I HUMAN CASE WEEK #4 69 YEAR OLD MALE REASON
FOR ENCOUNTER: CHEST PAIN (CLASS 6531)
LOCATION ; OUTPATIENT CLINIC WITH X-RAY,ECG,AND
LABARATORY CAPABILITIES. COMPLETE ACTUAL CASE
STUDY NEWEST 2024
Is the inability to urinate an emergency or should you tell Ms. Burd to continue to
monitor Noodle for the rest of the day? - ANSWER: Inability to urinate is an
emergency and should be treated right away
What does BUN stand for? What organ does a BUN test evaluate? - ANSWER: BUN is
Blood Urea Nitrogen - product of protein metabolism filtered out by kidneys. When
glomerular filtration rate is decreased or urinary tract is obstructed, urea nitrogen
will build up in blood stream. Kidneys are unable to fully filter out urea nitrogen out
of the vascular system causing BUN levels to decrease.
What other blood chemistry values may be altered in a patient with a urethral
blockage, especially with longer-term blockage? - ANSWER: It is important to
monitor blood pH; potassium levels of many animals with urethral blockages will
become hyperchloremic and acidotic which can be life threatening.
What is urohydropulsion? - ANSWER: Procedure used to clear urethra of foreign
materials in male dogs. Urinary catheter is inserted and fluids injected into urethra
while prepuce is closed shut. Urethra caudal to obstruction is also held shut rectally
allowing fluid to expand urethra and hopefully flush the stone backwards into the
urinary bladder.
Why would cystocentesis be the best method to collect urine and partially empty
Noodle's bladder? - ANSWER: Cystocentesis is best method to collect urine. Noodle
is blocked so catheters, free catch, and expression are not viable. Cystocentesis will
allow for emptying of the bladder and urine sample collection.
Why should urine collection be done before starting urohydropulsion? - ANSWER:
After urohydropulsion, bladder will have saline and lubricants in it which would alter
the results of the urinalysis rendering findings invalid.
What equipment is needed to perform urohydropulsion? - ANSWER:
Urohydropulsion requires urinary catheter, large syringe with a catheter tip, sterile
saline, exam glove, and lubricant. Ideally largest urinary catheter possible is used
because a tight fit is best for this procedure.
Is this USG within normal range? What is the proper method for preparing a urine
sample for a microscopic sediment examination? - ANSWER: Is slightly higher than
average USG but still in the normal range. To prepare urine sample for sediment you
would take the urine and place into centrifuge tube and centrifuge for 3-5 minutes
, and drop off most of the supernatant and leave ½ to 1 mL in the centrifuge tube then
suspend sediment in the fluid by flicking the tube carefully or mixing with a pipette.
Drop of mixed liquid is transported to a microscope slide and evaluated. Stain can be
added if desired and a cover slip is placed over the liquid.
What is a benefit of using a stain when examining urine sediment? What are some
problems that are associated with staining urine sediment? - ANSWER: Staining urine
sediment can improve differentiation between cell types, however, it can introduce
artifacts like bacteria or other precipitate material.
What are some other names for struvite crystals? Describe the appearance of
struvite crystals. - ANSWER: Struvite are frequently called triple phosphate or
magnesium ammonium phosphate. Resemble coffin lids and are generally 6-8 sided
prisms with tapered sides.
Is Noodle's acidic, neutral, or alkaline? How does diet affect urine pH? - ANSWER:
Slightly alkaline; alkaline urine most common in animals who have plant material
based diet and acidic is mostly commonly seen in animals with a meat or animal
based diet. Omnivores can have neutral, acidic, or neutral urine.
Name two crystals that form in acidic urine, two in alkaline urine, and two that form
in varying pH. Give descriptions of each of the crystal's microscopic appearance. -
ANSWER: Acidic Only
1) Amorphous urates: granular precipitate
2) Uric acid: many different shapes but usually rhomboid or diamond. Are yellow to
yellow brown in color.
3) Leucine: yellow or brown. Pin cushion or wheel shaped.
4) Tyrosine: dark refractive needle projections; clustered.
5) Cystine: thin, flat hexagons
Alkaline Only
1) Amorphous phosphate: granular precipitate
2) Calcium Carbonate
Neutral or varying
1) Sulfonamide: acidic or neutral. Dark, round, crystals radiate from the center
2) Ammonium biurate: slightly acidic/neutral/or alkaline urine. Brown with long or
irregular spicules like a thorn apple.
3) Calcium oxalate dehydrate: acidic, neutral, or alkaline. Small squares with an X on
the back of the crystals.
4) Calcium oxalate monohydrate: acidic, neutral, or alkaline urine. Dumbbell shaped
or elongated with pointed ends.
5) Calcium carbonate: neutral or alkaline urine. Round with lines radiating from the
center or dumbbell shaped.
