1diets composed of vegetables causes ______________
alkaline urine
2performs scientific analysis of non-blood body fluids
Clinical Microscopy
3It helps clinician in early detection of gastrointestinal
bleeding, liver and biliary duct disorders and
malabsorption syndrome
Clinical Microscopy
4Test offered in Clinical Microscopy
1. Routine urinalysis
2. Routine fecalysis
3. Pregnancy test
4. Fecal occult blood test
5. Micral test
6. Sperm analysis
5Give some Standard Precautions in CM
Gloves must & worn at all times.
•Specimen must be collected in clean, dry, leak-proof containers.
•ProperIy applied screw-top lids are less likely to leak than snap-on lids.
• Containers must be:
-Wide mouth with wide, flat bottom to prevent overturning
-Made of a clear materials to allow for determination of
color and clarity
-recommended capacity is 50 mL (allows 12 mL of
specimen needed)
•ALL SPECIMENS MUST BE LABELED PROPERLY
-Labels must be attached to the containers and not to the lid
6What are the specimen rejection in CM?
-Specimen in unlabeled containers.
-Non Matching labels and requisition form.
-Specimens contaminated with feces or toilet paper.
-Specimen of insufficient Quantity.
-Specimens that have been improperly transported.
•Requisition/ Request forms must accompany specimens.
•Specimen must be sent to the laboratory and tested within 2 hours.
7is a system for monitoring analytical testing to ensure the reliability and accuracy of each measurement performed on specimen.
quality control
8are designed and
implemented to detect pre analytical variables and analytical variable including analytical (equipment and reagent problems) or technical errors during analysis to prevent reporting of incorrect individual results.
Laboratory Quality Control Procedures
9What increases when specimen are not properly preserved?
1. pH
2. bacteria
3. odor
4. nitrite
10What decreases when specimen are not properly preserved?
1. clarity
2. glucose
3. ketones
4. bilirubin
5. urobilinogen
6. RBCs & WBCs
7. color
11T or F: References to the study of urine can be found in drawing of cavemen and in Egyptian hieroglyphics such as the Ewin Smith surgical papyrus
True
12Who wrote a book on uroscopy?
Hippocrates
13When was color charts develop that describe the significance of 20 different colors
11140 AD
14Who is responsible for chemical testing progress from "Ant testing" and "Taste testing" for glucose and discovery of albuminuria in boiling urine?
Fredrik Dekkers 1694
15Who is responsible for invention of microscope lead to the examination of urinary sediment and to the development methods for quantitating microscopic sediments?
thomas addis (17th century)
16Who introduced the concept of urinalysis as part of a doctor's routine examination?
Richard Bright (1897)
17Year when urinalysis began to disappear from routine examination
1930s
18What are the 2 unique characteristics of a urine specimen account for discontinued popularity?
1. Urine is a readily available in easily collected specimen
2. Contains information about many of the body's major metabolic functions
19What are the commonly ordered panel of tests on a urine sample.
-Kidney failure
-Acid-base disorders
-UTI
-Volume status
-Kidney and urethral stones
-Rhabdomyolysis
-Response to alkalization therapy
-GU malignancies
20What are the three categories in urinalysis?
1. Gross inspection or physical test
2. Dipstick or chemical test
3. Microscopy or microscopic test
21What are tested in Gross inspection or physical test?
- color
- characteristics or turbidity
22What are tested in Dipstick or chemical test?
- Blood
- bilirubin
- urobilinogen
- ketones
- protein
- nitrite
- glucose
- S.G
-leukocyte esterase
23What are tested in Microscopy or microscopic test?
- WBCs
- RBCs
- epithelial cells
- mucus thread
- bacteria
- urates
- crystals
- yeasts
- renal cells
- casts
24this characteristic varies from time to time
color
25this urine color means consuming plenty of liquids
very light yellow
26this urine color means dehydrated
very dark yellow/amber
27it is influenced by medical condition,
medication, and even some foods.
