Labs W/ Urinalysis

Front 1

What does a Urinalysis check?

Back 1

1 COLOR
2 CHARACTER
3 SPECIFIC GRAVITY
4 pH
5 GLUCOSE
6 KETONES
7 PROTEIN
8 BILIRUBIN
9 UROBILINOGEN
10 BLOOD
11 NITRITE
12 LEUKOCYTE ESTERASE
13 BACTERIA
14 RBCs
15 WBCS
16 EPITHELIAL CELLS
17 CASTS

Front 2

CA corrected=

Back 2

[(4-albumin)x0.8mg/dl]+ Ca uncorrected

Front 3

CA uncorrected is 7.9 and albumin is 1.7mg/dl. What is Ca corrected?

Back 3

9.74 mg/dl

[(4-1.7) x 0.8] +7.9=

Front 4

NORMAL URINE COLOR?

Back 4

Yellow to Amber

Front 5

NORMAL URINE CHARACTER ?

Back 5

Clear

Front 6

NORMAL URINE SPECIFIC GRAVITY ?

Back 6

1.015-1.025
is the weight of urine. A low specific gravity indicates dilute urine and a high specific gravity indicates concentrated urine.

Front 7

NORMAL URINE pH ?

Back 7

4.5 –8.0

Front 8

NORMAL URINE GLUCOSE ?

Back 8

Negative

Front 9

NORMAL URINE KETONES ?

Back 9

Negative

Front 10

NORMAL URINE BILIRUBIN ?

Back 10

Negative

Front 11

NORMAL URINE UROBILINOGEN ?

Back 11

Negative to Trace

Front 12

NORMAL URINE BLOOD ?

Back 12

Negative

Front 13

NORMAL URINE NITRITE ?

Back 13

Negative

Front 14

NORMAL URINE LEUKOCYTE ESTERASE?

Back 14

Negative

Front 15

NORMAL URINE BACTERIA ?

Back 15

Negative

Front 16

NORMAL URINE RBCs (RED BLOOD CELLS?

Back 16

Negative

Front 17

NORMAL URINE WBCS (WHITE BLOOD CELLS?

Back 17

Negative

Front 18

NORMAL URINE CASTS ?

Back 18

Negative

Front 19

What gives urine it's COLOR?

Back 19

(Normal: Yellow to Amber) - Urochrome gives urine its color.

Front 20

Factors that may alter urine color include?

Back 20

specific gravity, foods, bilirubin, and drugs (pyridium- orange stains that are permanent).

Front 21

CHARACTER of urine is normally?

Back 21

Clear

Front 22

SPECIFIC GRAVITY is normally?

Back 22

1.015-1.025

Front 23

Specific Gravity measures the?

Back 23

weight of urine

Front 24

A low specific gravity indicates?

Back 24

dilute urine (less than 1.015)

Front 25

A high specific gravity indicates?

Back 25

concentrated urine. (greater than 1.025)

Front 26

pH of urine is normally?

Back 26

4.5 –8.0
Changes seen with acid base imbalances. Values will increase with urinary tract infections and if the specimen is old (ammonia – a base, is produced).

Front 27

The renal threshold for blood sugar in the urine is?

Back 27

160-180 mg/dl.

Front 28

What are possible causes of high glucose in the urine?

Back 28

1 Pregnancy
2 endocrine
3 renal problems can lower the renal threshold – thus
glucose spills over more easily.

Front 29

Ketones are?

Back 29

a product of fat metabolism.

Front 30

Possible causes of ketonuria include?

Back 30

1 DKA
2 starvation
3 fasting
4 vomiting
5 strenuous exercise
6 dehydration.

Front 31

Benign conditions that increase protein in urine are?

Back 31

1 stress
2 pregnancy
3 cold
4 fever
5 strenuous exercise
6 vaginal secretions.

Front 32

Non-benign conditions that increase protein in the urine are?

Back 32

1 hypertension
2 diabetes (renal damage)
3 post-renal infection (renal damage)
4 multiple myeloma (also serum protein elevated, A/G ratio abnormal, urine protein up, Bence-Jones proteins up).

Front 33

When bilirubin is present in the urine, it is usually due to?

Back 33

a hepatobiliary obstruction.

Front 34

UROBILINOGEN is normally resulted in the urine as?

Back 34

Negative to Trace

Front 35

When UROBILINOGEN is decreased or absent in the urine, it may be due to?

Back 35

hepatobiliary duct obstruction.

Front 36

When UROBILINOGEN is increased in the urine, it may mean?

Back 36

liver damage or hemolytic disease.

