
acid oxidase - used in catabolism of phenylalanine and
tyrosine
Alcaptonuria
Brown pigment accumulates in blood, tissues, and urine.
May lead to arthritis, liver, cardiac disorders. No mental
retardation.
Urine turns blue with ferric chloride, yellow precipitate
with Clinitest, black with silver nitrate and ammonium
hydroxide; quantitative tests available
Amino acids with a methyl group that branches from the
main aliphatic carbon chain; Leucine, isoleucine, valine
Maple syrup urine disease (MSUD); early degradation
products accumulate
Organic acidemias; accumulation of organic acids further
down in pathway
positive ketones
Inborn error of metabolism, autosomal recessive. Rare
disease.
leucine, isoleucine, and valine
strong odor of maple syrup and thick, dark appearance
11
64
UA PPT Flashcards
1032) In maple syrup urine disease 2,4dinitrophenylhydrazine produces what?
1033) What is the procedure manual for 2,4Dinitrophenylhydrazine (DNPH) test?
1034) Organic acidemias are
1035)
1036) The symptoms for organic acidemias
are:
1037) Three more common organic
acidemias:
1038) How can be sovaleric, propionic, and
methylmalonic acidemias detected?
1039) Increased urinary excretion of the
metabolites indican and 5hydroxyindoleacetic acid (5-HIAA)
characterize which disorders?
1040) This disorder can accompany various
intestinal disorders
1041) Indicanuria is most often associated
with which disease?
1042) What happens to Tyrptophan in
indicanuria?
1043) In indicanuria, exposure of urine to air
causing urine to turn to what color?
1044) Hartnup disease is known as
1045) Hartnup disease requires what dietary
supplements?
1046) Inherited disorder that affects
intestinal reabsorption of indole and
renal tubular reabsorption = Fanconi
syndrome
1047) What is the lining of the brain and
spinal cord called?
1048) What is the outer layer of meninges
called?
1049) Which layer of meninges touches the
surface of the brain and spinal cord?
1050) What is the name of the middle
meninges?
1051) Where is cerebrospinal fluid
yellow precipitate turbidity
1. Place 1 mL of urine in a tube.
2. Add 10 drops of 0.2% 2,4-DNPH in 2N HCl.
3. Wait 10 minutes.
4. Observe for yellow or white precipitate.
Other branched chain disorders include isovaleric,
propionic, and methylmalonic aminoacidemias/acidurias.
vomiting, metabolic acidosis, hypoglycemia, ketonurina,
increased blood ammonia levels.
Isovaleric acidemia - (isovaleryl co-enzyme A deficiency.
Urine and sometimes patient smell like sweaty feet.)
Propionic acidemia and Methylmalonic academia(no
conversion of valine, threonine, methylmalonate to
succinyl coenzyme A)
by newborn screening programs using MS/MS
Tryptophan disorders
Tryptophan Disorders-Indicanuria
Hartnup disease
Tyrptophan is converted to indole in the gut, reabsorbed
into the blood, excreted in the urine, which causing a
bluish urine, or “blue diaper syndrome.”
Indigo blue
blue diaper syndrome
Niacin
Hartnup disease
meninges
dura mater
pia mater
arachnoid
choroid plexuses of the four ventricles
65
UA PPT Flashcards
produced?
1052) At what rate is CSF produced in a
typical adult?
1053) How much CSF does a typical adult
body contain?
1054) How much CSF is in a typical neonate?
1055) Between which layers can CSF fluid be
found flowing?
1056) What happens to CSF in arachnoid
granulations/villae?
1057) How is CSF formed?
1058) What is the blood-brain barrier
composed of?
1059) How do molecules cross the bloodbrain barrier?
1060) Which structure prevents the transfer
of chemicals and harmful substances
into CSF?
1061) What are two diseases that disrupt
the blood-brain barrier?
1062) Where is CSF typically collected from
on a patient?
1063) Which department does the first tube
of CSF from a spinal tap typically go to
for testing?
1064) Why is the first tube from a spinal tap
not used for microbiology testing?
1065) What is the determining factor for
how much CSF should be taken out
during a spinal tap?
1066) The following considered for
specimen collection and handling of
what type of body fluid?
1067) Usually STAT requests
1068) Handle carefully to avoid repeat taps
1069) Preservation
1070) The following preservation are used
for specimen collection of what type of
body fluid?
1071) Hematology
1072) Refrigerate
1073) Microbiology
1074) Room temperature
1075) Chemistry/serology
1076) Frozen
1077) What is appearance of CSF?
20 mL/min
90 to 150mL
10 to 60mL
arachnoid and pia mater
reabsorbed into blood
selective filtration of blood
very tight-fitting endothelial cells
active transport
blood-brain barrier
meningitis and multiple sclerosis
between third to fifth lumbar vertebrae
Chemistry/serology
possibility of skin contamination in first tube
based on patient volume and opening pressure
CSF
CSF
Crystal clear, cloudy/turbid, milky, xanthochromic,
hemolyzed/bloody
66
UA PPT Flashcards
1078) In CSF body fluid Cloudy = ---------; and
milky = -------1079) The following are appearance of what
type of CSF which is seen in particular
medical condition.
1080) Pink, orange, yellow
1081) RBC degradation products
1082) Also jaundice, ↑ ↑ protein, carotene
1083) Pathologic = cerebral hemorrhage
Infection-Lipid or protein
1084) Define traumatic tap in collecting CSF
1085) True or false
1086) Traumatic tap Differentiates from
cerebral hemorrhage
1087) How we can differentiate between a
traumatic tap and a subarachoid
hemorrhage?
Blood vessel punctured during tap
True
1088) Clots present in traumatic tap or
hemorrhage?
1089) damage to blood-brain barrier is
defined as
1090) web-like pellicle after refrigeration is
seen in what type of infection?
1091) Is clot formed in Nonbloody CSF and
TB meningitis?
1092) The following are characteristics of
what term of CSF?
1093) Not present in a recent traumatic tap
1094) Indicates older hemorrhage
1095) D-dimer test for hemorrhage
1096) How often RBC cell count in CSF?
1097) Why STAT test should be done
immediately?
1098) Normal adult ------- WBCs/µL
1099) Neonates -------- mononuclear cells/µL
1100) What type of cell counters can be
used in Neubauer counting chamber?
1101) What system is used for body fluid
counting?
1102) What is formula for Standard
Neubauer calculation (cells/µL)?
1103) True or False
1104) Standard Neubauer calculation
formula (cells/µL) Can be used for
diluted and undiluted samples
Xanthochromic
Uneven blood distribution in tubes with traumatic tap
Erythrophagocytosis, hemosiderin granules
Hemorrhage = even distribution in all tubes
Traumatic tap = decreasing tubes 1 through 3
Clots present = traumatic tap (plasma)
Hemorrhage does not have enough fibrinogen
Nonbloody CSF
TB meningitis
yes
Xanthochromia
seldom
Because Granulocytes lyse within 1 hour
0 to 5
Up to 30
Automated cell counters
Body fluid specific automation
Number of cells counted × dilution
Number of cells counted × volume of 1 square
= cells/µL
True
67
UA PPT Flashcards
1105) Give an example of calculating CSF
cells count
1106) Following are considered in what cell
count?
1107) Clear specimens count undiluted
unless overlapping cells are seen.
1108) Load with transfer pipette.
1109) Dilute with normal saline if necessary.
1110) What is the diluting solution for a
manual WBC count?
1111) The following are considered to be
done for what blood cell count?
1112) undiluted rinse transfer pipette with
acetic acid, gently rotate pipette
1113) ----------stain helps to see WBCs
1114) What controls are available for spinal
fluid RBC and WBC?
1115) How often all diluent should be
checked for contamination?
1116) How often cytocentrifuge speed and
timing should be checked?
1117) The following are sterilize of what
type of counting chamber
1118) Soak chambers in bactericidal solution
for 15 minutes; rinse; clean with
isopropyl alcohol
1119) Why identifying the type or types of
cells present in the CSF is valuable?
1120) True or False
1121) The differential count on CSF should
be performed on a stained smear and
the cells in counting chamber.
1122) Why specimen should be
concentrated prior to the preparation of
the smear?
1123) What method are available for
specimen concentration?
1124) When the differential count is
performed for CSF count------- cells
should be counted, classified, and
reported in terms of ---------1125) The following is the principle of--------for CSF differential count
1126) Forces cells onto a slide in a
monolayer
1127) Filter paper absorbs moisture
cells counted × dilution × 1 μL
cells/µL
1 μL (0.1 × 10)
(volume counted) </exeq)
Total cell count
=
3% acetic acid
WBC count
Methylene blue
Liquid commercial control
Every two weeks
monthly
Nondisposable chamber
It is diagnostic aid
False
It should be done only in stain smear.
To ensure the maximum number of cells are available for
examination
Sedimentation, filtration, centrifugation, and
cytocentrifugation
100- percentage
Cytocentrifugation
68
UA PPT Flashcards
a. mL CSF to 1 drop 30% albumin
1128) Positively charged slides to attract
cells
1129) Albumin -------- the cell yield and ------the cellular distortion.
1130) In cytocentrifugation ------- control of
0.2 mL ------- and two drops of ------stained for bacterial contamination.
1131) What type of cells found in normal
CSF?
1132) Does adult have more lymphocyte or
monocyte? What is the ratio?
1133) What is the ratio for children?
1134) True or False
1135) Occasional neutrophils are normal in
CSF
1136) increased amounts of normal cells is
defined as:
1137) What is associated with determining
the cause of meningitis?
