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Activation and selection occur in the medulla; mature T cells are stored in the cortex until activated by antigen Immunology/Apply knowledge of fundamental biological characteristics/Immune system/Cells/1 77 78 Chapter 3 | Immunology 5 trusted 50 mg voveran spasms just before falling asleep. Which complement component is found in both appears during the first stage of T-cell the classic and alternative pathways? Effective against virally infected cells infected cells order voveran 50 mg with amex spasms of the colon, and neither requires antibody to be C proven voveran 50mg muscle relaxant pharmacology. What is the name of the process by which are attracted toward an area where they detect a phagocytic cells are attracted to a substance disturbance in the normal functions of body tissues generic 50mg voveran fast delivery spasms after gallbladder surgery. Phagotaxis that function in opsonization, chemotaxis, and Immunology/Apply knowledge of fundamental anaphylatoxin formation but do not induce an biological characteristics/Immune system/Cells/1 antiviral state in target cells. Anaphylatoxin formation alternative pathway, C3b binds to an activator on Immunology/Apply knowledge of fundamental the cell surface. It forms a complex with factor B biological characteristics/Complement/Functions/1 called C3bBb which, like C4b2a3b, can split C5. IgG3 and IgA Immunology/Apply knowledge of fundamental Immunology/Apply knowledge of fundamental biological characteristics/Complement/Activation/1 biological characteristics/Immunoglobulins/Structures/1 13. C Both IgG and IgM are the immunoglobulins that help 1 hour to initiate the activation of the classic complement C. A Complement activity in serum in vitro is destroyed biological characteristics/Complement/Activation/1 by heating the serum at 56°C for 30 min. What is the purpose of C3a, C4a, and C5a, the procedures where complement may interfere with split products of the complement cascade? To bind with specific membrane receptors of complement activity in the test sample by heat lymphocytes and cause release of cytotoxic inactivation. To cause increased vascular permeability, complement cascade that participate in various contraction of smooth muscle, and release of biological functions such as vasodilation and smooth histamine from basophils muscle contraction. To regulate and degrade membrane cofactor protein after activation by C3 convertase 15. A The Fab (fragment antigen binding) is the region of Immunology/Apply knowledge of fundamental the immunoglobulin molecule that can bind antigen. Which region of the immunoglobulin molecule consists of a light chain and the V and C regions H H1 can bind antigen? B The composition and structure of the constant H region of the heavy chain determine whether that Immunology/Apply knowledge of fundamental immunoglobulin will fix complement. The Fc biological characteristics/Immunoglobulins/ fragment (fragment crystallizable) is formed by partial Structures/1 immunoglobulin digestion with papain and includes 16. Immunology/Apply knowledge of fundamental biological characteristics/Immunoglobulins/Structures/1 80 Chapter 3 | Immunology 18. Which immunoglobulin appears first in the Answers to Questions 18–23 primary immune response? All subclasses of IgG can cross the Immunology/Apply knowledge of fundamental placenta, but IgG2 crosses more slowly. This process biological characteristics/Immunoglobulin/Function/1 requires recognition of the Fc region of the IgG by placental cells. IgE causes the release of Immunology/Apply knowledge of fundamental such immune response modifiers as histamine and biological characteristics/Immunoglobulins/Functions/1 mediates an allergic immune response. IgE as tumor necrosis factor, which destroy the infected Immunology/Apply knowledge of fundamental cell and virions. All of the following are functions of chromosome 6 and codes for antigens expressed immunoglobulins except: on the surface of leukocytes and tissues. Facilitating phagocytosis through opsonization products include the antigens that determine C. C Complement components C2 and C4 of the classic pathway and Factor B of the alternative pathway are 25. What molecule on the surface of most T cells T cells may express a γ-δ receptor instead of the recognizes antigen? TcR, consisting of two chains, alpha and beta β-chains of the T-cell receptor are encoded by V genes that undergo rearrangement similar to that Immunology/Apply knowledge of fundamental observed in immunoglobulin genes. The α-chain biological characteristics/Functions/1 gene consists of V and J segments, similar to an 27. The β-chain consists immunoglobulin molecules in that it: of V, D, and J segments, similar to an immunoglobulin A. The α- and β-chains each have a single secreted C-region gene encoding the constant region of the B. Answers C and D are true for a fetus certain immunoglobulin heavy-chain isotypes but Immunology/Apply knowledge of fundamental are not true for the T-cell receptor. The name comes from their similarity to the biological characteristics/Innate immune system/ Toll protein in Drosophila. Macrophages produce which of the following Answers to Questions 29–31 proteins during antigen processing? Complement Immunology/Apply knowledge of fundamental biological components are produced by a variety of cells but characteristics/Innate