Urinalysis and Body Fluids

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ncrook
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216336
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Urinalysis and Body Fluids
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2013-05-03 00:56:39
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Urine Screening Tests Body Fluids Fecal Analysis
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Urine Screening Tests, Body Fluids and Fecal Analysis
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  1. What test is used to test for the presence of phenylalanine
    Phenylalanine indicates defective metabolic conversion of phenylalanine to tyrosine, which is caused by a genetic failure to produce phenylalanine hydrolase
    If undetected will result in sever mental retardation
    Phenylketonuria (PKU)
  2. What type of PKU test:
    Uses blood from a heel stick
    Blood is placed on filter paper disks on culture media streaked with Bacillus subtilis
    If phenylalanine is present, beta-2-thienylalanine in the media (an inhibitor of B. subtilis) will be counteracted, and there will be growth of B. subtilis around the disks
    Guthrie bacterial inhibition test
  3. What type of PKU test:
    Is a urine test
    Uses ferric chloride (positive is blue-green)
    Urine test for phenylpyruvic acid
  4. What type of PKU test:
    Directly measures phenylalanine in dried blood filter disks
    Is quantitative test
    Not affected by antibiotics
    Microfluorometric assay
  5. What special screening/confirmaotry test is used for:
    Tyrosinosis - Excess tyrosine or its by products in the urine
    Inherited or metabolic defects
    Associated with transitory tyrosinemia premature infants with an underdeveloped liver, and acquired severe liver disease
    • Screening test: nitrosonaphthol test
    • Confirmatory test: Chromatography
  6. What special screening test is used for:
    Alkaptonuria - a genetic defect resulting in failure to produce homogentisic acid oxidase, which causes an accumulation of homogentisic acid in blood and urine
    Produces a brown pigment deposits in the body tissue that can lead to arthritis, liver, and cardiac problems
    • Ferric chloride tube test
    • Benedict's test
    • Alkalization of fresh urine
  7. What screening test is used for:
    Melanuria - increased melanin in the urine that is produced from tyrosine (urine darkens upon standing)
    Indicates malignant melanoma
    • Ferric chloride test
    • Sodium nitroprusside
  8. What screening test is used for:
    Maple Syrup urine disease - caused by low levels of branched-chained keto acid decarboxylase - which inhibits metabolism of leucine, isoleucine, and valine
    Characteristic of this disorder is the maple syrup smell of the urine, breath, and skin
    If untreated, causes severe mental retardation, convulsion, acidosis, hypoglycemia
    Death occurs within a year
    2,4-dinitrophenylhydrazine (DNPH)
  9. How is CSF made?
    • CSF is made by the brain's third choroid plexus as an ultrafiltrate of plasma
    • 20 mL of CSF is produced each hour
  10. What is the function of CSF?
    • Supplies nutrients to nervous tissue
    • Removes waste
    • Cushions the brain and spinal cord against trauma
  11. What is the total CSF volume for adults and neonates?
    • Adult volume: 140-170 mL
    • Neonates: 10-60 mL
  12. Where is a CSF sample taken from?
    Lumbar puncture performed between 3-4 or 4-5 lumbar vertebrae
  13. What is the order of draw and which tubes go to which department?
    • Tube 1: Chemistry and Serology (Hematology may also get this tube to compare with Tube 3 for a traumatic tap)
    • Tube 2: Microbiology
    • Tube 3: Hematology
  14. What is the normal values for CSF testing?
    • Clear and colorless
    • CSF protein: 15-45 mg/dL
    • CSF glucose: 60-70% of patient's plasma glucose
    • Cell count: 0-5 WBC/micro-L (lymphs and monos predominate)
    • Microbiology: No growth
  15. What condition has the following CSF results:
    Cloudy/Turbid
    CSF protein: 100-500 mg/dL
    CSF glucose: Decreased
    CSF WBC Count: >50,000/micro-L
    Cell type: 90% Segs
    Bacterial Meningitis
  16. What condition has the following CSF results:
    Clear and colorless
    CSF protein: 30-100 mg/dL
    CSF glucose: Normal (60-70% of patient's plasma glucose)
    CSF WBC Count: Slightly increased
    Cell type: Lymphs
    Viral Meningitis
  17. What condition has the following CSF results:
    Clear and colorless
    CSF protein: 25-50 mg/dL
    CSF glucose: Normal
    CSF WBC Count: <25/micro-L
    Cell type: Mononuclear
    Multiple Sclerosis
  18. What can a cloudy CSF indicate?
    • WBCs
    • RBCs
    • Protein
    • Bacteria
    • (Meningitis, Hemorrhage, Disorders of the blood-brain barrier, etc...)
