Name: Test Bank for Urinalysis and Body Fluids 6th Edition by Strasinger
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ISBN-10 ‏ : ‎ 9780803639201
ISBN-13 ‏ : ‎ 978-0803639201
Author: Susan King Strasinger (author) & Marjorie Schaub Di Lorenzo (author) (Author)

Here’s a concise, comprehensive, and carefully structured introduction to the analysis of non-blood body fluids. Through six editions, the authors, noted educators and clinicians, have taught generations of students the theoretical and practical knowledge every clinical laboratory scientist needs to handle and analyze non-blood body fluids, and to keep themselves and their laboratories safe from infectious agents.

Their practical, focused, and reader friendly approach first presents the foundational concepts of renal function and urinalysis. Then, step by step, they focus on the examination of urine, cerebrospinal fluid, semen, synovial fluid, serous fluid, amniotic fluid, feces, and vaginal secretions.

The 6th Edition has been completely updated to include all of the new information and new testing procedures that are important in this rapidly changing field. Case studies, clinical situations, learning objectives, key terms, summary boxes, and study questions show how work in the classroom translates to work in the lab.

Redeem the Plus Code inside new, printed texts to access your DavisPlus student resources, including Davis Digital, your complete text online.

Table of Content:

PART ONE Background
CHAPTER 1 Safety and Quality Assessment
LEARNING OBJECTIVES
KEY TERMS
SAFETY
Biologic Hazards
Table 1–1 Types of Safety Hazards
Figure 1–1 Chain of infection and safety practices related to the biohazard symbol.
Personal Protective Equipment
Hand Hygiene
PROCEDURE 1-1 Hand Washing Procedure
Biologic Waste Disposal
Sharp Hazards
Figure 1–2 Biohazard symbol.
Figure 1–3 Technologist disposing of urine (A) sample and (B) container.
Chemical Hazards
Chemical Spills and Exposure
Chemical Handling
Chemical Hygiene Plan
Chemical Labeling
Material Safety Data Sheets
Figure 1–4 Chemical safety aids. A, emergency shower; B, eye wash station.
Radioactive Hazards
Electrical Hazards
Figure 1–5 Chemical hazard symbols.
Fire/Explosive Hazards
Figure 1–6 NFPA hazardous material symbols.
Physical Hazards
Table 1–2 Types of Fires and Fire Extinguishers
QUALITY ASSESSMENT
Urinalysis Procedure Manual
Preexamination Variables
Figure 1–7 Example of procedure review documentation.
Specimen Collection and Handling
Figure 1–8 Cause-and-effect diagram for analyzing urinalysis TAT.
Table 1–3 Policy for Handling Mislabeled Specimens
Table 1–4 Criteria for Urine Specimen Rejection
Examination Variables
Reagents
Instrumentation and Equipment
Testing Procedure
Quality Control
Figure 1–9 Sample of Quality Improvement Follow-up Report form.
Figure 1–10 Sample instrument QC recording sheet.
External Quality Control
Internal Quality Control
Figure 1–11 Levy-Jennings charts showing in-control, shift, and trend results.
Electronic Controls
Proficiency Testing (External Quality Assessment)
Personnel and Facilities
Figure 1–12 “Out-of-control” procedures.
Postexamination Variables
Reporting Results
Figure 1–13 Sample standardized urine microscopic reporting format.
Figure 1–14 An example of procedure instructions for reporting critical values in the urinalysis section. A procedure review document similar to that shown in Figure 1–7 would accompany this instruction sheet.
SUMMARY 1-1 Quality Assessment Errors
Preexamination
Examination
Postexamination
Interpreting Results
References
Study Questions
Case Studies and Clinical Situations
CHAPTER 2 Introduction to Urinalysis
LEARNING OBJECTIVES
KEY TERMS
History and Importance
Figure 2–1 Physician examines urine flask.
Figure 2–2 Instruction in urine examination.
Figure 2–3 A chart used for urine analysis.
Urine Formation
Urine Composition
Urine Volume
TECHNICAL TIP
Table 2–1 Primary Components in Normal Urine3
Figure 2–4 Differentiation between diabetes mellitus and diabetes insipidus.
Specimen Collection
Containers
Labels
Requisitions
Specimen Rejection
TECHNICAL TIP
Table 2–2 Changes in Unpreserved Urine
Specimen Handling
Specimen Integrity
Specimen Preservation
TECHNICAL TIP
TECHNICAL TIP
Table 2–3 Urine Preservatives
Types of Specimens
Random Specimen
Table 2–4 Types of Urine Specimens
First Morning Specimen
HISTORICAL NOTE
Glucose Tolerance Specimens
24-Hour (or Timed) Specimen
PROCEDURE 2-1 Sample 24-Hour (Timed) Specimen Collection Procedure
TECHNICAL TIP
Catheterized Specimen
Midstream Clean-Catch Specimen
Suprapubic Aspiration
Prostatitis Specimen
Three-Glass Collection
TECHNICAL TIP
PROCEDURE 2-2 Clean-Catch Specimen Collection: Female Cleansing Procedure2
PROCEDURE 2-3 Clean-Catch Specimen Collection: Male Cleansing Procedure2
Pre- and Post-Massage Test
Pediatric Specimens
HISTORICAL NOTE
Stamey-Mears Test for Prostatitis
TECHNICAL TIP
Drug Specimen Collection
PROCEDURE 2-4 Urine Drug Specimen Collection Procedure
References
Study Questions
Case Studies and Clinical Situations
CHAPTER 3 Renal Function
LEARNING OBJECTIVES
KEY TERMS
Renal Physiology
Figure 3–1 The relationship of the nephron to the kidney and excretory system.
Renal Blood Flow
Figure 3–2 The nephron and its component parts.
Glomerular Filtration
Cellular Structure of the Glomerulus
Glomerular Pressure
TECHNICAL TIP
Figure 3–3 Factors affecting glomerular filtration in the renal corpuscle (A). Inset B, glomerular filtration barrier. Inset C, the shield of negativity.
Renin-Angiotensin-Aldosterone System
Figure 3–4 Close contact of the distal tubule with the afferent arteriole, macula densa, and the juxtaglomerular cells within the juxtaglomerular apparatus. Note the smaller size of the afferent arteriole indicating increased blood pressure.
Figure 3–5 Algorithm of the renin-angiotensin-aldosterone system.
Table 3–1 Actions of the RAAS
Tubular Reabsorption
Reabsorption Mechanisms
Table 3–2 Tubular Reabsorption
TECHNICAL TIP
Tubular Concentration
Collecting Duct Concentration
Figure 3–6 Renal concentration.