immune system/Toll cytokines/2 are not part of the macrophage antigen presentation 30. A portion of an immunoglobulin molecule and can activate T cells without the involvement of complement component C1 an antigen-presenting cell. The simultaneous of a T-cell receptor activation of this amount of T cells causes a heavy D. Immunology/Apply knowledge of fundamental biological characteristics/Antigen processing/ 31. T regulator cells, responsible for controlling be expressed by activated T cells, but is constitutively autoimmune antibody production, express which expressed by the T-regulator cells. Te interaction between an individual antigen Answers to Questions 1–4 and antibody molecule depends upon several types of bonds such as ionic bonds, hydrogen 1. B Affinity refers to the strength of a single antibody– bonds, hydrophobic bonds, and van der Waals antigen interaction. How is the strength of this attraction interactions between many different antibodies in characterized? Valency arthritis specimens would be expected to test Immunology/Apply principles of basic laboratory negative if the assay has high specificity. Te those specimens would be included in the laboratory includes serum from healthy volunteers evaluation, they are not listed in the question. Tese specimens determine should be considered, if a test system fails to yield which factor of the assay? Specificity of the antigen–antibody complexes by other Immunology/Apply principles of basic laboratory antibody molecules. A shift in the zone of equivalence forms a precipitin ring by reaction with antibody.

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When seen in large numbers buy generic voveran 50 mg online spasms all over body, nucleus dark blue they indicate urinary tract injury (with pseudopod B voveran 50 mg lowest price spasms below rib cage. Renal epithelium: cytoplasm light blue purchase voveran 50 mg mastercard muscle relaxant jaw pain, nucleus extensions voveran 50mg without a prescription muscle relaxant reversal drugs, they point to infection). Glitter cells: cytoplasm dark blue, nucleus dark results from contamination by vaginal or skin flora purple that multiply in vitro, especially in unrefrigerated D. Red cells stain very pale pink or not at all and hyaline casts stain faintly pink. Insufficient volume is causing microscopic results unless corrective action is taken. The specimen to be underestimated should be diluted with normal saline to 12 mL, then D. Sediment should be prepared according to the established Body fluids/Apply knowledge to identify sources of procedure and the results multiplied by the dilution error/Urinalysis/3 factor (in this case, 12 ÷ 5, or 2. B Caudate cells are transitional epithelium that have a epithelial cells in the urinary system is correct? Caudate epithelial cells originate from the upper bladder and the pelvis of the kidney. Transitional cells originate from the upper and the ureters as well as the urinary bladder and urethra, ureters, bladder, or renal pelvis renal pelvis. Cells from the proximal renal tubule are usually polyhedral, or oval, depending upon the portion of round in shape the tubule from which they originate. Squamous epithelium line the vagina, urethra, proximal tubule are columnar and have a distinctive and wall of the urinary bladder brush border. Squamous epithelia line the vagina Body fluids/Apply knowledge of fundamental biological and lower third of the urethra. Which of the statements regarding examination and can be confused in unstained sediment. Renal cells can be differentiated reliably from sheets of transitional and squamous cells. Large numbers of transitional cells are often seen derived from the urinary bladder. Neoplastic cells from the bladder are not found they should be referred to a pathologist for in urinary sediment cytological examination. Which of the following statements regarding cells Answers to Questions 7–11 found in urinary sediment is true? Transitional cells are considered a an eccentric round nucleus normal component of the sediment unless present C. Clumps of bacteria are frequently mistaken for significant when seen conclusively in the sediment. Conclusive Body fluids/Apply knowledge of fundamental biological identification requires staining. Trichomonas vaginalis characteristics/Urine sediment/2 displays an indistinct nucleus and two pairs of 8. Renal tubular epithelial cells are shed into the when passing through the glomerulus, often urine in largest numbers in which condition? Oval fat bodies are often seen in: approximately 150 × 60 μm and are nonoperculated. B Oval fat bodies are degenerated renal tubular epithelia that have reabsorbed cholesterol from the Body fluids/Correlate clinical and laboratory data/ filtrate. Although they can occur in any inflammatory Urine sediment/2 disease of the tubules, they are commonly seen in the nephrotic syndrome, which is characterized by marked proteinuria and hyperlipidemia. All of the following statements regarding urinary Answers to Questions 12–17 casts are true except: A. C Proteinuria accompanies cylindruria because protein jogging or exercise is the principle component of casts. An occasional granular cast may be seen in a exercise, hyaline casts may be present in the normal sediment sediment in significant numbers but will disappear C. Hyaline casts will dissolve readily in alkaline urine solute