Section 3,4,5 Review

Josefina Gonzalez
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Section 3,4,5

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Question Answer
WHAT IS PRECISION? means that you are consistent with your results, time after time
WHAT IS ACCURACY? obtaining correct results in lab tests
WHAT IS SPECIFICITY? DISEASE FOCUSED AND MEASURES THE PERCENTAGE OF INDIVIDUALS WITHOUT THE CONDITION BEING TESTED FOR, WHO WILL HAVE A NEGATIVE TEST
WHAT IS SENSITIVITY? WELLNESS FOCUSED AND THE MORE SENSITIVE A TEST IS THE FEWER NEGATIVE RESULTS IT PRODUCES
WHAT ARE STANDARDS? ARE MATERIALS WHICH CONTAIN ACCURATELY DETERMINED CONCENTRATION OF AN ANALYTE THAT ARE USED TO EITHER CONFIRM A TESTING METHOD VALIDITY, OR TO MAKE SURE AN INSTRUMENT READS CORRECTLY
WHAT IS A CALIBRATOR? AN INSTRUMENT ALLOWS EVERY UNKNOWN PATIENT SAMPLE OR CONTROL TO BE ANALYZIED FROM A MEASURED STARTING POINT
RANDOM ERRORS OCCUR WHEN? EXTREMELY SMALL VARIABLES IN TESTING THAT ARE NOT EASILY MANAGED, SUCH AS STRICKLY DEFINED SAMPLE SIZE OR EXACT PIPETTE DELIVERY OR INNAPROPRIATELY COLLECTED SPECIMEN IS USED FOR TESTING
RANDOM ERRORS AFFECT? THE PRECISION OF A TEST
SYSTEMIC ERROR OCCURS WHEN? SOMETHING ALTERS THE TESTING PROCESS, CAUSING ALL RESULTS TO BE BIASED; WHEN IMPROPER STANDARDS ARE USED OR A DIRTY LENS IS PRESENT IN A MEASURING DEVICE;
SYSTEMIC ERROR AFFECTS? BOTH PATIENT RESULTS AND CONTROL MEASUREMENTS, MAKING IT MORE DIFFICULT TO DETECT AND IS SOMETIMES BROUGHT TO LIGHT BECAUSE OF CHANGES IN THE STATISTICAL MEAN ARE AN IDICATION OF A SYSTEMIC ERROR AND MUST BE INVESTIGATED
WHAT IS INTERNAL QC? USUALLY INVOLVES TESTING COMMERCIALLY-PURCHASED MATERIALS AND COMPARING THE RESULTS TO KNOWN VALUES; USED FOR IMMEDIATE DECISIONS;
WHAT IS EXTERNAL QC? AKA PROFICIENCY TESTING; EVALUATES A LABS TESTING RESULTS BY COMPARING THEM TO THOSE OF SIMILAR LABS; SPECIALLY PREPARED SPECIMENS ARE OBTAINED BY MULTIPLE LABS FROM PROFICIENCY TESTING PROGRAM SPONSORED BY PROFESSIONAL SOCIETIES, SUCH AS CAP AND AMERICAN ASSOCIATIONS OF BIOANALYSTS
WHAT SHOULD THE EXTERNAL QC EVALUATION REPORT SHOW? NUMBER OF LABORATORIES COMPRISING THE PEER GROU; COMPARATICE MEAN OF THE GROUP FOR THAT PARTICULAR ANALYTE; THE LABS PERFORMANCE COPARED TO THE PEER GROUP; WHETHER THE PERFORMANCE WAS SATISFACTORY OR UNSATISFACTORY
WHATS THE STANDARD DEVIATION CALCULATION? ?
