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Fungal Infections and Immune Response
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Fungal Infections and Immune Response

Created by
@TollFreeLesNabis

Questions and Answers

What type of host defense response is elicited by infection with systemic fungi such as Histoplasma and Coccidioides?

  • IgE mediated immediate hypersensitivity response
  • Complement mediated response composed of neutrophils and macrophages
  • Granulomatous response composed of macrophages and helper T cells (correct)
  • Pyogenic response composed of neutrophils

    • What is the consequence of a reduced number of neutrophils in patients infected with fungi such as Aspergillus and Mucor?

  • Increased risk of allergic bronchopulmonary aspergillosis
  • Decreased risk of liver cancer
  • Decreased risk of disseminated disease
  • Increased risk of disseminated disease (correct)

    • What is the purpose of a control skin test with a common antigen, such as Candida albicans, in patients with suspected fungal infections?

  • To determine the presence of fungal allergy
  • To determine whether the patient can mount a delayed hypersensitivity response (correct)
  • To determine the presence of fungal toxins
  • To determine the presence of liver cancer

    • What is the effect of amanitin, a fungal toxin found in Amanita mushrooms?

    <p>It inhibits the RNA polymerase that synthesizes cellular mRNA</p> Signup and view all the answers

    What is the consequence of ingestion of peanuts and grains contaminated with Aspergillus flavus?

    <p>Liver cancer</p> Signup and view all the answers

    What type of hypersensitivity response is caused by inhalation of the spores of Aspergillus fumigatus?

    <p>IgE mediated immediate hypersensitivity response</p> Signup and view all the answers

    What is the significance of a positive skin test in patients with suspected fungal infections?

    <p>It indicates that the patient has been infected with the fungus, but it is not known whether it was in the past or present</p> Signup and view all the answers

    What is the consequence of a false-negative skin test in patients with suspected fungal infections?

    <p>It may occur in patients with reduced cell-mediated immunity</p> Signup and view all the answers

    What is the purpose of KOH in microscopic examination?

    <p>To dissolve human cells, allowing visualization of fungal structures</p> Signup and view all the answers

    What is the purpose of using Sabouraud's agar to grow fungi?

    <p>To inhibit the growth of bacteria, allowing the slower-growing fungi to emerge</p> Signup and view all the answers

    What is the advantage of using DNA probes to identify fungi?

    <p>They can identify fungi at an earlier stage of growth</p> Signup and view all the answers

    What is the target of amphotericin B in fungal cells?

    <p>Ergosterol in fungal cell membranes</p> Signup and view all the answers

    What is the target of azole drugs in fungal cells?

    <p>The synthesis of ergosterol</p> Signup and view all the answers

    What is the target of echinocandins in fungal cells?

    <p>The synthesis of D-glucan</p> Signup and view all the answers

    What is the classification of Microsporum?

    <p>A dermatophyte that infects superficial keratinized structures</p> Signup and view all the answers

    How are dermatophytoses usually spread?

    <p>Through direct contact with infected persons or animals</p> Signup and view all the answers

    What is the causative organism of Tinea versicolor?

    <p>Malassezia furfur</p> Signup and view all the answers

    What is the typical appearance of Tinea nigra lesions?

    <p>Brownish spot</p> Signup and view all the answers

    How is Tinea versicolor diagnosed?

    <p>By observing budding yeast cells and hyphae in KOH preparations</p> Signup and view all the answers

    What is the treatment of choice for Tinea versicolor?

    <p>Topical miconazole</p> Signup and view all the answers

    What is the causative organism of Sporotrichosis?

    <p>Sporothrix schenckii</p> Signup and view all the answers

    What is the typical presentation of Sporotrichosis?

    <p>Local pustule or ulcer with nodules along the draining lymphatics</p> Signup and view all the answers

    What is the typical feature of Mycetoma?

    <p>Abscesses with pus discharged through sinuses</p> Signup and view all the answers

    What is the causative organism of Tinea nigra?

    <p>Cladosporium werneckii</p> Signup and view all the answers

    How is transmission of Aspergillus fumigatus typically achieved?

    <p>Through airborne conidia</p> Signup and view all the answers

    In which of the following patients is Aspergillus fumigatus most likely to invade the lungs and other organs?

    <p>Immunocompromised persons, especially those with neutropenia</p> Signup and view all the answers

    What is a characteristic feature of Aspergillus infection in the lungs?

    <p>Growth in cavities, producing an aspergilloma</p> Signup and view all the answers

    What is typically seen in biopsy specimens of Aspergillus infected tissue?

    <p>Septate, branching hyphae</p> Signup and view all the answers

    What is a laboratory test that may be used to diagnose invasive aspergillosis?

    <p>Detection of galactomannan antigen in serum</p> Signup and view all the answers

    What is the typical treatment for invasive aspergillosis?

    <p>Amphotericin B</p> Signup and view all the answers

    What is a common predisposing factor for invasive aspergillosis?

    <p>Neutropenia</p> Signup and view all the answers

    What is a characteristic feature of Aspergillus colonies in culture?

    <p>Radiating chains of conidia</p> Signup and view all the answers

    How do yeast cells of Histoplasma survive within the phagolysosome of the macrophage?

    <p>By producing alkaline substances that raise the pH</p> Signup and view all the answers

    What is the significance of finding oval yeast cells within macrophages in tissue biopsy specimens or bone marrow aspirates?

    <p>It suggests a fungal infection, possibly Histoplasma</p> Signup and view all the answers

    What is the purpose of testing for Histoplasma antigen in the urine of immunocompromised patients?

    <p>To diagnose disseminated disease in immunocompromised patients</p> Signup and view all the answers

    What is the significance of a positive complement fixation (CF) test with yeast phase antigens?

    <p>It is diagnostic of Histoplasma infection</p> Signup and view all the answers

    What is the characteristic feature of Blastomyces dermatitidis?

    <p>It is a dimorphic fungus</p> Signup and view all the answers

    How does Blastomyces dermatitidis typically infect humans?

    <p>Through inhalation of conidia</p> Signup and view all the answers

    What is the purpose of the immunodiffusion (ID) test in diagnosing Histoplasma infection?

    <p>To detect precipitating antibodies (precipitins) against Histoplasma antigens</p> Signup and view all the answers

    Why may the complement fixation (CF) test be less specific than the immunodiffusion (ID) test?

    <p>Because the CF test may cross-react with other fungi</p> Signup and view all the answers

    What is the term used to describe the damage inflicted on the cell by the virus?

    <p>Cytopathic effect</p> Signup and view all the answers

    What is the type of RNA that has the same base sequence as the mRNA?

