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135 Cards in this Set
- Front
- Back
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What is the cause of yellow-orange urine?
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normal urochorome pigments and pyridium therapy
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If you had a pseudomanas infection, what color will your urine most likely be?
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green
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What things can cause a green tinted urine?
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pseudomanas infection, methylene blue or other blue dyes, elevated urinary copper levels, phenol, iodochlorhydroxyquin, amitriptyline hydrochloride, and chlorophyll breath fresheners
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What can cause black urine?
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melanoma, alkaptonuria, phenol, black water fever, alphamethydopa
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What can cause purple urine?
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porphobolin
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What can cause red urine?
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Hemoglobin, laxatives containing phenolphthalein, myoglobin, senna, beets, rifampin
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What can cause a milky white urine?
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Pus, chyle, and phosphates
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If your urine has a maple syrup odor, what could it mean?
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Maple syrup disease
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If your urine has a cabbage or hops odor, what could it mean?
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methionine malabsorption
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If your urine smells mousy, what could it mean?
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PKU
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If your urine smells like rotting fish, what could it mean?
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Trimethylamiuria
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If your urine smell racid, what could it mean?
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tyrosinemia
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What is the normal specific gravity for urine?
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1.003-1.040
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What is the normal pH for urine?
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5-9
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What is the normal protein for urine?
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<30 mg/dL
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What is the normal glucose for urine?
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<100 mg/dL
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What is the normal ketone range for urine?
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variable
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What is the normal amount of blood in the urine?
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none
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What is the normal amount of bilirubin in the urine?
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none
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What is the normal amount of nitrite in the urine?
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none
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What can cause a false-positive for protein in the urine?
Explain how to decide significance |
-a high specific gravity
-if sg is < 1.020 1+ protein is significant, but if sg is >1.020 2+ is significant |
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What protein does urine anaylsis test for?
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albumin
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What occurs in the urine as a result of accelerated fat matabolism?
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ketones
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What can bilirubin and urobilinogen in the urine mean?
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liver dysfunction and hemolytic anemia
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What is the bilirubin and urobilinogen in each of the following disorders?
1-Health 2-Hemolysis 3-Hepatic Disease 4-Billiary obstruction |
1-normal, negative
2-increased, negative 3-increased, negative or positive 4-low/absent, positive |
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If hemoglobin is present in the urine, what could it mean?
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infection, cancer (colon, and bladder), intravascular hemolysis, and kidney stones
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What can a positive nitrite in the urine mena?
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infection
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What is leukocyte esterase a good indicator of?
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UTI
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How do you decide if a urine sample is a bad sample?
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More than 20 squamous epithelial cells per high power field
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A hyline cast may mean what?
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high level of protein in the urine and should take a look at the kidneys
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In gout what kind of cast might you see?
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coarse granular cast
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The presence of Homovanillic Acid in the urine can mean what?
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pheochromycytoma and neauroblastoma
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More than ________ erythrocytes, leukocytes, or renal tubular cells per high powered field is abnormal.
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5
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More than ______ hyline casts, or more than ______ granular casts, or the presence of any other cast per low power field is abnormal?
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-3 hyline
-1-granular |
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The amount of how much bacteria per high power field is abnormal?
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1+ (3 to 5)
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What is high power and what is low power field?
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430X
100X |
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What is elevated in endocrine tumors?
What can interfere with the test? |
Hydroxyindoclacetic acid
-foods |
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What does vanilymadelic acid in the urine mean?
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sympathetic overstimulation
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For women who start to develop masculine characteristics, what do you test for and why?
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17-ketosteroids to check for androgren production that could mean Cushings Syndrome
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Microalbumin tests will detect less than _______ ug/L of protein in the urine?
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30
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What is proteinuria defined as?
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More than 300 mg of in 24 hrs
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When screen for parasites, how many tests do you need to do and why?
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3 because you are not always shedding parasites
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Extracellular volume is regulated by what two hormones?
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vasopressin and aldosterone
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What are ways to alter the body's salt output?