color
28Causes of red color urine
Bleeding, Food and Medication
29source of bleeding in urine
kidneys, ureters , bladder or urethra
30food that causes red urine
beefs, blackberries, and rhubarb
31medication that causes red urine
Rifampin for TB (Rifadin, Rimactane) phenazopyridine (Pyridium) laxative
32Causes of orange color urine
hyperbilirubinemia, medical condition and medication
33source of hyperbilirubinemia
yeIIow foam when shaken and positive chemical test
34medical condition that causes orange urine
Bile duct or liver disease and dehydration
35medication that causes orange urine
Acriflavin, phenazopyridine (Pyridium), nitrofurantoin and phenindione
36Causes of brown/ black color urine
Melanin/homogentisic acid, medical condition and medication
37medical condition that causes brown/ black color urine
liver and kidney disorders and uti
38What medical condition that causes brown/ black color urine
Some liver and kidney disorders and some urinary tract infections
39medication that causes brown/ black color urine
Chloroquine and primaquine (antimalarial drugs), metronidazole (Flagyl) and nitrofurantoin (Furadantin), and meth
40Causes of green color urine
Dye, Medical condition and Medication
41What is used for some tests of kidney and bladder function
Dye
42What medical condition that causes green color urine
Urinary tract infections caused by pseudomonas bacteria
43medication that causes green color urine
AmitriptyIine, indomethacin (Indocin, Tivorbex) and propofol (Diprivan)
44Causes of purple color urine
Purple urine bag syndrome, food, medical condition
45medication that causes green color urine
Similar to increase spasms, autonomic dysreflexia, mild lower back pain, or other aches, and fatigue, fever or chills, urinary leakage or having to catheterize more often nausea, headache, blood or sediment in urine, cloudy urine or a foul odor to the urine
46What causes white urine
Hypercalciuria and chyluria and medical conditions
47What medical condition that causes white urine
Filariasis, systomiasis, post-surgery, malignancy, hyperuricosuria, phosphaturia, hyperoxaluria, proteinuria, pyuria, lipiduria, caseous material from renal tuberculosis, congenital malformations of the lymphatic vessel
48-defines how how clear or cloudy the urine is
-reported in qualitative terms
Turbidity
49may indicate presence of UTI or precipitated crystals
turbid urine
50Characteristic of urine that has no visible particulates, and transparent
Clear
51Characteristic of urine that has few particles print easily seen through urine
Hazy
52Characteristic of urine that has many particulates, print blurred through the urine
cloudy
53Characteristic of urine that print cannot be seen hrough the urine
Turbid
54Characteristic of urine that has many precipitate or be clotted
Milky
55What is consist of a series of pads embedded on a reagent strip and may vary between different manufacturers?
Chemical Test or Dipstick
56What has the ff. characteristics:
•Auto calibra1ion with power-on
•Maximum 720 tests / hour
•Easy input multiple ID and
use data by keyboard
•2,000 tests results memory
•10 parameters testing available
SD Urometer 720 Urine Analyzers
57What part of SD Urometer 720 Urine Analyzers is used for starting or selecting a mad at each step?
Enter Key
58What part of SD Urometer 720 Urine Analyzers is used to terminate testing from each step?
Escape Key
59What part of SD Urometer 720 Urine Analyzers is used for moving or selecting menu?
Navigation key
60What part of SD Urometer 720 Urine Analyzers is used for selection of menu
Number Key
61What is the measure of relative density?
specific gravity
62Specific gravity formula
Density urine/density of water
63Specific gravity of urine may vary from ________ to _______
1.000 to 1.030
64Reading time of specific gravity of urine
45 seconds
65-Also known as acid dissociation constant
-It is a charge of a polyelectrolytes
pKA
66What are the clinical significance of specific gravity?
-water-loss dehydration
-evaluates the body's water balance (hydration).
-heIps evaluate kidney functions and possible kidney diseases.
67not the only test used to elderly
Universily of East Anglia (UEA)
68the kidneys can produce urine with a pH ranging from _____ to _____.
5.0 to 8.0
69Reading time of ph (concentration of hydrogen ions) of urine
60 seconds
70What are the clinical significance of ph (concentration of hydrogen ions)?
- diagnosing renal tubular acidosis (RTA)
- monitoring urine alkalization
- aids in the elimination of certain drugs
- differentiation of types of kidney stones
71What pH indicates:
- Acidemia
- hypoventilation
- excessive production of lactate or ketones
pH 5 or lower
72What pH indicates:
- Aklalemia
-Distal RTA
- UTIs secondary to urease producing organisms
pH 7.0 and 8.0
73Give examples of urease producing organisms
Proteus and Klebsiella
74diets rich in animal proteins causes ______________
acidic urine
75What is freely filtered through the glomerulus and reabsorbed in the proximal tubule?
Glucose
76What do you call the glucose in urine?
glycosuria
77Glucose is measured in ___________
mg/dL
78Reading time of Glucose of urine
30 seconds
79Example of Proximal tubuIar dysfunction
fanconi syndrome
80What are the clinical significance of Glucose ?
hyperglycemia and Proximal tubuIar dysfunction (fanconi syndrome)
81In benedict's test, color blue means?
Non-reducing sugar
82In benedict's test, color green ppt. means?
traceable
83In benedict's test, color yellow ppt. means?
Low (1+)
84In benedict's test, color orange-red ppt. means?
Moderate (2+)
85In benedict's test, color brick-red ppt. means?
High (3+)
86What is highly sensitive to hemoglobin?
Blood
87Blood is measured in ____________
RBCL
88it means blood in urine
hematuria
89Reading time of blood of urine
60 seconds
90What are the clinical significance of blood ?
- UTI
- Kidney infection
- medication
- strenuous exercise
91The most likely cause of a false positive blood on microscopic exam is:
menstrual contamination
92Its detection is the most sensitive on urine dipstick for albumin.