Tubular Secretion
Figure 3–7 Summary of movement of substances in the nephron.
Acid–Base Balance
Figure 3–8 Reabsorption of filtered bicarbonate.
Figure 3–9 Excretion of secreted hydrogen ions combined with phosphate.
Figure 3–10 Excretion of secreted hydrogen ions combined with ammonia produced by the tubules.
Renal Function Tests
Figure 3–11 The relationship of nephron areas to renal function tests.
Glomerular Filtration Tests
Clearance Tests
HISTORICAL NOTE
Urea Clearance
HISTORICAL NOTE
Inulin Clearance
Creatinine Clearance
Procedure
EXAMPLE
EXAMPLE
Estimated Glomerular Filtration Rates
Figure 3–12 Creatinine filtration and excretion.
Figure 3–13 A nomogram for determining body surface area.
HISTORICAL NOTE
Original MDRD Calculation
Cystatin C
Beta2-Microglobulin
Radionucleotides
Clinical Significance
Tubular Reabsorption Tests
Figure 3–14 The effect of hydration on renal concentration. Notice the decreased specific gravity in the more-hydrated Patient B.
Osmolality
Figure 3–15 Differentiation of neurogenic and nephrogenic diabetes insipidus.
Freezing Point Osmometers
Vapor Pressure Osmometers
Technical Factors
Clinical Significance
TECHNICAL TIP
Free Water Clearance
EXAMPLE
Tubular Secretion and Renal Blood Flow Tests
PAH Test
Titratable Acidity and Urinary Ammonia
HISTORICAL NOTE
Phenolsulfonphthalein Test
References
Study Questions
Case Studies and Clinical Situations
PART TWO Urinalysis
CHAPTER 4 Physical Examination of Urine
LEARNING OBJECTIVES
KEY TERMS
Color
Table 4–1 Laboratory Correlation of Urine Color1
Normal Urine Color
Abnormal Urine Color
Dark Yellow/Amber/Orange
Red/Pink/Brown
Brown/Black
Figure 4–1 Differentiation of red urine testing chemically positive for blood.
Blue/Green
Clarity
Normal Clarity
Table 4–2 Urine Clarity
PROCEDURE 4-1 Urine Color and Clarity Procedure
Nonpathologic Turbidity
Pathologic Turbidity
Table 4–3 Nonpathologic Causes of Urine Turbidity
Specific Gravity
Table 4–4 Pathologic Causes of Urine Turbidity
Refractometer
Box 4-1 Current Urine Specific Gravity Measurements
HISTORICAL NOTE
Urinometry
EXAMPLE
Figure 4–2 Steps in the use of the urine specific gravity refractometer.
Figure 4–3 Calibration of the urine specific gravity refractometer.
Osmolality
HISTORICAL NOTE
Harmonic Oscillation Densitometry
TECHNICAL TIP
Table 4–5 Particle Changes to Colligative Properties
Reagent Strip Specific Gravity
Odor
TECHNICAL TIP
Table 4–6 Possible Causes of Urine Odor1
References
Study Questions
Case Studies and Clinical Situations
CHAPTER 5 Chemical Examination of Urine
LEARNING OBJECTIVES
KEY TERMS
Reagent Strips
Reagent Strip Technique
Errors Caused by Improper Technique
PROCEDURE 5-1 Reagent Strip Technique1,2
Handling and Storing Reagent Strips
Quality Control of Reagent Strips
Confirmatory Testing
pH
Clinical Significance
SUMMARY 5-1 Care of Reagent Strips
Table 5–1 Causes of Acid and Alkaline Urine
TECHNICAL TIP
SUMMARY 5-2 Clinical Significance of Urine pH
Reagent Strip Reactions
TECHNICAL TIP
SUMMARY 5-3 pH Reagent Strip
Protein
Clinical Significance
Prerenal Proteinuria
Bence Jones Protein
Renal Proteinuria
Glomerular Proteinuria
Microalbuminuria
HISTORICAL NOTE
Screening Test for Bence Jones Protein
Orthostatic (Postural) Proteinuria
Tubular Proteinuria
Postrenal Proteinuria
HISTORICAL NOTE
Microalbuminuria Testing
Reagent Strip Reactions
SUMMARY 5-4 Clinical Significance of Urine Protein
Reaction Interference
Sulfosalicylic Acid Precipitation Test
Testing for Microalbuminuria
TECHNICAL TIP
SUMMARY 5-5 Clinical Significance of Urine Protein
PROCEDURE 5-2 Sulfosalicylic Acid Precipitation Test
Table Reporting SSA Turbidity
Albumin: Creatinine Ratio
Reagent Strip Reactions
Albumin
Creatinine
Albumin/Protein: Creatinine Ratio
Glucose
Clinical Significance
Figure 5–1 A protein:creatinine ratio determination chart.
SUMMARY 5-6 Immunologic Tests
SUMMARY 5-7 Clinical Significance of Urine Glucose
Reagent Strip (Glucose Oxidase) Reaction
Reaction Interference
Copper Reduction Test (Clinitest)
SUMMARY 5-8 Glucose Reagent Strip
Clinical Significance of Clinitest
PROCEDURE 5-3 Clinitest Procedure
Ketones
Clinical Significance
TECHNICAL TIP
SUMMARY 5-9 Clinical Significance of Urine Ketones
Reagent Strip Reactions
Reaction Interference
Acetest Tablets
Blood
Figure 5–2 Production of acetone and butyrate from acetoacetic acid.
PROCEDURE 5-4 Acetest Procedure
Clinical Significance
Hematuria
Hemoglobinuria
Myoglobinuria
Reagent Strip Reactions
SUMMARY 5-11 Clinical Significance of a Positive Reaction for Blood
HISTORICAL NOTE
Hemoglobinuria Versus Myoglobinuria
Reaction Interference
SUMMARY 5-12 Blood Reagent Strip
Bilirubin
Bilirubin Production
Clinical Significance
Table 5–2 Urine Bilirubin and Urobilinogen in Jaundice
SUMMARY 5-13 Clinical Significance of Urine Bilirubin
Figure 5–3 Hemoglobin degradation and production of bilirubin and urobilinogen.
