HSBTE Sample Paper MLT IVth Semester Analytical Clinical Biochemistry for First Sessional Examination.

DMLT IVth. Semester

Subject: Analytical Clinical Biochemistry, Ist. Sessional Examination. Time 1.30 Hrs M.M 30

Section A

Attempt all. Each question carries one mark 1 x 3

Q 1. Urine excretion in excess amounts is called

a) Oliguria b) Ketouria c) Polyuria d) None of the above. Ans: c) Polyuria

Q. 2. Bendict’s test is used for the analysis of

a) sugar, b) protein c) Fat d) None. Ans: a) sugar

Q 3. The presence of glucose is present in urine is called

a) Glucosuria b) Glycemia c) glucoma d) None of the above. Ans: a) Glucosuria.

Section B

Attempt all. Each question carries one mark 1 X 3

Q 4. What is urobilinogen?

Red blood cells break down and release hemoglobin. Hemoglobin is converted into bilirubin. Bilirubin is then transported to the liver. where it undergoes further processing. Bilirubin Metabolism in the liver produces metabolites. Urobilinogen is one of the metabolic products.

Urobilinogen is released into the bloodstream and excreted primarily through the kidneys into the urine. A small amount of urobilinogen is also excreted in feces.

In urine, the presence of urobilinogen indicates liver normal function and the breakdown of red blood cells. High levels of urobilinogen in urine sometimes indicate liver disease or hemolytic disorders. Low levels may be seen in certain types of liver dysfunction.

Q 5. The yellow-brown color of urine is due to the presence of ___________.

The yellow-brown color of urine is due to the presence of urobilin. Urobilin is a metabolic product of bilirubin. Bilirubin is a yellow pigment produced during the breakdown of red blood cells. It is excreted by the liver and eventually eliminated from the body through urine and feces.

Therefore, the yellow-brown color of urine is mainly due to the presence of urobilin, which is the breakdown product of bilirubin.

Q 6. Define haematuria

Hematuria is a medical term that refers to the presence of red blood cells in the urine.

Note: Urine color may be red or pink in hematuria. It depends on the amount of blood present in urine. Blood in urine may be visible to the naked eye or under a microscope.

Hematuria can be caused by various factors, including urinary tract infections, kidney stones, trauma to the urinary tract, kidney diseases, or certain medications. It is essential to identify the underlying cause of hematuria through medical evaluation.

Section C

Attempt all. Each question carries four marks 4 X 4

Q 7. Write the principle of urinary protein estimation

Ans: Principle: Urine contains soluble protein. Acid, such as sulfosalicylic acid or Trichloroacetic acid denaturate soluble proteins. Protein denaturation causes precipitation of protein. Protein precipitate develops cloudiness in the urine.

Q 8. What is Albuminuria

Ans: Albuminuria: The presence of albumin (a type of protein) in the urine is called Albuminuria. Normally, the kidneys filter the blood, preventing the passage of proteins into the urine. However, when the filtration process is damaged, albumin may leak into the urine.

Causes:

• · Diabetes Mellitus: Like glycosuria, diabetes is a common cause of albuminuria. High blood glucose levels damage the blood vessels in the kidneys. This leads to increased permeability and the leakage of albumin.

• · Hypertension (High Blood Pressure): Chronic high blood pressure also damages the kidneys and results in albuminuria.

• · Kidney Disease: Various kidney diseases, such as glomerulonephritis and nephrotic syndrome, can cause albuminuria.

• · Other Conditions: Certain systemic diseases and infections can contribute to albuminuria.

Symptoms

• · In the early stages, there may be no noticeable symptoms.

• · As the condition progresses, swelling (edema) in the hands, feet, and face may occur.

Diagnosis and Treatment:

• · Diagnosis is made through urine tests that measure the levels of albumin.

• · Treatment involves addressing the underlying cause, such as managing diabetes, controlling blood pressure, and treating kidney disease.

