Physical Examination Of Urine

Front 1

What are normal variations of color caused by?

Back 1

Normal metabolic functions, physical activity, ingested materials, and pathologic conditions.

Front 2

What are abnormal variations of urine color caused by?

Back 2

Bleeding, liver disease, and infection.

Front 3

Urochrome

Back 3

Pigment that gives urine it's yellow color.

Front 4

What is urochrome a product of?

Back 4

Endogenous metabolism.

Front 5

Amount of urochrome is dependent on:

Back 5

Body's metabolic state.

Front 6

Urochrome is excreted at a _________ rate.

Back 6

Constant.

Front 7

What other pigments are found in urine?

Back 7

Uroerythrin and urobilin. Found in older specimens.

Front 8

Cause of colorless urine

Back 8

Recent fluid consumption, only observed with random specimens.

Front 9

Urochrome is increased with:

Back 9

Thyroid disorders and fasting, when specimen sits at room temp.

Front 10

What is urochrome a normal bi product of?

Back 10

RBC destruction.

Front 11

Uroerythrin

Back 11

Pink pigment. Attached to amorphous urates formed in refrigerated specimens.

Front 12

Urobilin

Back 12

Oxidation of normal constituent. Orange brown color in older specimens.

Front 13

Amorphous urates

Back 13

Crystals formed when refrigerated.

Front 14

Dark yellow and Amber urine

Back 14

Normal = concentrated

Abnormal = bilirubin

Bilirubin is suspected if yellow foam appears when specimen is shaken.

Front 15

What can bilirubin possibly indicate?

Back 15

Possibly hepatitis virus present.

Front 16

White foam in urine

Back 16

Indicates increased concentration of proteins.

Front 17

Yellow orange urine can indicate:

Back 17

Photo oxidation of large amounts of urobilinogen. No yellow foam when shaken.

Front 18

Photooxidation of bilirubin produces:

Back 18

Yellow green urine cause by presence of biliverdin.

Front 19

What can cause a thick orange pigment and yellow foam?

Back 19

Phenazopyridine (pyridium) or Azo-Gantrisin for UTI. Produces yellow foam.

Front 20

Common cause of red urine

Back 20

Blood.

Front 21

Variations of red urine

Back 21

Pink = small amount of blood

Brown = oxidation of hemoglobin to methmeglobin

Front 22

Methmeglobin in urine

Back 22

RBCs remaining in acid urine. Fresh brown specimen can indicate glomerular bleeding.

Front 23

Cloudy red urine

Back 23

RBCs.

Front 24

Clear red urine

Back 24

Hemoglobin or myoglobin.

Front 25

Hemoglobin in urine

Back 25

In vivo lysis of RBCs. Consider in vitro lysis and specimen handling. Plasma will appear red.

Front 26

Myoglobin

Back 26

Breakdown of skeletal muscle, fresh urine is often more reddish/brown, patient's plasma is clear.

Front 27

Port wine colored urine

Back 27

Oxidation of porphobilogen to porphyrins.

Front 28

Non pathogenic red urine

Back 28

Menstrual contamination, pigmented foods, and medications such as rifampin and pheno compounds. Fresh beets and black raspberries in acid urine.

Front 29

What can occur in genetically susceptible persons eating fresh beets?

Back 29

Red alkaline urine.

Front 30

Additional testing is recommended for: (black and brown)

Back 30

Turn black after standing at room temp and test negative for blood.

Front 31

Melanin

Back 31

Excess in malignant melanoma and oxidation of melanogen to melanin. Can cause black urine.

Front 32

Homogentisic acid

Back 32

Black color in alkaline urine.

Front 33

Medications that make urine black

Back 33

Levodopa, phenol derivatives, and flagyl.

Front 34

Cause of blue/green urine

Back 34

Urinary and intestinal infections. Urinary: pseudomonas. Intestinal: infection causing increased urinary Indican oxidizing to indigo blue.

Front 35

What color do catheter bags cause urine to be?

Back 35

Purple from Klebsiella, providencia, and Indican.

Front 36

What medications cause urine to be green?

Back 36

Clorets.

Front 37

What medications cause urine to be blue?

Back 37

Robaxin, methylene blue, and ampitriptyline.

Front 38

Clarity

Back 38

Refers to the transparency or turbidity. Hold up to source of light. View against white background. Maintain adequate room lighting. Evaluate consistent volume.

Front 39

Normal clarity of urine

Back 39

Clear, hazy, cloudy, turbid, and milky.

Front 40

Visual exam of urine

Back 40

Gently swirl in clear container in front of a good light source.

Front 41

Clear urine

Back 41

No visible particulates.

Front 42

Hazy urine

Back 42

Few particulates, print easily seen through urine.

Front 43

Cloudy urine

Back 43

Many particulates, print blurred through urine.

Front 44

Turbid urine

Back 44

Print cannot be seen through urine.

Front 45

Milky urine

Back 45

May precipitate or be clotted.

Front 46

Non pathogenic turbidity

Back 46

1. Hazy female specimens with squamous epithelial cells and mucous.

2. Bacterial growth in non preserved specimens

3. Refrigerated specimens with precipitated amorphous phosphates and urates.

4. Contamination: fecal, talc, semen, vaginal creams, IV contrast media.

Front 47

Most common pathological causes of turbidity

Back 47

RBCs, wbcs, and bacteria. Also: epithelial cells, yeast, crystals, lymph fluid, and lipids.