Reagent Strip (Diazo) Reactions
Reaction Interference
Ictotest Tablets
SUMMARY 5-14 Bilirubin Reagent Strip
PROCEDURE 5-5 Ictotest Procedure
Urobilinogen
Clinical Significance
Reagent Strip Reactions and Interference
SUMMARY 5-15 Clinical Significance of Urine Urobilinogen
Reaction Interference
Nitrite
Clinical Significance
TECHNICAL TIP
SUMMARY 5-16 Urobilinogen Reagent Strip
Reagent Strip Reactions
Reaction Interference
SUMMARY 5-17 Clinical Significance of Urine Nitrite
SUMMARY 5-18 Nitrite Reagent Strip
Leukocyte Esterase
Clinical Significance
Reagent Strip Reaction
SUMMARY 5-19 Clinical Significance of Urine Leukocytes
Reaction Interference
Specific Gravity
Reagent Strip Reaction
SUMMARY 5-21 Clinical Significance of Urine Specific Gravity
Figure 5–4 Diagram of reagent strip–specific gravity reaction.
Reaction Interference
SUMMARY 5-22 Urine Specific Gravity Reagent Strip
References
Study Questions
Case Studies and Clinical Situations
CHAPTER 6 Microscopic Examination of Urine
LEARNING OBJECTIVES
KEY TERMS
Macroscopic Screening
Table 6–1 Macroscopic Screening and Microscopic Correlations
Specimen Preparation
Specimen Volume
Centrifugation
Sediment Preparation
Volume of Sediment Examined
Commercial Systems
Examining the Sediment
Reporting the Microscopic Examination
EXAMPLE
Correlating Results
HISTORICAL NOTE
Addis Count
Table 6–2 Routine Urinalysis Correlations
Sediment Examination Techniques
Sediment Stains
Table 6–3 Urine Sediment Stain Characteristics
Table 6–4 Expected Staining Reactions of Urine Sediment Constituents
Lipid Stains
Gram Stain
Hansel Stain
Prussian Blue Stain
Cytodiagnostic Urine Testing
Microscopy
The Microscope
Table 6–5 Urinalysis Microscopic Techniques
Figure 6–1 Parts of the binocular microscope.
PROCEDURE 6-1 Care of the Microscope
Köhler Illumination
Figure 6–2 Centering the condenser and Köhler illumination.
Types of Microscopy
Bright-Field Microscopy
Phase-Contrast Microscopy
Polarizing Microscopy
Figure 6–3 Phase-contrast ring adjustment.
Interference-Contrast Microscopy
Figure 6–4 Diagram of polarized light.
Dark-Field Microscopy
Figure 6–5 Differential interference-contrast (Nomarski) microscopy.
Fluorescence Microscopy
Figure 6–6 Dark-field microscopy.
Urine Sediment Constituents
Red Blood Cells
Figure 6–7 Fluorescent microscopy.
Figure 6–8 Normal RBCs (×400).
Figure 6–9 Microcytic and crenated RBCs (×100).
Figure 6–10 Yeast. The presence of budding forms aid in distinguishing from RBCs (×400).
Figure 6–11 KOVA-stained squamous epithelial cells and oil droplets (×400). Notice how the oil droplet (arrow) resembles an RBC.
Figure 6–12 Air bubble. Notice no formed elements are in focus (×100).
Clinical Significance
Figure 6–13 Dysmorphic RBCs (×400). Notice the smaller size and fragmentation.
White Blood Cells
SUMMARY 6-1 Microscopic RBCs
Figure 6–14 RBCs and one WBC (×400). Notice the larger size and granules in the WBC.
Figure 6–15 WBCs. A. One segmented and one nonsegmented WBC (×400). B. Notice the multilobed nucleoli (×400).
Eosinophils
Figure 6–16 Glitter cells (×400). Observe the very noticeable granules.
Figure 6–17 Hansel-stained eosinophils (×400).
Mononuclear Cells
Figure 6–18 WBCs with acetic acid nuclear enhancement. Notice the ameboid shape in some of the WBCs.
Epithelial Cells
SUMMARY 6-2 Microscopic WBCs
Squamous Epithelial Cells
Figure 6–19 Sediment-containing squamous, caudate transitional, and RTE cells (×400).
Figure 6–20 A. Squamous epithelial cells identifiable under low power (×100). B. KOVA-stained squamous epithelial cells (×400). Compare the size of the nucleus with the RBCs in Figure 6–8.
Figure 6–21 Phenazopyridine-stained sediment showing squamous epithelial cells and phenazopyridine crystals formed following refrigeration (×400).
Figure 6–22 Clump of squamous epithelial cells (×400).
Figure 6–23 Clump of squamous epithelial cells with folded forms (×400).
Transitional Epithelial (Urothelial) Cells
Figure 6–24 Transitional epithelial cells.
Figure 6–25 KOVA-stained spherical transitional epithelial cells (×400).
Figure 6–26 Caudate transitional epithelial cells (×400).
Figure 6–27 Syncytia of transitional epithelial cells from catheterized specimen (×400).
Renal Tubular Epithelial Cells
Figure 6–28 RTE cell. Columnar proximal convoluted tubule cell with granules and attached fat globules (×400). N, nucleus.
Figure 6–29 RTE cells. Oval distal convoluted tubule cells. Notice the eccentrically placed nuclei (×400).
Figure 6–30 RTE cells, cuboidal from the collecting duct (×400).
Figure 6–31 Fragment of RTE cells from the collecting duct under phase microscopy (×400).
Clinical Significance
Figure 6–32 Prussian blue–stained hemosiderin granules.
Oval Fat Bodies
Figure 6–33 Oval fat body (×400).
Figure 6–34 Sudan III-stained oval fat body (×400).
Figure 6–35 Oval fat body under bright-field (left) and polarized (right) microscopy. Notice the Maltese cross formation (arrow) (×400).
Bacteria
SUMMARY 6-3 Epithelial Cells
Figure 6–36 A. Rod-shaped bacteria often seen in urinary tract infections. B. KOVA-stained bacteria and WBC (×400).
Yeast
Figure 6–37 A. Budding yeast B. Yeast showing mycelial forms (×400).
Parasites
Figure 6–38 Trichomonas vaginalis. Notice the flagella and undulating membrane.
Spermatozoa
Figure 6–39 Schistosoma haematobium ova (×300). Eggs are often contained in the last few drops of urine expelled from the bladder.
Figure 6–40 A. Enterobius vermicularis ova (×100) B. Enterobius vermicularis ova (×400).
Figure 6–41 Spermatozoa (×400).
Mucus
Casts
Figure 6–42 A. Mucus threads (×400). B. Mucus clump (×400).
SUMMARY 6-4 Miscellaneous Structures
Cast Composition and Formation
Hyaline Casts
Figure 6–43 Hyaline casts under low power (×100).