Q 9. Write about qualitative analysis of bile salts in urine.

Ans: A trace of bile salt is present in the normal urine. Obstruction in the bile duct or drug-induced cholestasis leads to excretion of bile salt in urine. Hay’s Sulphur test is used to detect bile salts in the urine sample. Add 5 mL of urine to a test tube. Sprinkle a pinch of sulfur flowers on the surface of the urine sample in a test tube. Cool it below 15 degrees C.

Result: Bile salt reduces surface tension. Sinking of the flower of sulfur indicates the presence of bile salt in urine.

Q 10. Give the procedure of Benedict's test for glucose estimation in urine.

Ans: Bendict’s Test for Qualitative Test for Sugar in Urine

Composition of reagent

• · Cupric sulfate: 17.3 gm

• · Sodium carbonate: 100 gm

• · Sodium citrate: 173 gm

• · Distilled water: 1.000 mL

Principle: Copper sulfate reacts with sugar to form an insoluble cuprous oxide of red or yellow color.

Procedure: Take 5 mL of Benedict's reagent in a test tube. Boil for a minute. Add 8 drops of urine, boil for 3 to 5 minutes, and cool it. Observe the color change

Result

• · Negative: No color change

• · Trace: Pale green with cloudiness,

• · 1+: Green

• · 2+: Yellow

• · 3+: orange to red

• · 4+: Black red.

Section D

Attempt anyone. Each question carries eight mark 8

Q. 11. Write the composition of urine & clinical importance of urine Analysis

Ans: Normal composition of urine

The normal composition of urine reflects the body's waste elimination process and provides information about the functioning of the kidneys. The typical components of normal urine include

• 1. Water: Water constitutes about 95% of the total volume of urine. Adequate hydration levels influence the color and concentration of urine.

• 2. Urea: Urea is a byproduct of protein metabolism. Urea is the main nitrogenous waste in urine. It contributes to the characteristic odor of urine.

• 3. Uric Acid: This compound is a byproduct of the breakdown of purines. These are substances found in certain foods. Elevated levels may indicate conditions like gout.

• 4. Ammonia: Ammonia is a product of protein metabolism and is usually present in small amounts in urine.

• 5. Creatinine: Creatinine is a waste product generated from the breakdown of muscle tissue. Its levels in urine can provide information about kidney function.

• 6. Creatine: A breakdown product of creatine phosphate, which is involved in energy metabolism in muscles.

• 7. Electrolytes:

  • · Sodium (Na): Essential for maintaining fluid balance.

  • · Potassium: Important for nerve and muscle function.

  • · Chloride: Plays a role in maintaining electrolyte balance.

• 8. Bicarbonate (HCO3): Maintain the pH balance of urine.

• 9. Enzymes: Only trace amounts of enzymes are found in urine. Elevated levels indicate damage to the urinary tract or other organs.

• 10. Hormones: Small amounts of hormones may be excreted in urine. It reflects the endocrine system's activity.

The specific composition of urine depends on factors such as diet, hydration status, and individual health. Abnormal levels of certain substances in urine may indicate underlying health conditions. Interpretation of urine analysis results requires consideration of the overall clinical context.

Clinical significance of urine analysis

Urine analysis (urinalysis) is a diagnostic tool used in clinical settings to evaluate and assess various aspects of a person's health. Urine analysis includes an examination of the composition of urine. Urine analysis provides valuable information about the body's metabolic processes, organ function, and potential health problems. The following are the clinical significance of urine analysis:

i.  Detection of Medical Conditions:

• Diabetes Mellitus: Urine analysis identifies elevated levels of glucose in the urine. It indicates poorly controlled diabetes.

• Kidney Diseases: Abnormal levels of proteins (such as albumin) in the urine are signals of kidney dysfunction or damage.