    <p>Positive polarity RNA</p> Signup and view all the answers

    What is the purpose of the RNA polymerase in the virion?

    <p>To synthesize the mRNA</p> Signup and view all the answers

    What is the exception to the rule that most positive-polarity genomes are translated into viral proteins without the need for a polymerase in the virion?

    <p>Retroviruses</p> Signup and view all the answers

    What is the result of the interaction of proteins on the surface of the virus with specific receptor proteins on the surface of the cell?

    <p>Attachment of the virus to the cell</p> Signup and view all the answers

    What is the characteristic of infectious nucleic acid?

    <p>It has no associated protein</p> Signup and view all the answers

    What determines the species specificity and organ specificity of the virus?

    <p>The interaction of proteins on the surface of the virus with specific receptor proteins on the surface of the cell</p> Signup and view all the answers

    What is the result of the virus infecting a cell and producing hundreds of progeny virions within hours?

    <p>The rapid spread of the virus from cell to cell</p> Signup and view all the answers

    What is the characteristic of the genome of all RNA viruses, except that of reo viruses?

    <p>Single-stranded</p> Signup and view all the answers

    Which of the following viruses has a positive-polarity RNA genome and uses a DNA polymerase to synthesize a DNA copy of the RNA genome?

    <p>Retrovirus</p> Signup and view all the answers

    What is the characteristic of the genome of parvoviruses?

    <p>Single-stranded</p> Signup and view all the answers

    Which of the following viruses has a double-stranded RNA genome and has an RNA polymerase in the virion that synthesizes the viral mRNA?

    <p>Rotavirus</p> Signup and view all the answers

    Which of the following viruses replicates in the cytoplasm and has an RNA polymerase in the virion that synthesizes the viral mRNA?

    <p>Poxvirus</p> Signup and view all the answers

    What is the characteristic of the genome of all DNA viruses, except that of parvoviruses?

    <p>Double-stranded</p> Signup and view all the answers

    Which of the following viruses has a negative-polarity RNA genome and has an RNA polymerase in the virion that synthesizes the viral mRNA?

    <p>Influenza virus</p> Signup and view all the answers

    What is the characteristic of the genome of reo viruses?

    <p>Double-stranded</p> Signup and view all the answers

    What is the shape of the inclusion bodies in giant cells in urine and in tissue?

    <p>Oval owl’s-eye shape</p> Signup and view all the answers

    What is the diagnostic method that involves a four-fold or greater rise in antibody titer?

    <p>Rise in antibody titer</p> Signup and view all the answers

    What is the treatment for CMV retinitis and pneumonia in patients with AIDS?

    <p>Ganciclovir</p> Signup and view all the answers

    Why should infants with cytomegalic inclusion disease who are shedding virus in their urine be kept isolated from other infants?

    <p>To prevent the spread of CMV</p> Signup and view all the answers

    What is the host range of poliovirus?

    <p>Limited to primates</p> Signup and view all the answers

    What is the reason for the limited host range of poliovirus?

    <p>Due to the binding of the viral capsid protein to a receptor found only on primate cell membranes</p> Signup and view all the answers

    What is the significance of the presence of antibody against each of the three serologic types of poliovirus?

    <p>Protection from disease requires the presence of antibody against each of the three types</p> Signup and view all the answers

    What is the process by which the virion interacts with specific cell receptors on the cell membrane and then enters the cell?

    <p>Replicative cycle</p> Signup and view all the answers

    What is the primary purpose of performing a PCR-based test after a positive RIBA result?

    <p>To determine the presence of viral RNA in the serum</p> Signup and view all the answers

    What is the characteristic of a chronic infection of hepatitis C?

    <p>Elevated transaminase levels, a positive RIBA, and detectable viral RNA for at least 6 months</p> Signup and view all the answers

    What is the effect of treatment of acute hepatitis C with alpha interferon?

    <p>It significantly decreases the number of patients who become chronic carriers</p> Signup and view all the answers

    What is unique about the hepatitis D virus (HDV)?

    <p>It is a defective virus that cannot replicate by itself</p> Signup and view all the answers

    What is the helper virus for HDV?

    <p>HBV</p> Signup and view all the answers

    What is the genome of HDV?

    <p>A single-stranded, negative-polarity, covalently closed circle</p> Signup and view all the answers

    How is HDV transmitted?

    <p>By the same means as is HBV (i.e., sexually, by blood, and perinatally)</p> Signup and view all the answers

    What is the protein encoded by the RNA genome of HDV?

    <p>Internal core protein called delta antigen</p> Signup and view all the answers

    What is the difference between HCV and HBV in terms of chronic carriage?

    <p>The rate of chronic carriage of HCV is much higher than the rate of chronic carriage of HBV</p> Signup and view all the answers

    What is the effect of alcoholism on HCV-infected individuals?

    <p>It increases the rate of hepatocellular carcinoma</p> Signup and view all the answers

    What is the primary mode of HCV infection?

    <p>Infection through contaminated blood products</p> Signup and view all the answers

    What is the role of cytotoxic T cells in HCV infection?

    <p>They play a role in immune attack, leading to death of hepatocytes</p> Signup and view all the answers

    What is the typical incubation period for HCV infection?

    <p>8 weeks</p> Signup and view all the answers

    What is the test used to diagnose HCV infection?

    <p>ELISA</p> Signup and view all the answers

    What is the consequence of chronic HCV infection?

    <p>It may lead to chronic active hepatitis and cirrhosis</p> Signup and view all the answers

    What is a common characteristic of HCV and HBV infections?

    <p>They both have a high rate of chronic carriage</p> Signup and view all the answers

    Which of the following characteristics is unique to HCV?

    <p>It has no virion polymerase</p> Signup and view all the answers

    What is the major difference in treatment approaches between HBV and HCV?

    <p>Antiviral therapy is typically used in acute HCV, but not in acute HBV</p> Signup and view all the answers

    Which of the following is a common feature shared by both HBV and HCV?

    <p>Both are transmitted primarily via blood</p> Signup and view all the answers

    What is the primary mode of transmission for HCV?

    <p>Transmission via blood transfusion</p> Signup and view all the answers

    Which of the following is a unique feature of HCV?

    <p>It has a hypervariable region in the envelope glycoprotein</p> Signup and view all the answers

    What is the target of potent anti-HCV therapy?

    <p>The protease enzyme</p> Signup and view all the answers

    Which of the following is NOT a characteristic of HCV?

    <p>It is primarily transmitted via contaminated food and water</p> Signup and view all the answers

    What is the result of the interaction of proteins on the surface of HCV with specific receptor proteins on the surface of the cell?