1138) Increase number of neutrophil
indicate what type of meningitis?
1139) High percentage of Lymphocytes is
considered indicative of what type of
meningitis?
1140) Following are associated with what
type of CSF cell?
1141) Primarily in bacterial meningitis
1142) Often contain phagocytized bacteria
1143) Increased early viral, fungal,
tubercular, parasitic
1144) Vacuoles may be present
1145) This cell is seen with bone marrow
contamination from tap in 1% of
specimens
1146) ------------- may resemble NRBCs
1147) What structure and cells may be seen
following traumatic tap?
1148) Reactive lymphocyte are frequently
present during ---------1149) --------- has 50 or fewer
lymphocytes/μL, both normal and
reactive
1150) Increased lymphocytes are seen in
cases of -----------,----------1151) Increased eosinophils is associated
with what infections?
Increase- decrease
Daily-saline-albumin
Normal lymphocytes and monocytes
Adult usually has predominate of lymphocyte normal
lymphocytes: monocytes = 70:30
It is reversed of adult ratio
True
Pleocytosis
Pleocytosis of normal cells
Bacterial meningitis
viral, tubercular, fungal, parasitic meningitis
neutrophil
Nucleated RBCs (NRBC)
Neutrophils with pyknotic nucleii
Capillary structures and epithelial cells
Viral infection.
Multiple sclerosis
HIV infection and AIDS
Parasitic and fungal infections (primarily Coccidioides
immitis)
69
UA PPT Flashcards
1152) Introduction of foreign material,
including medication and shunts into
the CSF causes to increase of what cells?
1153) What is the purpose of macrophages
in the CSF?
1154) What type of cells might be seen
following repeated taps?
1155) Increasing of what type of cells is an
indicative of a previous hemorrhage?
1156) This cells type appear within 2 hours
to phagocytize RBCs
1157) Define unconjugated bilirubin
1158) When nonclinically significant cells are
seen?
1159) The following belong to pathologically
or nonpathologically significant cells?
1160) Choroidal cells
1161) Epithelial lining of choroid plexus,
singular and in clumps, uniform cells
1162) Ependymal cells lining ventricles and
neural canal; less defined cell
membranes in clumps
1163) Spindle cells lining arachnoid seen in
clumps
1164) What are malignant cells of
hematologic origin in CSF?
1165) These cells are seen in CSF as a serious
complication of acute leukemias.
1166) ------------may be more prominent than
in blood smear.
1167) --------- cells are also seen in the CSF
indicating Dissemination from lymph
organs and nuclei may appear
1168) Cleaved and prominent nucleoli are
present.
1169) What are the two types of malignant
cells of nonhematologic origin?
1170) What are two reasons for abnormal
CSF test relults?
1171) In the cerebrospinal protein test, what
are the normal values for total protein?
1172) What is the significance of elevated
levels of cerebrospinal protein?
1173) What are the two primary
methodologies for testing CSF?
eosinophils
remove cellular and other debris
Macrophages
Macrophages
Macrophages
RBCs degraded to hematoidin crystals representing
unconjugated bilirubin
Seen after diagnostic procedures
Nonpathologically significant cells
Lymphoblasts, monoblasts, and myeloblasts Lymphomas
Lymphoblasts, monoblasts, and myeloblasts
Nucleoli
Lymphoma
Metastatic carcinoma cells
Primary tumors
Alterations in the permeability of the blood-brain barrier.
Increased production or metabolism by the neural cells
in response to a pathologic condition.
15 to 45 mg/dL
damage to blood-brain barrier, IG production within CNS,
decreased clearance, degeneration of neural tissue
Turbidity
Automated instrumentation
70
UA PPT Flashcards
1174) Name five reasons for calculating
protein fractions.
1175) What is the equation for IgG index?
1176) What is the purpose of
electrophoresis as an immunophoretic
technique?
1177) What is the electrophoresis result for
Multiple Sclerosis?
1178) What is the significance of Myelin
basic protein?
1179) What is the significance of CSF
glucose?
1180) Name two causes of decreased CS
glucose.
1181) What is the clinical significance of CSF
Lactate?
1182) Why is CSF Glutamine tested?
1183) What type of CSF sample is used in
Microbiology tests?
1184) Latex agglutination tests are available
for:
1185) Where is the parasite Naegleria
fowleri found?
1186) What is the primary reason for
serologic testing of CSF
1187) Name four areas specialized in clinical
Andrology.
Comparisons between serum and CSF levels of albumin
and IgG
CSF/serum albumin index
Blood-brain barrier integrity
CSF IgG index
Comparison of the CSF/serum albumin index with the
CSF/serum IgG index
Values for CSF albumin and globulin adapted for
automated instruments
CSF IgG (mg/dL)/serum IgG (g/dL)
CSF albumin (mg/dL)/serum albumin (g/dL)
Detection of oligoclonal bands
no bands in serum, bands in CSF
Presence in CSF indicates demyelination of myelin
sheath around axons of neurons
Values that are decreased relative to plasma values
Elevated CSF glucose values are always a result of plasma
elevations
bacterial meningitis
Tubercular meningitis
Diagnosis and management of meningitis
Bacterial, TB and fungal levels >25 mg/dL
Viral <25 mg/dL
More reliable than CSF glucose
Levels remain elevated until treatment becomes
effective, then fall rapidly
Can result from any condition that decreases oxygen
flow to the tissues
Monitor severe head injuries
Indirect test for the presence of excess ammonia in the
CSF
Gram stain and cultures must be performed on sediment
from centrifuged CSF
Group B streptococcus, Haemophilus influenzae, S.
pneumocystis Neisseria meningitidis, and Escherichia coli
ponds, lakes, and some pools
Primary test is for neurosyphilis, third stage
Assisted reproductive technology (ART)
Abnormal results on the routine semen analysis
Specialized andrology laboratories
Fertility testing
In vitro fertilization (IVF)
71
UA PPT Flashcards
1188) List the four components for semen.
Testes and epididymis
Seminal vessels
Prostate
Bulbourethral glands
1189) What are the functions of the seminal
vessels?
Produce majority of fluid (60% to 70%); transport
medium
Provide fructose and flavin for sperm metabolism
Sperm are not motile without this fluid
1190) What are the physiological processes
in the prostate gland?
Produce acidic fluid (20% to 30%)
Contains acid phosphatase, citric acid, zinc, and
proteolytic enzymes
Enzymes coagulate semen prior to ejaculation and cause
liquefaction after ejaculation
1191) Why must a semen sample be a
complete specimen?
First portion of the ejaculate is missing, then
-Sperm count will be decreased
-pH is falsely increased
-Specimen will not liquefy
Last portion of ejaculate is missing, then
-Semen volume is decreased
-Sperm count is falsely increased
-pH is falsely decreased
-Specimen will not clot
1192) What is the recommendation from the The WHO recommends that two or three samples be
WHO in regards to semen collection?
collected not less than 7 days or more than 3 weeks
apart?
1193) For home semen collection when
Deliver to the laboratory within 1 hour; keep specimen at
should the specimen be delivered and to 37 degrees C
the laboratory and what temperature
should the specimen be kept at?
1194) What three things should be recorded
- Patient name and date of birth
in regards to semen specimen
- Period of abstinence
collection?
Time of collection and receipt
1195) How should a semen specimen be
a) Collected by masturbation
collected?
1196) What three things should be kept in
• Standard precautions must be observed at all
mind in regards to semen specimen
times during analysis.
handling?
• Specimens are discarded as biohazardous waste.
b) Sterile materials and techniques must be used.
1197) These eight things are measured in a
a) Macroscopic/microscopic, appearance, volume,
fertility evaluation:
viscosity, pH, sperm concentration and count,
motility, and morphology
1198) What is the normal color of semen?
b) Normal is gray-white, translucent
72
UA PPT Flashcards
1199) What is the normal odor of semen?
1200) What indicates an infection in a
semen sample? What two things should
be done to verify?
1201) What does a red appearance indicate
in a semen sample?
1202) What does a yellow appearance
indicate in a semen sample?
1203) What results from urine contact with
semen?
1204) Slide 16….
1205) What’s the normal volume of a semen
specimen?
1206) What is the effect of extended
abstinence on semen volume?
1207) How is the volume of a semen sample
measured?
1208) What could cause a decrease in
volume in semen?
1209) What is a normal viscosity
appearance?
1210) What qualifies as a highly viscous
semen sample?
1211) What is the rating system for viscosity
of semen?
1212) When should the pH be measured for
a semen sample?
1213) What is the normal pH of semen?
1214) What pH of semen indicates an
infection?
1215) What three things could result in a
decrease in pH in semen?
1216) How is semen pH measured?
1217) Sperm concentration and count is a
valid measurement of what?
1218) What is the formula for sperm
concentration?
1219) What is sperm count?
1220) What is the formula for total sperm
count?
1221) What is the reference value for sperm
count?
1222) What is considered borderline for
sperm count?
1223) What is the formula for normal count
for sperm?
