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Clin Med Lab > eval of body fluids > Flashcards

eval of body fluids Flashcards

1
Q

what are the two types of effusion

A
  • transudate
  • exudate
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2
Q

what is a transudative effusion

A
  • acumulation of fluid in a body cavity due to filtration of blood serum across a physiologically intact vascular wall
  • due to pressure differences between body compartments
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3
Q

what is an exudative effusion

A
  • accumulation of fluid within a body cavity due to inflammation and vascular damage
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4
Q

which type of effusion requires further testing? What conditions are being r/o?

A
  • exudative
    • infection: cultures
    • malignancy: cytology
    • inflammatory disorder
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5
Q

differentiate between transudative and exudative analysis in terms of protein fluid/serum ratio

A
  • transudate: protein fluid/serum ratio < 0.5
  • exudate: protein fluid/serum ratio > 0.5
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6
Q

differentiate between transudative and exudative analysis in terms of total protein levels

A
  • transudative: total protein level < 3 g/dl
  • exudative: total protein level > 3 g/dl
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7
Q

differentiate between transudative and exudative analysis in terms of color of fluid and number of WBC

A
  • transudative: clear, thin fluid; WBC < 300/uL, mononuclear
  • exudative: cloudy, thick, viscous fluid; WBC > 500/uL, neutrophils
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8
Q

differentiate between transudative and exudative analysis in terms of LDH fluid/serum ratio

A
  • transudative: LDH fluid/serum ratio < 0.6
  • exudate: LDH fluid/serum ratio > 0.6
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9
Q

differentiate between transudative and exudative analysis in terms of glucose concentration

A
  • transudate: glucose equal to serum glucose
  • exudate: glucose < serum glucose (< 60 mg/dl)
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10
Q

differentiate between transudative and exudative analysis in terms of pH

A
  • transudate: pH = 7.4-7.5
  • exudate: pH < or = 7.3-7.4
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11
Q

effusions with triglycerides/cholesterol can indicate?

A
  • chylous effusion - thoracic duct impairtment: lymphoma, trauma, recent surgery
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12
Q

effusions with amylase can indicate

A
  • esophageal rupture, pancreatitis, malignancy, bowel perforation
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13
Q

What are the most common causes of transudative pleural effusions

A
  • CHF
  • cirrhosis
  • nephrosis
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14
Q

What are the most common causes of exudative pleural effusions

A
  • parapneumonic effusion
  • malignant effusion
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15
Q

What are the most common causes of parapneumonic effusion

A
  • bacterial pneumonia
  • lung abscess
  • bronchiectasis
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16
Q

What are the most common causes of malignant effusions

A
  • lung CA
  • breast CA
  • lymphoma
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17
Q

The following found in pleural effusion indicates what condition:

RBC > 100,000uL, Hct of fluid > or = 50% of peripheral blood smear, fluid is serosanginous in appearance.

A

hemothorax

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18
Q

What are the main causes of hemothorax

A
  • trauma
  • malignancy
  • pulmonary embolism
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19
Q

what is empyema

A
  • pus in pleural space
  • WBC > 50,000 - 100,000
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20
Q

What type of cells would you expect to find in an empyema caused by inflammation/infection? caused by neoplasm or TB?

A
  • inflammation/infection: > 50% neutrophils
  • neoplasm or TB: >50% lymphocytes
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21
Q

Triglycerides seen in pleural fluid indicates

A
  • chylous effusion seen in trauma, neoplasm, obstructed lymphatics
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22
Q

What is light’s criteria rule

A
  • if at least one of the following three criteria is fulfilled, the fluid is defined as an exudate
    • pleural fluid protein/serum protein ratio > 0.5
    • pleural fluid LDH/serum LDH ratio >0.6
    • pleural fluid LDH > 2/3rds of the upper limits of the lab’s normal serum LDH
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23
Q

a pulmonary embolism can cause what type of effusion?

