Final Exam

Question 1

For what four reasons might amniotic fluid be collected during pregnancy?

Answer 1

genetic and congenital disorders, lung maturity, sex determination, and assessment of fetal distress due to infection or Rh/other isoimmunization

Question 2

At what stage of pregnancy would amniocentesis be performed for the detection of genetic or congenital disease?

Answer 2

15-18 weeks

Question 3

What is oligohydraminos?

Answer 3

deficiency of amniotic fluid

Question 4

Why would amniotic fluid need to be protected from light sources?

Answer 4

preserving any bilirubin that is present

Question 5

When present in amniotic fluid, fetal cells are adversely affected by what?

Answer 5

refrigeration

Question 6

What is the normal color and turbidity of amniotic fluid?

Answer 6

pale yellow, slightly cloudy (depending on stage of pregnancy)

Question 7

What would cause amniotic fluid to appear dark yellow or amber?

Answer 7

bilirubin

Question 8

What would cause amniotic fluid to appear green?

Answer 8

meconium

Question 9

What would cause amniotic fluid to appear pink?

Answer 9

blood

Question 10

What is associated with amniotic fluid that is dark red-brown?

Answer 10

fetal death

Question 11

What four tests are done to evaluate the surfactants present to the fetal pulmonary system?

Answer 11

lecithin : sphingomyelin (L/S) ratio; phosphatidyl glycerol (PG); foam stability index; microviscosity

Question 12

In regards to the L/S ratio and PG determination, what indicates fetal lung maturity?

Answer 12

L/S ratio >/= 2.0 (affected by blood and meconium); PG needs to be present (not affected by any other factors)

Question 13

What is important to remember about the PG factor?

Answer 13

lack of PG with an L/S ratio >2 can suggest lung maturity, but this can also be seen in diabetics

Question 14

What do the three zones mean in reference to the delta A540 and the Liley’s 3-zone chart.

Answer 14

Zone 1: normal; Zone 2: moderate hemolysis; Zone 3: severe hemolysis (fetus will die without intervention)

Question 15

What are the appearance and characteristics of transudates?

Answer 15

usually clear, do not contain clots, contains few cells, specific gravity

Question 16

What are the appearance and characteristics of exudates?

Answer 16

cloudy, contains clots and many cells, specific gravity >1.015, and total protein >3.0

Question 17

What is the difference between transudates and exudates in terms of their causes?

Answer 17

transudates are non-inflammatory and usually the result of oncotic pressure; exudates are inflammatory and usually secondary to disease states

Question 18

Name the three biochemical indicators used to evaluate the secretory function of the prostate, including which one can positively identify seminal fluid and is useful in cases of sexual assault (*).

Answer 18

acid phosphatase*, zinc, citric acid

Question 19

What are four reasons for a physician to order a semen analysis?

Answer 19

fertility determinations, forensic applications, donation purposes, vasectomy follow-up

Question 20

Which structures contribute secretions to seminal fluid?

Answer 20

seminal vesicles, testes, prostate gland, epididymis

Question 21

What is the normal concentration of seminal fluid?

Answer 21

20-250 million sperm per mL (cc)

Question 22

Is the normal concentration of seminal fluid constant within a single individual, and what factors might influence concentration?

Answer 22

no; abstinence, viral infections, and stress can all affect concentration

Question 23

Is concentration the most important factor in fertility determinations?

Answer 23

no

Question 24

What percentage of sperm with normal morphology is considered normal or acceptable?

Answer 24

> /= 50%

Question 25

How is sperm morphology determined?

Answer 25

stained smears of a fresh specimen

Question 26

What parameter of a semen analysis is directly related to and provides a check of the motility evaluation (include how)?

Answer 26

viability; distinguishes dead from immobile

Question 27

What is the normal pH of seminal fluid?

Answer 27

7.2-7.8

Question 28

What might a pH

Answer 28

congenital aplasia of vasa deferentia and seminal vesicles or epididymis

Question 29

What might a pH of >7.2 indicate?

Answer 29

reproductive tract infection

Question 30

What does testing fructose in seminal fluid reflect?