1224) What’s the normal count of sperm?
c) Musty odor
d) White turbidity; culture and LE reagent strip
e) Blood cells, abnormal
f)
Urine, prolonged abstinence, medications
g) Urine is toxic to sperm resulting in no motility
h)
i) 2 to 5 mL
j)
Increased volume may be seen following periods
of extended abstinence
k) In a graduated cylinder
l)
Infertility, incomplete collection
m) Droplets with thin threads from a pipette are
normal
n) Form threads longer than 2 cm are highly viscous
o) Rate 0 (watery) to 4 (gel-like) or low, normal,
high
p) Measure within 1 hour of ejaculation
q) Normal: 7.2-8.0
r) Over 8.0
s) Increased prostate fluid, ejaculatory duct
obstruction, or poorly developed seminal vesicles
t) Check with pH pad of a urinalysis reagent strip
u) Fertility
v) Concentration= number sperm/mL
w) Count= number sperm per ejaculate
x) Sperm concentration x specimen volume
y) >20 to 250 million sperm per milliliter
z) 10-20 million
aa) Concentration x volume
bb) >40 million/ejaculate
73
UA PPT Flashcards
1225) What is used to count sperm
concentration?
1226) What does Neubaur chamber consist
of?
1227) What is the common dilution for
Neubaur chamber?
1228) What is the diluting fluid for Neubaur
chamber?
1229) How are sperm counted using
Neubaur chamber?
1230) What is the multiplication factor for
sperm concentration?
1231) What is the formula for sperm count?
1232) For sperm motility, sperm should
display this movement:
1233) For sperm motility how should the
specimen be prepped and what is the
time in which the specimen should be
examined?
1234) How many fields should be used to
evaluate sperm motility?
1235) Instead of counting sperm per HP
field, this alternative can be used:
1236) For sperm motility, how should
grading be done?
1237) What’s the minimum motility
acceptable for sperm motility?
1238) How is sperm motility graded by the
World Health Organization (WHO)?
1239) What instrumentation is available for
sperm motility analysis?
1240) True/False:
1241) Sperm morphology is critical to
fertilization:
1242) What four things should be evaluated
in sperm morphology?
1243) What are the classic characteristics of
the head of a sperm?
1244) How long is the neckpiece of a sperm
what two things does it attach too?
1245) What is the midpiece of the sperm
cc) Performed in Neubauer chamber
dd) Five small squares, corners, and center of large
center square
ee) 1 to 20
ff) Sodium bicarbonate and formalin, must
immobilize sperm
gg) Count both sides of chamber, sides must agree
within 10%; use the average; multiply sperm
counted by 1,000,000=sperm/mL
hh) Must multiply sperm per uL by 1000 to reach
sperm/mL
ii) Sperm/mL x volume
jj) Forward, progressive movement
kk) Well-mixed, liquefied semen specimen; examine
within 1 hour, undiluted on glass slide with cover
slip
ll) Progressive, forward motion in 20 HP fields
mm)
Examine 200 sperm per slide and count
the percentages of the different motile
categories using a manual cell counter
nn) Using a scale of 0 to 4, with 4 indicating rapid,
straight-line movement and 0 indicating no
movement
oo) A minimum of 50% with a rating of 2.0 after 1
hour is considered normal
pp) Motility is graded as progressive motility (PM),
nonprogressive motility (NP), and immotility
(IM); motility must be specified as total motility
(PM and NP) or progressive motility (PM)
qq) Computer-assisted semen analysis (CASA)
rr) True
ss) Head, neck, midpiece, tail
tt) Oval with acromosal cap at end and covering half
of the head; 5um long and 3 um wide; contains
enzymes for ovum penetration
uu) 7.0 um long; attaches head to midpiece and tail
vv) Sheath of mitochondria for tail movement
74
UA PPT Flashcards
surrounded by?
1246) How long is the flagellar tail?
1247) What magnification should be used to
observe sperm morphology?
1248) Which three stains can be used for
sperm morphology?
1249) How many sperm morphology should
be counted?
1250) What are the abnormalities in head
sperm structure?
1251) What are the abnormalities in sperm
tail structure?
1252) What three things are included with
Kruger’s criteria is sperm morphology?
ww)
45 um
xx) Observe on thin smear under oil immusion
yy) Wright’s, Giemsa, Shorr, or Papanicolaou
Count 200 and report number of abnormal
zz)
Double heads, giant and amorphous heads, pinheads,
tapered heads, and constricted heads
Abnormal sperm tails are frequently doubled, coiled, or
bent
Measuring head, neck, and tail size
Measuring acrosome size
Evaluating for the presence of vacuoles
1253) Why is important to have strict criteria Strict criteria evaluation is an integral part of assisted
in sperm morphology evaluation?
reproduction evaluations
1254) >? % normal forms when using routine 30%
criteria:
1255) >?% normal forms when using strict
14%
critieria:
1256) What are three thing that should be
White blood cells (WBCs) and spermatids (immature
considered when calculating round
sperm)
bodies?
Differentiate on morphology smear
Count number of each separately in 100 cells
1257) What is the formula used in sperm
C= (N x S)/100
morphology round body calculation?
1258) What does N represent in the round
N is the number of spermatids or neutrophils counted
bodies formula?
per 100 mature sperm
1259) What does S represent in the round
S is the sperm concentration in millions per milliliter
bodies formula?
1260) What’s the normal value of round
Normal: <1,000,000
bodies in sperm morphology?
1261) What is the stain used in sperm
Eosin-nigrosin stain
vitality?
1262) What color do normal cells stain and
Dead cells stain red; normal are blue-white
what color do dead cells stain?
1263) What formula is used in sperm
Count number/100 cells
vitality?
1264) What is the normal percentage in
Normal: 75% living
sperm vitality?
1265) What does sperm vitality correspond
Motility
to?
1266) What test is sperm vitality used in?
Seminal fructose tests
1267) Seminal fluid fructose test can be
Low sperm concentration; low to absent fructose level in
useful in evaluating these three things?
the semen, lack of the support medium
1268) Which 5 things are considered for lack Abnormalities of the seminal vesicles
75
UA PPT Flashcards
of support medium in the seminal fluid
fructose test?
1269) Ture/False:
1270) Anitsperm antibodies are present in
both men and women:
1271) When are antisperm antibodies more
commonly seen in men?
1272) How does the immune system see
sperm?
1273) What is the result of damaged sperm?
1274) When should antibodies be suspected
in regards to male and female samples?
1275) How are female samples prepared for
antisperm antibodies?
1276) What method category is used for
antisperm antibodies in males?
1277) What is a specific test used in
antisperm antibodies analysis, and how
does that method work?
1278) What is the normal result in antisperm
antibodies?
1279) What does the immunobead test
demonstrate?
1280) What are bead coated with in the
immunobead test?
1281) What does microscopic examination
show in the immunobead test?
1282) What is the function of the head and
the tail?
1283) What is the normal for antisperm
antibodies?
1284) What indicates a prostate infection in
a semen sample?
1285) If >1 million WBCs are found what
three organisms are tested for?
1286) What chemistry tests are done and
what does a decrease in each indicate?
Bilateral congenital absence of the vas deferens
Obstruction of the ejaculatory duct
Partial retrograde ejaculation
Androgen deficiency
True
Surgery, vasectomy reversal, trauma
Sperm normally do not encounter the immune system,
so body considers them foreign
Damaged sperm create female antibodies
Suspect male antibodies when clumps of sperm are seen;
female no clumping
Mix female serum with sperm and check for
agglutination
Immunoassay
Mixed agglutination reaction (MAR) test
– Incubate sperm with antihuman globulin
(AHG) and IgG-coated latex particles
AHG combines with particles and antibody-coated sperm
forming clumps
<10% motile sperm attach to particles
Demonstrates antibodies to head, neck, midpiece, and
tail
Antihuman globulin
Microscopic examination shows where on sperm
antibodies are attacking
Tail= movement
Head= penetration
Normal: beads on <20% of sperm
>1 million WBCs
Culture and test for Mycoplasma hominis, Chlamydia
trachomatis, Ureaplasma urealyticum
neutral α-glucosidase, zinc, citric acid, acid phosphatase
– ↓ Neutral α -glucosidase = epididymis
↓ Zinc, citric acid, acid phosphatase =↓ prostatic fluid
>/= 20 mU/ejaculate
1287) What is the normal neutral aglucosidase value for semen?
1288) What is the normal Zinc value for
>/= 2.4 umol/ejaculate
semen?
1289) What is the normal citric acid value for >/= 52 umol/ejaculate
76
UA PPT Flashcards
semen?
1290) What is the normal acid phosphatase
value for semen?
1291) Synovial fluid functions as _____
1292) Synovial fluid supplies nourishment to
_____
1293) Crystals that are found in synovial
fluid during attacks of gout are most
likely:
1294) Synovial fluid is produced by:
1295) What are the classifications of
disorders (arthritis)
1296) Is Lupus Erythematosus (LE)
inflammatory or noninflammatory?
1297) What type of disorder ‘microbial
infection’ is?
1298) The concentration of which chemicals
found in synovial fluid differs most
noticeably from the plasma
concentration?
1299) A turbid synovial fluid with yellowgreen color indicates:
1300) Can Neutrophils be seen in normal
synovial fluid?
1301) Can ‘increased ingestion of dairy
products’ cause crystals to be present in
the synovial fluid?
1302) A cloudy, yellow-green synovial fluid
with 100,000 white blood cells (WBCs),
a predominance of neutrophils, and a
decreased glucose should be classified
as:
1303) What is the normal knee fluid amount
level, if inflamed?
1304) Are normal and diseased, both fluids
clot?