WHAT DO VALUES OUTSIDE OF THE REFERENCE RANGES INDICATE? NOT ONLY AN ABNORMALITY IN THE PATIENT, BUT ALSO A PROBLEM WITH THE TEST RESULTS; 1 OUT OF 5 WILL BE OUT OF THE 2+/- STANDARD DEVIATION
WHAT IS THE MOST COMMONLY USED METHODS FOR DOCUMENTATION? LEVEY-JENNINGS CONTROL CHART OFTEN REFERRED TO AS THE L-J CHART
HOW TO AVOID PROBLEMS AFFECTING QC INCLUDE? CLEANING; MAINTENANCE;
THE FIRST THING (CORRECTIVE ACTION 1) TO DO WHEN THE QC IS WRONG? RERUN THE CONTROL THAT IS OUT OF RANGE; RANDOM ERRORS IN SAMPLING MAY BE RESOLVED BY SIMPLY RUNNING THE TEST AGAIN USING THE SAME CONTROL AND A FRESH TESTING DEVICE
WHAT IS THE SECOND THING YOU DO IF THE PROBLEM IS NOT CORRECTED? CHECK YOUR REAGENTS AND CONTROLS; MAKE CERTAIN ALL LOT NUMBERS AND EXPIRATION DATES OF REAGENTS AND CONTROLS USED IN THE TESTING PROCESS ARE CURRENT; VERIFY THAT THE RECOMMENDED STORAGE CONDITIONS WERE FOLLOWED
WHAT IS CORRECTIVE ACTION 3? RUN THE CONTROL USING A NEW, UNOPENED BOTTLE OF CONTROL; IMPROPER STORAGE MAY HAVE ACCELERATED THE DETERIORATION OF THE ORIGINAL CONTROL OR TESTING MATERIAL MAY HAVE EXPIRED
WHAT IS CORRECTIVE ACTION 4? REVIEW CALIBRATION OF THE TEST INSTRUMENT; TEST INSTRUMENTS NEED TO BE CALIBRATED ACCORDING TO THE MANUFACTURERS INSTRUCTIONS OR MORE FREQUENTLY IF NECESSARY; FEDERAL REQUIREMENTS CALL OF FOR ANALYTIC TESTS TO BE RECALIBRATED AT LEAST EVERY SIX MONTHS TO VERIFY THE ACCURACY OF THE TESTING PROCEDURE
WHAT IS CORRECTIVE ACTION 5? CALL THE TEST MANUFACTURER FOR ADVICE; MANUFACTURERS HAVE ADDITIONAL INFORMATION THAT MAY HELP RESOLVE QC PROBLEMS; SPECIMENS SHOULD BE STORED PROPERLY FOR LATER TESTING IF THE PROBLEM CANNOT BE RESOLVED
what does urine color and clarity indicate? glomerular bleeding; liver disease; inborn errors of metabolism; UTI; or renal tubular dysfunction
Variations in color of urine are caused by? metabolic function; physical activity; ingested materials; pathologic conditions
when would myoglobin be seen in urine? extreme physical activity that causes hemoglobin in muscles to be released
What is the normal color of urine? straw to amber
what is the cause of colorless urine? recent fluid consumption
what is the cause of pale yellow urine? polyuria or diabetes insipidus (with normal or low specific gravity)/diabetes mellitus (with high specific gravity)
Dark yellow urine cause? concentrated specimen; dehydrated
amber/orange urine cause? bilirubin is not normal in urine; liver disease; certain meds (acriflavin - green, pyridium - orange, nitrofurantoin, phenindione)
yellow/green to yellow/brown urine cause? seen with the conversion of bilirubin to biliverdin or vice versa
green - blue/green urine causes? pseudomonas infection (bacteria)PATHOLOGIC; certain meds (amitriptyline - for migraines, robaxin - muscle relaxer, clorets - dye, indican (for bacterial infections), methylene blue - dye, phenol - disinfectant)
pink/red urine causes which are pathologic? RBC's, hemoglobin, myoglobin, porphyrins
pink/red urine causes? beets/blackberries, rifampkin, menstrual comtamination
what causes a black or brown urine which are pathologic? oxidized RBC's to methemoglobin; methemoglobin; alkaptonuria (metabolic disorder); melanin or melanogen (should not be in urine)
black/brown urine causes non pathologic? phenol derivatives, argyrols (antiseptic), methyldopa or levodopa, petronidazole (flagyl)
purple urine is caused by? indican - medication; PATHOLOGIC: kiebsiella or providencia spp. (bacterial infections)
what is urochrome? a product of endogenous metabolism; if your dehydrated you will see more in urine; it will also be increased in thyroid conditions, fasting, and in urine that is left standing
what is uroerythrin? (pink) evident in specimens that have been refrigerated (amorphous urates); urates (crystals) are normal but form when refrigerated
what is urobilin? (orange/brown) pigment caused by oxidation product of urobilinogen; color is produced when the specimen is not fresh (more than 2 hours)