A

either a transudative or exudative effusion

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24
Q

A parapneumonic effusion should be sampled if it meets any of the following criteria

A
  • it layers out > 25 mm of a lateral decubitus film
  • it is loculated
  • it is associated with thickened parietal pleura on CT
  • it is clearly delineated by US
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25
Q

Differential diagnosis of pericardial effusions

A
  • acute pericarditis
  • autoimmune disease
  • post-MI, cardiac surgery
  • chest trauma
  • malignancy
  • mediastinal radiation
  • renal failure
  • myxedema
  • aortic dissection
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26
Q

When is pericardiocentesis indicated

A
  • tamponade
  • not indicated for pericardial effusion without tamponade unless fluid is needed for diagnostic purposes
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27
Q

What labs should you order when assessing pericardial fluid

A
  • CBC
  • CMP
  • thyroid function
  • ANA
  • gram stain
  • cultures
  • cytology
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28
Q

what is ascites

A

accumulation of fluid within the peritoneal cavity

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29
Q

What are the two primary causes of ascites

A
  1. hepatic cirrhosis (81%)
    • due to portal HTN
  2. malignancy (10%)
30
Q

What is the gold standard for diagnosis peritoneal fluid-ascites

A

abd US

31
Q

When is a abd paracentesis indicated

A
  • new onset ascites or recurrent ascites
  • fever
  • abd tenderness (r/o peritonitis)
  • mental status change
  • hypotension
  • peripheral leukocytosis
  • worsening renal function
  • GI bleed
32
Q

What initial tests should you order on ascitic fluid

A
  • culture and sensitivity
  • albumin
  • cell count with differential
  • protein: amylase (along with serum amylase)
33
Q

What is the SAAG classification?

A
  • serum-to-ascites albumin gradient
  • SAAG = (serum albumin) - (ascitic fluid albumin)
34
Q

conditions leading to ascites through portal hypertension have a serum-to-ascites albumin gradient of

A

> 1.1 g/dL

35
Q

conditions leading to ascites in the absence of portal hypertension (such as malignancy or infection) have a serum-to-ascites albumin gradient of

A

gradient < 1.1 g/dL

36
Q

what is the WBC in the ascitic fluid in an uncomplicated cirrhosis

A

< 500 cell/uL

37
Q

What is an extremely useful test in ascitic fluid analysis

A

ascitis fluid cell count

38
Q

Patients with cirrhosis and ascites commonly get this condition?

clinical presentation

  • abrupt onset of fevr, chills, abd pain
  • rebound tenderness
  • ascitic fluid WBC > 500 cells/uL with >50% neutrophils
A

spontaneous bacterial peritonitis

39
Q

cerebrospinal fluid is produced where

A

produced by the choroid plexus

40
Q

what is the most common collection technique for obtaining CSF

A

lumbar puncture

41
Q

what are the diseases detected by CSF analysis

A
  • hemorrhage
  • infection
    • miningitis
    • abscess
  • malignant process
    • brain tumor
    • leukemia or lymphoma
  • multiple sclerosis
42
Q

When is lumbar puncture contraindicated

A

increased intracranial pressure

  • consider CT of head prior to LP
43
Q

where in the vertebrae is the LP performed

A
  • enter at L3-L4, L4-L5 interspace
  • cauda equina terminates at L1-L2
44
Q

What are some conditions that can cause a decreased CSF opening pressure

A
  • hypovolemia (dehydration, shock), chronic CSF leak
45
Q

What are some conditions that can cause a increased CSF opening pressure

A
  • infection
  • bleeding
  • tumor
46
Q

What are some conditions that can cause a large difference in CSF opening and closing pressure

A

spinal cord obstruction (tumor)

47
Q

Indications for getting a CT before LP

A
  • immunocompromised
  • h/o CNS disease (mass, stroke)
  • new onset sz (w/in 1 weeks)
  • papilloedema
  • ALOC
  • focal neurologic deficit
48
Q

describe normal CSF, color and opening pressure

A
  • clear and colorless
  • opening pressure 60-200 mmH2O, up to 250 in obese
49
Q

what are the three tubes that are ordered to assess CSF

A
  1. chemistry analysis
  2. microbiology
    • gram and acid fast stain, C & S
  3. hematology
    • cell count and differential
50
Q

xanthochromia

A

the yellow discoloration indicating the presence of bilirubin in the cerebrospinal fluid (CSF)

  • indicates lysis of RBC
    • hgb -> oxyhemoglobin -> methemoglobin -> biliruben
  • present in > 90% of pts w/in 12 hours of subarachnoid hemorrhage
51
Q

What is the normal range of CSF glucose? What conditions cause decrease and increase in levels?

