Term
Where are all proteins synthesized? |
|
Definition
All in the liver except gamma globulins (B cells) |
|
|
Term
: separates proteins based on their electric charge properties; Cations [(+) net charge] migrate toward the cathode (negative terminal) while anions [(-) net charge] migrate toward the anode (positive terminal) |
|
Definition
Serum protein electrophoresis |
|
|
Term
MC screening test for protein abnormalities? Next most common? |
|
Definition
specific total protein and albumin measurements. Next is serum protein electrophoresis. |
|
|
Term
What 5 proteins can be identified on serum protein electrophoresis? |
|
Definition
Albumin, Alpha-1 globulin, Alpha-2 globulin, Beta, Gamma |
|
|
Term
What percentage of colloid osmotic pressure and total serum protein level are caused by albumin? |
|
Definition
80% of colloid osmotic and 60% of total serum protein level. |
|
|
Term
What causes a decreased albumin? Increased? |
|
Definition
Decreased = liver dz, renal dz, malnutrition, malabsorption syndromes, muscle wasting dz. Increased = dehydration. |
|
|
Term
What is a sensitive marker of inadequate dietary protein intake? |
|
Definition
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|
Term
What protein carries T3/T4 when complexed with retinol binding protein and also carries vit A? |
|
Definition
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|
Term
What condition is associated with degenerative emphysema in young patients that do not smoke? |
|
Definition
Alpha-1 Antitrypsin deficiency |
|
|
Term
:it is speculated that this protein protects the fetus from “attack” by the mother’s immune system. |
|
Definition
|
|
Term
What is used as a marker for prostate and liver cancer? |
|
Definition
|
|
Term
What can result from elevated AFP? |
|
Definition
neural tube defects in the fetus, atresia of the GI tract and fetal distress. |
|
|
Term
What can result from low AFP? |
|
Definition
Down's syndrome and trisomy 18 |
|
|
Term
:acute-phase reactant; it binds to free Hgb to prevent the loss of Hgb and iron from the kidneys; made by liver and RES |
|
Definition
|
|
Term
:acute-phase reactant; contains > 90% of the total serum copper |
|
Definition
|
|
Term
:inhibits a variety of protease enzymes (trypsin, pepsin, plasmin); made by liver |
|
Definition
|
|
Term
What results from a low ceruloplasmin? |
|
Definition
Wilson's disease - copper is deposited in brain, liver and skin). |
|
|
Term
:transports iron and prevents loss of iron through the kidneys; made by liver |
|
Definition
|
|
Term
:removes circulating heme and porphyrins; made by liver |
|
Definition
|
|
Term
What condition could lead to an increased hemopexin? |
|
Definition
|
|
Term
What condition leads to increased compliment? Decreased? |
|
Definition
Increased = inflammation. Decreased = SLE. |
|
|
Term
:acute-phase reactant; forms fibrin clot; one of the largest proteins in plasma |
|
Definition
|
|
Term
What condition will cause a decreased fibrinogen? |
|
Definition
|
|
Term
:acute-phase reactant; facilitates complement coating (opsonization); Can be used in place of a sed rate; commonly assayed as part of the risk assessment for CV dz |
|
Definition
|
|
Term
What percentage of plasma proteins are immunoglobulins? |
|
Definition
|
|
Term
Which immunoglobulin is increased with liver dz, autoimmune dz and infection? |
|
Definition
|
|
Term
Which immunoglobulin is increased with liver dz, infxns, conn. tissue disorders, and multiple myeloma? |
|
Definition
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|
Term
Which immunoglobulin is increased with asthma, allergic rhinitis, parasitic infxns? |
|
Definition
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|
Term
Which immunoglobulin is increased with increased in liver dz, infxns, and collagen dz; and is the most abundant? |
|
Definition
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|
Term
Which immunoglobulin is the first to appear in the immune response to a foreign Ag? |
|
Definition
|
|
Term
:An inhibitory protein found in cardiac muscle only; binds calcium permitting contraction of the heart muscle; increased in acute MI |