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-GFR
-Paritubular capillary oncotic and hyrdrostatic pressure -angiotensin II -aldosterone -catecholemines |
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What are the three non-renal ways that we lose water?
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-skin
-respiratory -GI tract |
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Osmolarity is by __________, while osmolality is by __________
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-volume
-weight |
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Na is an example as an ____________ osmol, which means it helps to maintain osmotic pressure and doesnt cross the membrane?
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effective
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About how much water do you lose via the GI tract a day?
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100mL
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What type of osmol is evenly distributed thru-out the body and does cross the membrane? Give an example.
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Ineffective, and Urea
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At normal serum glucose and urea concentrations, somalality almost equals what?
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serum Na X 2
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What part of the kidney is impermeable to water?
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Loop of Henley
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What are the 5 most common causes of hyponatremia?
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-overhydration
-diuretics -SIADH -Adrenal failure -Diabetic hyperosmolarity |
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For Overhydration, what is the:
1-serum Na 2-urine Na 3-urine Osm 4-serum K 5-24 h uNa |
1-low
2-low 3-low 4-normal/low 5-low |
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For Duiretics, what is the:
1-serum Na 2-urine Na 3-urine Osm 4-serum K 5-24 h uNa |
1-low
2-low 3-low 4-low 5-high |
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For SIADH, what is the:
1-serum Na 2-urine Na 3-urine Osm 4-serum K 5-24 h uNa |
1-low
2-high 3-high 4-normal/low 5-high |
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For adrenal failure, what is the:
1-serum Na 2-urine Na 3-urine Osm 4-serum K 5-24 h uNa |
1-low
2-mildly elevated 3-normal 4-high 5-high |
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For diabetic hyperosmolarity, what is the:
1-serum Na 2-urine Na 3-urine Osm 4-serum K 5-24 h uNa |
1-low
2-normal 3-normal 4-high 5-normal |
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With hyperosmolality (intracellular dehydration) you get what? (basically from salt accumulation)
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hallucinations, coma, and resp arrest
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Intracellular overhydration you get what?
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HA, disorientation, and coma
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Osmotic diuretics work where?
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PCT
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Where do thiazide diuretics work?
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Proximal DCT
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What diuretics work in the Distal DCT?
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osmotic and K-sparing
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What diuretics work in the collecting ducts?
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osmotic diuretics
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What test can be used to diagnose Addison's disease?
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ACTH stimulation test which measures blood cortisol levels after ACTH injection and it is positive if it really doesn't change
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For every 100mg/dL increase in serum glucose, how much of a decrease is serum Na is there in Diabetic Hyperosmolar State?
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1.6 decrease
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What are 3 common causes of hypernatremia?
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-dehydration
-diabetes insipidus -Cushings Disease |
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In dehydration, what are the levels of:
1-serum Na 2-Urine Na 3-urine Osm 4-Serum K 5-24 h uNa |
1-high
2-high 3-high 4-normal 5-varies |
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In diabetes insipidus, what are the levels of:
1-serum Na 2-Urine Na 3-urine Osm 4-Serum K 5-24 h uNa |
1-high
2-low 3-low 4-normal 5-low |
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In Cushings Disease, what are the levels of:
1-serum Na 2-Urine Na 3-urine Osm 4-Serum K 5-24 h uNa |
1-high
2-low 3-normal 4-low 5-low |
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For Central diabetes Insipidus, what signs and symptoms should you look for
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-polyuria
-polydypsia -electrolyte imbalance -possible dehydration -low ADH levels -low SG from urine analysis |
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How do you treat central diabetes insipidus?
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desmopressin
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What are 3 things you want to do to dx central diabetes insipidus?
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rule out other causes
-imagery of pituitary and hypothalamus -water deprivation test |
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How do you diagnose nephrogenic diabetes insipidus?
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rule out other causes
rule out CDI |
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What is the tx for nephrogenic diabetes insipidus?