Front 48

What should turbidity correspond to?

Back 48

Amount of material observed in the microscopic exam.

Front 49

Specific gravity evaluation

Back 49

Evaluation of urine concentration. Determines if specimen is concentrated enough to provide reliable screening results.

Front 50

Specific gravity and SG of distilled water

Back 50

Density of a solution compared with the density of an equal volume in distilled water at the same temp. 1.0000

Front 51

Isothenuric

Back 51

SG of 1.010.

Front 52

Hypothenuric

Back 52

SG lower than 1.010.

Front 53

Normal random specimen SG range

Back 53

1.003 to 1.035. Most common 1.015 to 1.025. Below 1.003 May not be urine.

Front 54

Direct methods to measure SG

Back 54

Urinometer and harmonic oscillation densiometry.

Front 55

Indirect methods of measuring SG

Back 55

Refractometer and chemical reagent strip (dipstick). <----- Most common.

Front 56

Refractometer

Back 56

Measures velocity of light in air versus velocity of light in a solution.

Front 57

What changes the velocity and angle at which the light passes through the solution?

Back 57

Concentration

Front 58

Prism the refractometer determines:

Back 58

Angle that light is passing through the urine and converts angle to calibrated viewing scale.

Front 59

Advantages of a refractometer

Back 59

Temp compensation not needed. Light passes through temp compensating liquid. Compensated between 15-38 Celsius. Small specimen size: one or two drops.

Front 60

Subtraction of protein and glucose.

Back 60

Subtract 0.003 for each gram of protein present. Subtract 0.004 for each gram of glucose present.

Front 61

Methodology of refractometer

Back 61

Drop of urine places on prism. Focus on light source and read. Wipe off prism between specimens. Calibration: distilled water should read 1.000. 5% NaCl should read 1.022. 9% sucrose should read 1.034.

Front 62

Abnormally high results of SG

Back 62

Greater than 1.040. Radiographic contrast media. Dextran and other IV expanders. Check patients clinical history. Reagent strip readings and osmometry are not affected by high molecular weight substances.

Front 63

What is osmolality affected by?

Back 63

Only affected by number of particles present. Primarily small molecules. A more representative measure of renal concentrating ability.

Front 64

Substances of interest in SG

Back 64

Urea, sodium, and chloride.

Front 65

Unit of measure in lab for osmolality

Back 65

Milliosmoles.

Front 66

Osmolality of a solution can be determined by:

Back 66

Measuring a property that is mathematically related to the number of particles in the solution.

Front 67

Changes in colligative properties (osmolarity)

Back 67

Lower freezing point, higher boiling point, increased osmotic pressure, and lower vapor pressure.

Front 68

Measuring osmolarity requires:

Back 68

Requires osmometer. Automated osmometers utilize freezing point depression to measure osmolality.

Front 69

Reagent strip SG reaction

Back 69

Reaction based on pka (dissociation constant) of a poly electrolyte in an alkaline medium.

Front 70

The more hydrogen ions released, the ______ the ph.

Back 70

Lower.

Front 71

What indicator on reagent pad measures change in ph?

Back 71

Bromothymol-LS blue.

Front 72

What does ph indicator change from in reagent strip?

Back 72

Blue (1.000 alkaline) through shades of green to yellow (1.030 acid).

Front 73

Odor of fresh and older urine

Back 73

Fresh: faintly aromatic

Older: ammonia

Front 74

Aromatic urine

Back 74

Normal

Front 75

Aromatic urine

Back 75

Normal

Front 76

Foul/Ammonia smell

Back 76

Bacterial decomposition, uti

Front 77

Fruity smell

Back 77

Ketones

Front 78

Maple syrup smell

Back 78

Maple syrup disease

Front 79

Maple syrup smell

Back 79

Maple syrup disease

Front 80

Mousy smell

Back 80

Phenylketonuria

Front 81

Maple syrup smell

Back 81

Maple syrup disease

Front 82

Mousy smell

Back 82

Phenylketonuria

Front 83

Rancid smell

Back 83

Tyrosinemia

Front 84

Maple syrup smell

Back 84

Maple syrup disease

Front 85

Mousy smell

Back 85

Phenylketonuria

Front 86

Rancid smell

Back 86

Tyrosinemia

Front 87

Sweaty feet smell

Back 87

Isovaleric acidemia

Front 88

Maple syrup smell

Back 88

Maple syrup disease

Front 89

Mousy smell

Back 89

Phenylketonuria

Front 90

Rancid smell

Back 90

Tyrosinemia

Front 91

Sweaty feet smell

Back 91

Isovaleric acidemia

Front 92

Cabbage smell

Back 92

Methionine malabsorbtion

Front 93

Maple syrup smell

Back 93

Maple syrup disease

Front 94

Mousy smell

Back 94

Phenylketonuria

Front 95

Rancid smell

Back 95

Tyrosinemia

Front 96

Sweaty feet smell

Back 96

Isovaleric acidemia

Front 97

Cabbage smell

Back 97

Methionine malabsorbtion

Front 98

Bleach smell

Back 98

Contamination