    <p>The cell becomes infected with the virus</p> Signup and view all the answers

    What is the primary function of the glomeruli in the nephron?

    <p>Filtration of the blood</p> Signup and view all the answers

    What is the term for the rate at which the glomeruli filter the blood?

    <p>Glomerular filtration rate (GFR)</p> Signup and view all the answers

    What is the purpose of testing for proteinuria in a patient's urine?

    <p>To detect kidney damage or disease</p> Signup and view all the answers

    What is the functional unit of the kidney?

    <p>Nephron</p> Signup and view all the answers

    What is the term for a group of tests used to assess kidney function?

    <p>Renal function test (RFT)</p> Signup and view all the answers

    What is the purpose of a renal function test?

    <p>To detect and manage kidney disease</p> Signup and view all the answers

    What is the term for the process by which the kidneys filter waste and excess fluids from the blood?

    <p>Glomerular filtration</p> Signup and view all the answers

    What is the term for the amount of protein in the urine?

    <p>Proteinuria</p> Signup and view all the answers

    What is the volume of plasma flowing through the kidneys per minute under normal circumstances?

    <p>700 ml</p> Signup and view all the answers

    What percentage of cardiac output at rest is approximately equal to the volume of plasma flowing through the kidneys per minute?

    <p>25%</p> Signup and view all the answers

    What is the characteristic of creatinine that makes it close to being an ideal substance for measuring GFR?

    <p>All of the above</p> Signup and view all the answers

    What is the limitation of using serum creatinine to measure GFR?

    <p>It only starts to increase above normal when kidney function drops by half</p> Signup and view all the answers

    What is the percentage of urea eliminated via kidneys?

    <p>85%</p> Signup and view all the answers

    What is the term that describes the volume of plasma from which a substance is completely removed during one pass through the kidney per time unit?

    <p>Clearance</p> Signup and view all the answers

    What is the rate at which creatinine is released from skeletal muscle?

    <p>Steady rate</p> Signup and view all the answers

    What is the relationship between serum creatinine concentration and GFR?

    <p>Inversely proportional</p> Signup and view all the answers

    Which of the following can increase cystatin C concentration?

    <p>Hypercorticism</p> Signup and view all the answers

    What is the primary function of urine osmolality test?

    <p>To measure kidney's concentrating ability</p> Signup and view all the answers

    What is the normal range of serum osmolality during water deprivation test?

    <p>275-295 mmol/kg</p> Signup and view all the answers

    Which of the following tests is used to assess proximal tubular function?

    <p>Glycosuria</p> Signup and view all the answers

    What is the consequence of decreased GFR on cystatin C concentration?

    <p>Cystatin C concentration increases</p> Signup and view all the answers

    What is the significance of urine osmolality >800 mmol/kg in a random urine sample?

    <p>It excludes the need to perform further diagnostic tests</p> Signup and view all the answers

    Why does cystatin C concentration increase later than creatinine concentration in response to decreased GFR?

    <p>Cystatin C has a larger molecule than creatinine</p> Signup and view all the answers

    What is the purpose of water deprivation test?

    <p>To assess the kidney's ability to produce concentrated urine</p> Signup and view all the answers

    What is the effect of heme on ALAS1?

    <p>It represses the transcription of ALAS1 gene.</p> Signup and view all the answers

    What is the consequence of lead poisoning in heme biosynthesis?

    <p>Inhibition of ALA dehydratase.</p> Signup and view all the answers

    Where does the formation of uroporphyrinogen occur?

    <p>Cytosol.</p> Signup and view all the answers

    What is the enzyme responsible for the conversion of hydroxymethylbilane to uroporphyrinogen III?

    <p>Uroporphyrinogen III synthase.</p> Signup and view all the answers

    What is the result of the decarboxylation of acetate groups in uroporphyrinogen III?

    <p>Formation of coproporphyrinogen III.</p> Signup and view all the answers

    What is the enzyme responsible for the conversion of coproporphyrinogen III to protoporphyrinogen IX?

    <p>Coproporphyrinogen III oxidase.</p> Signup and view all the answers

    What is the significance of ALAS2 in erythroid cells?

    <p>It is erythroid specific.</p> Signup and view all the answers

    What is the result of loss-of-function mutations in ALAS2?

    <p>X-linked sideroblastic anemia.</p> Signup and view all the answers

    What is the prosthetic group for hemoglobin, myoglobin, and cytochromes?

    <p>Heme</p> Signup and view all the answers

    What is the major site of heme synthesis?

    <p>Erythroid cells of the bone marrow</p> Signup and view all the answers

    What is the committed and rate-limiting step in porphyrin biosynthesis?

    <p>Formation of δ-aminolevulinic acid</p> Signup and view all the answers

    What is the cofactor required for the reaction catalyzed by ALAS?

    <p>Pyridoxal phosphate (PLP)</p> Signup and view all the answers

    What is the source of the carbon and nitrogen atoms of the porphyrin molecule?

    <p>Glycine and succinyl CoA</p> Signup and view all the answers

    Where do the initial reaction and the last three steps of porphyrin biosynthesis occur?

    <p>Mitochondria</p> Signup and view all the answers

    What is the significance of the two isoforms of ALAS, 1 and 2?

    <p>They are produced by different genes and controlled by different mechanisms</p> Signup and view all the answers

    Why can't mature red blood cells synthesize heme?

    <p>They lack mitochondria</p> Signup and view all the answers

    What is the enzyme responsible for introducing iron (as Fe2+) into protoporphyrin IX?

    <p>Ferrochelatase</p> Signup and view all the answers

    What is the primary source of heme destined for degradation?

    <p>Senescent red blood cells</p> Signup and view all the answers

    What is the byproduct of heme degradation that has biologic function as a signaling molecule and anti-inflammatory?

    <p>Carbon monoxide</p> Signup and view all the answers

    What is the name of the enzyme that catalyzes the first step in the degradation of heme?

    <p>Heme oxygenase</p> Signup and view all the answers

    What is the result of the degradation of heme by the microsomal heme oxygenase system?

    <p>Formation of biliverdin and carbon monoxide</p> Signup and view all the answers

    What is the name of the green pigment formed during heme degradation?

    <p>Biliverdin</p> Signup and view all the answers

    What is the result of the reduction of biliverdin?

    <p>Formation of bilirubin</p> Signup and view all the answers

    What is the function of bilirubin at low levels?

    <p>Antioxidant</p> Signup and view all the answers

    What is the primary purpose of glucose measurement in urine?

