3S [LEC]: Synovial Fluid Flashcards
1
Q
T/F: Synovial fluid has a limited diagnostic or clinical significance
A
True
2
Q
Found in the cavities of the movable joints
A
Synovial fluid
3
Q
Enables the nonselective filtering capacity of synovial fluid
A
Synovial membrane
4
Q
Specialized cell in the synovial membrane that secretes mucopolysaccharide with hyaluronic acid and protein
A
Synoviocytes
5
Q
Type of synoviocyte that is macrophage-like and located in the superficial layer of synovial membrane
A
Type A cells
6
Q
Type of synoviocyte that is fibroblast-like with prominent endoplasmic reticulum located in a deeper layer
A
Type B cells
7
Q
Ultrafiltrate of the plasma across the synovial membrane
A
Synovial fluid
8
Q
Component/s of the mucopolysaccharide that is secreted by synoviocytes
A
Hyaluronic acid
Protein (1/3)
9
Q
Contribute the noticeable viscosity to the synovial fluid
A
Hyaluronate molecules
10
Q
Normal volume of synovial fluid
A
<3.5 mL
11
Q
Normal color of synovial fluid
A
Pale yellow/ Colorless
12
Q
The string formed by the synovial fluid due to its viscosity measures how long?
A
4-6 cm
13
Q
Normal value of erythrocyte count in synovial fluid
A
<2000 cells/uL
14
Q
Normal value of leukocyte count in synovial fluid
A
<200 cells/uL
15
Q
Normal value of neutrophils in synovial fluid
A
<20-25% of the differential
16
Q
Normal value of lymphocytes in synovial fluid
A
<15% of the differential
17
Q
Normal value of monocytes and macrophages in synovial fluid
A
65% of the differential
18
Q
T/F: Crystals are normally seen in synovial fluid
A
False (none should be present)
19
Q
Normal value of glucose in synovial fluid
A
<10 mg/dL lower than blood glucose
20
Q
Normal value of lactate in synovial fluid
A
<250 mg/dL
21
Q
Normal value of total protein in synovial fluid
A
<3 g/dL
22
Q
T/F: A normal synovial fluid has a uric acid that is equal to blood or plasma value
A
True
23
Q
Most abundant WBC in the synovial fluid
A
Monocyte and macrophages
24
Q
Identify the classification of joint disorder:
Degenerative joint disorder
A
Non-inflammatory
25
Identify the classification of joint disorder:
Osteoarthritis/ Osteoporosis
Non-inflammatory
26
Two possible origins of inflammatory joint disorder
Immunologic
Crystal-induced
27
Identify the classification of joint disorder:
Rheumatoid arthritis
Inflammatory
28
Identify the classification of joint disorder:
Lupus erythematosus
Inflammatory
29
Identify the classification of joint disorder:
Scleroderma
Inflammatory
30
Identify the classification of joint disorder:
Polymyositis
Inflammatory
31
Identify the classification of joint disorder:
Ankylosing spondylitis
Inflammatory
32
Identify the classification of joint disorder:
Lyme arthritis
Inflammatory
33
Identify the classification of joint disorder:
Gout
Inflammatory
34
Identify the classification of joint disorder:
Pseudogout
Inflammatory
35
Identify the classification of joint disorder:
Microbial infection
Septic
36
Identify the classification of joint disorder:
Traumatic injury
Hemorrhagic
37
Identify the classification of joint disorder:
Tumors
Hemorrhagic
38
Identify the classification of joint disorder:
Hemophilia
Hemorrhagic
39
Identify the classification of joint disorder:
Coagulation disorders
Hemorrhagic
40
Identify the classification of joint disorder:
Anticoagulant overdose
Hemorrhagic
41
Identify the classification of joint disorder:
Green tinge in synovial fluid
Septic
42
Method of collection of synovial fluid
Arthrocentesis
43
Synovial fluid is often collected in a syringe that has been moistened with ___
Heparin
44
T/F: Normal synovial fluid will clot, while a diseased joint will not
False
45
The first 4-5 mL of the synovial fluid is placed in what type of collection tube?