Figure 6–44 Hyaline cast (A) and amorphous urates (B) attached to mucus pseudocast (×100).
Figure 6–45 A. Hyaline cast (×400). B. Hyaline cast under phase microscopy (×400).
Figure 6–46 Convoluted hyaline cast (×400).
RBC Casts
Figure 6–47 Hyaline cast containing occasional granules (×400).
Figure 6–48 RBC cast (×400).
Figure 6–49 KOVA-stained RBC cast under phase microscopy (×400).
Figure 6–50 Disintegrating RBC cast. Notice the presence of free RBCs (arrows) to confirm identification.
Figure 6–51 Cast containing hemoglobin pigment. A comparison of RBCs (A) and yeast (B) also can be made (×400).
Figure 6–52 Granular, dirty, brown cast (×400).
WBC Casts
Figure 6–53 WBC cast. Notice the free WBCs to aid in identification.
Figure 6–54 KOVA-stained WBC cast (×400).
Figure 6–55 Disintegrating WBC cast (×400).
Bacterial Casts
Figure 6–56 WBC clump. Notice the absence of a cast matrix.
Epithelial Cell Casts
Fatty Casts
Figure 6–57 RTE cell cast (×400).
Figure 6–58 A. KOVA-stained RTE cell cast (×400). B. KOVA-stained RTE cell cast under phase microscopy (×400).
Figure 6–59 RTE cast with bilirubin-stained cells (×400).
Mixed Cellular Casts
Figure 6–60 Fatty cast showing adherence of fat droplets (arrows) to cast matrix (×400).
Figure 6–61 Fatty cast (×400).
Figure 6–62 Fatty cast under phase microscopy (×400).
Granular Casts
Figure 6–63 Finely granular cast (A) and uric acid crystals (B) (×400).
Figure 6–64 Granular cast formed at a tubular bend (×400).
Figure 6–65 Granular disintegrating cellular cast (×400).
Figure 6–66 Coarsely granular cast (A), squamous epithelial cell (B), and mucus (C) (×400).
Waxy Casts
Figure 6–67 Granular cast degenerating into waxy cast (×400).
Figure 6–68 KOVA-stained waxy casts (×100).
Figure 6–69 KOVA-stained waxy casts (×200).
Figure 6–70 KOVA-stained waxy cast (×400).
Broad Casts
Urinary Crystals
Figure 6–71 KOVA-stained broad waxy cast (×400).
Figure 6–72 Broad granular cast becoming waxy (×400).
Figure 6–73 Broad bile-stained waxy cast (×400).
Crystal Formation
General Identification Techniques
SUMMARY 6-5 Urine Casts
Normal Crystals Seen in Acidic Urine
Table 6–6 Major Characteristics of Normal Urinary Crystals
Figure 6–74 Amorphous urates (×400).
Figure 6–75 Amorphous urates attached to a fiber.
Figure 6–76 Uric acid crystals (×400).
Figure 6–77 Clump of uric acid crystals (×400). Notice the whetstone, not hexagonal, shape that differentiates uric acid crystals from cystine crystals.
Figure 6–78 A. Uric acid crystals under polarized light (×100). B. Uric acid crystals under polarized light (×400).
Figure 6–79 Classic dihydrate calcium oxalate crystals (×400).
Figure 6–80 Classic dihydrate calcium oxalate crystals under phase microscopy (×400).
Figure 6–81 Attached classic dihydrate calcium oxalate crystals (×400).
Figure 6–82 Monohydrate calcium oxalate crystals (×400).
Normal Crystals Seen in Alkaline Urine
Figure 6–83 Amorphous phosphates (×400). Urine pH 7.0.
Figure 6–84 Amorphous phosphates (×400).
Figure 6–85 Triple phosphate crystal (×400).
Figure 6–86 Triple phosphate crystals (arrow) and amorphous phosphates (×400).
Figure 6–87 Calcium carbonate crystals (×400).
Figure 6–88 Ammonium biurate crystals (×400). Notice the “thorny apple” appearance.
Figure 6–89 Ammonium biurate crystals A. Ammonium biurate and triple phosphate crystals (×100). Note thorn (arrow). B. Ammonium biurate and triple phosphate crystals (×400).
Figure 6–90 Ammonium biurate crystals (×400). Note thorns (arrow).
Abnormal Urine Crystals
Cystine Crystals
Cholesterol Crystals
Table 6–7 Major Characteristics of Abnormal Urinary Crystals
Figure 6–91 Cystine crystals (×400).
Radiographic Dye Crystals
Crystals Associated With Liver Disorders
Figure 6–92 Clump of cystine crystals (×400). Notice the hexagonal shape still visible.
Figure 6–93 Cholesterol crystals. Notice the notched corners (×400).
Figure 6–94 Cholesterol crystals under polarized light (×400).
Figure 6–95 Tyrosine crystals in fine needle clumps (×400).
Figure 6–96 Tyrosine crystals in rosette forms (×400).
Figure 6–97 Leucine crystals (×400). Notice the concentric circles.
Figure 6–98 Bilirubin crystals. Notice the classic bright yellow color (×400).
Sulfonamide Crystals
Ampicillin Crystals
Figure 6–99 Sulfa crystals in rosette form (×400).
Figure 6–100 Sulfa crystals, WBCs, and bacteria seen in UTI (×400).
Figure 6–101 Ampicillin crystals. A. Nonrefrigerated ampicillin crystals. (×400). B. Ampicillin crystals after refrigeration (×400).
Urinary Sediment Artifacts
Figure 6–102 Starch granules. Notice the dimpled center (×400).
Figure 6–103 Fecal material and oil artifacts (×400).
Figure 6–104 Pollen grain. Notice the concentric circles (×400).
Figure 6–105 Fiber and squamous epithelial cell (×400).
Figure 6–106 Fiber under polarized light (×100).
Figure 6–107 Diaper fiber resembling a cast. Notice the refractility (×400).
Figure 6–108 Vegetable fiber resembling waxy cast (×400).