Front 37

If positive blood is in the urine it is usually what color?

Back 37

cloudy

Front 38

If the dipstick is positive for blood, urine should be examined microscopically in the lab for?

Front 39

Red Blood Cells (RBCs) in the urine could be caused by?

Back 39

1 urinary tract infection
2 pyelonephritis
3 glomerulonephritis
4 renal cancer
5 bladder cancer

Front 40

Myoglobin in the urine could be caused by?

Back 40

1 MI
2 trauma
3 crush injuries
4 or burns

Front 41

Hemoglobin in the urine could be caused by?

Back 41

1 transfusion reaction
2 sickle cell
3 DIC
4 hypertension

Front 42

Nitrites in the urine mean?

Back 42

bacteria are in urine.

Front 43

Bacteria is broken down into?

Back 43

urinary nitrites and nitrate.

Front 44

LEUKOCYTE ESTERASE reflects ?

Back 44

the presence of white blood cells.

Front 45

Positive LEUKOCYTE ESTERASE findings suggest?

Back 45

urinary tract infection.

Front 46

If bacteria are found in the urine, suspect?

Back 46

either your patient has a urinary tract infection or the specimen was contaminated.

Front 47

RBCs are normally negative in the urine. What result should cause concern?

Back 47

If >5

Front 48

If RBC >5, possible causes could be?

Back 48

1 pyelonephritis
2 renal trauma
3 tumor
4 kidney stones
5 cystitis
6 genitourinary malignancy

Front 49

At what WBC count in the urine do you suspect a UTI?

Back 49

If > 50, think urinary tract infection.

Front 50

If urine WBC is < 50, but positive, it is usually due to?

Back 50

1 exercise
2 fever
3 renal disease
4 urinary tract disease.

Front 51

EPITHELIAL CELLS are normal negative in the urine, but when present, in large to moderate amounts, think?

Back 51

possible acute tubular necrosis OR acute glomerulonephritis.

Front 52

CASTS are normally negative, but when present, may be due to?

Back 52

1 nephrotic syndrome
2 glomerulonephritis
3 kidney failure
4 renal malignancy.

Front 53

NORMAL URINE COLOR?

Back 53

Yellow to Amber

Front 54

NORMAL URINE CHARACTER ?

Back 54

Clear

Front 55

NORMAL URINE SPECIFIC GRAVITY ?

Back 55

1.015-1.025
is the weight of urine. A low specific gravity indicates dilute urine and a high specific gravity indicates concentrated urine.

Front 56

NORMAL URINE pH ?

Back 56

4.5 –8.0

Front 57

NORMAL URINE GLUCOSE ?

Back 57

Negative

Front 58

NORMAL URINE KETONES ?

Back 58

Negative

Front 59

NORMAL URINE BILIRUBIN ?

Back 59

Negative

Front 60

NORMAL URINE UROBILINOGEN ?

Back 60

Negative to Trace

Front 61

NORMAL URINE BLOOD ?

Back 61

Negative

Front 62

NORMAL URINE NITRITE?

Back 62

Negative

Front 63

NORMAL URINE LEUKOCYTE ESTERASE?

Back 63

Negative

Front 64

NORMAL URINE BACTERIA ?

Back 64

Negative

Front 65

NORMAL URINE RBCs (RED BLOOD CELLS?

Back 65

Negative

Front 66

NORMAL URINE WBCS (WHITE BLOOD CELLS?

Back 66

Negative

Front 67

NORMAL URINE CASTS ?

Back 67

Negative

Front 68

NORMAL URINE EPITHELIAL CELLS ?

Back 68

Negative.

Front 69

If urine is cloudy or hazy instead of normally clear, it may be due to?

Back 69

white blood cells, bacteria, fecal contamination, prostatic fluid, or vaginal secretions.

Front 70

If the dipstick is positive for blood, urine should be examined microscopically in the lab for?

Back 70

(1) Red Blood Cells
(2) Myoglobin
(3) Hemoglobin

Front 71

NORMAL URINE EPITHELIAL CELLS ?

Back 71

Negative.

Front 72

Troponin I will remain elevated for?

Back 72

up to 5 to 10 days

Front 73

Troponin T will remain elevated for?

Back 73

up to 2 weeks

Front 74

Troponins will begin to increase following MI within___ hours?

Back 74

Troponins will begin to increase following MI within 3 to 12 hours, about the same time frame as CK-MB. However, the rate of rise for early infarction may not be as dramatic as for CK-MB.

Front 75

Troponins?

