hannah
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Can someone help me with these cases study. I've been working on it a lot but still unable to answer these questions and it due tomorrow. Please any help is greatly appreciated. Thank You!!
Case 1. Patient A is an 8 year old European American girl who woke up one morning with a fever and complaining of back pain on the right side just above her waist. At the physician’s office later that morning on a clean catch, midstream urine sample, the following results were obtained.
Patient A
Color yellow
Clarity cloudy
Specific gravity (stik) 1.019
pH 6.0
Protein 1+
Glucose neg
Ketones neg
Blood 1+
Bilirubin neg
Urobilinogen 0.1
Nitrite pos
Leukocyte esterase 2+
Microscopic examination 40-60 WBC/hpf, 0-8 RBC/hpf, few squamous/lpf, rare renal epithelial cell/hpf, 3-6 WBC casts/hpf, moderate bacteria
1. Are there any inconsistencies between the macroscopic, chemical and microscopic findings that need to be explained? If so, what might explain them?
2. What condition is indicated by this constellation of findings and which particular findings support this diagnosis?
3. Is any additional testing indicated for this patient? If yes, what test and what is its principle?
4. What is the source of the positive protein finding in this condition?
5. What is the purpose of assessing specific gravity in urine? Why is it important to know that the specific gravity was measured with a dipstik?
Case 2. Patient B is a 14 year old African American boy who had a sore throat about two weeks ago but that is now gone. His mother has taken him to an urgent care facility because his ankles and hands seems very swollen and his urine is dark. The following results are on a clean catch, midstream sample collected at the urgent care facility.
Patient B
Color brown
Clarity cloudy
Specific gravity (stik) 1.026
pH 6.0
Protein 3+
Glucose negative
Ketones negative
Blood 3+
Bilirubin negative
Urobilinogen 0.1
Nitrite negative
Leukocyte esterase negative
Microscopic examination 40-50 rbc/hpf, 3-10 WBC/hpf, 0-5 hyaline casts/lpf, 0-2 rbc casts/lpf, 1-3 granular casts/lpf, few sq. epi/hpf
1. Are there any inconsistencies between the macroscopic, chemical and microscopic findings that need to be explained? If so, what might explain them?
2. What condition is indicated by this constellation of findings and which particular findings support this diagnosis?
3. Is any additional testing indicated for this patient? If yes, what test and what is its principle?
4. What is the source of the positive protein finding in this condition?
5. Why are the patient’s ankles swelling?
6. What is the relationship of the patient’s prior sore throat to his present condition?
7. Why is the microscopic examination negative for bacteria?
Case 3. Patient C is an 18 year European American female who sought treatment at the university health center complaining of frequent urination with burning. She reported that she had sexual intercourse two days previous to this visit and had no recent history illness. She was instructed to collect a clean catch, midstream sample that was tested with the following results.
Patient C
Color yellow
Clarity cloudy
Specific gravity (stik) 1.012
pH 5.5
Protein 1+
Glucose negative
Ketones negative
Blood 1+
Bilirubin negative
Urobilinogen 0.1
Nitrite neg
Leukocyte esterase 2+
Microscopic examination 50-75 WBC/lpf some in clumps, 15-20 rbc/lpf, many sq epi/lpf, 1+ mucous, many bacteria
1. Are there any inconsistencies between the macroscopic, chemical and microscopic findings that need to be explained? If so, what might explain them?
2. What condition is indicated by this constellation of findings and which particular findings support this diagnosis?
3. Is any additional testing indicated for this patient? If yes, what test and what is its principle?
Case 4. Patient D is a 56 year old Asian American man who has been experiencing a sharp but intermittent pain in his back for some time. His wife has been pressing him to see a doctor but he has resisted until today because the pain has become more severe and persistent. Below are the results of a routine urinalysis on a clean catch midstream sample collected and tested in the physician office.
Patient D
Color yellow
Clarity clear
Specific gravity (stik) 1.009
pH 6.0
Protein negative
Glucose negative
Ketones negative
Blood trace
Bilirubin negative
Urobilinogen 0.1
Nitrite negative
Leukocyte esterase negative
Microscopic examination 0-2 sq epi/lpf, 2-5 rbc/hpf, 0-1 WBC/hpf
1. Is the sample acceptable for evaluation? Explain your conclusion.
2. Are there any inconsistencies between the macroscopic, chemical and microscopic findings that need to be explained? If so, what might explain them?
3. What condition is suggested by this constellation of findings and which particular findings support this diagnosis?
4. Is any additional testing indicated for this patient? If yes, what test and what is its principle?
Case 5. Patient E is an 8 year old African American boy who was hospitalized with pneumonia following a cold. He was treated with antibiotics and within a day of beginning treatment, his urine turned dark. The results below are the from the second urine sample after the dark urine was discovered. A CBC collected shortly after the dark urine was reported showed an elevated white blood count with a left shift and toxic changes; normochromic, normocytic anemia with an occasional helmet cell and shistocyte; and normal platelet count and morphology.