concentration, slow movement of filtrate, and Body fluids/Apply knowledge to recognize sources of reduced filtrate formation. The appearance of a error/Urine casts/2 cast is dependent upon the location and time spent in the tubule, as well as the chemical and cellular 13. Reduced filtrate formation cells, immunoglobulins, light chains, cellular proteins, D. C Pseudocasts are formed by amorphous urates that characteristics/Urine casts/2 may deposit in uniform cylindrical shapes as the 14. Granular casts may form by Body fluids/Apply knowledge of fundamental biological degeneration of cellular casts, but some show no characteristics/Urine casts/1 evidence of cellular origin. Hyaline casts may also be increased in Body fluids/Apply knowledge to identify sources of patients taking certain drugs such as diuretics. Broad error/Urine casts/2 casts form in dilated or distal tubules and indicate 16. Which of the following statements regarding severe tubular obstruction seen in chronic renal failure. Fine granular casts are more significant than tubules and signal end-stage renal failure. Cylindroids coarse granular casts are casts with tails and have no special clinical B. Broad casts are associated with severe renal hematuria from ruptured vessels, but not casts. Body fluids/Apply knowledge of fundamental biological Sediment in chronic glomerulonephritis is variable, characteristics/Urine casts/2 but usually exhibits moderate to severe intermittent hematuria. Lower urinary tract obstruction Body fluids/Correlate clinical and laboratory data/ Urine sediment/2 346 Chapter 6 | Urinalysis and Body Fluids 18. Both waxy and broad casts Body fluids/Apply knowledge of fundamental biological form in chronic renal failure when there is severe characteristics/Urine casts/2 stasis, and they are associated with a poor prognosis. Small yellow-brown granular crystals at an are normal with the exception of a positive blood acid pH may be uric acid, bilirubin, or hemosiderin. Prussian blue stain hemosiderin include transfusion reaction, hemolytic Body fluids/Select course of action/Urine sediment/3 anemia, and pernicious anemia. C Epithelial casts are rarely seen but indicate a disease following is considered an abnormal finding? Acidify a 12-mL aliquot with three drops of glacial acetic acid and heat to 56°C for 5 minutes before centrifuging D. How can hexagonal uric acid crystals be Answers to Questions 23–28 distinguished from cystine crystals?

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Although currently a relatively small market purchase voveran 50 mg mastercard muscle relaxant alcoholism, the nasal route possesses many properties of an “ideal” delivery site (Table 3 purchase 50 mg voveran mastercard muscle relaxant commercial. New technologies in nasal delivery are primarily concerned with strategies to increase the rate of systemic drug absorption buy 50 mg voveran visa muscle relaxant vs painkiller, in particular generic voveran 50 mg muscle relaxants kidney failure, in developing absorption promoters with minimal toxicity. Pulmonary drug delivery Drug delivery by inhalation has a long history and is an obvious way of administering agents that act on the respiratory system. A more recent advance has been the investigation of this route for systemic drug delivery, although the morphology of the lungs makes drug access to the airways difficult. Furthermore, particles that gain access to the upper airways may subsequently be cleared by mucociliary clearance mechanisms. Pulmonary drug delivery research is addressing factors such as the use of optimized drug delivery devices and novel drug delivery systems, such as liposomes. Systemic drug delivery via the lungs has largely focused on nebulization procedures, which are the most efficient at delivering the emitted dose to the peripheral lung. Vaginal drug delivery The vaginal route, discussed in Chapter 11, constitutes another mucosal route of emerging importance for systemic drug delivery. As with other mucosal routes, a major challenge lies in the development of safe, non-toxic absorption enhancers, to potentiate drug absorption. Furthermore, the route is only applicable to approximately 50% of the population, so that it may be that the future of this route lies in the treatment of diseases specific or more common to the female population. Ophthalmic drug delivery In contrast to the other routes described above, ophthalmic drug delivery systems are designed to deliver drugs locally to the ocular tissue, to avoid systemic uptake and associated side-effects. Research has focused on the development of systems which will improve the retention of drug at the corneal surface in order to overcome the problems associated with tear film drainage. These strategies are discussed in detail in the relevant chapters; the following discussion comprises a general summary of some of the common approaches available. The hydrogen-bonding propensity of a drug molecule can be minimized by substitution, esterification or alkylation of existing groups on the molecules, which will decrease the drug’s aqueous solubility, again favoring partitioning of the drug into lipidic membranes. The degree of ionization of a drug may be suppressed by the judicious use of buffering agents. Drug solubility may be enhanced by the use of amorphous or anhydrous forms, or the use of the corresponding salt form of a lipophilic