|
Definition
|
|
Term
How will dehydration, vomiting, diarrhea, excessive sweating, Diabetes Insipidus, and DKA affect protein levels? |
|
Definition
They cause increased protein. |
|
|
Term
How do renal dz, liver dz, burns, bleeding, GI dz, fever, malignancy, chronic dz, chronic inflammation, and hyperthyroidism affect protein levels? |
|
Definition
They decrease protein levels |
|
|
Term
What is the most common total protein measuring procedure? |
|
Definition
|
|
Term
What 2 hormones are responsible for monitoring sodium? |
|
Definition
|
|
Term
What are some S&S of hypernatremia? |
|
Definition
tremors, irritability, ataxia, confusion and coma. |
|
|
Term
What is the cause of hypovolemic hypernatremia? |
|
Definition
|
|
Term
What are some causes of euvolemic hypernatremia? |
|
Definition
|
|
Term
What are some causes of hypervolemic hypernatremia? |
|
Definition
Hypertonic saline tx, sodium bicarbonate tx, hyperaldosteronism and Cushing's syndrome. |
|
|
Term
What are the S&S of hyponatremia? |
|
Definition
nausea,weakeness and mental confusion. |
|
|
Term
What are the causes of hypovolemic hyponatremia? |
|
Definition
fluid loss, thiazide diuretics, K-depletion in cells and aldosterone deficiency. |
|
|
Term
What are the causes of euvolemic hyponatremia? |
|
Definition
SIADH, severe hyperglycemia, polydipsia, diuretics and hypothyroidism. |
|
|
Term
What are the causes of hypervolemic hyponatremia? |
|
Definition
SIADH, CHF, cirrhosis, overhydration, and renal failure. |
|
|
Term
How is potassium regulated? |
|
Definition
|
|
Term
What is the most common drug that causes hyperkalemia? |
|
Definition
|
|
Term
What are the S&S of hyperkalemia? |
|
Definition
muscle weakness and cardiac arrhythmias |
|
|
Term
What is the most common cause of hypokalemia? What else can commonly cause it? |
|
Definition
diuretics, also caused by insulin. |
|
|
Term
What is the major cause of a low anion gap? |
|
Definition
|
|
Term
What are the major causes of a high anion gap? |
|
Definition
MUDPILES: Methanol Uremia DKA Paraldehyde Iron Lactic acidosis Ethanol Salicylates/Starvation |
|
|
Term
How do GH, ACTH, Cortison and Thyroid hormones affect plasma glucose levels? |
|
Definition
|
|
Term
How are urine ketones detected in urine? |
|
Definition
Detected by serum acetone test |
|
|
Term
:> 50% mortality; profound dehydration (loss of 10-11 L) and marked hyperglycemia (1000-1500) |
|
Definition
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|
Term
Which test reveals the earliest sign of reversible renal disease? |
|
Definition
|
|
Term
What is the best way to test for microalbunuria? Most convenient way? |
|
Definition
Best = 24 hour urine microalbumin testing. Convenient = random urine void (preferably first morning void). |
|
|
Term
:nitrogen-containing metabolite of protein catabolism; made in liver, excreted in kidney |
|
Definition
|
|
Term
|
Definition
|
|
Term
What is Prerenal azotemia? |
|
Definition
decreased renal blood flow; CHF, shock, dehydration, increased protein breakdown, high protein diet, GI hemorrhage |
|
|
Term
|
Definition
|
|
Term
What is postrenal azotemia? |
|
Definition
|
|
Term
:toxic condition; high serum urea accompanied w/renal failure; You don’t see BUN early on; a high BUN means there is severe kidney dz; whereas the creatinine shows up earlier |
|
Definition
|
|
Term
What are some causes of a high BUN/Creatinine ratio? |
|
Definition
|
|
Term
What are some causes of low BUN/creatinine ratios? |
|
Definition
acute tubular necrosis, low protein intake, starvation, liver dz |
|
|
Term
What could cause both the BUN and Creatinine to be elevated? |
|
Definition
post-renal obstruction or pre-renal azotemia superimposed on kidney dz |
|
|
Term
:Genetic defect of low LDL/HDL; Absent LDL w/low cholesterol will be detected in infancy (failure to thrive), steatorrhea, CNS degeneration, malabsorption of fats and vitamins |
|
Definition
|
|
Term
:increased accumulation of cholesterol in tonsils, adenoids, and spleen |
|
Definition
Absent HDL (Tangier's Dz). |
|
|
Term