    <p>To evaluate glycosuria and detect renal tubular defects</p> Signup and view all the answers

    What is the term for the cyclic series of enzymatically catalyzed reactions that operate in the mitochondrial matrix?

    <p>All of the above</p> Signup and view all the answers

    What is the result of a fasting blood sugar level of 126 mg/dL (7 mmol/L) or higher on two separate tests?

    <p>Diagnosis of diabetes mellitus</p> Signup and view all the answers

    Which of the following conditions may cause low blood glucose levels?

    <p>All of the above</p> Signup and view all the answers

    What is the purpose of glucose measurement in cerebrospinal fluid?

    <p>To evaluate meningitis</p> Signup and view all the answers

    What is the primary function of the pancreas in glucose regulation?

    <p>To produce insulin and glucagon</p> Signup and view all the answers

    What is the result of a random blood sugar test with a level of 200 mg/dL (11.1 mmol/L) or higher?

    <p>Diagnosis of diabetes mellitus</p> Signup and view all the answers

    What is the primary purpose of the TCA cycle?

    <p>To generate energy for the cell</p> Signup and view all the answers

    What is the earliest manifestation of renal disease in moderate forms of kidney damage?

    <p>Difficulty in concentrating the urine</p> Signup and view all the answers

    What is the purpose of the concentration test in assessing renal function?

    <p>To assess the ability of the kidneys to concentrate urine</p> Signup and view all the answers

    What is the normal range of specific gravity of urine in a healthy person?

    <p>1.008-1.032</p> Signup and view all the answers

    What is the purpose of the dilution test in assessing renal function?

    <p>To assess the ability of the kidneys to dilute urine</p> Signup and view all the answers

    What is the significance of a specific gravity of 1.003 in a urine sample?

    <p>The kidneys are able to dilute urine</p> Signup and view all the answers

    What is the purpose of the acid loading test in assessing renal function?

    <p>To assess the ability of the kidneys to acidify urine</p> Signup and view all the answers

    What is the dose of ammonium chloride given in the acid loading test?

    <p>0.1 g/kg body weight</p> Signup and view all the answers

    What is the effect of ammonium chloride on the body in the acid loading test?

    <p>It decreases the pH of the urine</p> Signup and view all the answers

    What is the name of the test used to analyze ketone bodies in urine?

    <p>Rothera’s test</p> Signup and view all the answers

    What is the condition in which ketonuria is commonly seen?

    <p>Diabetes mellitus</p> Signup and view all the answers

    What are the three types of ketone bodies?

    <p>Acetoacetate, beta hydroxybutyrate, and acetone</p> Signup and view all the answers

    What is the name of the strips available for rapid testing of ketone bodies?

    <p>Ketostix strips</p> Signup and view all the answers

    What are the causes of ketonuria?

    <p>Diabetes mellitus, starvation, persistent vomiting</p> Signup and view all the answers

    What is the test used to detect glucose in urine?

    <p>Benedict’s test</p> Signup and view all the answers

    What is the semiquantitative method for sugar estimation in urine?

    <p>Benedict’s test</p> Signup and view all the answers

    What is the color of the test when the concentration of sugar is 2 g%?

    <p>Red</p> Signup and view all the answers

    What is the main reason for a decrease in renal function?

    <p>The loss of functional nephrons</p> Signup and view all the answers

    What is the normal GFR for young adults?

    <p>120–130 mL/min/1.73M2</p> Signup and view all the answers

    What is the term for when small molecular weight proteins are increased in blood and overflow into urine?

    <p>Overflow proteinuria</p> Signup and view all the answers

    What is an example of overflow proteinuria?

    <p>All of the above</p> Signup and view all the answers

    What is the purpose of measuring the specific gravity of urine?

    <p>To measure the concentration of solutes in urine</p> Signup and view all the answers

    What is the reference range for urinary specific gravity?

    <p>1.005-1.030</p> Signup and view all the answers

    What happens to the specific gravity of urine in cases of proteinuria?

    <p>It increases</p> Signup and view all the answers

    What type of proteinuria is caused by the production of abnormally large amounts of light chains of immunoglobulins in multiple myeloma?

    <p>Bence-Jones proteinuria</p> Signup and view all the answers

    What is the typical concentration of proteins in normal urine?

    <p>Very low, and cannot be detected by usual tests</p> Signup and view all the answers

    What type of cells secrete proteins in urine?

    <p>Tubular epithelial cells</p> Signup and view all the answers

    What is the name of the test commonly used to assess proteinuria?

    <p>Heat and acetic acid test</p> Signup and view all the answers

    What is the modern method replacing the old methods for proteinuria assessment?

    <p>Dipstick test</p> Signup and view all the answers

    What is the cause of Hematuria?

    <p>Nephritis and post renal hemorrhage</p> Signup and view all the answers

    What is the cause of Hemoglobinuria?

    <p>Abnormal amount of hemolysis</p> Signup and view all the answers

    What is the test used to detect blood in urine?

    <p>Hemastix strips</p> Signup and view all the answers

    What is the purpose of Dipstick test?

    <p>To detect glucose in urine</p> Signup and view all the answers

    What is the normal volume of urine output per day?

    <p>1.5 liters</p> Signup and view all the answers

    What is the typical odor of urine in diabetic ketoacidosis?

    <p>Fruity</p> Signup and view all the answers

    What is the normal pH range of urine?

    <p>5.5-7.5</p> Signup and view all the answers

    What is the effect of excessive water intake on the specific gravity of urine?

    <p>It decreases</p> Signup and view all the answers

    What is the normal color of urine?

    <p>Straw colored (amber-yellow)</p> Signup and view all the answers

    What is the term for urine volume less than 400 mL per day?

    <p>Oliguria</p> Signup and view all the answers

    What is the effect of diabetes mellitus on the specific gravity of urine?

    <p>It increases</p> Signup and view all the answers

    What is the term for urine volume less than 100 mL per day?

    <p>Anuria</p> Signup and view all the answers

    What is the normal volume of urine produced in a day?

    <p>1.5 liters</p> Signup and view all the answers

    What is the term for urine volume less than 400 mL per day?

    <p>Oliguria</p> Signup and view all the answers

    What is the normal pH range of urine?

    <p>5.5 to 7.5</p> Signup and view all the answers

    What is the characteristic of urine in diabetic ketoacidosis?

    <p>Fruity odor</p> Signup and view all the answers

    What is the normal specific gravity of urine?

    <p>1.015-1.025</p> Signup and view all the answers

    What is the significance of fixed specific gravity of urine at 1.010?

    <p>Chronic renal failure</p> Signup and view all the answers

    What is the color of urine in jaundiced patients?