1305) A turbid synovial fluid with clear and
pale yellow (egg white) color indicates:
1306) Synovial fluid functions as _____
1307) Synovial fluid supplies nourishment
to__
1308) Crystals that are found in synovial
fluid during attacks of gout are most
likely:
1309) Synovial fluid is produced by:
1310) What are the classifications of
>/= 200 units/ejaculate
Lubrication for the movable joints: diarthroses
cartilage
Monosodium urate
Ultrafiltration of plasma
Noninflammatory; Inflammatory; Septic; and
Hemorrhagic
Inflammatory
Septic
Protein
Infection
No
No
Septic
3.5 mL - >25 mL
No. diseased fluid clots, while normal fluid does not
Normal
Lubrication for the movable joints: diarthroses
cartilage
Monosodium urate
Ultrafiltration of plasma
Noninflammatory; Inflammatory; Septic; and
77
UA PPT Flashcards
disorders (arthritis)
1311) Is Lupus Erythematosus (LE)
inflammatory or noninflammatory?
1312) What type of disorder ‘microbial
infection’ is?
1313) The concentration of which chemicals
found in synovial fluid differs most
noticeably from the plasma
concentration?
1314) A turbid synovial fluid with yellowgreen color indicates:
1315) Can Neutrophils be seen in normal
synovial fluid?
1316) Can ‘increased ingestion of dairy
products’ cause crystals to be present in
the synovial fluid?
1317) A cloudy, yellow-green synovial fluid
with 100,000 white blood cells (WBCs),
a predominance of neutrophils, and a
decreased glucose should be classified
as:
1318) What is the normal knee fluid amount
level, if inflamed?
1319) Are normal and diseased, both fluids
clot?
1320) A turbid synovial fluid with clear and
pale yellow (egg white) color indicates:
1321) An arthrocentesis is performed on a
patient with lupus erythematosus that
produces a cloudy yellow fluid with
2000 WBCs, of which 55% is neutrophils.
This fluid should be classified as:
1322) A clear, pale yellow synovial fluid with
good viscosity and a WBC count of 1000
should be classified as:
1323) To determine if an unknown fluid is
synovial fluid, the fluid can be tested:
1324) In the Ropes’ or mucin clot test,
normal synovial fluid forms a solid clot
when added to:
1325) The recommended diluting fluid for
synovial fluid cell counts is:
1326) To perform a cell count on highly
viscous synovial fluid, what type of filter
paper need to be used?
Hemorrhagic
Inflammatory
1327) On highly viscous synovial fluid, to
Count all nine large squares
Septic
Protein
Infection
No
No
Septic
3.5 mL - >25 mL
No. diseased fluid clots, while normal fluid does not
Normal
Inflammatory
Noninflammatory
By adding acetic acid and observing clot formation
2% to 5% glacial acetic acid
Normal saline/methylene blue
Moist filter paper using line petri dish
78
UA PPT Flashcards
count less than 200 WBCs/μL:
1328) On highly viscous synovial fluid, to
count greater than 200 WBCs/μL in the
above count:
1329) In differential count, how to incubate?
1330) Vacuolated macrophages containing
ingested neutrophils seen in synovial
fluid are called:
1331) Neutrophils with small, dark granules
containing RA factor (IgM) see in
synovial fluid are called:
1332) Crystal examination is done in the
cases of:
1333) Crystals frequently seen in patients’
joints with chronic inflammation are:
1334) In crystal examination, what is the
initial examination?
1335) Crystal may be seen in:
1336) Synovial fluid for crystal examination
should be:
1337) Crystals that appear to be needle
shaped; seen intra- and extracellularly;
may be seen sticking through cytoplasm
are:
1338) Crystals that appear to be rhombic,
square shaped, or short rods; often seen
in vacuoles of neutrophils are:
1339) Which crystal is highly birefringent
and appears brighter than CPPD?
1340) Compensated Polarized Light align
_____ crystals with slow vibration
1341) What color does MSU molecules
produce under compensated light?
1342) In which axis, CPPD molecules run
under compensated light?
1343) Synovial fluid protein is normal when:
1344) Mention two types of most common
autoimmune causes of arthritis:
1345) What is the reference value for the
upper limit of synovial fluid volume?
1346) What should the color of synovial fluid
be?
1347) What should the clarity of synovial
fluid be?
1348) What should the viscosity of synovial
fluid be?
1349) What is the reference value of the
Count the four corner squares; and the five small squares
used for a RBC count
Incubate with hyaluronidase, then cytocentrifuge
Reiter’s cells/neutrophages
Ragocytes (RA cells)
Acute and chronic cases; metabolic disorders; and
decreased renal functions
Cholesterol
Initial examination is wet preparation unstained under
low and high power
Differential
Examined unstained under direct and red compensated
polarized light
MSU crystals
CPPD crystals
MSU
Crystals
Yellow color (negative birefringence)
CPPD molecules run perpendicular to long axis
Less than 3 g/dL
RA and LE
< 3.5 mL
Colorless to pale yellow
Clear
Able to form a string 4-6 cm long
< 200 cells/µL
79
UA PPT Flashcards
leukocyte count in synovial fluid?
1350) What is the reference value for the
amount of neutrophils in the WBC
differential?
1351) What is the reference value for the
amount of crystals that should be
present in synovial fluid?
1352) What is the reference value for
glucose in synovial fluid?
1353) What is the reference value for total
protein in synovial fluid?
1354) List 3 things infections in synovial fluid
can be caused by.
1355) What microbiology stain is routinely
performed on synovial fluid?
1356) Culturing microbiological infections of
synovial fluid require what agar?
1357) List 4 primary organisms typically
involved in synovial fluid infection:
1358) In microbiology tests for synovial fluid,
fungal and Tuberculosis (TB) cultures are
determined by:
1359) Why are the majority of serologic
tests performed on serum and synovial
fluid?
1360) What are the most common
autoimmune causes of arthritis?
1361) Arthritis is a frequent complication of
this disease:
1362) In patients suspected with Lyme
Disease, serum should be tested for
what antibodies?
1363) What two serologic tests can be done
to assess the extent of inflammation in
synovial fluid?
1364) What is the purpose of serous fluid?
1365) The ultrafiltrate of plasma forms:
1366) In the capillaries lining the
membranes, serous fluid is formed due
to what 2 pressures?
1367) Normally, oncotic pressure on both
sides of the membrane are:
1368) What type of pressure primarily
causes the production of serous fluid?
1369) Small amounts of excess serous fluid
are absorbed by what type of
< 25% of the differential
None should be present
< 10mg/dL lower than the blood glucose plasma
difference
< 3g/dL
Inflammation, trauma and systemic infections
Gram stain
Chocolate agar
Staphylococcus, Streptococcus, Haemophilus influenzae,
and Neisseria gonorrhoeae
Patient history
To serve as confirmatory tests
RA (Rheumatoid Arthritis) and LE (Lupus Erythematosus)
Lyme disease
Borrelia burgdorferi
Test for C-reactive protein and fibrinogen
To provide lubrication between the two membranes
(parietal and visceral)
Serous fluid
Hydrostatic and oncotic (protein) pressure
same
Hydrostatic pressure
Lymphatic capillaries
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UA PPT Flashcards
capillaries?
1370) What term is used to describe the
disruption of serous fluid formation or
reabsorption that causes fluid buildup
1371) List 6 causes of serous fluid effusion
1372) How is congestive heart failure, salt
and fluid retention a pathological cause
of effusion?
1373) How is nephrotic syndrome, hepatic
cirrhosis, malnutrition or protein-losing
enteropathy a pathological cause of
effusion?
1374) How is are microbial infections,
membrane inflammations or malignancy
a pathological cause of effusion?
1375) How are malignant tumor,
lymphomas, infection and inflammation
or thoracic duct injury a pathological
cause of effusion?
1376) How is serous fluid collected?
1377) Serous fluid is collected in what
cavities?
1378) How much serous fluid should be
collected?
1379) Serous fluid collected in an EDTA tube
goes to what department?
1380) Serous fluid collected in heparinized
or plyanethol sulfonate (SPS) tube goes
to what departments?
1381) Clotted or heparinized serous fluid
should be tested by what departments?
1382) When should serous fluid be kept on
ice?
1383) For serous fluid being tested by
microbiology or cytology departments,
fluid should be concentrated how?
1384) Chemical tests for serous fluid are
compared with tests are compared to
what other type of test?
1385) The primary classification of serous
fluids involve what 2 categories?
1386) Systemic disorders disrupting filtration
and reabsorption, congestive heart
Effusion
Hydrostatic pressure increased from congestive heart
failure, Oncotic pressure decreased from
hypoproteinemia, Increased capillary permeability from
inflammation, Infection, Malignancy, Lymphatic
obstruction from tumors
Increased capillary hydrostatic pressure disrupts
mechanisms of serous fluid formation and reabsorption.
Decreased oncotic pressure disrupts mechanisms of
serous fluid formation and reabsorption.
Increased capillary permeability disrupts mechanisms of
serous fluid formation and reabsorption.
Lymphatic obstruction disrupts mechanisms of serous
fluid formation and reabsorption.
Needle aspiration
Pleural cavity (Thoracentesis), Heart cavity
(Pericardiocentesis), and Peritoneal cavity (Paracentesis)
Abundant fluid should be collected > 100mL
Hematology
Microbiology, Cytology
Chemistry, Serology
For specimens being tested for pH
Centrifuging 100mL
Blood tests drawn at the same time
Transudates and Exudates
Transudates
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UA PPT Flashcards
failure or nephrotic syndrome cause
what category of serous fluid?
1387) Conditions affecting membranes,
inflammation, infection or malignancy
cause what category of serous fluid
1388) Which requires little further testing?
Transudates or Exudates?
1389) Differentiation of transudates and
exudates is important for:
1390) Which are seldom tested further?
Transudates or exudates?