Where is cholesterol made? What transports it? |
|
Definition
Made in liver and intestine and transported by LDL and HDL. |
|
|
Term
Where are triglycerides made? What transports them? |
|
Definition
Made in the liver, transported by chylomicrons and VLDL. |
|
|
Term
What binds to bilirubin to make it conjugated? |
|
Definition
|
|
Term
:positive test indicates presence of disease being investigated |
|
Definition
|
|
Term
:negative test indicates absence of disease being investigated |
|
Definition
|
|
Term
What biomarker is elevated in Reye's syndrome, brain disorders, bladder, stroke, lung, prostate, colon, seizure or shock conditions and is the fastest CK? |
|
Definition
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|
Term
Which biomarker is the 2nd fastest CK and is seen with cardiac conditions, and increases in 4-6 hours, peaks after 12-24 hours and normalizes at 2-3 days? |
|
Definition
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|
Term
Which CK makes up 98-100% of total CK and is the 3rd fastest CK and is elevated with any muscle disorder, malignant hyperthermia, post-physical activity, post-intramuscular injection? |
|
Definition
|
|
Term
Which form of LDH is in mitochondria (heart, RBCs, kidneys), 24-40% of total serum LDH? |
|
Definition
|
|
Term
Which form of LDH is the major form in serum, 35-46% of total serum LDH? |
|
Definition
|
|
Term
Which form of LDH is in the platelets, lymph nodes, 17-33% of total serum LDH? |
|
Definition
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|
Term
Which form of LDH is major fraction in skeletal muscle and liver (6-17%) of total serum LDH? |
|
Definition
|
|
Term
How can you tell if the heart, RBCs or kidneys are damaged by looking at LDH? |
|
Definition
LD-1 will be greater than LD-2. |
|
|
Term
How can you tell if the skeletal muscle or liver is damaged by looking at LDH levels? |
|
Definition
LD-5 will be greater than LD-4 |
|
|
Term
What do high LDH levels in CSF indicate? |
|
Definition
It is high in 90% of bacterial infections and 10% of viral. |
|
|
Term
What are the LDH abnormalities seen with Megaloblastic anemia? |
|
Definition
|
|
Term
What LDH abnormalities are seen with Germ cell tumors? |
|
Definition
|
|
Term
What LDH abnormalities are seen with malignant diseases, liver disease, hypoxia, hyperthermia, CHF and renal disease? |
|
Definition
|
|
Term
What are the LDH abnormalities seen with ITP, mononucleosis, lymphomas and leukemias? |
|
Definition
|
|
Term
:works at an alkaline pH; moves substances across cell membrane, lipid transport in GI, calcifying process in bone; isoenzymes found in liver, bone, kidney, spleen, intestine, placenta. |
|
Definition
|
|
Term
Where is heat stable alk phos and non-heat stable alk phos found? |
|
Definition
Heat stable = liver. Non-heat stable = bone. "Bone burns and liver lasts" |
|
|
Term
When is alk phos levels highest? What else can cause it to be high? |
|
Definition
When there is osteoblast involvement (Paget's disease, bone cancer). Can also be high with hepatic obstruction. |
|
|
Term
:catalyzes the breakdown of glycogen and starch to sugar; Requires Ca and Cl; Readily filtered by kidneys; mostly found in salivary glands, then pancreas, ovaries, testes, tears, colostrum, lungs, adipose tissue |
|
Definition
|
|
Term
What kind of amylase is made by acinar cells; major digestion of starches? |
|
Definition
Pancreatic amylase (p-type) |
|
|
Term
What type of amylase is made by salivary glands in the mouth; neutralized by stomach pH? |
|
Definition
Salivary amylase (s-type) |
|
|
Term
What are some common causes of hyperamylasemia? |
|
Definition
Acute pancreatitis, cholecystitis, mumps, bowel obstruction, salivary gland inflmmation, and carcinomas (lung and ovary). |
|
|
Term
:Hydrolyzes ester linkage of triglycerides to produce glycerol and fatty acids; bile salts assist in emulsification (break down of fat); found in pancreas, tongue; Lipase and amylase are commonly ordered together for suspected pancreatitis, but lipase is more specific for pancreatic dz |
|
Definition
|
|
Term
What is the most common cause of hyperlipasemia? |