References
Study Questions
Case Studies and Clinical Situations
CHAPTER 7 Renal Disease
LEARNING OBJECTIVES
KEY TERMS
Glomerular Disorders
Glomerulonephritis
Acute Poststreptococcal Glomerulonephritis
Rapidly Progressive (Crescentic) Glomerulonephritis
Goodpasture Syndrome
Wegener Granulomatosis
Henoch-Schönlein Purpura
Membranous Glomerulonephritis
Membranoproliferative Glomerulonephritis
Chronic Glomerulonephritis
Immunoglobulin A Nephropathy
Nephrotic Syndrome
Minimal Change Disease
Focal Segmental Glomerulosclerosis
Tubular Disorders
Acute Tubular Necrosis
Table 7–1 Laboratory Testing in Glomerular Disorders
Table 7–2 Clinical Information Associated With Glomerular Disorders
Hereditary and Metabolic Tubular Disorders
Fanconi Syndrome
Alport Syndrome
Uromodulin-Associated Kidney Disease
Diabetic Nephropathy
Nephrogenic Diabetes Insipidus
TECHNICAL TIP
Renal Glycosuria
Interstitial Disorders
Table 7–3 Laboratory Testing in Metabolic and Hereditary Tubular Disorders
Table 7–4 Clinical Information Associated With Metabolic and Tubular Disorders
Acute Pyelonephritis
Chronic Pyelonephritis
TECHNICAL TIP
Acute Interstitial Nephritis
Renal Failure
Table 7–5 Laboratory Results in Interstitial Disorders
Table 7–6 Clinical Information Associated With Interstitial Disorders
Table 7–7 Causes of Acute Renal Failure
Renal Lithiasis
References
Study Questions
Case Studies and Clinical Situations
CHAPTER 8 Urine Screening for Metabolic Disorders
LEARNING OBJECTIVES
KEY TERMS
Overflow Versus Renal Disorders
Table 8–1 Abnormal Metabolic Constituents or Conditions Detected in the Routine Urinalysis
Newborn Screening Tests
Table 8–2 Major Disorders of Protein and Carbohydrate Metabolism Associated With Abnormal Urinary Constituents, Classified by Functional Defect
Figure 8–1 Specimen collection form for MS/MS newborn screening test.
Amino Acid Disorders
Phenylalanine-Tyrosine Disorders
Phenylketonuria
Figure 8–2 Phenylalanine and tyrosine metabolic pathway including the normal pathway (blue), enzymes (yellow), and disorders caused by failure to inherit particular enzymes (green).
Tyrosyluria
PROCEDURE 8-1
Melanuria
PROCEDURE 8-2 Nitroso-Naphthol Test for Tyrosine
Alkaptonuria
TECHNICAL TIP
TECHNICAL TIP
PROCEDURE 8-3 Homogentisic Acid Test
TECHNICAL TIP
Branched-Chain Amino Acid Disorders
Maple Syrup Urine Disease
Figure 8–3 α-Alpha amino acid and branched chain amino acid structures. A. Structure of an α-amino acid. B. Structure of the branched chain amino acid leucine.
Organic Acidemias
Tryptophan Disorders
PROCEDURE 8-4
Indicanuria
5-Hydroxyindoleacetic Acid
Figure 8–4 Tryptophan metabolism.
Cystine Disorders
PROCEDURE 8-5
Cystinuria
PROCEDURE 8-6 Silver Nitroprusside Test for Homocystine
Cystinosis
Homocystinuria
Porphyrin Disorders
PROCEDURE 8-7
Figure 8–5 Pathway of heme formation, including normal pathway (green), enzymes (orange), and stages affected by the major disorders (yellow) of porphyrin metabolism.
Table 8–3 Common Porphyrias
HISTORICAL NOTE
Vampires in Old Europe
Mucopolysaccharide Disorders
PROCEDURE 8-8 Watson-Schwartz Differentiation Test
PROCEDURE 8-9 Watson-Schwartz reactions.
PROCEDURE 8-10
Purine Disorders
Carbohydrate Disorders
PROCEDURE 8-11
TECHNICAL TIP
References
Study Questions
Case Studies and Clinical Situations
PART THREE Other Body Fluids
CHAPTER 9 Cerebrospinal Fluid
LEARNING OBJECTIVES
KEY TERMS
Formation and Physiology
Figure 9–1 The layers of the meninges. A, the layers of the meninges in the brain. B, the layers of the meninges in the spinal cord.
Specimen Collection and Handling
Figure 9–2 The flow of CSF through the brain and spinal column.
Appearance
Figure 9–3 CSF specimen collection tubes.
TECHNICAL TIP
TECHNICAL TIP
Figure 9–4 Tubes of CSF. Appearance left to right is normal, xanthochromic, hemolyzed, and cloudy.
Traumatic Collection (Tap)
Uneven Blood Distribution
Table 9–1 Clinical Significance of CSF Appearance
Clot Formation
Xanthochromic Supernatant
Cell Count
Methodology
Figure 9–5 Neubauer counting chamber depicting the nine large square counting areas.
Calculating CSF Cell Counts
EXAMPLE
Total Cell Count
WBC Count
Quality Control of CSF and Other Body Fluid Cell Counts
Differential Count on a CSF Specimen
Cytocentrifugation
Figure 9–6 Cytospin 3 cytocentrifuge specimen processing assembly
CSF Cellular Constituents
Table 9–2 Cytocentrifuge Recovery Chart7
Figure 9–7 Normal lymphocytes. Some cytocentrifuge distortion of cytoplasm (x1000).
Figure 9–8 Normal lymphocytes and monocytes (x500).
Neutrophils
Table 9–3 Predominant Cells Seen in CSF
Figure 9–9 Neutrophils with cytoplasmic vacuoles resulting from cytocentrifugation (x500).
Figure 9–10 Neutrophils with intracellular bacteria (x1000).
Figure 9–11 Neutrophils with intracellular and extracellular bacteria (x1000).
Figure 9–12 Neutrophils with pyknotic nuclei. Notice the cell with a single nucleus in the center (x1000).
Figure 9–13 Nucleated RBCs seen with bone marrow contamination (x1000).
Lymphocytes and Monocytes
Figure 9–14 Bone marrow contamination (x1000). Notice the immature RBCs and granulocytes.
Figure 9–15 Capillary and tissue fragments from a traumatic tap (x100).
Figure 9–16 Broad spectrum of lymphocytes and monocytes in viral meningitis (x1000).
Eosinophils
Macrophages
Nonpathologically Significant Cells
Figure 9–17 Eosinophils (x1000). Notice cytocentrifuge distortion.
Figure 9–18 Macrophages. Notice the large amount of cytoplasm and vacuoles (x500).
Figure 9–19 Macrophages showing erythrophagocytosis (x500).
Figure 9–20 Macrophage with RBC remnants (x500).
Figure 9–21 Macrophage with aggregated hemosiderin granules (x500).
Figure 9–22 Macrophage containing hemosiderin stained with Prussian blue (x250).