• Liver Diseases: Changes in the color of urine may be due to liver disorders. Such as darkening suspects bilirubin in urine that occurs in certain liver diseases such as jaundice.

ii. Monitoring and Management of Chronic Diseases:

• Diabetes Management: Regular urine analysis helps monitor blood sugar control in individuals with diabetes. It assesses the effectiveness of treatment.

• Hypertension Management: Monitoring urine protein levels is essential in managing conditions like hypertension.

iii. Assessment of Dehydration and Electrolyte Balance:

• Specific Gravity: The concentration of urine indicates the body's hydration status. Low specific gravity may suggest dilute urine, while high specific gravity may indicate dehydration.

• Electrolyte Levels: Abnormal levels of electrolytes in the urine indicate imbalances in the body's electrolyte homeostasis.

iv. Identification of Infections:

• Urinary Tract Infections (UTIs): The presence of white blood cells, red blood cells, or bacteria in the urine indicates a urinary tract infection.

• Sexually Transmitted Infections (STIs): Infections such as gonorrhea or chlamydia are sometimes detected through urine analysis.

v.. Screening for Drug Use:

Drug Metabolites: Some drugs and their metabolites are excreted in the urine. This allows the detection of drug use or abuse.

vi. Pregnancy Monitoring:

Human Chorionic Gonadotropin (hCG): Urine analysis detects the presence of hCG. Hcg is a hormone produced during pregnancy. This is the confirmatory test of pregnancy.

vii. Assessment of Renal Function:

Creatinine and Blood Urea Nitrogen (BUN): Levels of these substances in the urine state the renal function condition. They help to assess the kidneys' ability to eliminate waste products.

viii. Evaluation of Metabolic Disorders:

Ketones: The presence of ketones in the urine indicates conditions like diabetic ketoacidosis or starvation.

ix. Monitoring Treatment Response:

Chemotherapy and Medications: Urine analysis can be used to monitor the effects of certain medications or chemotherapy on the body.

Q 12. What are ketone bodies? How to detect ketone bodies in urine.

Ans: Ketone bodies are the intermediate products of fat metabolism. Ketone bodies consist of acetoacetic acid, acetone, and Beta-hydroxybutyric acid. The presence of ketone bodies in urine is called ketoneuria. The formation of ketone bodies inside the human body is called ketosis or ketoacidosis. Ketosis occurs due to increased metabolism of fat in diabetes or a severe lack of carbohydrates in the diet.

Causes of ketonuria

• · Uncontrolled diabetes mellitus

• · Chronic Starvation

• · Pregnancy with vomiting

• · Severe vomiting

• · Glycogen storage disease.

Qualitative test for ketone bodies.

Stick test

• 1. Sample collection: Obtain a clean-catch or midstream sample of urine to minimize contamination.

• 2. Test Strips: Test strips contain a pad or pads that react with ketones to produce a visible color change.

• 3. Dipping the Strip: A small portion of the test strip is dipped into the urine sample. Ensure that the strip is fully immersed, and follow the manufacturer's instructions regarding the duration of immersion.

• 4. Reaction: If ketones are present in the urine, they react with the reagents on the test strip. This reaction leads to a color change on the strip.

• 5. Results: The results are interpreted as either "positive" or "negative." A positive result suggests the presence of ketones in the urine.

Rothera’s test:

It is a very sensitive test for ketone bodies in urine. It is commonly used in most laboratories.

Principle: Ketone bodies (Acetoacetic acid and acetone) with sodium nitroprusside develop a purple color complex in an alkaline environment.

Method

• 1. Add 5 mL of urine in a test tube. Saturate it with ammonium sulfate. Add 0.5 mL 20 % aqueous solution of sodium nitroprusside or one crystal of sodium nitroprusside. Shake the tube and allow to stand for 10 minutes.

• 2. Carefully pour concentrated ammonia into a test tube. It forms a layer above the urine sample.

• Result: The formation of a purple color ring at the junction of urine and concentrated ammonia indicates ketone bodies (Acetoacetic acid and acetone) in the urine sample.

Dr Pramila Singh