Protein
93Reading time of protein in urine
60 seconds
94What is is reported on a trace to 4+ scale?
proteinuria
95What are the clinical significance of protein?
Glomerular disease
- diabetic nephropathy
overflow proteinuria
- multiple myoloma
-Rhabdomyolysis
- intravascular hemolysis
96Example of Glomerular disease
diabetic nephropathy
97Example of overflow proteinuria
- multiple myoloma
- Rhabdomyolysis
- intravascular hemolysis
98Degree of turbidity which means very slight cloudiness is observed
Trace
99Degree of turbidity which means distinct turbidity, no granulation
1+
100Degree of turbidity which means turbidity with granulation, no flocculation
2+
101Degree of turbidity which means turbidity with granulation and flocculation
3 +
102Degree of turbidity which means clumps of protein
4+
103What aids in the diagnosis of UTIs?
Leukocyte esterase and Nitrites
104What enzyme is released by white blood cells?
Leukocyte esterase
105Leukocyte esterase and Nitrites measured in _____
WBCL
106Reading time of Leukocyte esterase in urine
2 minutes
107What detects the presence of bacteria and is measured in either positive or negative?
Nitrites
108What species lacks the ability to form nitrites?
Enterococcus
109What are the few reasons for negative nitrite test in urine?
- Insufficient ladder incubation time
- Decrease excretion of nitrates in the urine
- Low urine ph
110Reading time of Nitrites in urine
60 seconds
111What are the clinical significance of Leukocyte esterase and Nitrites?
- Diagnosis of UTIs
- Indwelling urinary catheter
112Ketones is measured in ________
mg/dl
113Reading time of Ketones in urine
40 seconds
114Ketones uses ______________ reaction
sodium nitroprusside reaction
115What condition indicates:
-Poorly controlled diabetes
- infection and heart attack
- alcoholism and starvation
Ketoacidosis
116What diet is preferred for kids with severe epilepsy?
ketogenic diet
117What are the clinical significance of Ketones?
Ketoacidosis
118Dipstick can only detect ____________ and _________
acetoacetate and acetone
119What is the breakdown product of bilirubin and is formed from the reduction of bilirubin?
Urobilinogen
120Urobilinogen is measured in ________
mg/dl
121Urobilinogen uses ______________ reaction
Ehrlich reaction
122Reading time of Urobilinogen in urine
60 seconds
123What test only measures the liver function?
Urobilinogen
124What are the clinical significance of Urobilinogen?
-cirrhosis
-viral hepatitis
-liver damage due to drugs
or toxic substances
-increased RBC destruction (hemolytic anemia)
125What is a highly pigmented compound that is a by-product of hemoglobin degradation?
Bilirubin
126Bilirubin uses ______________ reaction
Diazo reaction
127Bilirubin is measured in ________
mg/dl
128Reading time of Bilirubin in urine
30 seconds
129What are the clinical significance of Bilirubin and Urobilinogen?
liver disease (hepatitis)
130What is common in urinalysis lipsticks and are known to yield a high rate of false positive results?
Urine-bilirubin measurement
131In urine microscopy urine is centrifuged for ___ minutes at a speed of ________to _______
5 minutes; 1500 to 2000
132What is the resuspended material or the remaining pellet when most supernatant is poured off
urine sediment
133What is quantified as number of cells/HPF and is LACK of nuclei.
RBCs
134Presence of dysmorphic RBCs strongly suggestive of ________________________
glomerular disease
135What is considered abnormal RBCs in urine?
>3 RBCs/HPF
136What are the possible findings in presence of RBCs in urine?
- UTIs
- renal stones
- GU malignancies
- coagulopathy
- glomerular nephritis
- sickle cell anemia
- renal TB
- Vigorous exercise
-Contamination of Menstrual blood
137What is quantified as number of cells/HPF and is sign of inflammation?
WBCs
138What is considered abnormal WBCs in urine?
>5 WBCs/HPF
139What are the possible findings in presence of WBCs in urine?
- UTIs
- Indwelling urinary catheter
- Recent instrumentation of GU tract
- Urologic malignancy
- Chronic interstitial nephritis
- Interstitial cystitis
- Intra-abdominal inflammatory process adjacent the GU tract
- Contamination with vaginal secretions
140What suggests that sample was contaminated?
Squamous epithelial cells
141Squamous epithelial cells contains cells from _______________ of men and ______________ of women.
Urethra (men)
Vaginal opening (women)
142What is the thick slimy substance that coats and moistens certain parts of the body that may indicate UTIs or other medical conditions?
Mucus threads
143What is caused by UTIs with negative leukocyte esterase and nitrite and is related to poor collection technique?
Bacteria
144What is composed of small number of ions and molecules?
Crystals
145What is the long, cylindrical structures formed in the renal tubules due to the precipitation of Tamm-Horsfall mucoprotein?
Casts
146What is promoted by acidic and concentrated urine?
Casts
147What is reported from rare, few, moderate and many?
Mucus threads, Squamous epithelial cells, and Bacteria