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-oral chlorathizide
-chloropropramide -NSAIDS -restrict Salt |
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What is the cause of CDI?
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trauma or disease of pituitary or hypothalamus
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What is the cause of NDI
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trauma or disease of the kidney
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What is the main difference between CDI and NDI?
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In CDI you don't make ADA and in NDI there are defects in ADH recptors or aquaporins
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What is the main difference between Cushings Disease and Syndrome?
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Disease is primary and Syndrome is more secondary
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What are some unique causes of hypoK?
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-infusion of insulin
-alkalosis -vomiting |
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What things besides dehydration and diabetes insipidus causes hyperK?
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-acidosis
-diabetic ketoacidosis -hemolysis -any sort of cell damage |
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What is Inulin and what can it be used for?
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-polysaccharide that can be used to measure GFR
(mostly done inpatient) |
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What is urea?
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the end product of ammonia metabolism in the liver
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____________ is excreted by the renal tubules at a rate roughly proportional to the GFR.
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urea
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BUN=?
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1/GFR
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What does a low BUN mean?
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little clinical significance (liver disease, overhydration, pregnancy, malnutrition)
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What are 2 reasons you may have an elevated BUN?
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-prerenal disease
-true renal disease |
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What is the normal BUN:creatinine ratio?
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10:1 to 20:1
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As GFR _________ cystatin C levels raise.
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fall
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Cystatin C is not affected by what?
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sex
age race muscle mass |
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Cystatin C can be used to estimate what?
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GFR
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In renal failure Ca levels_____________ and phosphate leves _________.
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Ca falls
PO4 rise |
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What are 2 ways the kidneys regulate calcium levels?
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-PTH
-synthesis 1,25-dihydroxycholecaldiferol |
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What are some causes of hypoCa?
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-calcitonin
-hypoparathyroidism -alkalosis -renal failure |
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What are some causes of hyperCa?
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-cancer
-hyperthyrodism -iatrogenic -multiple myeloma -hyperParathroidism -sarcoidosis |
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What is hypoglycemia defined as?
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glucose level <60
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What are the 3 main causes of hypoglycemia?
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-hypoglycemic drugs
-hypersensitivity to insulin -insulin secreting tumors |
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What is the maximum amount of tylenol you should have per day?
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4g
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What are some factors that affect toxicity of acetaminophen?
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-age
-genetics -chronic liver disease -alcohol (modifies CYP 2E1 and depeletes GSH) -drugs -nutritional status (fasting) -smoking -autoprotection (tolerance develops) |
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How long after an acetopminophen overdose does liver enzymes start to mildly rise?
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8-12 hrs
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WHen is stage 2 of acetominophen overdose and what happens there?
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-24-72 hrs post ingestions
-pt appears well, but evidence of hepatotoxicity can appear -nephrotoxicity and oliguria may develop |
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What can happen in stage 3 of acetominophen overdose?
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hepatocellular necrosis and death
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What are the three mechanisms that actaminophen uses to damage the body?
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-overdose
-excessive CYP activation -depletion of glutathione stores |
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Name some Dx/Dx of acetaminophen toxicity?
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-viral hepatitis
-drug or toxin induced hapatitis -Reye syndrome -acute fatty liver of pregnancy -ishemic hepatitis -alcoholic hapatitis and or acute decompensation of chronic liver disease |
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Measuring acetaminophen levels prior to ______ hors after ingestion does not help?
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4
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in acetominophen overdose, if the AST and ALT levels are normal and the acetaminophin level is less than 10, then how likely is there to be hapatoxicity?
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Very UNLIKELY
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What is antedote for acetaminophen overdose?
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N-acetylcysteine
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What are some indications to give N-acetylcysteine for an acetaminophen overdose?
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if you don't know the serum concentration or time of ingestion and APAP levels are > 10g/mL then give it
-if APAP concentration is above hepatic toxicity line -estimated single does of >150 mg/kg -lab evidence of hapatic toxicity -repeated supratherapeutic ingestions and a serum APAP concentration >10g/mL |
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When should management of acetaminophen overdose be started?