|
Definition
|
|
Term
:helps in amino acid synthesis and breakdown |
|
Definition
|
|
Term
What is an elevated ALT (Alanine aminotransferase) indicative of? |
|
Definition
|
|
Term
What is a decreased ALT indicative of? |
|
Definition
Hepatic obstruction disorders |
|
|
Term
What conditions can lead to an increased level of AST (Aspartate aminotransferase)? |
|
Definition
acute MI, muscular dystrophy and hepatic disorders |
|
|
Term
:transports amino acids through cell membrane; found in all cells except muscle; primarily ordered to evaluate liver, biliary system, kidneys |
|
Definition
GGT (Gamma glutamyltransferase) |
|
|
Term
What is a normal Gamma glutamyltransferase (GGT) and elevated ALP indicative of? |
|
Definition
|
|
Term
What is an elevated Gamma glutamyltransferase (GGT) and elevated ALP indicative of? |
|
Definition
liver or bile duct disease |
|
|
Term
What is a more sensitive of an indicator than ALP, ALT, AST for obstructive jaundice, cholecystitis & cholangitis (occurs earlier and persists longer)? |
|
Definition
Gamma glutamyltransferase (GGT) |
|
|
Term
What conditions can cause an elevated gamma glutamyltransferase (GGT)? False positive? |
|
Definition
Elevated with liver disease, pancreatitis, prostate malignancy and highest with hepat/biliary obstruction. Falsely elevated with anticonvulsant drugs. |
|
|
Term
:This panel assesses renal function as well as the serum glucose level. (glucose, BUN, Creatinine, Na+, K+, Cl-, CO2, anion gap) |
|
Definition
|
|
Term
:this panel assesses renal and liver function and provides a glucose level (glucose, BUN, Creatinine, GFR-nonblack, GFR-black, Na+, K+, Cl-, CO2, anion gap, Ca+, protein total, albumin, alk phos, AST, total bilirubin, ALT) |
|
Definition
|
|
Term
What does a lipid panel consist of? |
|
Definition
Cholesterol, Trigs, HDL, LDL and Chol/HDL ratio. |
|
|
Term
What does an electrolyte panel consist of? |
|
Definition
Na, K, Cl, CO2 and anion gap |
|
|
Term
What type of panel is this? (Albumin, total bilirubin, alk phos, AST, ALT, bilirubin direct and protein total. (GGT is not routinely included).) |
|
Definition
|
|
Term
What type of panel is this? (o albumin, Ca+, CO2, Cl-, Creatinine, glucose, phosphorus, K+, Na+, BUN, GFR-nonblack, GFR-black) |
|
Definition
|
|
Term
What kind of panel is this? (amylase (50-120 IU/L), lipase (10-150 IU/L), Ca+ (8.5-10.5 mg/dL), TGs (50-150 mg/dL), glucose (70-110 mg/dL)) |
|
Definition
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|
Term
What kind of panel is this? (ALT (5-35 IU/L), AST (10-34 IU/L), GGT (0-50 IU/L), albumin/total protein (3.4-5.5 and 6.0-8.5 mg/dL), total bilirubin and direct bilirubin (0.3-1.5 and 0-0.3 mg/dL), PT (11-14 sec), ALP 920-140 IU/L)) |
|
Definition
|
|
Term
What kind of panel is this? (troponin T/I (0-0.2 mcg/L), CK-MB (< 6% of total CK), total CK (30-150 IU/L), myoglobin (10-95 mcg/L for males; 10-65 mcg/L for females), LDH (70-180 IU/L)(flipped pattern: LD-1 > LD-2), AST (10-34 IU/L)) |
|
Definition
|
|
Term
:enzyme found in the prostate gland, bone, liver, spleen, kidney, RBCs, and platelets; Historically used as an aid in the dx of metastatic prostate Ca but PSA is now used, elevated with prostate cancer, BPH and post prostate surgery |
|
Definition
|
|
Term
Why does albumin not go through the glomerulus? |
|
Definition
It is small enough but its negative charge prevents it from going through. |
|
|
Term
What is the average daily urine output? |
|
Definition
|
|
Term
:Greatly reduced volume of urine; Commonly seen in states of dehydration resulting from water loss due to excessive vomiting, diarrhea, perspiration, or from severe burns |
|
Definition
|
|
Term
:can result from serious damage to kidneys or dec. in blood flow to the kidneys, lack of urine output |
|
Definition
|
|
Term
:Increase in daily output of urine; output >3L/day; Urine looks dilute but has a high osmolality |
|
Definition
|
|
Term
What does dark amber (beer brown) urine indicate? |
|
Definition
Presence of conjugated bilirubin |
|
|
Term
What does pink or red urine indicate? |
|
Definition