drug. Low molecular weight analogues of an active moiety can be 69 developed, to facilitate trans-membrane transport. Alternatively, derivatives may be prepared which are substrates of natural transport carriers. Considerable effort has been directed towards the stabilization of therapeutic peptides and proteins both in vitro and in vivo. Several methods of modifying peptide structure to improve metabolic stability have been investigated, as outlined in Section 1. Traditionally drug design has focused on optimizing the pharmacological properties of a drug with less concern for potential drug bioavailability, toxicity and metabolism, which all form part of the later pharmaceutical development process. However, with the increasing numbers of compounds entering pharmaceutical development there is a need to limit resource wastage in developing compounds with poor biopharmaceutical profiles. This has led to the development of more rationalized approaches to drug design in order to optimize the bioavailability of potential drug substances in the early stage of drug discovery process to ensure that new drugs can be effectively delivered to their site of action. The process of rational drug design and delivery is discussed in more detail in Chapter 16. Although the pharmaceutical industry strives to develop drugs with appropriate pharmacokinetic and pharmacodynamic properties to ensure effective drug delivery, it is often difficult to obtain effective potency, low toxicity and acceptable bioavailability. Methods to improve delivery by manipulating the dosage form are described below and in the relevant chapters. The mechanisms of absorption promotion proposed for the different compounds are numerous and it is likely that more than one mechanism is involved (see Section 8. The use of penetration enhancers to improve drug absorption by variety of delivery routes is presently under investigation; for example, various studies have recently been carried out to identify penetration enhancers to facilitate the absorption of peptides and proteins by various routes (Table 3. However, as mentioned previously, a serious drawback associated with the use of penetration enhancers is their potential deleterious effect to the epithelial tissue, either directly, by damaging vital cell structures 70 and/or functions, or indirectly, by increasing the permeability of the epithelium and thus paving the way for inward penetration of toxic agents and organisms. Some routes of drug delivery, such as the transdermal and buccal, allow the spatial containment of absorption enhancers within an adhesive patch, thereby limiting the adverse effects to a specific area. Mucoadhesives, which are generally hydrophilic polymers, may be included in a dosage form to increase drug bioavailability. These agents are believed to act by: • increasing the contact time of the drug at the absorbing surface; • increasing the local drug concentration at the site of adhesion/absorption; • protecting the drug from dilution and possible degradation. Several mechanisms by which mucoadhesives adhere to biological surface have been suggested, including the electronic, adsorption, wetting, diffusion, and fracture theories. It is likely that water movement from the mucosa to the polymer and physical entanglement of the adhesive polymer in the mucus glycoprotein chains are important in obtaining adherence. Work in this field has concentrated on the use of protease inhibitors to facilitate the absorption of therapeutic peptides and proteins. For example, because it does not have a dissolution step, the bioavailability from an aqueous solution will be greater than from a tablet, etc. Increasing the drug concentration increases the rate of drug absorption via passive diffusion mechanisms. Examples include the use of eutectic mixtures and supersaturated systems to enhance the transdermal penetration of drugs (see Chapter 8). Other formulation strategies include altering the formulation pH and tonicity to effect favorable absorption. Various further strategies are specific for the route in question, for example the use of iontophoresis to enhance the transdermal delivery of drugs. The following chapters provide a more in-depth discussion of each of the major routes of drug delivery and discuss both advantages and disadvantages of these routes. The existing technologies employed to maximize delivery using the various routes is discussed along with the perceived challenges and opportunities for the future. Explain the following terms: (a) sustained release, (b) zero-order release, (c) bio-responsive release, (d) rate-controlled release and (e) targeted drug delivery. Outline the advantages and disadvantages of the following routes of administration: (a) parenteral, (b) oral and (c) pulmonary. Outline how the physicochemical properties of a dosage form can be modulated to improve drug absorption. Such systems are most commonly used for 74 sustained parenteral administration, including ocular and subcutaneous drug delivery. This chapter focuses on such implant systems and the mechanisms of rate control which form an intrinsic component of implantable systems. As these rate control mechanisms are applicable to many other drug delivery systems, this chapter also serves as a general introduction to the methods of rate control which are achievable using advanced drug delivery and targeting strategies.