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w/in 8-10 hrs but still indicated w/in 24 hrs post ingestion
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What things can happen from salicylate poisoning from ASA?
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-lactic acidosis due to increased mitochondrial metabolism
-fever -glycogen depletion -gluconeogensis -catabolism of proteins and free fatty acids -CNS hypoglycemia ***mainly because of mitochondria being forced to do anaerobic metabolism) |
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ASA is metabolized where and in conjugation with what?
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in the liver with glycine
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ASA can cause what acid-base disturbances?
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1-respiratory alkalosis
2-mixed acid-base disturbances 3-metabolic acidosis |
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What is the classic presentation of salicylism?
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hyperventilation
tinnitus GI irritation |
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What is the problem w/ the drugs that mix ASA w/barbituates?
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can suppress common S and S of ASA overdose, for example, they may not breath rapidly
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What is the late presentation of ASA overdose often misdiagnosed as?
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MI, sepsis, or psych disturbance
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How does death result from ASA overdose?
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-metabolic acidosis leading to the development of PE and cerebral edema
-CNS depression -myocardial depression |
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Salicylate toxicity does/does not correlate with serum levels?
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does NOT
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What is required to determine ASA toxicity?
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-serial blood gasses and salicylate determinations
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How do you treat ASA toxicity?
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Resuscitation
---volume replacement w/ alkalinized solutions -----Airway management Gastic decomtamination Enhanced elimination |
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What types of test are available for a UDT?
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-immunoasssay
-gas chromatography -liquid chromatography |
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What are the DOT 5?
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-Amphetamine
-marijuana metabolites -cocaine metabolites -opiate metabolites -PCP |
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What characteristics are checked to see if urine specimen has been altered?
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-specific gravity
-temp -pH -adulterants screen (creatinine < 5 is incompatable w/kidney function) |
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What are some Dx/Dx for a transudative pleural effusion?
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-CHF
-Pericardial Disease -Nephrotic syndrome -Myxedema -iatrogenic |
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What some Dx/Dx for an exudative pleural effusion?
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-neoplastic disease
-infectious diseases -PE -collagen vascular -post coronary bipass surgery -sarcoidosis |
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A pleural effusion is exudative if it meets 1 or more of what 3 criteria?
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-The ratio of pleural fluid protein to serum protein is > 0.5
-The ratio of pleural fluid LDH to serum LDH is > 0.6 -Pleural fluid LDH is more than two-thirds the upper limit of normal serum LDH |
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For an exudative pleural effusion the following are either high or low:
1-protein 2-LDH 3-pH 4-glucose 5-WBCs |
1-high protein
2-high LDH 3-low pH 4-low glucose 5-high WBCs |
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For trasudative pleural effusion the following are either high or low:
1-protein 2-LDH 3-pH 4-glucose 5-WBCs |
1-low protein
2-low LDH 3-high pH 4-normal glucose 5-low WBC |
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Protein is elevated in which type of pleural effusion?
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exudative
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What does LDH in pleural fluid reflect?
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-rate of cell turnover in pleural space
-degree of inflammation in pleural space |
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What can be used to determine whether a chest tube is indicated?
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pH and pCO2
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What could an acidotic pleural fluid indicate?
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an highly inflammatory process via lactic acid and CO2 in pleural space
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In what conditions is pleural fluid amylase elevated?
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-pancreatic disease
-malignancy -esophageal perforation |
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What tests can be run on the pleural fluid to check for vascular and collagen disease?
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-RA
-ANA |
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What could a low glucose concentration in the pleural fluid mean?
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-Thickened pleura with impaired diffusion of glucose
I-ncreased metabolic activity and increased glucose utilization |
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Pleural Effusions do to an acute process generaly contain more _______ cells?
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PMNs
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What other tests can you run on the pleural fluid to get a cause of the pleural effusion?
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-cytology
-fluorescent in situ hybridization -immunohistochemical staining -gram stain culture |