clarity is? the transparency or turbidity of a specimen
to determine clarity, how many ml are minimum? 10 ml
what are pathologic causes of turbidity? RBC's, WBC's, bacteria, yeast, nonsquamous epithelial cells, abnormal crystals, lymph fluid, and lipids
what are nonpathological causes of turbidity? squamous epithelial cells, mucus, amorphous, phosphates/urates and other normal crystals, semen, spermatozoa, fecal contamination, radiographic contrast media, talcium powder, and vaginal creams
what is seen with acidic urine (6 or less)?? amorphous urates; radiographic contrast media
what is seen with alkaline urine? amorphous phosphates, carbonates
what is soluble with heat? amorphous urates, uric acid crystals
what is soluble in dilute acetic acid? RBC's, amorphous phosphates, carbonates
what is insoble in dilute acetic acid? WBCs, bacteria, yeasts, and spermatozoa
what is soluble in ether? lipids and lymphatic fluid (chyle)
what is specific gravity? assesses the kidneys ability to reabsorb (tubular function); also detects dehydration and abnormalities in ADH; can be used to determine whether or not specimen concentration is adequate to ensure accuracy of chemical tests
what is the definition of specific gravity? the density of a solution compared with the density of a similar volume of distilled water at a similar temperature; it is influenced by the number of molecules present and the size of the molecules
what is a urinometer? very inaccurate; requires large volume of urine (10-15ml); temperature, glucose, and protein readings have to be corrected
how do you correct readings on a urinometer for temperature? subtract or add 0.001 for every 3 degrees the specimen is below or above the calibrated temp of the urinometer
how do you correct readings on a urinometer for protein? subtract 0.003 for every gram of protein present
how do you correct readings on a urinometer for glucose? subtract 0.004 for every gram of glucose present
Calibrated temp: 20 C Urine Temp: 35 C Protein: 1 g Glucose: 2 g Specific Gravity: 1.025 correct for temp: 1.025 + 0.005 = 1.030 correct for protein: 1.030 - 0.003 = 1.027 correct for glucose: 1.027 - 0.008 = 1.019
refractometer is? uses small quantities (1-2 drops); temperature corrections are not necessary, as the temp is automatically compensated for when it is between 15 C and 38 C BUT corrections for high protein and glucose concentrations should be made
refractometer calibration involves? distilled water: 1.000 5% NaCl: 1.022 +/- 0.001 or 9% sucrose: 1.034 +/- 0.001 run 2 levels of quality control every time
what is harmonic oscillation densitometry? based on the principle that the frequency of a sound wave entering a solution will change in proportion to the density of the solution; the yellow iris (an automated) urinalysis analyzer) uses this method to determine specific gravity
what is the reagent strip method? measures the pKa (chemical property) changes of a polyelectrolyte
isosthenuric means? sg normal: 1.003-1.035 sg median is 1.010
hyposthenuric sg means? less than 1.010 specimen is probably not urine
hypersthenuric sg means? greater than 1.035 diabetes mellitus, excessive solutes excreted patients receiving IVs of high molecular weight substances (dextran plasma expanders, ect.); excretion of injection radiographic dyes, as in IVP
aromatic urine odor indicates? normal
Foul, ammonia like urine odor indicates? bacterial decomposition, UTI
fruity, sweet urine odor indicates? ketones (diabetes mellitus, starvation, vomiting)
maple syrup urine odor indicates? maple syrup urine disease
mousy urine odor indicates? PKU
rancid urine odor indicates? tyrosinemia
sweaty feet urine odor indicates? isovaleric acidemia
cabbage urine odor indicates? methionine malabsorption (metabolic disorder)
bleach urine odor indicates? contamination
the protein chemical reaction on the phenomenon is known as? protein error of indicators
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