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Case 2 As part of a routine physical examination, a urinalysis is performed on a midstream voided urine collection from an apparently healthy (asymptomatic), 8 year old girl. The following results are obtained. Urinalysis results: Physical appearance color: yellow transparency: hazy Chemical Screening pH 6 specific gravity 1.010 protein 30 mg/dL protein (SSA ) 1+ blood negative nitrite negative leukocyte esterase positive glucose negative ketones negative bilirubin negative urobilinogen normal Because of the results of the protein test by reagent strip, the urine was tested with the sulfosalicylic acid test for protein. A microscopic examination of the urine sediment was performed. Microscopic examination of the urinary sediment: red blood cells 0-2/hpf white blood cells 10-25/hpf casts none seen epithelial cells few squamous bacteria moderate After reviewing the results of the urinalysis, the physician requests a gram stain and urine culture. Microbiology results: Gram stain Gram positive cocci in chains Urine culture Greater than 100,000 cfu/ml Enterococcus faecalis Questions: 1. What urinalysis findings are abnormal? 2. This laboratory does not perform microscopic on all routine urinalysis tests. Why was a microscopic examination of the urine sediment performed in this case? 3. Can the urine collection already tested (U/A and sediment) be gram stained and culture? Why or why not? 4. Explain the negative nitrite result and the presence of bacteria in the urine sediment. 5. Would the results be more likely to represent an upper or lower urinary tract infection? Explain.
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