Patient E
Color red-brown
Clarity clear
Specific gravity (stik) 1.015
pH 5.5
Protein trace
Glucose negative
Ketones negative
Blood 4+
Bilirubin negative
Urobilinogen negative
Nitrite negative
Leukocyte esterase negative
Microscopic examination negative
1. Is the sample acceptable for evaluation? Explain your conclusion.
2. Are there any inconsistencies between the macroscopic, chemical and microscopic findings that need to be explained? If so, what might explain them?
3. What condition is suggested by this constellation of findings and which particular findings support this diagnosis?
4. Is any additional testing indicated for this patient? If yes, what test and what is its principle?
5. What changes to the results of the urinalysis would be expected in the next few days? What is the principle of the test on the stik that will detect these changes?
Case 6. Patient F, a 56 year old white male, had some basic tests performed as part of an insurance policy screening. The urine sample was collected at the patient’s home and then delivered to a laboratory for testing and reporting. The sample was a random void without directions to collect it midstream or clean catch.
Patient F
Color yellow
Clarity hazy
Specific gravity (stik) 1.012
pH 6.0
Protein negative
Glucose negative
Ketones negative
Blood negative
Bilirubin negative
Urobilinogen 0.1
Nitrite negative
Leukocyte esterase negative
Microscopic examination: moderate calcium oxalate crystals, few bacteria
1. Is the sample acceptable for evaluation? Explain your conclusion.
2. Are there any inconsistencies between the macroscopic, chemical and microscopic findings that need to be explained? If so, what might explain them?
3. What condition is suggested by this constellation of findings and which particular findings support this diagnosis?
4. Is any additional testing indicated for this patient? If yes, what test and what is its principle?
5. Under what conditions are crystals seen in urine? Which crystals are considered normal?
Case 7. Patient G is a 40 year old African American woman who has been experiencing sharp pains under her ribs on the right side for several months. She seems to think that it is related to eating heavy meals. She has finally decided to see her physician because this morning when she woke up she noticed that her eyeballs had turned yellow and this was pretty scary to her. A urine sample collected in the physician’s office showed the results below.
Patient G
Color dark yellow
Clarity hazy
Specific gravity (stik) 1.020
pH 5.5
Protein negative
Glucose negative
Ketones negative
Blood negative
Bilirubin positive
Urobilinogen negative
Nitrite negative
Leukocyte esterase negative
Microscopic examination moderate sq. epi/hpf
1. Is the sample acceptable for evaluation? Explain your conclusion.
2. Are there any inconsistencies between the macroscopic, chemical and microscopic findings that need to be explained? If so, what might explain them?
3. What condition is suggested by this constellation of findings and which particular findings support this diagnosis?
4. Is any additional testing indicated for this patient? If yes, what test and what is its principle?
Case 8. Patient H is 18 month old European American boy seen in the doctor’s office for a routine well-child visit. The urine sample was collected with one of the pediatric bags.
Patient H
Color yellow
Clarity hazy
Specific gravity (stik) 1.013
pH 6.5
Protein negative
Glucose negative
Ketones negative
Blood negative
Bilirubin negative
Urobilinogen 0.1
Nitrite negative
Leukocyte esterase negative
Microscopic examination 15-20 sq epis/lpf, few uric acid crystals/lpf
1. Is the sample acceptable for evaluation? Explain your conclusion.
2. Which results are outside reference ranges or acceptable limits?
3. Are there any inconsistencies between the macroscopic, chemical and microscopic findings that need to be explained? If so, what might explain them?
4. What condition is suggested by this constellation of findings and which particular findings support this diagnosis?
5. Is any additional testing indicated for this patient? If yes, what test and what is its principle?
Case 9. Patient I, a 35 year old Mexican American woman, provided the urine sample whose results are below during a routine physical examination. She was instructed to provide a mid-stream sample. Her weight was down approximately 10 pounds from the prior year and she said she had been working out and eating more healthfully. She was found to be healthy.
Patient I
Color straw
Clarity clear
Specific gravity (stik) 1.007
pH 5.5
Protein negative
Glucose negative
Ketones 1+
Blood negative
Bilirubin negative
Urobilinogen 0.1-1.0 EU
Nitrite negative
Leukocyte esterase negative
Microscopic examination 0-2 sq epis/lpf,
1. Is the sample acceptable for evaluation? Explain your conclusion.
2. Are there any inconsistencies between the macroscopic, chemical and microscopic findings that need to be explained? If so, what might explain them?
3. What condition is suggested by this constellation of findings and which particular findings support this diagnosis?
4. Is any additional testing indicated for this patient? If yes, what test and what is its principle?
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| reet
Forum Fanatic
Topics: 152
Posts: 1,411
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hannah ,,if u put your question one by one... that would be easy to answer all..
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