A

2/3 of plasma glucose

  • levels are decreased in bacterial meningitis and fungal infection
  • levels are increased in hyperglycermia
52
Q

presence of “oligo clonal bands” and “myeling basic protiens” are characteristic of

A

multiple sclerosis

53
Q

What is the classic triad of symptoms in meningitis

A
  • Altered mental status
  • nuchal rigidity
  • fever
    • also can cause N/V, photophobia
    • meningococcal can cause diffuse petechial rash
54
Q

what is the gold standard in diagnosing causative organism in meningitis

A

CSF culture

55
Q

Describe the method and function of KOH prep

A
  • sample placed on slide with drop of KOH, slide is heated briefly with flame, then examined
  • KOH dissolves host cells and bacteria, sparing fungi and elastin fibers
56
Q

what slide is commonly used to diagnose herpes virus? describe the method

A
  • Tzank prep
  • slides prepared from lesion scrapings and stained with giemsa or wright
    • presence of multinucleated giant cells indicates infection with HSV
57
Q

what slide preparation is used for diagnosing CSF with cryptococci? what is the method

A
  • india ink
  • drop of centrifuged CSF is placed on slide next to drop of india ink
    • cryptococci are identified by large capsules which exclude the ink
58
Q

What methods are used to diagnose symphilis via direct identification of spirochetes

A
  • dark field microscopy
  • direct fluorescent antibody testing
  • failure to identify organisms in specimen does not exclude primary symphilis **
59
Q

which organism that causes syphilis can’t be cultured

A

Treponema pallidum

60
Q

what antibody tests are done to diagnose syphillis

A
  1. non-treponemal is done first
    • venereal disease research lab= use for CSF
  2. specific treponemal: done if (1) is positive
    • confirmation of syphilis - T. pallidum enzyme immunoassay
61
Q

what is expected to be seen in direct examination of coccidiomycosis (valley fever)

A

mature spherules with endospheres

62
Q

what immunoglobulins respond to coccidiomycosis

A

igG and IgM

63
Q

what detection techniques are used to detect specific etiologic agents in infectious disease

A
  • latex agglutination
  • enzyme immunoassay
  • PCR
64
Q

What is important about using the micro dilutation method in antimicrobial sensitivity

A
  • gives minimum inhibitory concentration (MIC): the lowest concentration of Abx that inhibits visible growth of bacteria
65
Q

What is important to remember when ordering blood cultures

A
  • two different specimens must be ordered from two different sites
    • if one is positive and other negative, + result is likely due to contaminant
  • do not draw cultures from IV
  • lab must be notified if Abx were initiated prior to the blood draw
66
Q

differentiate between bacteremia and sepsis

A
  • bacteremia: presence of organisms that be cultured from blood
  • sepsis: presence of infection together with systemic manifestations of infection, can lead to organ dysfunction
67
Q

What are the most common etiologic organisms causing sepsis? What organism has the highest mortality rate

A
  • staphylcocci, streptococci,
  • e-coli, enterbacter
  • pseudomonas aeruginosa
  • ***MRSA has the highest mortality rate
68
Q

What Abx should be given initially in sepsis until cultures are available

A

empirical coverage of gram + and - organisms

69
Q

what are the major risk factors for sepsis

A
  • bacteremia
  • age >65 yo
  • immunosuppression
  • DM
  • malignancy
  • community acquired PNA
  • previous hospitalization (w/in 90 days)
70
Q

clinical presentation

  • temp > 38.3
  • tachypnea, tachycardia
  • AMS
  • significant edema WBC > 12,000
  • increased CRP, lactate
  • thrombocytopenia
  • hyperglycemia in absence of DM
  • Cr > 0.5 mg/dL
  • hypotension (<90/70)
  • organ failure
A

sepsis

71
Q

what is the definition of septic shock

A

sepsis induced hypotension that persists despite attempts at fluid resuscitation

Clin Med Lab (6 decks)

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