Figure 9–23 Macrophage with coarse hemosiderin granules (x500).
Figure 9–24 Macrophage containing hemosiderin and hematoidin crystals (x500).
Figure 9–25 Macrophages with hemosiderin and hematoidin (x250). Notice the bright yellow color.
Figure 9–26 Choroidal cells showing distinct cell borders and nuclear uniformity (x500).
Figure 9–27 Ependymal cells. Notice the nucleoli and less distinct cell borders (x1000).
Malignant Cells of Hematologic Origin
Figure 9–28 Cluster of spindle-shaped cells (x500).
Figure 9–29 Lymphoblasts from acute lymphocytic leukemia (x500).
Figure 9–30 Myeloblasts from acute myelocytic leukemia (x500).
Figure 9–31 Monoblasts and two lymphocytes (x1000). Notice the prominent nucleoli.
Figure 9–32 Cleaved and noncleaved lymphoma cells (x1000).
Figure 9–33 Lymphoma cells with nucleoli (x500).
Malignant Cells of Nonhematologic Origin
Figure 9–34 Burkitt lymphoma. Notice characteristic vacuoles (x500).
Figure 9–35 Medulloblastoma (x1000). Notice cellular clustering, nuclear irregularities, and rosette formation.
Chemistry Tests
Cerebrospinal Protein
Clinical Significance of Elevated Protein Values
Methodology
Protein Fractions
Table 9–4 Clinical Causes of Abnormal CSF Protein Values*
Electrophoresis and Immunophoretic Techniques
Figure 9–36 Normal and abnormal oligoclonal banding.
Myelin Basic Protein
CSF Glucose
CSF Lactate
CSF Glutamine
Microbiology Tests
Table 9–5 CSF Chemistry Tests
Gram Stain
Table 9–6 Major Laboratory Results for Differential Diagnosis of Meningitis
Figure 9–37 India ink preparation of C. neoformans (x400). Notice budding yeast form.
Figure 9–38 Gram stain of C. neoformans showing starburst pattern (x1000).
Serologic Testing
Figure 9–39 Naegleria fowleri trophozoite.
References
Study Questions
Case Studies and Clinical Situations
CHAPTER 10 Semen
LEARNING OBJECTIVES
KEY TERMS
Physiology
Table 10–1 Semen Composition
Figure 10–1 The male genitalia. Top, sagittal view; bottom, anterior view.
Specimen Collection
SUMMARY 10-1 Semen Production
TECHNICAL TIP
Specimen Handling
Semen Analysis
Appearance
Table 10–2 Reference Values for Semen Analysis5
Liquefaction
Volume
Viscosity
PROCEDURE 10-1
PROCEDURE 10-2
TECHNICAL TIP
pH
Sperm Concentration and Sperm Count
Figure 10–2 Areas of the Neubauer counting chamber used for red and white blood cell counts. W, typical WBC counting area; R, typical RBC counting area.
Calculating Sperm Concentration and Sperm Count
EXAMPLES
Sperm Motility
Table 10–3 Sperm Motility Grading
Table 10–4 Alternative Sperm Motility Grading Criteria1
Sperm Morphology
TECHNICAL TIP
Figure 10–3 Normal spermatozoon structure.
Figure 10–4 Spermatozoon with double head, hematoxylin-eosin (×1000).
Figure 10–5 Spermatozoon with amorphous head, hematoxylin-eosin (×1000).
Figure 10–6 Spermatozoon with double tail, hematoxylin-eosin (×1000).
Calculating Round Cells
Additional Testing
Figure 10–7 Common abnormalities of sperm heads and tails.
Figure 10–8 Spermatozoon with bent neck and spermatid, hematoxylin-eosin (×1000).
Figure 10–9 Immature spermatozoa, hematoxylin-eosin (×1000).
Sperm Vitality
Seminal Fluid Fructose
Table 10–5 Additional Testing for Abnormal Semen Analysis
Figure 10–10 Nonviable spermatozoa demonstrated by the eosin-nigrosin stain (×1000).
PROCEDURE 10-3
Antisperm Antibodies
Microbial and Chemical Testing
Table 10–6 Reference Semen Chemical Values1
Postvasectomy Semen Analysis
Sperm Function Tests
Semen Analysis Quality Control
TECHNICAL TIP
Table 10–7 Sperm Function Tests
References
Study Questions
Case Studies and Clinical Situations
CHAPTER 11 Synovial Fluid
LEARNING OBJECTIVES
KEY TERMS
Physiology
Figure 11–1 A synovial joint.
Table 11–1 Normal Synovial Fluid Values2
Specimen Collection and Handling
Table 11–2 Classification and Pathologic Significance of Joint Disorders
Table 11–3 Laboratory Findings in Joint Disorders3
Table 11–4 Required Tube Types for Synovial Fluid Tests
TECHNICAL TIP
Color and Clarity
Viscosity
Cell Counts
Differential Count
Table 11–5 Cells and Inclusions Seen in Synovial Fluid
Crystal Identification
Types of Crystals
Table 11–6 Characteristics of Synovial Fluid Crystals
Slide Preparation
Crystal Polarization
Figure 11–2 Unstained wet prep of MSU crystals (×400). Notice the characteristic yellow-brown of the urate crystals.
Figure 11–3 Wright’s-stained neutrophils containing CPPD crystals (×1000).
Figure 11–4 Strongly birefringent MSU crystals under polarized light (×500).
Figure 11–5 Weakly birefringent CPPD crystals under polarized light (×1000).
Figure 11–6 Extracellular MSU crystals under compensated polarized light. Notice the change in color with crystal alignment (×100).
Figure 11–7 MSU crystals under compensated polarized light. The yellow crystal is aligned with the slow vibration (×500).
Figure 11–8 CPPD crystals under compensated polarized light. The blue crystal is aligned with the slow vibration (×1000).
Chemistry Tests
Figure 11–9 Negative and positive birefringence in MSU and CPPD crystals. (A) MSU crystal with grain running parallel to the long axis. The slow ray passes with the grain, producing negative (yellow) birefringence. (B) CPPD crystal with grain running perpendicular to the long axis. The slow ray passes against the grain and is retarded, producing positive (blue) birefringence.
TECHNICAL TIP
Microbiologic Tests
Serologic Tests
References
Study Questions
Case Studies and Clinical Situations
CHAPTER 12 Serous Fluid
LEARNING OBJECTIVES
KEY TERMS
Formation
Specimen Collection and Handling
Figure 12–1 The body areas and membranes where serous fluid is produced.
Figure 12–2 The normal formation and absorption of pleural fluid.