RBCs, Hgb, myoglobin, porphyrins; Intact cells give the specimen a CLOUDY appearance |
|
|
Term
What does black or brown urine indicate? |
|
Definition
Methemoglobin, Homogentisic acid or melanin (malignant melanoma) |
|
|
Term
What does dark orange urine indicate? |
|
Definition
can be caused by the cystitis drug Pyridium (phenazopyridine) or by rifampin |
|
|
Term
What is the normal urine chemstrip (dipstick) pH? |
|
Definition
|
|
Term
What is the best test to check for albumin in urine? |
|
Definition
|
|
Term
Which test is used to retest all specimens with a positive chemstrip result? What do they order if that test is positive? |
|
Definition
Sulfosalicylic acid (SSA) confirmatory test. If that test is positive then they order a 24 hour urine test to quantify the amount of protein being secreted per day. |
|
|
Term
What is ordered if a 24 hour urine test protein specimen is over 150 mg/day? |
|
Definition
A urine protein electrophoresis to detect proportions of albumin and other proteins. |
|
|
Term
What is the "spot" method of urinalysis useful for? |
|
Definition
Useful for detecting the albumin to creatinine ratio (which corrects for variations in concentration w/o doing a 24-hour collection) for a diabetic pt; used to detect microalbumin (a protein present in the urine but is not detectable by routine Chemstrip testing) in the urine to dx and follow diabetic nephropathy |
|
|
Term
What level of proteinuria is considered pathologic? What level is indicative of nephrotic syndrome? |
|
Definition
Pathologic = greater than 150 mg/day. Nephrotic syndrome = greater than 3.5g/day. |
|
|
Term
How are glucose test results reported? |
|
Definition
Negative, trace, 1 or greater than/equal to 2g/dL. Negative is normal. |
|
|
Term
:confirmatory test that’s performed if the glucose test is > Trace on the chemstrip; it detects all sugars (not just glucose); since it also detects galactose, it picks up inherited defect of galactosemia |
|
Definition
|
|
Term
How are ketones reported on urinalysis testing? |
|
Definition
Negative, trace, small, moderate or large |
|
|
Term
:confirmatory test for ketones in the urine if the chemstrip is > Trace. |
|
Definition
|
|
Term
:formed by the breakdown of Hgb in the spleen and RE cells and this Hgb is then attached to albumin and now called______? |
|
Definition
|
|
Term
When bilirubin is in the liver and it is conjugated with glucuronic acid, making it soluble in water it is called_______? |
|
Definition
|
|
Term
Much of the bilirubin goes into the bile and thus out into the small intestine; Some of the direct bilirubin remains in the large intestine and is metabolized by colonic bacteria to_______? |
|
Definition
|
|
Term
What gives urine its brown color? |
|
Definition
|
|
Term
What gives feces its brown color? |
|
Definition
|
|
Term
:kind of bilirubin formed from Hgb breakdown; never found in urine since it’s insoluble |
|
Definition
Unconjugated (indirect) bilirubin |
|
|
Term
:confirmatory test that detects direct bilirubin in urine; shake test is first test performed by lab techs to detect direct bilirubin in urine, where the specimen is shaken vigorously and yellow foam (like beer head) forms if present |
|
Definition
|
|
Term
What are the 3 most common causes of bilirubinuria? |
|
Definition
liver dz, hepatic obstruction, and hemolysis. |
|
|
Term
:Results reported as Normal (0.2-1), 2, 4, or 8 Ehrlich Units (EU); formed in the intestinal tract by bacterial breakdown of conjugated bilirubin; majority is excreted in feces and some is excreted in urine |
|
Definition
|
|
Term
What are the confirmatory tests for increased and decreased urobilinogen? |
|
Definition
Decreased levels = check stool sample. Increased = check chemstrip. |
|
|
Term
What conditions cause increased urobilinogen? Decreased? |
|
Definition
Increased = hepatic dz. Decreased = hepatic obstruction. |
|
|
Term
What kind of urine specimen is preferred for detection of urinary tract pathogens that can convert nitrate to nitite? |
|
Definition
|
|
Term
What does a positive urine nitrite result indicate? |
|
Definition
Bacteria are present in the specimen in significant numbers. |
