urinalysis

| December 10, 2015

urinalysis

Order Description
There are five case studies, two of them need to be done(by choice of the writer). The situations are given, the writers only need to answer the questions. Half a page required per study.
Case 1.
This specimen was from a 14 year old boy whose mother brought him to their family physician because he had a fever of 101°F and shaking chills for the previous day. On physical examination, he had mild right lower back angle tenderness
Macroscopic Urinalysis:
Color Yellow
Appearance Turbid
Specific Gravity 1.017
pH 6.5
Protein Neg
Glucose Neg
Ketones 1+
Bilirubin Neg
Blood Small
Urobilinogen 0.1 mg/dl
Nitrite Neg
Leukocyte Esterase 4+

Microscopic Urinalysis:
WBC/hpf >50/hpf
RBC/hpf 10-15/hpf
Casts Many WBC cast
Bacteria Moderate
Other Occasional transitional cells

Questions:
1. How do you explain the appearance of the urine?
2. How do you relate this to other findings?
3. What chemical findings are inconsistent with microscopic findings?
4. What findings on microscopic urinalysis would be of help with a diagnosis?
5. The physician determined that the boy had a urinary tract infection. Based on the UA lab findings, is the infection from the lower or upper urinary tract?
6. What else should be done to confirm the cause of the infection and treatment?

Case 2.
Fluid collected by thoracentesis is sent to the laboratory. Its appearance is bloody.
1. If the appearance of the blood in the fluid is uneven and streaked, what is the most probable cause of the bloody fluid?
2. State 2 conditions that would produce an even distribution of blood in this fluid.
3. What further testing can be done to distinguish between the 2 conditions you identified in question 2 above?
4. If the fluid appeared milky instead of bloody, name 2 substances that could be present andstate a reason for their presence.
5. Describe 2 tests that can be performed to distinguish between these 2 substances identified in question 4 above.

Case 3
A 50 year-old male patient complaining of severe pain in the large toe of his right foot is seen in the emergency room. The toe appears red and swollen. A serum uric acid level is elevated. The physician performs an arthrocentesis.
1. What type of fluid is sent to the laboratory?
2. Considering the patient’s symptoms, what is the most diagnostically significant test that can be performed on this fluid?
3. State 3 types of microscopy that can be used to examine this fluid?
4. Based on the patient’s uric elevated acid level, what would you expect to find? Describe the appearance with the type of microscopy you identified in question 3 above.
5. If the patient’s uric acid level is normal, what would you expect to find? Describe the appearance with the type of microscopy you identified in question 3 above.
Case 4.

This urine is from a 30 year old male with recurring kidney stones. Both he and his younger brother, who is experiencing similar problems, had intravenous pyelograms 3 hours earlier. The tech noted on the microscopic exam 2 types of unusual crystals: colorless, refractile hexagonal shaped and colorless needles and plates with notched corners. A previous UA noted the presence of the hexagonal crystals.

Macroscopic Urinalysis:
Color Yellow
Appearance Hazy
Specific Gravity 1.022 Specific Gravity by Refractometer 1.050
pH 5.0
Protein Trace Protein by SSA positive 3+
Glucose Neg
Ketones Neg
Bilirubin Neg
Blood large
Urobilinogen 0.1 mg/dl
Nitrite Neg
Leukocyte Esterase Neg

Microscopic Urinalysis:
WBC/hpf 0-3/hpf
RBC/hpf 40-50/hpf
Casts None
Crystals Few hexagonal
Many needles and plates with notched edge

1. Why do the dipstick results for specific gravity and protein differ from the alternative testing methods?
2. What is the most probable cause for the hexagonal shaped crystals? Thin needles and notched plates?
3. What action would you take, if any, before reporting this UA?
4. What condition is suspected?
Case 5.
A 20 year old male complained of red-brown urine and severe muscle pain 3 hours after his early practice run for the Los Angeles Marathon. A physical exam done in the ER was unremarkable except for muscle tenderness. A routine physical performed two weeks earlier indicated he was in good health.
Color Brown
Appearance Clear
Specific Gravity 1.030
pH 6.5
Protein 2+
Glucose Neg
Ketones Large 3+
Bilirubin Neg
Blood 2+ diffuse
Urobilinogen 0.1 mg/dl
Nitrite Neg
Leukocyte Esterase Neg

Microscopic Urinalysis:
WBC/hpf 0-1/hpf
RBC/hpf 0-1/hpf
Casts 6-10 hyaline/lpf
Other Occasional transitional cells

1. What are the causes of red-brown urine?
2. In light of the patient’s recent activities, how would you interpret the positive UA result?
3. Does this patient have renal disease?
4. What recommendation would you make to the health care provider about the UA results?

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