Table 12–1 Pathologic Causes of Effusions
Transudates and Exudates
General Laboratory Procedures
Table 12–2 Laboratory Differentiation of Transudates and Exudates
Pleural Fluid
Appearance
Table 12–3 Correlation of Pleural Fluid Appearance and Disease5
Hematology Tests
Table 12–4 Differentiation Between Chylous and Pseudochylous Pleural Effusions
Table 12–5 Significance of Cells Seen in Pleural Fluid
Figure 12–3 Systemic lupus erythematosus cell in pleural fluid. Notice the ingested “round body” (×1000).
Figure 12–4 Normal pleural fluid mesothelial cells, lymphocytes, and monocytes (×250).
Figure 12–5 Normal mesothelial cell (×500).
Figure 12–6 Reactive mesothelial cells showing eccentric nuclei and vacuolated cytoplasm (×500).
Figure 12–7 One normal and two reactive mesothelial cells with a multinucleated form (×500).
Figure 12–8 Pleural fluid plasma cells seen in a case of tuberculosis. Notice the absence of mesothelial cells (×1000).
Figure 12–9 Pleural fluid adenocarcinoma showing cytoplasmic molding (×250).
Figure 12–10 Pleural fluid adenocarcinoma showing nuclear and cytoplasmic molding and vacuolated cytoplasm (×1000).
Figure 12–11 Enhancement of nuclear irregularities using a toluidine blue stain (×250).
Figure 12–12 Poorly differentiated pleural fluid adenocarcinoma showing nuclear irregularities and cytoplasmic vacuoles (×500).
Figure 12–13 Pleural fluid small cell carcinoma showing nuclear molding (×250).
Chemistry Tests
Figure 12–14 Metastatic breast carcinoma cells in pleural fluid. Notice the hyperchromatic nucleoli (×1000).
Table 12–6 Characteristics of Malignant Cells
Table 12–7 Significance of Chemical Testing of Pleural Fluid
Microbiologic and Serologic Tests
Pericardial Fluid
Figure 12–15 Algorithm of pleural fluid testing.
Table 12–8 Significance of Pericardial Fluid Testing
Appearance
Laboratory Tests
Figure 12–16 Malignant pericardial effusion showing giant mesothelioma cell with cytoplasmic molding and hyperchromatic nucleoli (×1000).
Peritoneal Fluid
Transudates Versus Exudates
Table 12–9 Significance of Peritoneal Fluid Testing
EXAMPLE
Appearance
Laboratory Tests
Cellular Examination
Figure 12–17 Lipophages (macrophages containing fat droplets) in peritoneal fluid (×500).
Figure 12–18 Budding yeast in peritoneal fluid (×400).
Figure 12–19 Ovarian carcinoma showing community borders, nuclear irregularity, and hyperchromatic nucleoli (×500).
Figure 12–20 Ovarian carcinoma cells with large mucin-containing vacuoles (×500).
Figure 12–21 Adenocarcinoma of the prostate showing cytoplasmic vacuoles, community borders, and hyperchromatic nucleoli (×500).
Figure 12–22 Colon carcinoma cells containing mucin vacuoles and nuclear irregularities (×400).
Figure 12–23 Psammoma bodies exhibiting concentric striations (×500).
Chemical Testing
Microbiology Tests
Serologic Tests
References
Study Questions
Case Studies and Clinical Situations
CHAPTER 13 Amniotic Fluid
LEARNING OBJECTIVES
KEY TERMS
Physiology
Function
Volume
Table 13–1 Tests for Fetal Well-Being and Maturity
Figure 13–1 Fetus in amniotic sac.
Chemical Composition
Differentiating Maternal Urine From Amniotic Fluid
Specimen Collection
Indications for Amniocentesis
Table 13–2 Indications for Performing Amniocentesis
Collection
Specimen Handling and Processing
Color and Appearance
Tests for Fetal Distress
Hemolytic Disease of the Newborn
Table 13–3 Amniotic Fluid Color
Figure 13–2 Rh antibodies crossing the placenta.
Figure 13–3 Spectrophotometric bilirubin scan showing bilirubin and oxyhemoglobin peaks.
Neural Tube Defects
Figure 13–4 Example of a Liley graph.
Tests for Fetal Maturity
Fetal Lung Maturity
Lecithin-Sphingomyelin Ratio
Phosphatidyl Glycerol
Foam Stability Index
Lamellar Bodies
PROCEDURE 13-1 Foam Shake Test
PROCEDURE 13-2 Foam Stability Index
HISTORICAL NOTE
Microviscosity: Fluorescence Polarization Assay
Lamellar Body Count
PROCEDURE 13-3 Lamellar Body Count18
References
Study Questions
Case Studies and Clinical Situations
CHAPTER 14 Fecal Analysis
LEARNING OBJECTIVES
KEY TERMS
Physiology
Figure 14–1 Fluid regulation in the gastrointestinal tract.
Diarrhea and Steatorrhea
Diarrhea
Secretory Diarrhea
TECHNICAL TIP
Osmotic Diarrhea
Table 14–1 Common Fecal Tests for Diarrhea
Table 14–2 Differential Features for Diarrhea
Altered Motility
Steatorrhea
Specimen Collection
Macroscopic Screening
Color
Appearance
Table 14–3 Macroscopic Stool Characteristics12,26
Microscopic Examination of Feces
Fecal Leukocytes
Muscle Fibers
PROCEDURE 14-1 Methylene Blue Stain for Fecal Leukocytes
Qualitative Fecal Fats
Figure 14–2 Meat fibers present in fecal emulsion specimen using brightfield microscopy examination (×400).
Figure 14–3 Note striations on meat fiber present in a fecal emulsion specimen (×1000).
PROCEDURE 14-2 Muscle Fibers
Figure 14–4 Several orange-red neutral fat globules present in a fecal suspension stained with Sudan III (×400).
