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Clin Med Lab Med > Exam #2: Body Fluids > Flashcards

Exam #2: Body Fluids Flashcards

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1
Q

If an effusion is transudative, what will the blood vessels look like?

A

INTACT vessel walls

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2
Q

What is generally the underlying cause of accumulation in transudative effusions?

A

Due to pressure differences between compartments

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3
Q

If an effusion is exudative, what will the blood vessels look like?

A

DAMAGED vessel walls

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4
Q

What is generally the underlying cause of accumulation in exudative effusions?

A

Secondary to malignancy, infection, inflammatory disorder, trauma

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5
Q

Does transudative effusion or exudative effusion require further testing?

A

Exudative effusion to determine cause

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6
Q

What are the three most common causes of Transudative Pleural Effusion?

A
  • CHF
  • Cirrhosis
  • Nephrotic Syndrome
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7
Q

What is the most common cause of Exudative Pleural Effusion?

What is the 2nd most common cause?

A

Parapneumonic (bacterial PNA, lung abscess, bronchiectasis)

  • 2nd most: malignancy
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8
Q

What condition involves RBCs in pleural space?

A

Hemothorax

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9
Q

If there is a chylous effusion, what does this look like and what two components cause this appearance?

A

Appear cloudy/milky

- Contains TGs and lipids

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10
Q

What can be caused by either Transudative Pleural Effusion or Exudative Pleural Effusion?

A

PE!!!

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11
Q

Is a Protein Fluid/Protein Serum ratio >0.5 indicative of Transudative Pleural Effusion or Exudative Pleural Effusion?

A

Exudative Pleural Effusion

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12
Q

Is a Protein Fluid/Protein Serum ratio <0.5 indicative of Transudative Pleural Effusion or Exudative Pleural Effusion?

A

Transudative Pleural Effusion

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13
Q

Is WBCs >500 cells/uL indicative of Transudative Pleural Effusion or Exudative Pleural Effusion?

A

Exudative Pleural Effusion

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14
Q

Is WBCs <300 cells/uL indicative of Transudative Pleural Effusion or Exudative Pleural Effusion?

A

Transudative Pleural Effusion

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15
Q

Is LDH Fluid/LDH Serum >0.6 indicative of Transudative Pleural Effusion or Exudative Pleural Effusion?

A

Exudative Pleural Effusion

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16
Q

Is LDH Fluid/LDH Serum <0.6 indicative of Transudative Pleural Effusion or Exudative Pleural Effusion?

A

Transudative Pleural Effusion

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17
Q

Is glucose < serum glucose OR <60 mg/dL indicative of Transudative Pleural Effusion or Exudative Pleural Effusion?

A

Exudative Pleural Effusion

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18
Q

Is a basic pH indicative of Transudative Pleural Effusion or Exudative Pleural Effusion?

A

Transudative Pleural Effusion

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19
Q

Is an acidic pH indicative of Transudative Pleural Effusion or Exudative Pleural Effusion?

A

Exudative Pleural Effusion

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20
Q

Is Amylase Fluid > Amylase Serum indicative of Transudative Pleural Effusion or Exudative Pleural Effusion?

A

Exudative Pleural Effusion

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21
Q

What imaging should be obtained before performing a Thoracentesis?

A

CXR with PA, lateral, lateral decubitus views

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22
Q

Under what conditions would you obtain a sample for Thoracentesis (4)?

A
  • Layers out >25 mm on lateral decubitus view
  • Loculated
  • Associated with thickened pleura on CT
  • Clearly delineated by US
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23
Q

What does Eosinophilia on Pleural Fluid Analysis indicate?

A

Parasitic infection

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24
Q

What is Light’s Criteria Rule used for?