1391) Microbiology, cytology and tests for
general symptoms for transudates or
exudates?
1392) Differentials are routinely performed
on what type of serous fluid specimens?
1393) Differentials performed on
cytocentrifuged serous fluid specimens
involve looking at what 3 types of cells?
1394) Additional tests to differentiate
transudate versus exudate uses pleural
fluid cholesterol. Transudates and
exudates will have what values?
1395) Additional tests to differentiate
transudate versus exudate uses fluidserum cholesterol ratio. Transudates
and exudates will have what values?
1396) Additional tests to differentiate
transudate versus exudate uses serumbilirubin ratio. Transudates and
exudates will have what values?
1397) Normal pleural fluid should appear:
1398) Turbid pleural fluid indicates:
1399) Milky pleural fluid indicates:
1400) Bloody pleural fluid indicates:
1401) How is hemothorax and membrane
damage differentiated using pleural
fluid?
1402) How is a chylous and pseeudochylous
differentiated?
1403) In hematology differentials of serous
fluid, what are the 7 types of cells can
be observed?
1404) Which type of cells are the highest
Exudates
Transudates
Further testing
Transudates
Exudates
Cytocentrifuged specimens
WBCs, normal tissue cells, and malignant cells
Pleural fluid cholesterol <60 mg/dL versus >60 mg/dL
Fluid-serum cholesterol ratio <0.3 versus >0.3
Fluid-serum bilirubin ratio <0.6 versus >0.6
Clear, pale yellow
WBCs, inflammation, infection
Chylous material from thoracic duct leakage,
pseudochylous material from chronic inflammations
Hemothorax (trauma), hemorrhagic effusion (membrane)
damage
Do a hematocrit on pleural fluid; >50% blood HCT is a
hemothorax (more blood), while membrane damage will
have low blood
Sudan III stain will show chylous, which is triglycerides,
while pseudochylous is cholesterol and will polarize and
show crystals in a wet bright-field view
Neutrophils (primary), lymphocytes, macrophages,
eosinophils, mesothelial cells, plasma cells and malignant
cells
Macrophages (scavengers)
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UA PPT Flashcards
number in hematology differentials of
serous fluid?
1405) Increased neutrophils in serous fluid
indicates:
1406) Increased lymphs in serous fluid
indicates:
1407) Eosinophils may be seen in serous
fluid in what circumstances?
1408) What cells may be multinucleated in a
serous fluid observation?
1409) What type of cell is described: Single
cell layer lines membranes, common to
see in serous fluid, pleomorphic, dark
blue cytoplasm, round nuclei, normal
and reactive; has a “fried egg
appearance”
1410) A lack of mesothelial cells is significant
in what disease and why?
1411) List the primary cancer cells that may
be found in pleural fluid
1412) Describe adenocarcinoma cells
1413) Describe small cell or oat cell
carcinoma cells
1414) Describe mesothelioma cells
1415) In inflammations and infections,
glucose levels in pleural fluid are:
1416) pH of pleural fluid < 7.0 indicates the
need for:
1417) pH of pleural fluid < 6.0 indicates:
1418) Pleural fluid adenosine deaminase is
elevated in what two conditions?
1419) Pleural fluid amylase is elevated in
what two conditions?
1420) Microbiology tests for pleural fluid
involve:
1421) Serology tests on pleural fluid are
done for:
1422) Tumor markers in pleural fluid for
metastatic malignancy are:
1423) Carcinoembryonic antigen tumor
marker for metastatic malignancy is
specific for what type of malignancy?
1424) CA125 tumor marker for metastatic
malignancy is specific for what type of
malignancy
1425) What is the volume of pericardial
fluid?
Bacterial infection, pancreatitis, pulmonary infarction
TB, viral infections, autoimmune disorders, malignancy
Trauma introducing air and blood, allergic reactions,
parasites
Reactive mesothelial cells
Mesothelial cells
Tuberculosis (TB), because exudate covers membranes
Adenocarcinoma cells, small or oat cell carcinoma cells,
mesothelioma cells
Large and irregular
Small like lymph cells
Large
decreased
Chest tubes
Esophageal rupture (gastric fluid)
TB and malignancy
Esophageal rupture and malignancy
Gram stains, aerobic and anaerobic cultures of fluid, TB
smears and cultures
Autoimmune disorders
Carcinoembryonic antigen and CA125
GI malignancy
Uterine and ovarian malignancy
10-50mL (normally small amount)
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UA PPT Flashcards
1426) Permeability of membranes from
infection (pericarditis, endocarditis),
malignancy, trauma produces what type
of pericardial fluid?
1427) Hypothyroidism, uremia and immune
disorders produce what type of
pericardial fluid?
1428) Pericardial fluid is detected by
1429) What is the appearance of normal
pericardial fluid?
1430) Turbid pericardial fluid indicates:
1431) Bloody pericardial fluid indicates:
1432) Milky pericardial fluid indicates:
1433) Pericaridal fluid transudate vs exudate
is differentiated using
1434) WBCs > 1000uL in pericardial fluid
indicates:
1435) Malignant cells found in pericardial
fluid are due to:
1436) Pericardial fluid Gram stains and
cultures for endocarditis are often done
when endocarditis is caused by:
1437) Pericardial fluid TB smears and
cultures are done on persons with:
1438) In patients who have had asbestos
exposure, what is the primary malignant
cell seen in the pleural fluid?
1439) Effusion between peritoneal
membranes is called?
1440) Fluid collected from the peritoneal
membranes is called by what name?
1441) Transudates in peritoneal fluid are of
what origin/disease?
1442) What are the 3 causes of exudates in
peritoneal fluid?
1443) Why is a peritoneal lavage
performed?
1444) True or False: Blunt trauma injuries
can be a reason to perform a peritoneal
lavage.
1445) Complete the following statement in
regards to a peritoneal lavage. Normal
saline injected into cavity, withdrawn,
and a _____ ______ is performed.
1446) A RBC count greater than _____
indicates blunt trauma?
1447) In lieu of a peritoneal lavage, what
Exudates
Transudates
Cardiac tamponade (compression) heard by a physician
Clear, pale yellow
Infection, malignancy (also blood streaked)
Accidental puncture, anticoagulants
Chylous and pseudochylous material
Fluid-serum protein and LD ratios
Bacterial endocarditis
Lung or breast metastasis
previous respiratory infections
AIDS
Metastatic giant mesothelioma cell
Ascites
Ascitic fluid
Hepatic origin (cirrhosis)
Bacterial peritonitis from intestinal perforation, ruptured
appendix, and malignancy
To detect early abdominal bleeding and need for surgery
True
RBC count
>100,000
Radiographic procedures
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UA PPT Flashcards
other procedure is available to
physicians to assess blunt trauma and
abdominal bleeding?
1448) Are transudates and exudates easier
or more difficult to determine in
peritoneal fluid versus pleural or
pericardial fluid?
1449) What method is the best way to
determine transudate versus exudate?
1450) How do you determine the serumascites gradient?
1451) Determine if the fluid is a transudate
or exudate. Serum albumin is 3.8 and
the fluid albumin is 1.2
1452) What is the normal appearance of
peritoneal fluid?
1453) If a peritoneal fluid is turbid, what
might this suggest?
1454) If peritoneal fluid has a green-brown
color, what is most likely present in the
fluid?
1455) A milky appearance in peritoneal fluid
is indicative of what?
1456) What is the normal WBC count in a
peritoneal fluid?
1457) In a peritoneal fluid, what does an
absolute neutrophil count of >50% of
the total WBC count indicate?
1458) Lymphocyte counts in peritoneal fluid
is elevated in what disease?
1459) Glucose levels below that of plasma
levels in peritoneal fluid is a sign of what
2 things?
1460) In what 2 diseases is peritoneal
amylase elevated?
1461) Increased peritoneal alkaline
phosphatase is indicative of what
problem?
1462) What 2 laboratory values from a
peritoneal fluid will be elevated in both
a ruptured bladder and accidental
perforation?
1463) What are the 3 routine microbiology
tests done on peritoneal samples?
1464) True or False: If an anaerobic culture
More difficult
Serum-ascites gradient
Measure both the serum and fluid albumin levels, then
subtract the fluid level from albumin level. If the
difference (gradient) is >1.1 than you have a transudate
(hepatic origin)
3.8-1.2 = 2.6 (>1.1 = hepatic transudate)
Clear and pale yellow
Bacterial or fungal infection
Bile
Chylous and pseudochylous with trauma and lymphatic
blockage
350 cells/uL
Infection
TB
Peritonitis and malignancy
Pancreatitis and gastrointestinal perforation
Intestinal perforation
BUN and creatinine
Gram stain, aerobic and anaerobic cultures
True
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UA PPT Flashcards
is ordered on peritoneal fluid, the
anaerobic blood culture bottle should
be inoculated at the bedside.
1465) If TB is suspected, what 3 additional
microbiology tests should be performed
on peritoneal fluid?
1466) What 2 tumor markers are tested
when a GI tumor is suspected?
1467) If a patient presents with a positive
CA125 tumor antigen but a negative
CEA, what is the likely source causing
the positive CA125 antigen?
1468) A positive CEA antigen test suggests
the tumor source is from what location?
1469) What is the amnion?
1470) Name the 5 functions of amniotic fluid
1471) During the first trimester,
approximately how much of the
amniotic fluid is derived from maternal
circulation?
1472) The peak in amniotic fluid seen in the
third trimester is the result of what
fluid?
1473) How does the fetus compensate for
the increased urine buildup during the
third trimester?
