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By Y. Gorok. Chowan College. 2018.

Pseudocasts of urate mistaken for true casts They are characterized by uneven distribution of D discount torsemide 10 mg otc blood pressure extremely low. Mucus mistaken for casts hemoglobin generic 10mg torsemide free shipping arteria spanish, 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.

Spore production is not culture obtained from a 59-year-old male usually seen with this organism buy 10mg torsemide with mastercard diastolic blood pressure 0, which may also stain patient undergoing chemotherapy quality 20mg torsemide arteria zigomatica, required gram negative. During the summer break, several middle-aged from the blood of a patient after gallbladder elementary school teachers from the same school surgery. Te bacteria grew well on agar containing district attended a 3-day seminar in Chicago. What is the most likely the group were hospitalized with pneumonia, identification? Only the specific concentrations necessary to report S, I, or R Answers to Questions 27–30 C. Microbiology/Select methods/Reagents/Media/ A good screening agar is a 20% bile plate that does Antibiotic testing/2 not support the growth of Prevotella spp. B Breakpoint susceptibility testing is done by selecting gram-negative rods on blood and chocolate agars. The most common environmental sites for recovery are shower heads, faucets, water tanks, and air-conditioning systems. A catalase-positive, gram-positive coccus (clusters coccobacillus resembling the Streptococcus on Gram stain smear) grew pale yellow, creamy viridans group was isolated from the blood of a colonies on 5% sheep blood agar. Te specimen 42-year-old female patient undergoing a bone was recovered from pustules on the face of a marrow transplant. They are often recovered from blood cultures obtained from a 60-year-old patient positive neonatal blood cultures resulting from diagnosed with endocarditis. An immunocompromised patient with prior antibiotic treatment grew aerobic gram-positive cocci from several clinical specimens that were cultured. A tissue biopsy specimen of the stomach was newborn grew predominantly β-hemolytic obtained from a 38-year-old male patient colonies of gram-positive cocci on 5% sheep blood diagnosed with gastric ulcers. Te newborn infant was covered with small was transported immediately and processed for skin eruptions that gave the appearance of a culture and histology. Which tests should bacilli on chocolate and Brucella agar with follow for the appropriate identification? A 20-year-old female patient entered the Microbiology/Evaluate data for identification/ emergency clinic complaining of abdominal pain, Gram-negative curved rods/3 fever, and a burning sensation during urination. The production of a potent exotoxin >100,000 col/mL of a nonhemolytic, catalase- (exfoliatin) causes the epidermis to slough off, negative, gram-positive organism on 5% sheep leaving the newborn’s skin with a red, raw texture blood agar. It is part of the normal flora of the female Bacitracin = Neg Optochin = Neg genitourinary tract and the human gastrointestinal A. A sputum specimen from an 89-year-old male due to the capsule surrounding the organism. To differentiate the viridans colonies appeared donut shaped and mucoidy and streptococci from S. Coagulase, glucose fermentation, lysostaphin Optochin but viridans streptococci are resistant. Microbiology/Evaluate laboratory data to make Other means of successful identification are rapid identification/Gram-positive cocci/3 urease test on biopsy material; urea breath test; and serological tests for the detection of antibodies to H. A catalase-positive, gram-positive short rod was Answers to Questions 39–41 recovered from the blood of a prenatal patient. Te following tests were 5% sheep blood agar, which often mimics group B performed, indicating the patient was infected β-hemolytic streptococci. Exposure through direct contact Voges–Proskauer = + (respiratory or cutaneous lesions) is the most likely A.

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Definition: “Identification ► noun cheap torsemide 20mg mastercard hypertension 28 years old, the action or process of identifying someone or something or the fact of being identified cheap 20 mg torsemide otc hypertension 39 weeks pregnant. When realising the indefinite number of substances that exist (also including substances not yet known to mankind), unequivocal identification is an impossible task [80] and therefore a degree of uncertainty of the qualitative result should be considered depending on the risks involved related to a false positive finding [81]. Selectivity The identification power and therefore the qualitative uncertainty of the confirmatory method is expressed in its selectivity. This term is often interchangeably used with ‘specificity’ [99], which is actually the ultimate of selectivity [100]. In case of a false positive result the presence of a certain substance is reported whereas this specific substance is not present. The power of discrimination between the substance present and closely related substances (isomers, metabolites, degradation products, endogenous substances, matrix constituents, etc. When one realises that non-compliant analytical results in food product analysis can have a huge effect on personal lives and society as well as on economy this becomes more than evident. In case the presence of a banned substance is reported whereas it is not truly present in the sample, farmers may be falsely accused of using banned carcinogenic antibiotics and go bankrupt after prosecution; certain branches may get a bad reputation and people may choose to avoid buying certain products; shipments of perfect quality food products might be destroyed, affecting the economy, international relations and food security. From this it is clear that, especially for confirmatory methods, selectivity is a very important parameter. This depends on the point of view taken: strict criteria result in an increased probability of false negative results whereas less strict criteria result in an increased possibility of obtaining a false positive result. Although all of the ion ratio criteria were established based on experts’ judgment, it is not unlikely that incorrect identification takes place. The influence of matrix constituents on the ion ratio was described and appointed as a possible cause of deviating ion abundances. In summary, maximum tolerance limits for ion ratio and retention time as established in several legal documents are very useful tools for the confirmation but not necessarily for the identification of compounds. However, some aspects that are not explicitly stated in the guidelines should be taken into account: - The selectivity of the whole procedure, including the sample preparation procedure. An alternative to the use of a priori established tolerance limits as indicated by the legal framework was presented by Van de Voet et al. The applicability of constructing a confidence interval for the ion ratio based on empirical data was demonstrated using a multi-variate approach. This approach was found very useful to replace a priori established tolerance limits, especially at very low concentration levels. Using these approaches, the confidence needed for determination of the identity can be easily set by adjusting the confidence interval parameters. But the chance on false positives and false negatives is set based on empirical data (e. First, potentially interfering substances that are likely to be encountered shall be evaluated. Representative blank samples shall be fortified at a relevant concentration with these substances to test for interferences. Second, at least 20 representative blank samples shall be analysed under within-laboratory reproducibility conditions to detect the presence of possible interferences and to estimate the effect of these interferences. According to the regulations, from the combination of the ‘identification points concept’ and the recommendations to test for interferences, optimal selectivity should be obtained, even though the guidelines do not seem to originate from statistically supported data. At the same time the document states: “An estimate to which extent this (the occurrence of a false positive result) is possible has to be provided.

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