Back 75

Troponin I and T are structural components of cardiac muscle. They are released into the bloodstream with myocardial injury. They are highly specific for myocardial injury--more so than CK-MB--and help to exclude elevations of CK with skeletal muscle trauma.

Front 76

However, this continued elevation of Troponin T has the disadvantage because?

Back 76

However, this continued elevation has the disadvantage of making it more difficult to diagnose reinfarction or extension of infarction in a patient who has already suffered an initial MI.

Front 77

Which troponin lacks specificity?
Why?

Back 77

Troponin T lacks some specificity because elevations can appear with skeletal myopathies and with renal failure

Front 78

Myoglobin?

Back 78

protein found in skeletal and cardiac muscle which binds oxygen.
It's very sensitive indicator of muscle injury. However, it is not specific for cardiac muscle, and can be elevated with any form of injury to skeletal muscle. The rise in myoglobin can help to determine the size of an infarction. A negative myoglobin can help to rule out myocardial infarction. It is elevated even before CK-MB.

Front 79

Creatine Kinase - Total?

Back 79

The total CK is a simple and inexpensive test that is readily available using many laboratory instruments. However, an elevation in total CK is not specific for myocardial injury, because most CK is located in skeletal muscle, and elevations are possible from a variety of non-cardiac conditions.

Front 80

Creatine Kinase - MB Fraction
Peaks?
Rises?
Sensitivity?

Back 80

increase within 3 to 4 hours of myocardial necrosis, then peak in a day and return to normal within 36 hours.
It is less sensitive than troponins.

Front 81

Can Creatine Kinase - MB Fraction be used for subsequent MI's?

Back 81

The CK-MB is also useful for diagnosis of reinfarction or extensive of an MI because it begins to fall after a day, so subsequent elevations are indicative of another event.

Front 82

BNP

Back 82

B-type natriuretic peptide amino acid polypeptide secreted by the ventricles of the heart in response to excessive stretching of heart muscle cells (cardiomyocytes).

Front 83

BNP value of concern?

Back 83

For patients with CHF, BNP values will generally be above 100 pg per milliliter; however, a more conservative interpretation of the BNP is that normal values are less than 50 pg per milliliter

Marker for HF

Front 84

BNP is released from ventricular myocardium. BNP release can be stimulated by?

Back 84

1 systolic and diastolic left ventricular dysfunction
2 acute coronary syndromes, 3 stable coronary heart disease
4 valvular heart disease
5 acute and chronic rt ventricular failure, and left and right ventricular hypertrophy secondary to arterial or pulmonary hypertension.
BNP is a marker for heart failure.

Front 85

CRP

Back 85

C-reactive protein (CRP) is an acute phase protein elevated when inflammation is present. Since inflammation is part of atheroma formation, then CRP may reflect the extent of atheromatous plaque formation and predict risk for acute coronary events. However, CRP lacks specificity for vascular events.

Front 86

The 3 CK isoenzymes are?

Back 86

The three isoenzymes are designated MM, MB and BB.

Front 87

The classic patterns enzymes may not be elevated very early in the course of the AMI. Therefore, you should?

Back 87

not depend on one set of enzyme determinations but must order a sequence of test over several days. The initial enzyme determination in the ER may be normal.

Front 88

The total CK will begin to rise in?

Back 88

4-6 hours after the onset of the infarct

Front 89

The total CK will reach peak levels within ____hrs?

Back 89

24 hours.

Front 90

The CK-MB level rises?

Back 90

within 4-6 hrs

Front 91

The CK MB disappears in about?

Back 91

72 hours and gradually disappear over 7-4 days post MI.

Front 92

What do the levels of enzymes LDH-1 and LDH-2do?

Back 92

"flip" or reverse in AMI. Normally, the LDH level is less than the LDH-2 level. AST(SGOT) levels rise within the first 24 hours and disappear in 3-4 days.

Front 93

the LDH flip generally returns to normal in?

Back 93

Returns to baseline in 8-12 days

Front 94

Ischemia on EKG?

Back 94

elevated ST segment

Front 95

Injury on EKG?

Back 95

inverted t

Front 96

Infarct on EKG?

Back 96

new significant Q wave

Front 97

Mangement strategy when you suspect that the patient may have Myocardial infarction in the Emergency room

Back 97

•Oxygen by NC
•Sublingual Nitroglycerine
•Adequate analgesia Morphine
•Aspirin 160-325 mgm
•12 lead EKG
•Draw baseline Cardiac Enzyme markers
•Limit activities
•Use of Heparin, Beta blocker, ACE inhibitor
•Admit patient to ICU
•Abort the infarct
oDecide on early reperfusion strategy with Cardiology consultation and do it.