1474) What is tested by physicians to
determine fetal lung maturity?
1475) Name the 3 components that make up
the volume of amniotic fluid.
1476) Define polyhydramnios
1477) What volume is considered to be
polyhydramnios?
1478) Name 4 diseases/disorders that can
cause polyhydramnios
1479) Define oligohydramnios
1480) What volume of amniotic fluid causes
oligohydramnios
1481) Name the cause for oligohydramnios
1482) The chemical composition of amniotic
fluid is similar to what other fluid?
1483) Sloughed fetal cells in the amniotic
fluid may be used for what type of fetal
testing?
Acid-fast smear, adenosine deaminase, and a culture for
TB
CEA and CA125
A tumor on the ovaries, fallopian tubes, or endometrium
Gastrointestinal
A membranous sac that surrounds the fetus
Provides protective cushion for fetus, allows fetal
movement, stabilizes fetal temperature exposure,
permits proper lung development, exchanges water and
chemicals among the fluid, fetus and maternal circulation
35mL
Fetal urine
The fetus increases swallowing
Lung surfactants in the amniotic fluid
Fetal urine, lung fluid, and maternal circulation
Excess amniotic fluid from failure of the fetus to swallow
>1200mL
Neural tube disorders, structural/chromosomal
abnormalities, cardiac arrhythmias, and infections
Decreased amniotic fluid from increased fetal swallowing
<800mL
Umbilical cord compression
Maternal fluid
Cytogenetic analysis
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UA PPT Flashcards
1484) What 9 biochemical substances
produced by the fetus are present in
amniotic fluid?
1485) Fetal urine causes an increase in what
biochemical substances?
1486) What biochemical substance can be
used to estimate fetal age?
1487) Creatinine levels of >2.0mg/dL
indicates the fetus has reached what
gestational age?
1488) A gestational age of <36 weeks is
indicated when the creatinine levels are
between what range?
1489) Why would a physician need to know
if a fluid was maternal urine or amniotic
fluid?
1490) Name the chemical tests to
differentiate maternal urine from
amniotic fluid
1491) What creatinine and urea values
indicate a fluid is amniotic fluid?
1492) A physician performs an
amniocentesis and sends the specimen
to the lab for stat urea and creatinine
testing. The results are creatinine
8mg/dL and urea 250mg/dL. Is the fluid
amniotic fluid? What might the
physician suspect happened?
1493) True/False: The presence of glucose
and protein, or both in fluid from an
amniocentesis is more closely
associated with amniotic fluid vs.
maternal urine
1494) In what test is a glass slide examined
microscopically for “fern-like” amniotic
crystals?
1495) What abnormal blood tests might
cause a physician to suggest an
amniocentesis?
1496) If a pregnant woman presents to her
physician and has a history of genetic
disorders and/or abnormal chromosome
analysis, would her physician
recommend an amniocentesis?
1497) A pregnant woman undergoes a
routine ultrasound and the physician
notes abnormal fetal body
Bilirubin, lipids, enzymes, electrolytes, urea, creatinine,
uric acid, proteins, and hormones
Creatinine, urea, and uric acid
Creatinine
>36 weeks
1.5-2.0mg/dL
To determine premature membrane rupture or
accidental puncture of maternal bladder from
amniocentesis.
Creatinine, glucose, protein, and urea
<3.5mg/dL creatinine and <30mg/dL urea
The fluid is most likely maternal urine, not amniotic fluid.
The physician may have accidentally punctured the
maternal bladder.
True
Fern test
Maternal alpha fetal proteins, human chorionic
gonadotropin, and unconjugated estriol
Yes
Amniocentesis
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UA PPT Flashcards
measurements. What may the physician
suggest?
1498) Can a physician perform an
amniocentesis later in the pregnancy? If
yes, why?
1499) The collection of what substances in
amniotic fluid indicates the genetic
material of the fetus?
1500) Name the 4 methods in which fetal
cells are tested for chromosomal
abnormalities.
1501) What method is utilized to analyze
biochemical substances produced by the
fetus?
1502) What is the maximum amount of
amniotic fluid that may be collected
during an amniocentesis?
1503) What should a physician do to prevent
contamination in the analysis of the
amniotic fluid?
1504) Should amniotic fluid specimens be
protected from light?
1505) Is an amniotic fluid specimen
considered a routine or stat specimen?
1506) If fetal lung maturity testing is
requested, what special handling
requirement is necessary?
1507) What temperature prolongs the
viability of cytogenetic specimens?
1508) State the normal color of amniotic
fluid
1509) If an amniotic fluid sample is bloody,
what may be the cause?
1510) What blood test would a physician
order to determine fetal versus
maternal cells?
1511) What substance may be present in
amniotic fluid if it is a bright yellow
color?
1512) A dark green amniotic fluid indicates
the presence of what substance?
1513) Fetal death may be indicated by what
colored amniotic fluid?
1514) How is Liley graph used to test for
Fetal Distress?
1515) What does Liley graph consist of?
1516) Name 3 zones and theirs indication on
Yes, because a doctor may need to determine fetal lung
maturity for a possible early delivery due to HDN or
infection
Fetal epithelial cells
Karyotyping, FISH, fluorescent mapping spectral
karyotyping, and DNA testing
Thin-layer chromatography
30mL
Discard the first 2-3mL collected
Yes. Protect from light for bilirubin analysis for HDN
Stat
Deliver test to lab on ice
Room temperature
Colorless
Traumatic tap, abdominal trauma, intra-abdominal
hemorrhage
Kleihauer-Betke
Bilirubin
Meconium
Dark red-brown
Plots ∆ A450 against gestational age
3 zones based on hemolytic severity
_ Zone I: mildly affected fetus
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UA PPT Flashcards
Liley graph?
_ Zone II: requires careful monitoring
_ Zone III: severely affected fetus, may require induction
of labor or intrauterine exchange transfusion
1517) Alpha-fetoprotein (AFP) used to
indicate neural tube defects in Fetal
Distress. What is it produced by?
1518) What does an increase in maternal
blood or amniotic fluid indicate?
1519) When an increased levels are found?
By fetal liver, prior to 18 weeks of gestation
1520) What is the procedure in measuring
neural tube defect?
1521) What is normal value based on?
Measure maternal blood first, then amniotic fluid
1522) What is multiples of the median
(MoM)?
A laboratory’s reference level for a given week of
gestation
1523) What is abnormal MoM?
1524) Does MoM need to be reported?
1525) What isacetylcholinesterase (AChE)?
More than two times the median (MOM)
Yes
It’s a amniotic fluid that are more specific for neural
disorders
Do not perform on a bloody specimen
1526) What is the special requirement when
performing AChE?
1527) What is the most common
complication of early delivery that can
be used to test for Fetal Lung Maturity
(FLM)?
1528) Respiratory distress syndrome (RDS)
happens due to what?
1529) What is lung surfactant?
1530) How does lung surfactant work?
1531) Test availability for FLM?
1532) What is the important of LecithinSphingomyelin
(L/S) Ratio?
1533) What is Lecithin?
1534) When does increased production
occur?
1535) What is the function of
Sphingomyelin?
1536) When is Sphingomyelin produced?
1537) What is the reference range and
Possible anencephaly or spinal bifida
When skin fails to close over neural tissue
Based on weeks of gestation (maximum AFP 12 to 15
weeks)
Respiratory distress syndrome (RDS)
Lack of lung surfactant
A substance what keeps the alveoli open during inhaling
and exhaling
Decreases the surface tension on the alveoli so they can
inflate more easily
Manny
Considered the reference method
Primary component of the lung surfactants
After the 35th week
Serves as a control for the rise in lecithin
Produced at a constant rate after the 26th week
L/S ratio is 1.6 prior to week 35 and rises to 2.0 or
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UA PPT Flashcards
interpretation for it?
greater for alveolar stability after week 35
 Preterm delivery is considered safe with an L/S ratio
of 2.0 or higher
1538) What is the test method for L/S ratio?
1539) What tests can be used to replace L/S
ratio ?
Thin-layer chromatography
Quantitative Phosphatidyl Glycerol Immunoassays and
Lamellar Body Density procedures
1540) What is the other test needed for lung
maturity?
1541) How to read Phosphatidyl Glycerol?
Lung surface lipid phosphatidyl glycerol
1542) What is Amniostat-FLM?
An immunologic agglutination test for PG using antibody
specific for phosphatidyl glycerol that can replace the L/S
ratio
Blood and meconium do not interfere with the test
1543) What is the positive aspect for
Phosphatidyl Glycerol test?
1544) Where can Foam Stability be
performed?
1545) What is the procedure for Foam
Stability?
Normally parallels lecithin, except in diabetics, so must
be included in L/S ratio
At the bedside
Amniotic fluid is mixed with 95% ethanol, shaken for 15
seconds, and allowed to sit undisturbed for 15 minutes
1546) How to read Foam Stability?
A continuous line of bubbles around the outside edge
indicates the presence of a sufficient amount of
surfactant to maintain alveolar stability (alcohol is an
antifoaming agent, and fluid can overcome this)
1547) What need to be added to increasing
amounts of 95% ethanol?
1548) What a value >47 indicates?
1549) What is the special note for Foam
Stability test?
0.5 mL amniotic fluid
1550) What is Lamellar bodies?
Storage form of surfactant (Approximately 90%
phospholipid and 10% protein)
1551) What is Lamellar bodies secreted by?
Type II pneumocytes of the fetal lung to the aveolar
space at about 24 weeks of gestation
1552) What is the reference range for
Lamellar bodies?