    <p>Yellow</p> Signup and view all the answers

    What is the term for the pigment responsible for the color of urine?

    <p>Urochrome</p> Signup and view all the answers

    What is the test used to detect bilirubin in urine?

    <p>Fouchet's test</p> Signup and view all the answers

    What is the cause of hemoglobinuria?

    <p>Abnormal amount of hemolysis</p> Signup and view all the answers

    What is the test used to detect bile salts in urine?

    <p>Hay's test</p> Signup and view all the answers

    What is seen in nephritis and post renal hemorrhage?

    <p>Hematuria</p> Signup and view all the answers

    What is the test used to detect urobilinogen in urine?

    <p>Schlesinger's test</p> Signup and view all the answers

    What is the significance of the reappearance of urobilinogen in urine?

    <p>Early sign of recovery</p> Signup and view all the answers

    What is the typical color of the Benedict's test for a sugar concentration of 2 g/100 mL?

    <p>Red</p> Signup and view all the answers

    What are the three ketone bodies?

    <p>Acetoacetic acid, beta hydroxybutyric acid, and acetone</p> Signup and view all the answers

    Bilirubin is a yellowish substance produced during the body's normal process of breaking down which cells?

    <p>Red blood cells</p> Signup and view all the answers

    If the liver is damaged, what can leak out of the liver and into the blood, causing jaundice?

    <p>Bilirubin</p> Signup and view all the answers

    What is the name of the condition characterized by a yellow color of skin, nail beds, and sclera (whites of the eyes) caused by deposition of bilirubin?

    <p>Jaundice</p> Signup and view all the answers

    What is the normal range of bilirubin levels in the blood?

    <p>0.3-1.2 mg/dL</p> Signup and view all the answers

    What is the result of the reduction of bilirubin diglucuronide by bacteria in the gut?

    <p>Formation of urobilinogen</p> Signup and view all the answers

    What is the name of the compound that gives feces its characteristic brown color?

    <p>Stercobilin</p> Signup and view all the answers

    What is the name of the cycle in which urobilinogen is taken up by the liver and then resecreted into the bile?

    <p>Enterohepatic urobilinogen cycle</p> Signup and view all the answers

    What is the name of the rare deficiency in the protein required for transport of conjugated bilirubin out of the liver?

    <p>Dubin-Johnson syndrome</p> Signup and view all the answers

    Study Notes

    Pathogenesis

    • Infection with certain systemic fungi, such as Histoplasma and Coccidioides, triggers a granulomatous host defense response, which is composed of macrophages and helper T cells.
    • Reduced cell-mediated immunity predisposes individuals to disseminated disease caused by systemic fungi.
    • Infection with other fungi, such as Aspergillus, Mucor, and Sporothrix, elicits a pyogenic response, which is composed of neutrophils.
    • Reduced neutrophil count predisposes individuals to disseminated disease caused by fungi such as Aspergillus and Mucor.

    Fungal Toxins and Allergies

    • Ingestion of Amanita mushrooms causes liver necrosis due to the presence of two fungal toxins, amanitin and phalloidin.
    • Amanitin inhibits RNA polymerase, which synthesizes cellular mRNA.
    • Ingestion of peanuts and grains contaminated with Aspergillus flavus causes liver cancer due to the presence of aflatoxin.
    • Inhalation of the spores of Aspergillus fumigatus can cause allergic bronchopulmonary aspergillosis, an IgE-mediated immediate hypersensitivity response.

    Laboratory Diagnosis

    • Microscopic examination of a KOH preparation can reveal the presence of fungal structures.
    • The purpose of KOH is to dissolve human cells, allowing visualization of fungi.
    • Sabouraud's agar is often used to grow fungi because its low pH inhibits the growth of bacteria, allowing the slower-growing fungi to emerge.
    • DNA probes can be used to identify fungi growing in culture at a much earlier stage.
    • Tests for the presence of fungal antigens and for the presence of antibodies to fungal antigens are often used.

    Antifungal Therapy

    • The selective toxicity of amphotericin B and the azole group of drugs is based on the presence of ergosterol in fungal cell membranes.
    • Amphotericin B binds to fungal cell membranes at the site of ergosterol and disrupts the integrity of the membranes.
    • Azole drugs, such as itraconazole, fluconazole, and ketoconazole, inhibit the synthesis of ergosterol.
    • Echinocandins inhibit the synthesis of D-glucan, which is a component of the fungal cell wall.

    Medical Mycoses

    • Medical mycoses can be divided into four categories: cutaneous, subcutaneous, systemic, and opportunistic.

    Cutaneous Mycoses

    • Dermatophytoses are caused by fungi that infect only superficial keratinized structures, such as skin, hair, and nails.
    • The most important dermatophytes are classified in three genera: Epidermophyton, Trichophyton, and Microsporum.
    • Microsporum is also spread from animals such as dogs and cats.
    • Tinea versicolor is a superficial skin infection caused by Malassezia furfur.
    • Tinea nigra is an infection of the keratinized layers of the skin caused by Cladosporium werneckii.

    Subcutaneous Mycoses

    • Sporotrichosis is caused by Sporothrix schenckii, a dimorphic fungus that grows on plants and in human tissue.
    • Mycetoma is caused by soil fungi, such as Petriellidium and Madurella, that enter through wounds on the feet, hands, or back.

    Aspergillus

    • Aspergillus fumigatus is a mold that grows on decaying vegetation and produces chains of conidia.
    • Transmission is by airborne conidia.
    • A. fumigatus can colonize and later invade abraded skin, wounds, burns, the cornea, the external ear, or paranasal sinuses.
    • In immunocompromised persons, A. fumigatus can invade the lungs and other organs, producing hemoptysis and granulomas.

    Systemic Mycoses

    • Coccidioides immitis causes coccidioidomycosis, a disease that is usually asymptomatic but can spread widely throughout the body.
    • The yeasts survive within the phagolysosome of the macrophage by producing alkaline substances, such as bicarbonate and ammonia, which raise the pH and thereby inactivate the degradative enzymes of the phagolysosome.
    • Blastomyces dermatitidis causes blastomycosis, also known as North American blastomycosis, a disease that is usually acquired through inhalation of conidia.
    • Infection with Blastomyces can cause a range of symptoms, including skin lesions, pneumonia, and central nervous system infections.