  19. What can a bloody CSF indicate?
    • Subarachnoid hemorrhage
    • Traumatic tap
    • Differentiation is made by comparing Tube 1 and Tube 3
  20. What can a xanthochromic CSF indicate?
    • Increased hemoglobin
    • Bilirubin
    • Protein
    • Immature liver in premature infants
  21. What can an increased Lymphs in CSF indicate?
    • Viral meningitis
    • Fungal meningitis
  22. What can increased PMNs (neutrophils) in CSF indicate?
    Bacterial meningitis (cerebral abscess)
  23. What can early cell forms of any cell lines in CSF indicate?
    Acute leukemia
  24. What can Plasma cells in CSF indicate?
    • Multiple sclerosis
    • Lymphocytic reactions
  25. In microbiology, what test can be performed to detect Crytococcus neoformans?
    India ink
  26. What does India ink detect in CSF?
    Cryptococcus neoformans
  27. What does finding Cryptococcus neoformans in CSF indicate?
    Possible complication of AIDS
  28. Why is seminal fluid analysis performed?
    Evaluation of infertility, post-vasectomy, and forensic medical cases
  29. How long should a patient be abstinent before submitting for fertility studies?
    Minimum of 3 days
  30. What are the normal values of a semen fertility test?
    Volume
    Viscosity
    Appearance
    pH
    Count
    Motility
    Morphology
    • Volume: 2-5 mL
    • Viscosity: No clumps or strings (must have liquified within 30-60 min)
    • Appearance: translucent, gray-white color
    • pH: 7.2-8.0
    • Sperm Count: 20-160 million/mL
    • Motility: 50-60% with a grade of 2 (grade of 4 is motile with strong forward progression)
    • Morphology: Oval shaped head with long, flagellar tail
  31. What does a pH >8.0 in a sperm indicate?
    Infection
  32. What is an abnormal sperm count?
    • Borderline: 10-20 million/mL
    • Sterile: <10 million/mL
  33. Name some abnormal sperm morphology?
    • Double heads
    • Giant heads
    • Amorphous heads
    • Pinheads
    • Double tails
    • Coiled tails
  34. What else is abnormally significant find in sperm?
    The presence of RBCs or WBCs would be significant
  35. What is plasma ultrafiltrate and is often called joint fluid?
    Synovial fluid
  36. What is the function of synovial fluid?
    • Lubricant
    • Nutrient transport to articular cartilage
  37. What is gastric analysis used for?
    Toxicology and for diagnosis of Zollinger-Ellison syndrome
  38. What is the function of amniotic fluid?
    Protective fluid surrounding the fetus
  39. What is the term for neddle aspiration of the protective fluid surrounding the fetus called?
    Amniocentesis
  40. Why is amniocentesis performed?
    • Bilirubin
    • Fetal bleeding
    • Infection
    • Fetal lung maturity
    • Meconium (dark green fetal intestinal secretions) - associated with meconium aspiration syndrome
  41. How is the differentiation of the presence of blood vs bilirubin in amniotic fluid be achieved?
    Measuring for increased absorbance at 410nm (bilirubin) and 450nm (hgb)
  42. What in amniotic fluid increases as fetus's lungs mature?
    Levels of phospholipids
  43. Where is peritoneal fluid found?
    Clear-pale yellow fluid contained between the parietal and visceral membranes in the peritoneum (abdomen and pelvis)
  44. Where is pleural fluid found?
    Around the lungs
  45. Where is pericardial fluid found?
    Around the heart
  46. What is the term for increased volumes in peritoneal, pleural, or pericardial fluids called?
    Effusions
  47. What is it called when:
    Increase in fluid volume is noninflammatory
    <1000 cells/micro-L
    < 3g/dL protein
    Transudate
  48. What is it called when:
    Increase in fluid volume is inflammatory
    >1000 cells/micro-L
    >3 g/dL protein
    Exudates
  49. What conditions is fecal analysis testing for?
    • GI bleeding
    • Liver and biliary duct disorders
    • Malabsorption syndromes
    • Infections
  50. What does black/tarry stools indicate?
    • Upper GI bleeding
    • Iron therapy
  51. What does a red stool indicate?
    Lower GI bleeding
  52. What does steatorrhea in stool indicate?
    Fat malabsorption
  53. What does diarrhea indicate?
    Watery fecal material
  54. What does ribbon-like stools indicate?
    • Bowel obstruction
    • Hemorrhoids
  55. What does mucus in a stool indicate?
    Inflammation of the intestinal wall (colitis)
  56. What does a clay-colored, pale stool indicate?
    • Bile duct obstruction
    • Obstructive jaundice
  57. What is the fecal leukocyte test used to perform?
    • Determine cause of diarrhea
    • Neutrophils: bacterial infections, ulcerative colitis, abscesses
    • No Neutrophils: toxin producing bacteria, viruses, and parasites
  58. Why is a qualitative fecal fat analysis performed?
    • Detects fat malabsorption disorders by staining fecal fats with Sudan III or Oil Red O
    • Increased fecal fat (>60 droplets/hpf) is suggestive of steatorrhea
  59. Why is the test for muscle fibers in stools performed?
    • Look for undigested striated muscle fibers
    • May indicate pancreatic insufficiency seen in cystic fibrosis
  60. Why is the test for occult blood performed?
    Used for early detection of colorectal cancer
  61. What are the chemicals used on the occult blood?
    • Ortho-toluidine
    • Gum guaiac
  62. What DNA test is associated with colorectal cancer?
    DNA test that detects K-ras mutation

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