Increase in amniotic concentration from 50,000 to
200,000/mL by the end of the third trimester
1553)
1554) What is the Lamellar body diameter
From 1.7 to 7.3 fL or 1 to 5 µm
FLM
Correlates well with L/S ratio and tests for phosphatidyl
glycerol
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UA PPT Flashcards
ranges in size?
1555) How can LBCs be obtained?
1556) What are the Advantages of LBC?
1557) What is the restriction of LBC?
1558) What is the protocol for Performing
LBC?
1559) What are feces?
1560) What are the 3 fecal analysis?
1561) What disease fecal analysis can be
used to detect?
1562) What does Fecal specimen contains?
Using the platelet channel of automated hematology
analyzer
– Rapid turnaround time
– Low reagent cost
– Wide availability
– Low degree of technical difficulty
– Low volume of amniotic fluid required
– Excellent clinical performance
Specimens contaminated with meconium or mucous
cannot be used
a.
1. Mix the amniotic fluid sample by inverting the
capped sample container five times.
2. Transfer the fluid to a clear test tube to allow for
visual inspection.
3. Visually inspect the specimen. Fluids containing
obvious mucus, whole blood, or meconium
should not be processed for an LBC.
4. Cap the tube and mix the sample by gentle
inversion or by placing the test tube on a tube
rocker for 2 minutes.
5. Flush the platelet channel; analyze the
instrument’s diluents buffer until a background
count deemed acceptable by the laboratory is
obtained in two consecutive analyses.
6. Process the specimen through the cell counter
and record the platelet channel as the LBC.
The end product of digestion
– Macroscopic
– Microscopic
– Chemical
•
•
•
•
•
•
•
Gastrointestinal (GI) bleeding
Liver and biliary duct disorders
Maldigestion/malabsorption syndromes
Pancreatic diseases
Inflammation
Diarrhea and steatorrhea
Detection and identification of pathogenic
bacteria, viruses, and parasites
Bacteria, cellulose, undigested foodstuffs, GI secretions,
bile pigments, cells from the intestinal walls, electrolytes,
and water
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UA PPT Flashcards
1563) How many gram of feces are excreted
in a 24h period?
1564) What is the primary site for the final
breakdown and reabsorption of
proteins, carbohydrates, and fats?
1565) What can aid small intestine in the
break down and reabsorption of
proteins, carbohydrates, and fats?
1566) How many ml of ingested fluid, saliva,
gastric, liver, pancreatic, and intestinal
secretions enter the digestive tract each
day
1567) Majority of fluids involved in digestion
are?
1568) What is diarrhea?
1569)
1570) What are the 4 factors of diarrhea?
100 to 200 g of feces
Small intestine
Pancreatic enzymes and bile salts
Approximately 9000 mL
Reabsorbed, with only about 150 mL excreted in feces
Excess water (>3000 mL) reaching large intestine, or
200 g stool weight per day with increased liquid and
more than three movements per day
–
–
–
–
Illness duration
Mechanism
Severity
Stool characteristics
1571) What is chronic Diarrhea?
1572) What is acute Diarrhea?
1573) What are the 3 Mechanisms of
diarrhea?
1574) What are Laboratory tests for
diarrhea?
1575) What does Ph <5.6 indicates?
1576) What can be used to calculate fecal
osmotic gap?
>4 week duration
<4 week duration
Secretory, osmotic, altered motility
1577) Total fecal osmolarity
Close to serum osmolarity (290 mOsm/kg)
1578) What is Osmotic gap?
290 [2 × (fecal Na + fecal K)]
1579) What is Osmotic diarrhea?
>50 mOsm/kg
1580) What is Secretory diarrhea?
<50 mOsm/kg
1581) What happens when an increased in
secretory and negligible in osmotic
diarrhea
1582) An increase secretion of water and
electrolytes indicate what?
Electrolytes loss
Fecal electrolytes, osmolarity, and pH
sugar malabsorption
Sodium, potassium, osmolarity
Bacterial, viral, and protozoan infections
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UA PPT Flashcards
1583) What are these bacteria?
Escherichia coli, Clostridium, Vibrio cholerae, Salmonella,
Shigella, Staphylococcus, Campylobactor,
Cryptosporidium
1584) What can affect the Secretory
Diarrhea?
Drugs, laxatives, inflammatory bowel disease/colitis,
endocrine disorders, malignancy, collagen vascular
disease
1585) What can exert osmotic pressure
across the intestinal mucosa in osmotic
diarrhea?
1586) What happens when there is
incomplete digestion or reabsorption of
food?
1587) What is Maldigestion?
Poor absorption
1588) What is Malnutrition?
1589) What are the issues involving Osmotic
Diarrhea?
Impaired reabsorption
Lactose intolerance, celiac sprue (malabsorption),
amebiasis, antibiotics, laxatives, antacids
1590) What can cause Irritable bowel
syndrome (IBS)?
1591) What is the motility rate that can
indicate Rapid Gastric Emptying (RGE)
(or Dumping Syndrome)
1592) The types of dumping syndrome can
be based on what?
1593) What are the 2 types of Dumping
Syndrome?
1594) What are the diseases that involve
with altered motility?
Hypermotility and constipation; food, chemicals, stress,
and exercise
<35 minutes
1595) What is Steatorrhea?
Increased fats in the stool >6 g/day
1596) What can cause Steatorrhea?
Pancreatic insufficiency and malabsorption and lack of
bile salts (triglyceride digestion)
1597) What disease decrease pancreatic
enzymes for lipid breakdown?
1598) What does D-xylose test for?
1599) Low level of D-xylose in urine indicates
what?
1600) What is the special note regarding Dxylose test?
Cystic fibrosis, pancreatitis, and malignancy
increases water retention in large intestine
Impaired digestion of foods
Timing of symptoms
Early: 10 to 30 minutes
Late: 2 to 3 hours
Gastrectomy, gastric bypass, postvagotomy, duodenal
ulcer, diabetes mellitus
Malabsorption
Malabsorption
D-xylose does not need to be digested but must be
reabsorbed to appear in the urine
1601) What are the procedures for specimen _ Use clean container and transfer to laboratory
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UA PPT Flashcards
collection?
container
_No toilet water contamination
_ Acceptable for some occult blood test kits
1602) Can we use Ova and parasite
containers for different purpose?
No, Ova and parasite containers are used only for that
purpose.
1603) What is the time requirement for
Quantitative collections?
1604) What is Quantitative collections?
72 hours
1605) What is the macroscopic screening for
stool?
– Color
– Appearance: formation
(GI disturbances can often be changes in the brown color
and formed consistency of the normal stool )
1606) Brown color of feces indicate what?
Urobilin
1607) Pale, acholic stools indicate what?
Bile duct blockage, barium sulfate
1608) How does blood appear in feces?
Bright red to dark red to black, depending on area of
digestive tract that is bleeding
Upper tract bleeding, medications, iron, bismuth,
charcoal
1609) Black color of feces indicate what?
Time required to pass through intestine
1610) Red color of feces indicate what?
1611) Green color of feces indicate what?
Lower tract bleeding, beets
Antibiotics, bilirubin to biliverdin
1612) A watery feces appearance indicate
what?
1613) A hard feces appearance indicate
what?
1614) A ribbon-like feces appearance
indicate what?
1615) What are the characteristics of
Steatorrhea?
1616) What does mucus coated feces
indicate?
1617) What does blood-streaked mucus
indicate?
1618) What should we do when we see
mucus in stool?
1619) What does fecal microscopic exam
for?
1620) What do neutrophil present in?
Diarrhea
1621) What do Salmonella, Shigella,
Constipation
Obstruction
Pale, bulky, frothy, foul odor
Intestinal irritation, inflammation, colitis, straining
Intestinal wall damage, dysentery, malignancy
Always report mucus
Fecal leukocytes, primarily neutrophils.
In bacterial dysentery, Dysentery from bacterial toxins,
food poisoning.
Bacterial dysentery because they invade the intestinal
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UA PPT Flashcards
Campylobacter, Yersinia, and E. coli
O157 cause?
1622) What is the microscopical
characteristic of Staphylococcus and
Vibrio in stool?
1623) What is food poisioning?
1624) For microscopic examination of fecal
matter, a smear is made with ____ or
____ stain.
1625) Under hp, how many neutrophils per
field is signigicant?
1626) Under oil immersion, any neutrophils
have a _____ % significance.
1627) Lactoferrin latex agglutination is good
for _____ specimens, refrigerated or
frozen.
1628) Lactoferrin is in the granules of what?
1629) In the methylene blue staining
procedure for fecal leukocytes, the lab
tech places mucus or a drop of liquid
stool on the slide and adds ____ drops
of Loffler methylene blue, mixes with a
wooden stick and allows to stand for
____ minutes before examination.
1630) When testing fecal matter for muscle
fibers, the patient must eat what before
collection?
1631) What disorders can cause undigested
striated mucsle fibers?
1632) Muscle fibers in feces can be seen on
a slide prepared with what?
1633) When examining a slide for muscle
fibers, the technician will count the
numbers of fibers that exhibit what?
1634) Undigested fibers exhibit _________
1635) Partially digested fibers
exhibit_______
1636) Digested fibers exhibit______
1637) When counting muscle fibers, only the
____ are counted and more than ____
per slide is abnormal.
1638) When performing screening for
steatorrhea, which lipids are included?
1639) What stain is used for steatorrhea
screening?