Nonanticoagulated red stopper tube
46
Which collection tube for synovial fluid is used to observe clotting?
Nonanticoagulated red stopper tube (1st tube)
47
The second 4-5 mL of the synovial fluid is placed in what type of collection tube?
Heparin/ EDTA tube
48
Which collection tube for synovial fluid is used for cell count, differential count, and crystal identification?
Heparin/ EDTA tube (2nd tube)
49
The last 4-5 mL of the synovial fluid is placed in what type of collection tube?
Sterile heparinized tube
50
Which collection tube for synovial fluid is used for microbiological studies?
Sterile heparinized tube (3rd tube)
51
T/F: In collecting synovial fluid, powdered anticoagulants may be used as alternative
False (should not be used; may produce artifacts that interfere with crystal analysis)
52
Which collection tube for synovial fluid is used for glucose analysis?
Sodium fluoride tube
53
Which collection tube for synovial fluid is usually centrifuged?
Nonanticoagulated red stopper tube
54
Synovial fluid is named as such, as it resembles ___
Egg white (ovum in Latin)
55
The color of synovial fluid becomes deeper ___ in the presence of noninflammatory and inflammatory effusions
Yellow
56
In synovial fluid, turbidity is primarily associated with the presence of which cell?
WBCs (synovial cell debris and fibrin also produce turbidity)
57
The synovial fluid may appear ___ when crystals are present
Milky
58
The viscosity of the synovial fluid comes from the polymerization of the ___
Hyaluronic acid
59
Effect of arthritis in the viscosity of the synovial fluid
Decreased (due to affected hyaluronate and its ability to polymerize)
60
Method of measuring the hyaluronate polymerization of synovial fluid
Ropes or mucin clot test
61
Which reagent causes a normal synovial fluid to form a solid clot surrounded by clear fluid?
2-5% acetic acid
62
The most frequently performed cell count on synovial fluid
WBC count
63
If the cell count in synovial fluid is not performed ASAP, what should be done to the sample?
Refrigerated
64
Very viscous fluid may need to be pretreated by adding a pinch of ___ to 0.5mL of fluid or one drop of ___ in phosphate buffer per mL of fluid
Hyaluronidase
0.05% Hyaluronidase
65
This reagent digests hyaluronate
Hyaluronidase
66
Equipment used for cell counting in synovial fluid
Neubauer counting chamber
67
What is done in turbid or blood synovial fluids for better cell counting?
Dilution
68
Usual diluent used in cell count in synovial fluid
Normal saline
69
If it is necessary to lyse the RBCs in cell counting in synovial fluid, which reagent is used?
Hypotonic saline (0.3%) or saline with saponin
70
Reagent used in cell counting in synovial fluid to stain WBC nuclei
Methylene blue
71
Which cell is increased in the synovial fluid of a patient with a possible septic condition?
Neutrophils
72
Which cell is increased in the synovial fluid of a patient with a nonseptic inflammation?
Lymphocytes
73
An abnormal cell that is present in the synovial fluid of a patient with lupus erythematosus
LE cells
74
An abnormal cell that may be found in the synovial fluid and is described as macrophages with ingested neutrophils
Reiter cells
75
An abnormal cell that may be found in the synovial fluid containing precipitated rheumatoid factor appearing as cytoplasmic granules in neutrophils
RA cells (ragocytes)
76
A cell abnormality that may be found in the synovial fluid that is caused by hemorrhagic process or cases of pigmented villonodular synovitis
Hemosiderin granules
77
An abnormal cell that is present in the synovial fluid of a patient with osteoarthritis
Cartilaginous cells
78
An abnormal cell that is present in the synovial fluid of a patient with septic and rheumatoid arthritis and tuberculosis
Rice bodies
79
An abnormal cell that is present in the synovial fluid indicating traumatic or crush injuries
Fat droplets
80
Aside from wet preparation technique, which stain preparation may also be used in observing crystals in the synovial fluid?
