0.1 PLEURAL FLUID (LUNGS)

Question 1

Pleural fluid is from?

Answer 1

pleural cavity

Question 2

Pleural fluid may be transudate or exudate. (T/F)

Answer 2

T

Question 3

Aside from routine tests to differentiate transudate and exudate, WHAT ARE 3 other tests are helpful in analyzing pleural fluid?

Answer 3

A. Pleural fluid Cholesterol
& Pleural Fluid:Serum Cholesterol
B. Pleural fluid:Serum Bilirubin
C. Glucose

Question 4

Exudate: A pleural fluid
cholesterol of ?

Answer 4

> 60 mg/dL

Question 5

Pleural Fluid:Serum cholesterol ratio of ?

Answer 5

> 0.3

Question 6

Exudate: A pleural fluid:Serum
bilirubin ratio of?

Answer 6

> 0.3

Question 7

Only done in effusions
suspected with rheumatoid
arthritis

Answer 7

Glucose

Question 8

Can provide diagnostic information regarding the cause of effusion.

Answer 8

Appearance

Question 9

➔ Presence of leukocytes
➔ Bacterial infection, tuberculosis, or an immunologic disorder,
such as rheumatoid arthritis

Answer 9

INCREASED TURBIDITY

Question 10

➔ Presence of RBCs
➔ Traumatic injury (hemothorax), membrane damages from
malignancies (hemorrhagic exudate), or traumatic aspiration

Answer 10

BLOODY APPEARANCE

Question 11

➔ Presence of chylous material or pseudochylous material.

Answer 11

MILKY

Question 12

TEST FOR HEMOTHORAX

Answer 12

HEMATOCRIT TEST

Question 13

TEST FOR HEMORRHAGIC EXUDATE

Answer 13

HEMATOCRIT TEST

Question 14

TEST FOR TRAUMATIC ASPIRATION

Answer 14

MACROSCOPIC APPEARANCE

Question 15

Fluid hematocrit of hemothorax?

Answer 15

> 50% of the whole blood hematocrit

Question 16

Why is hematocrit increased in hemothorax?

Answer 16

due to influx of RBCs from injury

Question 17

Hematocrit test of hemorrhagic exudate?

Answer 17

Fluid hematocrit is lesser compared to whole blood

Question 18

Macroscopic appearance of traumatic aspiration

Answer 18

Uneven bloody appearnce
Blood streaked

Question 19

Membrane damages conatains what?

Answer 19

Both blood and increased pleural fluid.

Question 20

Thoracic duct damage

Answer 20

Chylous

Question 21

Increased triglycerides

Answer 21

Chylous

Question 22

Chronic Inflammation & Lymphatic obstruction

Answer 22

Pseudochylous

Question 23

Increased cholesterol; decreased triglyceride

Answer 23

Pseudochylous

Question 24

Milk/White appearance

Answer 24

Chylous

Question 25

Predominant cells in chylous

Answer 25

Lymphocytes

Question 26

Presence of what crystals are found in pseodochylous?

Answer 26

Cholesterol crystals

Question 27

Positive for Sudan III sTAINING

Answer 27

Chylous

Question 28

Negative or weak reaction to Sudan III staining

Answer 28

Pseudochylous

Question 29

Most clinically significant test

Answer 29

Differential counting

Question 30

What are predominant nucleated cells, how many percent?

Answer 30

Monocytes and macrophage; 64-80%

Question 31

This indicate bacterial infection, pancreatitis and pulmonary infection, and how many percent?

Answer 31

Neutrophils

Question 32

18-30% Present both transudative and exudative effusions increase in tuberculosis and viral infections. -rheumatoid arthritis -systemic lupus erthematosus

Answer 32

Lymphocytes

Question 33

>10%=trauma resulting in the presence of air and blood (pneumothorax and hemothorax) increased in allergic and parasitic conditions

Answer 33

Eosinophils

Question 34

Cells of the serous membrane Appear pleomorphic=difficult to differentiate from: lymphocytes plasma cells malignant cells

Answer 34

Mesothelial cells

Question 35

Mesothelial cells have two forms, what?

Answer 35

Normal and reactive

Question 36

Large round cells with abundant lue and unifrom cytoplasm and round nuclei

Answer 36

Normal

Question 37

Appear in clusters; having varying amounts of cytoplasm, eccenteric nuclei, and prominent nucleoli. closely resemble malignant cells

Answer 37

Reactive

Question 38

Mesothelial cells are normally present in small amount. (T/F)

Answer 38

T

Question 39

Mesothelial cells are increased in pneumonia and malignancies. (T/F)

Answer 39

T

Question 40

Absence of metholial cells indicates?

Answer 40

Tuberculosis

Question 41

Most significant cell

Answer 41

Malignant cells

Question 42

Distinguishing characteristics of malignant cells. atleast 3

Answer 42

1. Abnormal nucleus:cytoplasm ratios 2. hyperchromatic nucleoli 3. nuclear and cytoplasmic irregularities

Question 43

Most common malignant cels in pleural effusion:

Answer 43

1. Adenoncarcinoma cells 2. Oat cell carcinoma cells = large lymphocytes 3. Metastaric breast carcinoma cells=clumps

Question 44

Fluid glucose =

Answer 44

Plasma glucose

Question 45

Glucose <60 mg/dL is considered

Answer 45

decreased

Question 46

Additional test to the glucose level

Answer 46

Lactate

Question 47

↑ in bacterial infections

Answer 47

Lactate

Question 48

What ph is the need for chest-tube drainage in cases of pneumonia

Answer 48

<7.3

Question 49

In cases of acidosis, what ph is significant?

Answer 49

>0.30 below blood

Question 50

What ph is esophageal rupture?

Answer 50

<6.0

Question 51

highly suggest tuberculosis

Answer 51

>40 U/L

Question 52

Also ↑ in malignancies

Answer 52

Adenosine Deaminase (ADA)

Question 53

First to increase in pleural fluid in cases of pancreatitis

Answer 53

Amylase

Question 54

Analysis if pleural exudates

Answer 54

Microbiology

Question 55

Differentiate effusions of immunologic origin from noninflammatory processes

Answer 55

Serology

Question 56

Most frequently performed serological tests:

Answer 56

● Antinuclear antibody (ANA) ● Rheumatoid factor

Question 57

Microorganisms primarily associated with pleural effusions include?

Answer 57

Staphylococcus aureus, Enterobacteriaceae, anaerobes, and Mycobacterium tuberculosis