1640) In the two-part test, neutral fat will
appear as ______ and ____ per hpf is
wall
Do not have leukocytes
Staphylococcus versus invasive dysentery
Wright or Gram
Three
70%
older
Neutrophils
Two drops; 2-3 minutes
Red meat
Pancreatic insufficienncy and cystic fibrosis
10% alcoholic eosin
Well preserved striations
vertical and horizontal striations
striations in only one direction
no striations
undigested; 10
neutral fats (triglycerides), fatty acid salts (soaps), free
fatty acids, and cholesterol
Sudan III or IV, oil red 0
large red-orange droplets; 60; split fat
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UA PPT Flashcards
indicative of steatorrhea and _____ is
more indicative.
1641) In the neutral fat stain procedure,one
part stool is homogenized with how
many parts water?
1642) In the neutral fat stain procedure
what stain is used and what is counted?
1643) In the split fat stain, _____ form after
heating and cooling and have
characteristic _____.
1644) In the split fat staining procedure, the
emulified stool is mixed with _____ and
stained with two drops of ______
before being heated.
1645) The test principle of fecal occult blood
testing is?
1646) The guaiac test will turn what color in
the presence of bood?
1647) Guaiac is less sensitive than urinalysis
reagent because why?
1648) Commercial kits for fecal occult blood
testing have strict dietary rules including
____ for three days prior.
1649) When performing the guaiac test in
the lab, the outside areas of the stool
might cause a false positive. Why?
1650) Aspirin, anti-inflammatory meds, red
meat, horseradish, raw broddoli, and
melons may lead to a _____ occult
blood test.
1651) High levels of vitamin C may cause a
_____ occult blood test
1652) Immunochemical Fecal Occult Blood
Test (iFOBT) is more sensitive because it
tests for specific _____, there is no need
for ____, and is more sensitive to _____.
1653) Hemoquant tests for ____ from
hemoglobin degradation that is not
detected by guaic
1654) Quantitative fecal fat testing to
confirm steatorrhea includes ____
collection in a preweighed container
that requires ____ to slow down
bacterial action.
1655) Reporting of fecal fat is done as grams
of fat or the coefficient of fat retention
based on 100 g/d intake of fat
Two
Sudan III; count orange droplets per high-power field
cholesterol crystals; flat shape and notched corners
36% acetic acid; Sudan III
pseudoperoxidase activity of hemoglobin
Blue
Up to 2.5 ml of blood in stool is normal
No red meat
Hemorrhoids might affect these areas of the stool
False positive
False negative
human hemoglobin, dietary restrictions, lower GI
bleeding
porphyrin
3-day; refrigeration
Doefficient of fat retention= dietary fat - fecal fat/dietary
fat (100)
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UA PPT Flashcards
represented by which calculation?
1656) Normal values of quantitative fecal fat
are?
1657) A rapid (5 minutes) for analyzing
quantitative fecat fat is what?
1658) What test for quantitative fecal fat
provides rapid estimate, requires a
single 5g specimen that is homogenized
and acidified and spun in a regular
hematocrit tube?
1659) How does a technician measure the
steatocrit after spinning?
1660) What is the normal adult steatocrit
value?
1661) Near-infrared reflectance
spectrophotometry scans surface of
stool with light between what
wavelengths?
1662) The APT test for fetal hemoglobin
checks for what?
1663) Afte emulsifying material in water to
release hemoglobin in the APT test, the
technician centrifuges and adds 1%
NaOH to pink supernatant. If pink color
remains, then that equals_____. If it
changes to a yellow-brown then that
equals ______.
1664) Maternal thalassemia major has
what?
1665) In th APT test procedure, the controls
use what specimens?
1666) Measuring pancreatic fecal enzymes
can help diagnose what disorders?
1667) What test for enzymes is not very
sensitive and involves stool dissolving
gelatin on x-ray paper?
1668) ____ is more sensitive than the classic
trypsin test, less degraded, and
spectrophotometric measuring is
available.
1669) _____ is an isoenzyme of elastase
produced by the pancreas, is present in
high concentrations and resistant to
degradation, is not affected by gastric
motility, and differentiates pancreatic
form nonpancreatic causes of
steatorrhea.
1 to 6 g/d or coefficient of fat retention of at least 95%
Hydrogen nuclear magnetic resonance spectrocopy (1H
NMR)
Acid steatocrit
Fatty layer/fatty layer + solid layer (100)
less than 31%
1400 and 2600 nM
Bloody stools and vomit from neonates who may have
swallowed maternal blood during delivery
Pink color= alkali-resistant fetal Hgb
yellow-brown = maternal Hgb
Increased Hgb
cord blood and adult blood
pancreatic insufficiency and cystic fibrosis
Trypsin test
Chymotrypsin
Elastase-1
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UA PPT Flashcards
1670) Why does increased stool
carbohydrates cause osmotic diarrhea?
1671) Common causes of increased stool
carbohydrates include?
1672) To test for maldigestion, what test can
be performed?
1673) To test for malabsorption, what test
can be performed?
1674) Common fecal testing on infants
include pH to detect what?
1675) Normal stool pH is 7 to 8, pH below
5.5 indicates what?
1676) The Clinitest can help distinguish
between carbohydrated-caused
diarrhea and ____ diarrhea.
1677) A positive Clinitest should be followed
by a ______
1678) What is the most common conditions
in female patients?
1679) Swab in a tube containing ____ to
____ of sterile physiologic saline and
agitated.
1680) What is the appearance of vaginitis?
1681) What is the pH of women with
vulvovaginal candidiasis?
1682) Where is squamous epithelial cells
located on human body?
1683) Alteration in the normal flora can
cause overgrowth of ___________
1684) What are the characteristics of
trichomonas vaginalis?
1685) Differentiation of yeast cells can be
made using the ___ test
1686) KOH test uses ___ of KOH solution
1687) Gold standard in identifying the
causative organisms of BV is?
1688) Trichomonas is incubated for ___ days
at __C in a CO2 atmoshere
1689) What is used to identify the causative
pathogen for vaginitis?
1690) Which activity is observed for vaginal
secreations for G. vaginalis?
1691) The most common cause of vaginitis,
affecting ___% to __% of women of
child bearing age.
Excess water is needed to remove the carbohydrates
The inability to reabsorb or lack of digestive enzymes
Lactose tolerance test
D-oxylose tolerance test
Fermentation of excess carbohydrates by intestinal
bacteria
Increased carbohydrates
viral-caused
Tolerance test
vaginitis
0.5 to 1.0 ml
Predominance of large, rod shaped, gram-positive
lactobacilli
4.5
Linings of vagina and female urethra
Opportunistic flora
Atrial flagellated protozoan, oval shaped, four anterior
flagella and undulating membrane that extends half of
the the length of the body.
KOH
10%
Gram stain
5 days, 37 C
DNA testing using DNA hybridization probe
Proline aminopeptidase activity
40-50%
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UA PPT Flashcards
1692) what is the recommended treatment
for trichomoniasis?
1693) What are some Candida Nonalbican
species?
1694) What are some changes in the vaginal
environment that permits the
overgrowth of Candida?
tinidazole
1695) What are some Clinical symptoms of
Candidiasis?
Genital itching or burning, Dyspareunia, Dysuria and
Abnormal thick, white, and curd-like vaginal discharge
1696) What does Candidiasis look
like/Characteristics of Candidiasis on
Saline and KOH wet prep and Gram
stain.
1697) How can species of Candida be
confirmed and identified
1698) Candidiasis can be treated with which
over the counter medications?
1699) What are some prescribed
medications for Candidiasis?
1700) What is an abbreviation for
Desquamative Inflammatory Vaginitis?
1701) What is Desquamative Inflammatory
Vaginitis?
budding yeast and pseudohyphae forms, large numbers
of WBCs, lactobacilli, and large clumps of epithelial cells
1702) What is the lab result for
Desquamative Inflammatory Vaginitis?
Testing reveals large numbers of WBCs, RBCs, occasional
parabasal and basal cells, squamous epithelial cells, and
reduced or absent lactobacilli
1703) How is Desquamative Inflammatory
Vaginitis treated?
1704) What is Atrophic Vaginitis?
With 2% clindamycin, Hormone replacement therapy
1705) Atrophic Vaginitis microscopic
evaluation is similar with what other
illness?
1706) What is the treatment of atrophic
vaginitis.
1707) What is the leading cause of neonatal
Desquamative Inflammatory Vaginitis? (DIV)
C. glabrata, C. parapsilosis, C. Tropicalis, and C. krusei
Broad-spectrum antibiotics, oral contraceptives, or
estrogen replacement therapy; hormonal changes that
occur with pregnancy; ovulation; and menopause.
Immunocompromised patients and those with conditions
such as diabetes mellitus, iron deficiency, and HIV
infection
Through culture and DNA hybridization probe
Butoconazole, clotrimazole, tioconazole, and miconazole
Oral fluconazole orintravaginal butoconazole,
Nystatin, and terconazole.
DIV
Profuse purulent vaginal discharge, vaginal erythema,
and dyspareunia
Found in postmenopausal women, thinning of thevaginal
mucosa due to decreased estrogen and glycogen; Vaginal
dryness and soreness, dyspareunia, inflamed vaginal
mucosa, and purulent discharge.
Estrogen replacement
Preterm delivery- delivery before the completion of 37
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UA PPT Flashcards
mortality and morbidity in the United
States?
1708) What are some complications from
vaginitis syndromes.
weeks gestation.
Premature rupture of fetal membranes and a high risk of
preterm labor.
100