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This was expected generic 50mg voveran with mastercard spasms in spanish, because in both chromatographic systems hydrophobic interactions are part of the retention mechanism discount 50mg voveran overnight delivery muscle relaxant klonopin. The effects of the nature of the organic modifier on the isomeric selectivity are not so easily 163 explained cheap voveran 50mg fast delivery muscle relaxant anesthesia. The elution order of some isomers changes when using a different organic modifier (figure 4 cheap 50 mg voveran mastercard muscle relaxant used for migraines. The trueness is between 90 and 105 % for all isomers, which is amply within the established criterion of 50 to 120 %. Over time the band width of the noise of blank -1 samples and the peak height of samples spiked at 0. For a few urine samples a slight deformation of the chromatographic peaks was observed which was in all cases directly related to the color of the extract indicating that occasionally some matrix components can have some influence on the chromatographic performance. In these cases the peak top can shift to a slightly lower retention time causing a difference in the compound’s retention time compared to the compound in the matrix-matched reference standards and therefore extra attention should be given to the confirmatory aspect e. From the method development, the sample clean-up was the most critical step in the analysis method. Three slight deviations to the procedure that might occur in practice, were tested: (1) evaporation of the eluent until only 200 µL of water remained after which ethyl acetate was added, (2) evaporation of the eluent until some methanol was still present after which ethyl acetate was added and (3) evaporation of the ethyl acetate fraction until dryness plus an additional 10 minutes. The duplicates analysed incorporating these deviations in the method showed good trueness and acceptable duplicates, indicating that the tested processes are robust. Furthermore, neither conversions to other isomeric forms nor any changes in the relative intensities of the isomers in the racemic mixtures were observed. Also after 7 days of storage the calibration lines remain sufficiently linear having a coefficient correlation above 0. It is concluded that urine extracts obtained with the described method are stable for at least 7 days when stored at -20 °C. If the results obtained using the chiral method would have been submitted for the proficiency test, z-scores of -0. Note that in a proficiency test, quantitative results are considered satisfactory if the z-score is between -2 and +2 [61], from which it is concluded that the quantitative aspect of the developed method is adequate. Especially the sample clean-up procedure proved to be a critical factor for obtaining reproducible chromatographic resolution. The validation showed good trueness, repeatability and within-lab reproducibility and the selectivity, robustness and stability proved to be sufficient to apply the presented method in routine analyses. Especially the sample clean-up procedure proved to be a critical factor for obtaining reproducible chromatographic resolution. The validation showed good trueness, repeatability and within-lab reproducibility and the selectivity, robustness and stability proved to be sufficient to apply the presented method in routine analyses. The occurrence of chloramphenicol in crops through the natural production by bacteria in soil Abstract Due to the unexpected findings of the banned antibiotic chloramphenicol in products of animal origin, feed and straw, the hypothesis was studied that the drug is naturally present in soil, through production by soil bacteria, and subsequently can be taken up by crops. The fate of chloramphenicol highly depends on soil type and showed a half-life of approximately one day in non-sterile topsoil. Second, the production of chloramphenicol in soil was studied and it was confirmed that Streptomyces venezuelae can produce chloramphenicol at appreciable amounts in non-sterile soil. Third, a transfer study was carried out using wheat and maize grown on three different soils, that were weekly exposed to aqueous chloramphenicol solutions at two different levels. Chloramphenicol was taken up by crops as determined by chiral liquid chromatography coupled to tandem mass spectrometric analysis and the levels in crop were found to be bioavailability related. It was concluded that chloramphenicol residues can occur naturally in crops as a result of the production of chloramphenicol by soil bacteria in their natural environment and subsequent uptake by crops. The drug has been evaluated by a number of organizations [2-4], most recently in 2005 by nd the Joint Expert Committee on Food Additives at its 62 meeting [5]. A more extensive follow-up study (n=104) carried out in our laboratories, showed 37 positives (36 %), of which 7 -1 -1 -1 above 0. Transfer studies confirmed the presence of detectable levels of veterinary drugs in plants, among which tetracyclines [68,69], trimethoprim [70], sulphonamides [69-71], anticoccidials [72] and florfenicol [22]. First, the stability of the antibiotic in soil was studied under sterile and non-sterile conditions. Wheat and maize were selected because these are the major crops used as stall bedding and/or animal feed constituent. Ammonium formate, formic acid, acetic acid and 25 % ammonia were obtained from Merck (Darmstadt, Germany). Milli-Q water was prepared using a Milli-Q -1 system at a resistivity of at least 18. Fresh soil was collected prior to the experiment on May th 10 2012 from 2 depth layers, i. Two hundred kg of both soil types was transferred to the laboratory where it was homogenised and sieved (< 2 mm using stainless steel 176 Chapter 4 sieve). To obtain a range in organic matter a third soil was created by mixing dried topsoil with an equivalent amount of sub-soil. This resulted in a series of soils with similar mineralogical properties and minor differences in pH. To obtain the desired moisture content at the start of the experiment, 370 mL of distilled water was added to each pot which is equivalent to 80 % of the water holding capacity for this soil type as determined experimentally. During the growth of the crops, the moisture content in the pot was maintained at 80 % of the water holding capacity by weight loss and correction for the total biomass present on the pot. In order to keep the growing conditions in all pots equal, a starting dose of N, P, K and Mg fertilizer was initially mixed with the soil. During the growth of the crops, aliquots of 50 mL of a nutrient solution based on the same ratio of N, P, K and Mg as listed here were added depending on the growing status of the plant. After mixing the bulk soil with the required amount of fertilizer, filling the pots with soil and installing the seeds in the top 0. The temperature and 177 humidity in the greenhouse were kept constant at 20 °C and 80 % respectively during the growth of the crop. After germination, the number of plants in each pot was reduced to 3 for maize and 10 for wheat. Daylight was maintained for 12 th hours after September 15 2012 using artificial light. The complete plants were nd th harvested after ripening on October 2 2012 (wheat) and October 18 2012 (maize). Samples were cut using a knife and subsequently minced under cryogenic conditions to obtain homogeneous samples and to improve extraction efficiency. In total 3 treatments levels were performed, including a 0-treatment receiving the same volume of deionised water, a low dose (7. From this stock solution 150 mL was diluted 10 times to a total volume of 1500 mL which served 178 Chapter 4 as the low treatment dose. Again, 10 gifts of this solution were added to the low dose treatment pots during the growing phase of the plants.

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C Highly buffered alkaline urine may cause a contaminated in vitro false-positive dry reagent strip protein test by B cheap voveran 50 mg mastercard 303 muscle relaxant reviews. C A positive nitrite requires infection with a Body fluids/Evaluate laboratory data to recognize nitrate-reducing organism order 50mg voveran otc spasms during pregnancy, dietary nitrate buy voveran 50 mg with amex spasms from dehydration, and inconsistent results/Urinalysis/3 incubation of urine in the bladder buy voveran 50mg low cost spasms lower right abdomen. When volume is below 12 mL, the sample should be diluted with saline to 12 mL before concentrating. Results are multiplied by the dilution (12 mL/mL urine) to give the correct range. Perform a quantitative urine glucose; report as control trace if greater than 100 mg/dL C. Request a new urine specimen ketone result Body fluids/Evaluate laboratory data to determine D. Request a new sample and repeat the urinalysis possible inconsistent results/Glucose/3 Body fluids/Evaluate laboratory data to recognize problems/Urinalysis/3 Answers to Questions 4–7 5. The trace ketone does not require Other findings: confirmation, provided that the quality control Color: Amber Transparency: Microscopic: Crystals of the reagent strips is acceptable. Perform a tablet test for bilirubin before dry reagent test and will confirm the presence of reporting bilirubin. Reduced possible inconsistent results/Urinalysis/3 renal blood flow causes increased urea reabsorption 6. A The urine glucose is determined by the blood All other results are normal and all tests are in glucose at the time the urine is formed. Report these results Body fluids/Evaluate laboratory data to recognize problems/Renal function/3 6. Urinalysis results from a 35-year-old woman are: patient gives positive tests for blood and protein. Support the finding of an extravascular transfusion reaction Select the most appropriate