6) Triple phosphate: mostly alkaline, slightly acidic, neutral
FOR ENCOUNTER: CHEST PAIN (CLASS 6531)
LOCATION ; OUTPATIENT CLINIC WITH X-RAY,ECG,AND
LABARATORY CAPABILITIES. COMPLETE ACTUAL CASE
STUDY NEWEST 2024
Is the inability to urinate an emergency or should you tell Ms. Burd to continue to
monitor Noodle for the rest of the day? - ANSWER: Inability to urinate is an
emergency and should be treated right away
What does BUN stand for? What organ does a BUN test evaluate? - ANSWER: BUN is
Blood Urea Nitrogen - product of protein metabolism filtered out by kidneys. When
glomerular filtration rate is decreased or urinary tract is obstructed, urea nitrogen
will build up in blood stream. Kidneys are unable to fully filter out urea nitrogen out
of the vascular system causing BUN levels to decrease.
What other blood chemistry values may be altered in a patient with a urethral
blockage, especially with longer-term blockage? - ANSWER: It is important to
monitor blood pH; potassium levels of many animals with urethral blockages will
become hyperchloremic and acidotic which can be life threatening.
What is urohydropulsion? - ANSWER: Procedure used to clear urethra of foreign
materials in male dogs. Urinary catheter is inserted and fluids injected into urethra
while prepuce is closed shut. Urethra caudal to obstruction is also held shut rectally
allowing fluid to expand urethra and hopefully flush the stone backwards into the
urinary bladder.
Why would cystocentesis be the best method to collect urine and partially empty
Noodle's bladder? - ANSWER: Cystocentesis is best method to collect urine. Noodle
is blocked so catheters, free catch, and expression are not viable. Cystocentesis will
allow for emptying of the bladder and urine sample collection.
Why should urine collection be done before starting urohydropulsion? - ANSWER:
After urohydropulsion, bladder will have saline and lubricants in it which would alter
the results of the urinalysis rendering findings invalid.
What equipment is needed to perform urohydropulsion? - ANSWER:
Urohydropulsion requires urinary catheter, large syringe with a catheter tip, sterile
saline, exam glove, and lubricant. Ideally largest urinary catheter possible is used
because a tight fit is best for this procedure.
Is this USG within normal range? What is the proper method for preparing a urine
sample for a microscopic sediment examination? - ANSWER: Is slightly higher than
average USG but still in the normal range. To prepare urine sample for sediment you
would take the urine and place into centrifuge tube and centrifuge for 3-5 minutes
, and drop off most of the supernatant and leave ½ to 1 mL in the centrifuge tube then
suspend sediment in the fluid by flicking the tube carefully or mixing with a pipette.
Drop of mixed liquid is transported to a microscope slide and evaluated. Stain can be
added if desired and a cover slip is placed over the liquid.
What is a benefit of using a stain when examining urine sediment? What are some
problems that are associated with staining urine sediment? - ANSWER: Staining urine
sediment can improve differentiation between cell types, however, it can introduce
artifacts like bacteria or other precipitate material.
What are some other names for struvite crystals? Describe the appearance of
struvite crystals. - ANSWER: Struvite are frequently called triple phosphate or
magnesium ammonium phosphate. Resemble coffin lids and are generally 6-8 sided
prisms with tapered sides.
Is Noodle's acidic, neutral, or alkaline? How does diet affect urine pH? - ANSWER:
Slightly alkaline; alkaline urine most common in animals who have plant material
based diet and acidic is mostly commonly seen in animals with a meat or animal
based diet. Omnivores can have neutral, acidic, or neutral urine.
Name two crystals that form in acidic urine, two in alkaline urine, and two that form
in varying pH. Give descriptions of each of the crystal's microscopic appearance. -
ANSWER: Acidic Only
1) Amorphous urates: granular precipitate
2) Uric acid: many different shapes but usually rhomboid or diamond. Are yellow to
yellow brown in color.
3) Leucine: yellow or brown. Pin cushion or wheel shaped.
4) Tyrosine: dark refractive needle projections; clustered.
5) Cystine: thin, flat hexagons
Alkaline Only
1) Amorphous phosphate: granular precipitate
2) Calcium Carbonate
Neutral or varying
1) Sulfonamide: acidic or neutral. Dark, round, crystals radiate from the center
2) Ammonium biurate: slightly acidic/neutral/or alkaline urine. Brown with long or
irregular spicules like a thorn apple.
3) Calcium oxalate dehydrate: acidic, neutral, or alkaline. Small squares with an X on
the back of the crystals.
4) Calcium oxalate monohydrate: acidic, neutral, or alkaline urine. Dumbbell shaped
or elongated with pointed ends.
5) Calcium carbonate: neutral or alkaline urine. Round with lines radiating from the
center or dumbbell shaped.
6) Triple phosphate: mostly alkaline, slightly acidic, neutral