A

Differentiate between transudate and exudate pleural effusion

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25
For Light’s Criteria Rule, what criteria must be met to be considered exudative pleural effusion?
1+ of 3... - Pleural fluid protein/serum protein ratio is 0.5+ - Pleural fluid LDH/serum LDH ratio is 0.6+ - Pleural fluid LDH is more than 2/3 of upper limits of lab’s normal serum LDH
26
What is a contraindication of Thoracentesis?
Significant thrombocytopenia
27
What are the two most common causes of Peritoneal Effusion (Ascites)?
- Portal HTN (cirrhosis) | - Malignancy
28
What test can help differentiate Transudative Peritoneal Effusion from Exudative Peritoneal Effusion?
Albumin gradient (SAAG)
29
What does an Albumin gradient (SAAG) is >1.1 g/dL indicate?
Transudative Peritoneal Effusion
30
What does an Albumin gradient (SAAG) is<1.1 g/dL indicate?
Exudative Peritoneal Effusion = HIGH Albumin
31
What is the gold standard diagnostic test for Peritoneal Effusion?
Abdominal US
32
When is a Paracentesis indicated?
New onset ascites Also +/- - Fever - Abd. pain - AMS - Hypotension - Trauma - Severe cirrhosis
33
What should you be careful of when performing a Paracentesis?
Careful not to puncture inferior epigastric artery
34
What four labs can be HIGH when evaluating Peritoneal Fluid?
- HIGH Bilirubin/brown effusion = bowel/biliary perforation - HIGH Amylase = pancreatitis, esophageal rupture, malignancy - HIGH Ammonia = rupture/strangulated bowel - HIGH Urea/Cr = possible bladder rupture (trauma)
35
What does a HIGH Amylase indicate (3)?
- Pancreatitis - Esophageal rupture - Malignancy
36
What does HIGH TGs/Lipids indicate?
Chylous effusion
37
In what two population is Spontaneous Bacterial Peritonitis (SBP) seen?
Patients with: - Hepatic cirrhosis - Ascites
38
What type of Effusion is Spontaneous Bacterial Peritonitis (SBP), and what is the prognosis?
SBP = EXUDATIVE effusion | - HIGH mortality
39
What condition involves no obvious source of infection BUT abrupt onset fever/chills, abd. pain, rebound tenderness?
Spontaneous Bacterial Peritonitis (SBP)
40
If acute pericarditis is present, what etiology should ALWAYS be considered?
Pericardial effusion
41
What is the gold standard diagnostic test to evaluate for Pericardial Effusion?
Echocardiogram/US
42
What condition involves " water bottle sign", and what diagnostic test does it appear with?
Pericardial Effusion | - CXR
43
When is a Pericardiocentesis indicated?
Pericardial effusion with tamponade
44
What four lab components CANNOT reliably differentiate exudate from transudate with Pericardial Effusion?
- Protein - LDH - RBCs - WBCs
45
What is the "classic triad" of Meningitis?
- AMS - Nuchal rigidity - Fever (HIGH)
46
What is the gold standard diagnostic test for evaluating CSF?
CSF Culture
47
When is a Lumbar Puncture (LP) indicated?
INFECTION - Meningitis - Encephalitis
48
What three complications are "common" with an LP?
- Back pain/leg paresthesias - HA - CSF leak
49
What is a major contraindication of a Lumbar Puncture (LP)?
Increased ICP
50
When checking opening/closing pressure, if it is decreased, what might this indicate (2)?
- Hypovolemia (dehydration, shock) | - Chronic CSF leak
51
When checking opening/closing pressure, if it is increased, what might this indicate (4)?
- Infection - Intracranial bleed - Tumor - Hydrocephalus
52
When checking opening/closing pressure, if there is a difference between the two, what might this indicate?
Spinal cord obstruction/tumor
53
WHEN would you order a CT BEFORE performing a Lumbar Puncture (LP) (6)?
- IC - History of CNS disease - New onset seizure - Papilledema - ALOC - Focal neuro deficit
54
When evaluating CSF, if CNS infection is a concern, what should be ordered/done (2)?
1. Obtain TWO blood cultures immediately | 2. Start empirical abx
55
What should NOT be delayed while waiting for a CT?
ABX
56
If CSF is cloudy, what does this indicate (2)?
- Infection | - High proteins
57
If CSF is pink/red, what does this indicate (2)?
Bleeding from procedure vs. Subarachnoid bleeding
58
If CSF is yellow, what does this indicate?
Xanthochromia (RBC lysis)
59
What level of WBCs is abnormal in CSF?
WBCs >5 cells/uL
60
What level of RBCs is abnormal in CSF?
RBCs >5 cells/uL
61
If you have Neutrophilia of CSF, what might this indicate?
Bacterial meningitis
62
If you have Lymphocytosis of CSF, what might this indicate?
Viral meningitis
63
If you have high Macrophages in CSF, what might this indicate (2)?
- TB | - Fungal meningitis
64
If you have Eosinophilia of CSF, what might this indicate (2)?
- Parasitic meningitis | - Allergic reaction to dye
65
If there is increased CSF pressure and NO clotting, what might this indicate?
Subarachnoid Hemorrhage (SAH)
66
If there is xanthochromia on centrifuge of CSF, what might this indicate? What should be considered though???
``` Subarachnoid Hemorrhage (SAH) - Xanthochromia very common within 12 hours of SAH onset but can also be from infection ```
67
+Oligoclonal gamma globulin bands in CSF Protein is indicative of what?
Multiple Sclerosis (MS)
68
When ordering CSF Glucose, what should also be ordered?
Serum Glucose to compare
69
If CSF glucose LESS THAN 2/3 serum glucose, what might this indicate (2)?
- Meningitis | - Tumor
70
If there is HIGH lactic acid or HIGH CRP on CSF, what can be ruled out?
Viral meningitis
71
HIGH lactic acid on CSF can indicate (2)?
- Bacterial meningitis | - Fungal meningitis
72
HIGH CRP on CSF can indicate?
Bacterial meningitis
73
What diagnostic test should be ordered to evaluate for Cryptococcus neoformans Meningitis?
India Ink
74
What diagnostic test should be ordered to evaluate for Syphilis?
VDRL
75
What are the four tubes for CSF collection used for?
- Tube 1: chemistry (protein, glucose) - Tube 2 = microbiology (stains, C&S, PCR) - Tube 3 = hematology - Tube 4 = your choice

Clin Med Lab Med (13 decks)

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