As part of a routine physical examination, a urinalysis is performed on a midstream voided uri

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As part of a routine physical examination, a urinalysis is performed on a midstream voided urine collection from an apparently healthy (asmptomatic) 8-year-old girl. The following results are obtained on a fresh specimen:

Physical Appearance      
Color Yellow    
Transparency Hazy    
Chemical Screening      
pH 6.0    
Specific Gravity 1.010    
Protein (strip) 30mg/dL (1+) (SSA) 1+  
Blood Neg    
Nitrate Neg    
Leukocyte esterase Pos    
Glucose Neg    
Ketones Neg    
Bilirubin Neg    
Urobilinogen Norm    
Microscopic examination of urinary sediment
RBC’s 0-3/hpf
WBC’s 10-25/hpf
epithelial cells few (squamous)
bacteria moderate (2+)

After reviewing the results of the urinalysis the attending physician requests a gram stain and urine culture

Microbiology Results:
Gram Stain Gram-positive cocci
Urine Culture >100,000 CFU/mL of Enterobacter species

1. Of the above results, which urinalysis findings are abnormal?

2. This lab does not perform microscopic examination on all routine urinalysis tests.  Explain why microscopic examination of the urined sediment performed in this case? 

3. Can the urine collection already tested be gram stained and cultured? Why?

4. Explain the negative nitrate results and the presence of bacteria in the urine sediment.

5. Would these results be more likely to represent an upper or lower urinary tract infection? Why?

SCIENCE
HEALTH SCIENCE
NURSING
BIOL MLT2234

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