|
|
Term
What is the confirmatory test for a positive urine nitrite result? |
|
Definition
Microscopic examination and a bacterial culture. |
|
|
Term
What conditions commonly lead to pyuria (increased WBCs in urine)? What is the confirmatory test for pyuria? |
|
Definition
Infection/inflammation of GU system. Confirmatory test is microscopic examination of the urine for WBCs. |
|
|
Term
:Ratio of density of substance (urine) to water; it reflects relative degree of concentration; Normal is 1.005-1.030; tested with a refractometer |
|
Definition
|
|
Term
What is the most common cause of an increased specific gravity? |
|
Definition
|
|
Term
What is the most common cause of a decreased specific gravity? |
|
Definition
|
|
Term
What condition is characterized by a constant specific gravity of 1.010 (normal) regardless of conditions? |
|
Definition
|
|
Term
:most commonly used for dx of polyuria when DM has been ruled out (disorders include DI and psychogenic water drinking) |
|
Definition
|
|
Term
What should be suspected if transitional epithelial cells are found in urine and there has not been any recent procedures regarding an instrument? |
|
Definition
|
|
Term
What does an increase in renal tubular epithelial cells in urine indicate? |
|
Definition
Tubular necrosis/damage or nephrotic syndrome. |
|
|
Term
|
Definition
|
|
Term
What factors increase cast formation? |
|
Definition
acid pH, high SG, proteinuria and stasis of urine. |
|
|
Term
What is the major constituent of casts? |
|
Definition
|
|
Term
What do hyaline casts indicate? |
|
Definition
Could be just due to exercise, dehydration, fever or stress. But could also be due to renal dz. |
|
|
Term
What do cellular casts indicate? |
|
Definition
Indicate serious renal disease |
|
|
Term
What do WBC casts indicate? |
|
Definition
Nephronal infection or inflammation |
|
|
Term
What do RTE cell casts indicate? |
|
Definition
|
|
Term
What are the causes of granular casts? |
|
Definition
Could be a by-product of metabolism or it could be any other dz causing cellular cast formation. |
|
|
Term
What do waxy casts indicate? |
|
Definition
Severe urine stasis and often chronic renal failure. |
|
|
Term
What do fatty casts indicate? |
|
Definition
|
|
Term
What do broad casts indicate? |
|
Definition
|
|
Term
When are uric acid crystals (Yellow to reddish-brown with irregular shapes) found on microscopic urine exam? |
|
Definition
Dz causing hyperuricemia (Gout). |
|
|
Term
When are calcium oxalate crystals (Colorless octahedrons that resemble envelopes) found on microscopic urine analysis? |
|
Definition
Seen in antifreeze poisoning |
|
|
Term
When are cystine crystals (colorless hexagonal plates) seen in microscopic urine examination? |
|
Definition
|
|
Term
When are cholesterol crystals seen in microscopic urine examination? |
|
Definition
|
|
Term
When are leucine crystals (Yellowish-brown spheres that contain concentric circles with radial striations) seen in microscopic urine examination? |
|
Definition
|
|
Term
When are tyrosine crystals (Fine, delicate colorless to yellow needles in clusters or sheaths) seen on microscopic urine evaluation? |
|
Definition
|
|
Term
When will bilirubin crystals (Yellow-brown colored clumped needles or granules) been seen on microscopic urine examination? |
|
Definition
|
|
Term
Which crystals are found in alkaline pH? Are they typically clinically significant? |
|
Definition
Triple phosphate, calcium phosphate, ammonium biurate and calcium carbonate. None are clinically significant. |
|
|
Term
What is the most common yeast in urine? |
|
Definition
|
|
Term
What is the most common parasite in urine? |
|
Definition
|
|
Term
What does the presence of several starch granules along with a large # of squamous epithelial cells and bacteria suggests in a urine sample? |
|
Definition
|
|
Term
When will hCG be produced in a pregnant women? When will it be noticeable in urine? |
|
Definition
It will be produced in 8-11 days after conception but will not be noticeable in urine until 1-2 days after a missed menstrual cycle. |
|
|