    Viral Gene Expression

    • Viruses require virus-specific messenger RNA (mRNA) to synthesize virus-specific proteins.
    • RNA viruses:
      • Some have positive-polarity RNA genome that serves as mRNA (e.g., poliovirus).
      • Some have negative-polarity RNA genome and have an RNA polymerase in the virion that synthesizes viral mRNA (e.g., influenza virus).
      • Some have double-stranded RNA genome and have an RNA polymerase in the virion that synthesizes viral mRNA (e.g., rotavirus).
    • Retroviruses:
      • Have a positive-polarity RNA genome.
      • Have a DNA polymerase in the virion that synthesizes a DNA copy of the RNA genome.
      • Use host cell RNA polymerase to synthesize viral mRNA.
    • DNA viruses:
      • Most have a double-stranded DNA genome.
      • Use host cell RNA polymerase to synthesize viral mRNA.
      • Poxviruses have an RNA polymerase in the virion that synthesizes viral mRNA.

    Viral Replication

    • All DNA viruses replicate in the nucleus, except poxviruses, which replicate in the cytoplasm.
    • All RNA viruses replicate in the cytoplasm, except retroviruses, influenza virus, and hepatitis D virus, which require an intranuclear step in their replication.
    • Many viruses encode a replicase, which is a DNA or RNA polymerase that synthesizes many copies of the progeny viral genomes.

    Viral Genome

    • The genome of all DNA viruses is double-stranded, except for that of parvoviruses, which is single-stranded.
    • The genome of all RNA viruses is single-stranded, except for that of reo viruses (e.g., rotavirus), which is double-stranded.

    Viral Growth Curve

    • One virion infects a cell and hundreds of progeny virions are produced within hours.
    • The eclipse period is the time when no virus particles are detected within the infected cell.
    • Cytopathic effect (CPE) is the term used to describe the damage, both morphologic and functional, inflicted on the cell by the virus.

    Viral Growth Cycle

    • Attachment: The interaction of proteins on the surface of the virus with specific receptor proteins on the surface of the cell.
    • Infectious nucleic acid is viral genome DNA or RNA, purified free of all proteins, that can undergo the entire replicative cycle within a cell and produce infectious progeny viruses.
    • Polarity of viral genome RNA:
      • Positive-polarity RNA genome has the same base sequence as the mRNA.
      • Negative-polarity RNA genome has a base sequence complementary to the mRNA.

    Cytomegalovirus (CMV) Diagnosis

    • Diagnostic methods include:
      • Viral growth curve.
      • CPE in cell culture.
      • Fluorescent antibody and histologic staining of inclusion bodies in giant cells in urine and tissue.
      • A four-fold or greater rise in antibody titer.
      • PCR-based assays for CMV DNA or RNA in tissue or body fluids.

    CMV Treatment and Prevention

    • Treatment: Ganciclovir (Cytovene) is moderately effective in the treatment of CMV retinitis and pneumonia in patients with AIDS.
    • Prevention: There is no vaccine. Ganciclovir can suppress progressive retinitis in AIDS patients. Infants with cytomegalic inclusion disease should be kept isolated from other infants. Blood for transfusion to newborns should be CMV antibody-negative.

    RNA Nonenveloped Viruses: Enteroviruses (Poliovirus)

    • Disease: Poliomyelitis.
    • Important properties:
      • Host range is limited to primates (i.e., humans and nonhuman primates).
      • Three serologic (antigenic) types based on different antigenic determinants on the outer capsid proteins.
      • Protection from disease requires the presence of antibody against each of the three types.
    • Replicative cycle:
      • The virion interacts with specific cell receptors on the cell membrane and then enters the cell.
      • The capsid proteins are then removed.

    Hepatitis C Virus (HCV)

    • HCV infects hepatocytes primarily, but does not cause a virus-induced cytopathic effect on the liver cells.
    • Death of hepatocytes is likely caused by immune attack by cytotoxic T cells.
    • HCV infection strongly predisposes to hepatocellular carcinoma, which is enhanced by alcoholism.
    • Sexual transmission and transmission from mother to child occur, but are inefficient modes.

    Immunity

    • Antibodies against HCV are made, but approximately 75% of patients are chronically infected.
    • Chronic active hepatitis and cirrhosis occur in approximately 10% of patients with chronic infection.
    • It is unknown whether reinfection can occur or whether there is lifelong immunity.

    Clinical Findings

    • Acute infection with HCV is milder than infection with HBV.
    • Fever, anorexia, nausea, vomiting, and jaundice are common symptoms.
    • Dark urine, pale feces, and elevated transaminase levels are seen.

    Laboratory Diagnosis

    • HCV infection is diagnosed by detecting antibodies to HCV in an ELISA.
    • A RIBA (recombinant immunoblot assay) is performed as a confirmatory test.
    • Detection of viral DNA (viral load) in the serum is strong evidence of infectious virions.

    Treatment & Prevention

    • No antiviral therapy is typically used in acute hepatitis C.
    • For chronic hepatitis B, peginterferon alfa-2a (Pegasys) or peginterferon alfa-2b (Peg-Intron) can be used.
    • Prevention involves the use of either the vaccine or hyperimmune globulin or both.

    HCV Properties

    • HCV is a member of the flavivirus family.
    • It is an enveloped virion containing a genome of single-stranded, positive-polarity RNA.
    • It has no virion polymerase.
    • HCV has at least six genotypes and multiple subgenotypes based on differences in the genes encoding envelope glycoproteins.
    • The genetic variability results in a “hypervariable” region in the envelope glycoprotein.

    Replicative Cycle

    • The replication of HCV is uncertain because it has not been grown in cell culture.
    • It is likely that HCV replication follows the flavivirus model.
    • The replication of HCV in the liver is enhanced by a liver-specific micro-RNA.

    Transmission & Epidemiology

    • Humans are the reservoir for HCV.
    • It is transmitted primarily via blood.
    • Transmission via blood transfusion rarely occurs.
    • Transmission via needle-stick injury occurs, but the risk is lower than for HBV.

    Hepatitis D Virus (HDV)

    • HDV causes hepatitis D (hepatitis delta).
    • HDV is a defective virus that cannot replicate by itself because it does not have the genes for its envelope protein.
    • HDV can replicate only in cells also infected with HBV because it uses the surface antigen of HBV (HBsAg) as its envelope protein.

    HDV Properties

    • HDV is an enveloped virus with an RNA genome that is a single-stranded, negative-polarity, covalently closed circle.
    • The RNA genome of HDV encodes only one protein, the internal core protein called delta antigen.

    Transmission

    • HDV is transmitted by the same means as HBV (i.e., sexually, by blood, and perinatally).

    Pathogenesis & Immunity

    • The pathogenesis of hepatitis caused by HDV and HBV is likely the same.
    • It is unknown whether long-term immunity to HDV exists.