PROCEDURE 14-3 Neutral Fat Stain
PROCEDURE 14-4 Split Fat Stain
Chemical Testing of Feces
Occult Blood
Guaiac-Based Fecal Occult Blood Tests
Immunochemical Fecal Occult Blood Test
Porphyrin-Based Fecal Occult Blood Test
Quantitative Fecal Fat Testing
TECHNICAL TIP
SUMMARY 14-1 gFOBT Interference
False-Positive
False-Negative
PROCEDURE 14-5 Acid Steatocrit
APT Test (Fetal Hemoglobin)
Table 14–4 Tests, Materials, and Instrumentation for Fecal Fat Analysis19
PROCEDURE 14-6 APT Test
Fecal Enzymes
HISTORICAL NOTE
Screening Test for Fecal Trypsin
Carbohydrates
Table 14–5 Fecal Screening Tests
References
Study Questions
Case Studies and Clinical Situations
CHAPTER 15 Vaginal Secretions
LEARNING OBJECTIVES
KEY TERMS
Specimen Collection and Handling
Table 15–1 Clinical Features and Laboratory Findings in Vaginitis2
Color and Appearance
Diagnostic Tests
pH
Table 15–2 Normal Findings in Vaginal Secretions
Microscopic Procedures
PROCEDURE 15-1 pH Test
Wet Mount Examination
Squamous Epithelial Cells
Table 15–3 Quantitation Scheme for Microscopic Examinations2
Figure 15–1 Squamous epithelial cells identifiable under low power (×100).
Clue Cells
White Blood Cells
Figure 15–2 Clump of squamous epithelial cells (×400).
Figure 15–3 Clue cells (×400).
Figure 15–4 White blood cells. Notice the multilobed nucleoli (×400).
Red Blood Cells
Parabasal Cells
Figure 15–5 Normal red blood cells (×400).
Figure 15–6 Parabasal cell surrounded by epithelial cells (×400).
Basal Cells
Bacteria
Trichomonas vaginalis
Figure 15–7 Bacteria. A, Large rods characteristic of Lactobacilli, the predominant bacteria in normal vaginal secretions (×400). B, Bacteria with white blood cells (×400).
Yeast Cells
Figure 15–8 Trichomonas vaginalis.
Figure 15–9 Trichomonas vaginalis in wet mount.
KOH Preparation and Amine Test
Figure 15–10 Budding yeast cells (×400).
Figure 15–11 Yeast cells showing mycelial forms (×400).
Other Diagnostic Tests
Gram Stain
PROCEDURE 15-2 Saline Wet Mount2
PROCEDURE 15-3 KOH Preparation2
PROCEDURE 15-4 Amine (Whiff) Test
Table 15–4 Nugent’s Gram Stain Criteria to Diagnose Bacterial Vaginosis
Culture
DNA Testing
Point of Care Tests
Vaginal Disorders
Bacterial Vaginosis
Trichomoniasis
Candidiasis
Desquamative Inflammatory Vaginitis
Atrophic Vaginitis
Additional Vaginal Secretion Procedures
Fetal Fibronectin Test
AmniSure Test
References
Study Questions
Case Studies and Clinical Situations
Back Matter
APPENDIX A Urine and Body Fluid Analysis Automation
Urinalysis Automation
Table A–1 Measurement Technology Methods in Automated Urinalysis
Semi-Automated Urine Chemistry Analyzers
Table A–2 Urinalysis Automation
Fully Automated Urine Chemistry Analyzers
Figure A–1 DiaScreen50 semi-automated urine chemistry analyzer.
Figure A–2 Cobas u 411 urine chemistry analyzer.
Figure A–3 Urisys 1100 semi-automated urine chemistry analyzer.
Figure A–4 Clintek Status + Analyzer. A, Clinitek Status Connect with Barcode Stand. B, Clinitek Status with test strip.
Figure A–5 Clinitek Advantus semi-automated urine chemistry analyzer.
Figure A–6 iChem 100 semi-automated urine chemistry analyzer.
Automated Microscopy
Figure A–7 Urisys 2400 automated urine chemistry analyzer.
Figure A–8 Clinitek Atlas automated urine chemistry analyzer.
Sysmex UF-1000i
Figure A–9 Aution Max AX-4030 fully automated urine chemistry analyzer.
Figure A–10 iChem Velocity automated urine chemistry analyzer.
Figure A–11 Sysmex UF 1000i urine chemistry analyzer.
Figure A–12 Diagram of urine particle analysis in the Sysmex UF1000i.
Figure A–13 Staining elements for the Sysmex UF1000i.
Figure A–14 UF1000i signal waveform for cells.
iQ 200
Figure A–15 Scattergram showing Sysmex UF1000i microscopy results.
Figure A–16 iQ 200 microscopy analyzer.
Figure A–17 Diagram of the iQ 200 digital flow capture process.
Figure A–18 Auto-Particle Recognition (APR) process.
Figure A–19 iQ 200 urinalysis results display, showing particle categories available for analysis or counting.
Automated Urinalysis Systems
Figure A–20 AUWi, a fully automated urinalysis system that combines the Siemens Clinitek Atlas Chemistry analyzer and the Sysmex UF-1000i particle analyzer.
Figure A–21 iRICELL3000, a fully automated Urinalysis System that combines the iChem Velocity urine chemistry analyzer and the iQ 200 microscopy analyzer.
Body Fluid Analysis Automation
References
Additional Information Sources
APPENDIX B Bronchoalveolar Lavage
White and Red Blood Cell Counts
Leukocytes
Figure B–1 Bronchoalveolar lavage: Normal macrophages and lymphocytes (×1000).
Erythrocytes
Epithelial Cells
Figure B–2 Bronchoalveolar lavage: Ciliated bronchial epithelial cells; notice the eosinophilic bar (×1000).
Fungi, Viruses, and Bacteria
Figure B–3 Bronchoalveolar lavage: Amorphous material associated with P. carinii when examined under low power (×100).
Figure B–4 Bronchoalveolar lavage: Characteristic cup-shaped organisms indicating P. carinii (×1000).
Cytology
References
Answers to Study Questions and Case Studies and Clinical Situations
Chapter 1
Study Questions
Case Studies and Clinical Situations
Chapter 2
Study Questions
Case Studies and Clinical Situations
Chapter 3
Study Questions
Case Studies and Clinical Situations
Chapter 4
Study Questions
Case Studies and Clinical Situations
Chapter 5
Study Questions
Case Studies and Clinical Situations
Chapter 6
Study Questions
Case Studies and Clinical Situations
Chapter 7
Study Questions
Case Studies and Clinical Situations
Chapter 8
Study Questions
Case Studies and Clinical Situations
Chapter 9
Study Questions
Case Studies and Clinical Situations
Chapter 10
Study Questions
Case Studies and Clinical Situations
Chapter 11
Study Questions
Case Studies and Clinical Situations
Chapter 12
Study Questions
Case Studies and Clinical Situations
Chapter 13
Study Questions
Case Studies and Clinical Situations
Chapter 14
Study Questions
Case Studies and Clinical Situations
Chapter 15
Study Questions
Case Studies and Clinical Situations
Abbreviations
Glossary
Index