Question

Course:

Urinalysis & Body Fluids, CLBT 1030

Name: _____________________

Score:

______________

Direction:

After

reading

the f

ollowing urinalysis case stud

ies

and

reviewing

related laboratory

results,

answer the

q

uestions

that follow from the

case studies

.

Each

question

is worth

2.5

points

.

(5 points

to be

added

to

Module 3

test

grade

)

.

Case study

: patient clinical presentation

A 25 year old CLT student is

presented to the ED with complaint of an acute onset of

intermittent, severe flank pain, hematuria, nausea, vomiting, and fever. The patient

explained to the admitting physician that she has been experiencing pain over the last

three weeks but the pain

has never been as intense as it has been since early

morning on the day of the ED visit. Patient stated

that she has not experienced dysuria or burning sensation except that the intermittent pain has kept her restless

lately. Recently, she has been experiencing significantly increased pressure to stay on

top of her studies and homework assignments. She spends most of her time indoor

studying. Because of lack of time to cook, she has turned to takeout pizza and coffee

for her daily sustenanc

e. When asked about relationship, she expressed that she lives

with her boyfriend, a track driver, who is on the road for most of the time.

Evaluation Vital data included temperature of 37.5 Co, respiration rate of 23/mm, blood pressure

148/100, pulse 101. Flank tenderness was noted on physical exam.

Blood and urine samples were sent to the lab.

Lab results. Complete blood count and electrolytes were all normal.

Some urinalysis results were abnormal, see table 1, below

.

Table 1.

Partial UA test results Parameters tested

Lab results Color Dark yellow Turbidity Cloudy Leukocyte esterase Negative Nitrite Negative Glucose Normal Protein 1+ Blood 3+

Note: Microscopic evaluation of urine sediment indicated 75 RBC

1. Based on the patient clinical history, signs and symptoms, and laboratory findings,

which of the following is the most likely diagnosis of this patient’s clinical

condition?

a)

Diabetes mellitus

b)

Urinary tract infection

c)

Diabetes insipidus

d)

Nephrolithiasis

2.

Based on the patient’s clinical history, signs and symptoms, and laboratory data,

which of the following provides the most likely explanation for the

abnormal

physical and chemical

urinalysis results?

a)

RBCs

b)

WBCs

c)

Bacteria

d)

Yeast

Direction:

Based on the patient clinical history, signs and symptoms, and laboratory

findings, determine whether the following statement is true or false.

3.

The

signs and symptoms,

and laboratory data indicate that the patient is suffering

from cystitis. (true or false)

Direction:

Based on the patient clinical history, signs and symptoms, and laboratory

findings, answer the following question.

4.

In one short paragraph, define pyelonephritis and p

rovide two laboratory

test results from the above case that support

and two that oppose the diagnosis of pyelonephritis in the

patient in the above case.

Directions.

Read directions carefully. Answer the following questions by circling the

best answer from the alternatives provided.

5.

A cloudy urine tested positive for nitrite and leukocyte esterase on reagent strip

urine dipstick. Which of the following microscopic results correlate well with

positive nitrate and leukocyte esterase?

a.

White blood cells in the urine

b.

Red blood cells in the urine

c.

Crystals in the urine

d.

Casts in the urine

6.

A diabetic patient was suspected of having yeast infection. The following results

were obtained on urine chemistry (Urine dipstick)

Partial results from urine dipstick

Glucose

2+

Protein

1+

Blood

3+

Clarity

Cloudy

A tech examining urine sediments from the above patient sample was having

hard time differentiating

Yeasts

from

Red Blood Cells. What is the best course

of action to differentiate yeasts from RBCs?

a.

Request uncontaminated sample

b.

Centrifuging the sample to remove WBCs

c.

Pipetting out the supernatant to visualize RBCs

d.

Lysing with acetic acid to remove RBCs

e.

Gram stain the sample to differentiate Yeast from RBCs

7.

Urine sample from a patient with symptom of lower back pain, burning

sensation and increased urinary frequency gave the following results:

1.

Protein, positive 2 +

2.

Leukocyte esterase, positive

3.

Nitrite, negative

4.

Color and clarity, cloudy and turbid

5.

Increased RBC and WBC

6.

Glucose, normal

Which combination of the above lists best support diagnosis of urinary tract infection?

A.

1, 2, 3, 6

B.

2, 3, 4, 5

C.

1, 3, 4, 6

D.

1, 2, 4, 5

8. What is the significance of fat (lipid) in urine?

Answer 1

1. Patient exhibits symptoms of acute flank pain, nausea and vomiting, hematuria, fever. These symptoms relate nephrolithiasis.

2. RBC

3. The patient’s symptoms of acute flank pain, nausea, vomiting, hematuria and fever indicates kidney stones.

The above symptoms are indicative of cystitis.

So the statement is true.

4. Pyelonephritis : pyelonephritis is a condition characterised by inflammation of kidney due to bacterial infections. The symptoms include flank pain and fever, nausea, vomiting, burning micturition, frequent urination. Urinalysis shows presence of bacteria and positive nitrate. CBC shows neutrophilia. Management includes antibiotics like fluoroquinolones, cephalosporins, aminoglycosides, or /sulfamethoxazole.

Two results supporting pyelonephritis are prence of protein and blood.

Two lab results opposing pyelonephritis are esterase negative and nitrate negative

5. A dipstick test positive for nitrite and leukocyte esterase on reagent strip indicates presence of white blood cells (leukocytes) in urine.

6. Adding Acetic acid will lyse the RBC but not the yeast. So lysing RBC with acetic acid will differentiate yeast from RBC.

The answer is (d)

7. UTI lab tests exhibits presence of proteins, leucocyte esterase, turbid and cloudy urine.

So the answer is (d)

8. Presence of fat or lipid in urine is known as lipiduria.

Lipiduria signifies

1. nephrotic syndrome i.e. excessive excretion of protein in urine

2. Fat embolism