Wright stain
81
Under direct polarization, birefringent substances appear as ___ on a black background
Bright objects
82
Under compensated polarizing light, crystals aligned parallel to the compensator appear ___
Yellow (negative birefringence)
83
Under compensated polarizing light, crystals aligned perpendicular to the compensator appear ___
Blue (positive birefringence)
84
Crystal in the synovial fluid that may indicate gouty arthritis
Monosodium urate crystals (MSU)
85
Needle-shaped crystals in the synovial fluid that may be extracellular or located within the cytoplasm of neutrophils
Monosodium urate crystals (MSU)
86
Birefringence result of monosodium urate crystals (MSU) under direct polarizing light
Highly birefringent
87
Birefringence result of monosodium urate crystals (MSU) under compensated polarized light
Negative (yellow in parallel, blue when perpendicular)
88
Synovial fluid crystal that may indicate gout
Monosodium urate crystals (MSU)
89
Synovial fluid crystal that may indicate pseudogout
Calcium pyrophosphate dihydrate (CCPD)
90
Crystal in the synovial fluid that usually appear rhomboid-shaped or square but may appear as short rods
Calcium pyrophosphate (CCPD)
91
Birefringence result of calcium pyrophosphate (CCPD) under compensated polarized light
Positive (blue in parallel, yellow in perpendicular)
92
A crystal in the synovial fluid that is seen as rhombic plates and is a nonspecific indication of associated with chronic inflammation
Cholesterol
93
Birefringence result of cholesterol crystal under compensated polarized light
Negative
94
Crystal in the synovial fluid that is associated with calcific deposition conditions and is seen as small and needle-shaped
Hydroxyapatite (HA) (Calcium phosphate)
95
This crystal in the synovial fluid may produce an acute inflammatory reaction
Hydroxyapatite (HA) (Calcium phosphate)
96
Microscope required in the examination of hydroxyapatite crystals in the synovial fluid
Electron microscope
97
Flat, variable shaped plates in the synovial fluid that is associated with intra-articular injections
Corticosteroid crystals
98
T/F: Corticosteroid crystals have no clinical significance
True
99
Crystal in the synovial fluid following renal dialysis
Calcium oxalate
100
Preferred fasting in glucose determination of synovial fluis
8 hours
101
If the difference between blood and synovial glucose values is ___, this may be indicative of inflammatory conditions
>25 mg/dL
102
If the difference between blood and synovial glucose values is ___, this may be indicative of sepsis
>40 mg/dL
103
The glucose level of the synovial fluid is considered low if the value is ___ serum plasma glucose value
< 1/2
104
Glucose testing in synovial fluid must be run within ___ of collection
1 hour
105
T/F: Total protein determination in synovial fluid is routinely done
False
106
Normal total protein value of synovial fluid in comparison with serum value
<1/3 of serum value (approx. 3 mg/dL)
107
Chemistry test in synovial fluid that may determine gout in conjunction with its plasma level
Uric acid
108
Chemistry test in synovial fluid that may differentiate between inflammatory and septic arthritis
Lactate
109
Estimated lactate level of synovial fluid in septic arthritis
>250 mg/dL
110
Estimated lactate level of synovial fluid in gonococcal arthritis
Normal to low
111
Most common bacteria associated with septic arthritis
Haemophilus
Neisseria gonorrhoeae
112
Usual enrichment medium used in culturing synovial fluid
Chocolate agar
113
Autoantibodies are typically seen in the synovial fluid of patients with what condition?
Rheumatoid arthritis (RA)
Lupus erythematosus (LE)
114
Bacterial infection that may be indicated when antibody is present in the synovial fluid of a patient
Borrelia burgdorferi