course of action. Recheck the blood reaction; if negative, look for transfusion reaction budding yeast D. Request a list of medications Body fluids/Correlate clinical and laboratory data/ Urinalysis/3 Body fluids/Evaluate laboratory data to recognize sources of error/Urinalysis/3 9. D The plasma free hemoglobin will be increased Body fluids/Select routine laboratory procedures to immediately after a hemolytic transfusion reaction, verify test results/Transfusion reaction/3 and the haptoglobin will be decreased. Given the following urinalysis results, select the hemoglobin will be eliminated by the kidneys, but most appropriate course of action: the haptoglobin will remain low or undetectable for 2–3 days. Call for a list of medications administered to the urine points to a patient with insulin-dependent patient diabetes. Perform a quantitative urinary albumin tolbutamide (Orinase) has been administered. Perform a test for microalbuminuria Body fluids/Evaluate laboratory data to determine 11. A A nonhemolyzed trace may have been overlooked possible inconsistent results/Urinalysis/3 and the blood test should be repeated. A routine urinalysis gives the following results: Answers to Questions 12–15 pH =6. Glucose= Trace Ketone = Neg These form yellow- or reddish-brown refractile Microscopic findings: deposits sometimes resembling blood or granular Blood casts: Mucus: Crystals: casts. False-negative blood reaction wall of the glomerulus, they become distorted, and B. False-negative protein reaction such cells are described as dysmorphic in appearance. Pseudocasts of urate mistaken for true casts They are characterized by uneven distribution of D. Mucus mistaken for casts hemoglobin, cytoplasmic blebs and an asymmetrical Body fluids/Evaluate laboratory data to determine membrane distinct from crenation. The cytoplasm possible inconsistent results/Urinalysis/3 may be extruded from the cell and may aggregate at 13. Intravascular hemolytic phenomenon is most often caused by: anemia causes hemoglobinuria rather than hematuria. Severe dehydration with extravascular hemolysis or hepatocellular Body fluids/Correlate clinical and laboratory data/ liver disease. A freshly voided specimen is needed Hematuria/2 to detect urobilinogen because it is rapidly photooxidized to urobilin. Urobilin does and turns brown after storage in the refrigerator not react with 2,4 dimethylaminobenzaldehyde or overnight. Te technologist requests a new 4-methoxybenzene diazonium tetrafluoroborate, specimen. Which test result would the urobilinogen test in the first sample will be normal, differ between the two specimens? Ketones and nitrites do not alter Body fluids/Apply knowledge to recognize sources of the pigment of the urine sample. Leukocytes cause the error/Urobilinogen/3 urine to be turbid but do not cause abnormal color. A patient’s random urine consistently contains These three tests are stable for 24 hours when urine is a trace of protein but no casts, cells, or other refrigerated within 30 minutes of collection. C Protein and other constituents of urine will often be sample is consistently negative for protein. A normal first-voided findings can be explained by: sample makes glomerular disease highly unlikely. Normal diurnal variation in protein loss Orthostatic albuminuria is a benign condition B. Orthostatic or postural albuminuria bent posture that puts back pressure on the kidneys. Microalbuminuria The quantity of albumin excreted into the urine is Body fluids/Evaluate laboratory data to determine small. Diagnosis is made by demonstrating a positive possible inconsistent results/Urinalysis/3 test after the person is erect for several hours, and the absence of proteinuria when the person is recumbent. Microalbuminuria seen in diabetic persons is usually accompanied by a positive test for urinary glucose. An error was made in the microscopic Answers to Questions 16–19 examination Body fluids/Evaluate laboratory data to determine 16. A urine sample has a negative blood reaction and test is significantly less sensitive. As a result, a trace to 5–10 cells per high-power field that resemble red small positive blood and negative protein test are blood cells. If a yeast infection Body fluids/Apply knowledge to recognize sources of is present, then the leukocyte esterase test will likely error/Microscopic/3 be positive; therefore, the leukocyte esterase test cannot be used to determine the identity of the cells. A pleural fluid submitted to the laboratory is Answers to Questions 20–23 milky in appearance. However, chylous effusions are odorless and have a twofold higher triglyceride than the Body fluids/Select test/Pleural fluid/2 plasma. A cerebrospinal fluid sample from an 8-year-old Pseudochylous effusions are foul smelling, usually child with a fever of unknown origin was tested have a mixed cellularity, and an elevated cholesterol.

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