    Hormonal Functions of the Kidney

    • Produces erythropoietin, which promotes erythropoiesis in bone marrow
    • Plays a role in calcium metabolism by activating vitamin D

    Excretory and Homeostatic Functions

    • Achieved through glomerular filtration, tubular reabsorption, and secretion
    • Renal function test (RFT) assesses kidney functions, including:
      • Screening for, detecting, and evaluating acute and chronic kidney diseases
      • Monitoring response to treatment or progression of renal disease
      • Identifying conditions that can harm the kidneys, such as diabetes or high blood pressure

    Nephron Structure and Function

    • Nephron is the functional unit of the kidney, with approximately 1 million per kidney
    • Comprised of five main functional segments
    • Glomeruli filter water, low-molecular-weight substances, and small proteins, while retaining cells and high-molecular-weight components

    Renal Function Tests

    • Classification:
      • Urine examination (urinalysis)
      • Testing of glomerular function
      • Examination of tubular function tests

    Glomerular Function Tests

    • Estimated glomerular filtration rate (GFR) and proteinuria (albuminuria) are key indicators of glomerular function
    • GFR is the volume of blood filtered across the glomerulus per unit time
    • Measurement of GFR is based on clearance, which is the volume of plasma from which a substance is completely removed during one pass through the kidney
    • Creatinine is a commonly used substance to estimate GFR, but it has limitations:
      • Not sensitive (only increases above normal when kidney function drops by half)
      • Influenced by muscle mass, food intake, and liver function
    • Cystatin C is a more sensitive and earlier marker of GFR than creatinine

    Tubular Function Tests

    • Distal tubular function tests:
      • Urine specific gravity
      • Urine osmolality
      • Water deprivation test
      • Ammonium chloride loading test
    • Proximal tubular function tests:
      • Glycosuria
      • Phosphaturia
      • Aminoaciduria
      • Alpha-1 microglobulin and beta-2 microglobulin

    Urine Osmolality and Tubular Concentrating Ability

    • Healthy kidney can change urine osmolality in a wide range (40-1200 mmol/kg)
    • Urine osmolality is directly proportional to the concentrating work done by the kidney and indirectly reflects activity of ADH
    • Water deprivation test assesses the ability of the kidney to produce concentrated urine in response to fluid deprivation and vasopressin administration

    Heme Proteins and Biosynthesis

    • Heme is the prosthetic group for various proteins, including hemoglobin, myoglobin, cytochromes, cytochrome P450, catalase, nitric oxide synthase, and peroxidase.
    • Heme proteins are rapidly synthesized and degraded, with 6-7 grams of hemoglobin synthesized daily to replace heme lost through normal erythrocyte turnover.

    Sites of Heme Biosynthesis

    • The liver and erythrocyte-producing cells of the bone marrow are the major sites of heme biosynthesis, with over 85% of all heme synthesis occurring in erythroid tissue.
    • Heme synthesis in the liver responds to alterations in the cellular heme pool, while synthesis in erythroid cells is relatively constant and matched to the rate of globin synthesis.

    Heme Biosynthesis Pathway

    • The initial reaction and the last three steps of the biosynthetic pathway occur in mitochondria, while the intermediate steps occur in the cytosol.
    • Mature red blood cells lack mitochondria and are unable to synthesize heme.
    • The pathway involves the formation of δ-aminolevulinic acid (ALA) from glycine and succinyl coenzyme A, which is catalyzed by ALA synthase and requires pyridoxal phosphate as a coenzyme.
    • The rate-limiting step in porphyrin biosynthesis is the formation of ALA.

    Heme Degradation

    • Red blood cells are taken up and degraded by the reticuloendothelial system, particularly in the liver and spleen, after approximately 120 days in circulation.
    • The first step in heme degradation is catalyzed by the microsomal heme oxygenase system, which results in the formation of bilirubin, carbon monoxide, and the release of Fe2+.
    • Biliverdin is reduced to form the red-orange bilirubin, which is unique to mammals and appears to function at low levels as an antioxidant.

    Regulation of Heme Biosynthesis

    • Heme accumulation, when porphyrin production exceeds the availability of apoproteins, leads to the conversion of heme to hemin by the oxidation of Fe2+ to Fe3+.
    • Hemin decreases the amount and activity of ALAS1 by repressing transcription of its gene, increasing degradation of its messenger RNA, and decreasing import of the enzyme into mitochondria.
    • In erythroid cells, ALAS2 is controlled by the availability of intracellular iron.

    Renal Diseases and Indices

    • Proteinuria is an important index of renal diseases, and in normal urine, protein concentration is very low and cannot be detected by usual tests.
    • Proteins are secreted by the tubular epithelial cells.
    • The heat and acetic acid test is commonly used to assess proteinuria, but it is being replaced by the dipstick test.

    Hematuria

    • Hematuria is seen in nephritis and post-renal hemorrhage.
    • Hemoglobinuria is due to an abnormal amount of hemolysis.
    • Occult test tablets and Hemastix strips are available for rapid testing of blood in urine.

    Reducing Sugars (Glycosuria)

    • Benedict's test is used as a semiquantitative method for sugar estimation in urine.
    • The approximate concentration of sugar in urine is indicated by the color of the test:
      • 0.5 g/100 mL (green)
      • 1 g% (yellow)
      • 1.5 g% (orange)
      • 2 g% (red)
    • Dipstick is now replacing the old Benedict's test for detection of glucose in urine.

    Ketone Bodies

    • Ketone bodies are acetoacetic acid, beta-hydroxybutyric acid, and acetone.
    • Ketonuria is seen in diabetes mellitus, starvation, persistent vomiting, von Gierke's disease, and alkalosis.
    • Ketone bodies are analyzed by Rothera's test, and ketostix strips are available for rapid testing.

    Bile Salts and Pigments

    • Bile salts are present in urine during the early phase of obstructive jaundice and are identified by Hay's test.
    • Bilirubin appears in urine during obstructive jaundice and is detected by Fouchet's test.
    • Urobilinogen is absent in urine during hepatocellular jaundice, and its reappearance is an early sign of recovery.
    • Urobilinogen is identified by Ehrlich test or Schlesinger's test.

    Urine Concentration and Dilution Tests

    • In moderate forms of kidney damage, the blood level of urea and creatinine may be within normal limits, but the inability to excrete waste products may be counterbalanced by large urine output.
    • The earliest manifestation of renal disease may be difficulty in concentrating the urine.
    • Concentration test:
      • Patient is allowed no food or water after a meal at 6 PM.
      • The next day, the bladder is emptied, and the specimen is discarded.
      • A second specimen is collected at 8 AM, and the specific gravity is measured.
      • If the specific gravity is more than 1.022, the patient has adequate renal function.
    • Dilution tests:
      • Patient is not allowed to drink any water after midnight.
      • Bladder is emptied at 7 AM, and a water load is given (1200 mL over the next 30 minutes).
      • Hourly urine samples are collected for the next 4 hours, and volume, specific gravity, and osmolality of each sample are measured.
      • A normal person will excrete almost all the water load within 4 hours, and the specific gravity of at least one sample should fall to 1.003.

    Urinary Acidification

    • The most useful test is acid loading test, which is indicated in unexplained hyperchloremic metabolic acidosis.
    • Acidification defects may occur due to generalized tubular defects or due to genetically determined defects in ion pumps.
    • Give ammonium chloride at a dose of 0.1 g/kg body weight to assess urinary acidification.

    Glucose Regulation and Measurement

    • Glucose concentration in blood is controlled within narrow limits by many hormones, the most important of which are produced by the pancreas.
    • The most frequent cause of hyperglycemia is diabetes mellitus resulting from a deficiency in insulin secretion or action.
    • Glucose measurement in urine is used as a diabetes screening procedure, to aid in the evaluation of glycosuria, to detect renal tubular defects, and in the management of diabetes mellitus.
    • Glucose measurement in cerebrospinal fluid is used for evaluation of meningitis, neoplastic involvement of meninges, and other neurological disorders.
    • Random blood sugar test:
      • A blood sugar level of 200 mg/dL or higher suggests diabetes.
    • Fasting blood sugar test:
      • A fasting blood sugar level less than 100 mg/dL is normal.
      • A fasting blood sugar level from 100 to 125 mg/dL is considered prediabetes.
      • If it's 126 mg/dL or higher on two separate tests, you have diabetes.

    Glomerular Filtration Rate (GFR)

    • GFR is the most useful index for assessing the severity of renal damage
    • A decrease in renal function is due to the loss of functional nephrons, rather than a decrease in individual nephron function
    • Normal GFR for young adults is 120-130 mL/min/1.73M2
    • GFR declines with age, with more than 25% of people over 70 years old having a GFR less than 60 mL/min

    Factors Affecting GFR

    • Age
    • Sex
    • Body size
    • Protein intake
    • Pregnancy

    Clearance and Filtration

    • Freely filtered substances: GFR = clearance (e.g. creatinine, inulin)
    • Substances partially reabsorbed: GFR > clearance (e.g. urea)
    • Substances not reabsorbed: GFR = 1000 mg/day = glomerular proteinuria

    Proteinuria

    • Overflow proteinuria: small molecular weight proteins in blood overflow into urine (e.g. hemoglobin, myoglobin, Bence-Jones proteins)
    • Specific gravity of urine is elevated in cases of proteinuria

    Tests for Tubular Function

    • Specific gravity of urine: measures the concentration of solutes in urine
    • Reference range: 1.005-1.030
    • Heat and acetic acid test: assesses proteinuria
    • Dipstick test: replacing old methods for detecting proteinuria

    Urine Analysis

    • Hematuria: seen in nephritis and post-renal hemorrhage
    • Hemoglobinuria: due to abnormal hemolysis
    • Glycosuria: Benedict's test estimates sugar concentration in urine
    • Ketonuria: seen in diabetes mellitus, starvation, and alkalosis
    • Bile salts and bile pigments: present in urine during obstructive jaundice
    • Urobilinogen: identified by Ehrlich test or Schlesinger's test

    Physical Characteristics of Urine

    • Volume: average output is 1.5 liters per day
    • Appearance: varies depending on factors such as diet and disease state
    • Odor: normal urine has a faintly aromatic smell
    • Color: normal urine is straw-colored due to urochrome
    • Specific gravity: normal range is 1.015-1.025

    Chemical Characteristics of Urine

    • Reaction to litmus: pH varies from 5.5 to 7.5 depending on diet and acid-base balance

    Urine Analysis

    • Proteinuria is an important index of renal diseases, with normal urine having a very low protein concentration.
    • Proteins in urine are secreted by tubular epithelial cells and can be assessed by the heat and acetic acid test, which is being replaced by dipstick tests.

    Hematuria and Hemoglobinuria

    • Hematuria is seen in nephritis and post-renal hemorrhage.
    • Hemoglobinuria is due to an abnormal amount of hemolysis and can be detected using occult test tablets and Hemastix strips.

    Glycosuria

    • Benedict's test is used as a semiquantitative method for sugar estimation in urine, with results indicated by color changes:
    • 0.5 g/100 mL (green)
    • 1 g% (yellow)
    • 1.5 g% (orange)
    • 2 g% (red)
    • Dipstick tests are replacing the old Benedict's test for glucose detection in urine.

    Ketonuria

    • Ketone bodies include acetoacetic acid, beta-hydroxybutyric acid, and acetone.
    • Ketonuria is seen in diabetes mellitus, starvation, persistent vomiting, von Gierke's disease, and alkalosis.
    • Ketone bodies are analyzed by Rothera's test, and ketostix strips are available for rapid testing.

    Bile Salts and Pigments

    • Bile salts are present in urine during the early phase of obstructive jaundice and are identified by Hay's test.
    • Bilirubin appears in urine during obstructive jaundice and is detected by Fouchet's test.
    • Urobilinogen is oxidized to urobilin, causing the deepening of urine color on standing, and is identified by Ehrlich test or Schlesinger's test.

    Blood/Serum Analysis

    • Estimation of blood urea, serum creatinine, protein, and electrolyte are often useful.

    Urine Examination

    • Routine examination of urine includes:
      • Volume: average output is 1.5 liters per day, which may be increased in diabetes mellitus and chronic renal diseases, or decreased in dehydration, edema, and kidney damage.
      • pH: varies from 5.5 to 7.5, affected by diet and kidney function.
      • Specific gravity: normal is 1.015-1.025, which may be decreased in excessive water intake, chronic nephritis, and diabetes insipidus, or increased in diabetes mellitus, nephrosis, and excessive perspiration.

    Jaundice

    • Jaundice refers to the yellow color of skin, nail beds, and sclera caused by deposition of bilirubin due to increased bilirubin levels in the blood.
    • Bilirubin is a yellowish substance produced during the breakdown of red blood cells, normally removed by the liver, but leaked into the bloodstream in liver damage.

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    This quiz covers the pathogenesis of fungal infections, including the immune response to different types of fungi and how reduced immunity affects the body's ability to combat these infections.

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