Answer 30

secretory function of the seminal vesicles and the functional integrity of the ejaculatory duct and vasa deferentia

Question 31

What is the primary function of seminal function?

Answer 31

transport of sperm

Question 32

What are the requirements for the collection of a specimen for semen analysis?

Answer 32

collected after 48-72 hours of abstinence (no longer than one week); patient must be given a private room (can only be collected through masturbation); collected in a wide-mouth clean container that is properly labeled and delivered to the lab within 30-60 minutes, kept warm; if more than one specimen is requested, should be collected over a 3 month period, at least 7 days apart

Question 33

What is the normal length of time (in minutes) for a semen specimen to liquefy?

Answer 33

30-60 minutes

Question 34

What does the viscosity resemble after liquefaction, and what is considered abnormal liquefaction?

Answer 34

resembles water; process takes longer than 60 minutes

Question 35

Motility should be evaluated within how many minutes following collection?

Answer 35

60 minutes

Question 36

Explain the color, clarity, viscosity, and clot formation of normal synovial fluid.

Answer 36

colorless/pale yellow, clear; use "string test" - 5cm string before breaking considered normal; should not contain clots

Question 37

Is fibrinogen a constituent of normal synovial fluid?

Answer 37

no

Question 38

Does hyaluronate affect the turbidity of synovial fluid? What other factors may affect turbidity?

Answer 38

no; red cells, white cells, crystals, synoviocytes, fat, and cellular debris

Question 39

Why should a synovial fluid be examined as soon as possible?

Answer 39

crystals can form or break down during refrigeration, and white cells can phagocytize crystals

Question 40

Which anticoagulant should be used on synovial fluids for microscopic examination purposes, and why should other anticoagulants be avoided?

Answer 40

sodium heparin; others can cause artifacts

Question 41

Which diluent should be used for synovial fluid if necessary?

Answer 41

0.85% NaCl (blood bank saline)

Question 42

A joint disease process is indicated by what?

Answer 42

presence of >25% neutrophils

Question 43

What type of microscopy differentiates synovial fluid crystals based on their birefringence, and how is this achieved?

Answer 43

compensated polarized microscopy; based on colors achieved (yellow or blue) when crystals are oriented parallel or perpendicular to the axis

Question 44

Which crystal appears yellow when parallel to the axis and blue when perpendicular to the axis, and what disease is associated with it?

Answer 44

monosodium urate monohydrate (MSU, uric acid); gout

Question 45

Which crystal appears blue when parallel to the axis and yellow when perpendicular to the axis, and what disease is associated with it?

Answer 45

calcium pyrophosphate dihydrate; pseudogout

Question 46

Are monosodium urate, calcium pyrophosphate dihydrate, and cholesterol crystals all birefringent?

Answer 46

yes

Question 47

Which analytes are present in synovial fluid at concentrations equal to blood plasma levels?

Answer 47

glucose and uric acid

Question 48

If a bloody CSF is received in the lab, what steps can be taken to determine if it is due to traumatic tap or from the patient having actually hemorrhaged?

Answer 48

look at all tubes in order of collection (if the amount of blood decreases from tube to tube, it is probably from traumatic tap; if the amount is about the same, hemorrhage is indicated); spin down all tubes - xanthochromic supernatant is indicative of hemorrhage, clear supernatant is indicative of traumatic tap

Question 49

What is xanthochromia?

Answer 49

pigment in the supernatant from lysed red cells

Question 50

Does fibrinogen normally pass through the blood-brain barrier?

Answer 50

no

Question 51

According to the lumbar puncture procedure, what is the first CSF tube collected used for?

Answer 51

chemical and immunologic testing

Question 52

A predominance of lymphocytes within CSF indicated which type of meningitis?

Answer 52

viral

Question 53

What are the normal ranges for glucose and protein in normal CSF?

Answer 53

glucose: 50-80 mg/dL, protein: 15-45 mg/dL

Question 54

What condition would decreased glucose and increased protein in CSF indicate?

Answer 54

meningitis

Question 55

What is the concentration of glucose in CSF in relation to the concentration in plasma?

Answer 55

60-70% or 2/3

Question 56

Define pleocytosis as it relates to CSF?

Answer 56

increase in the number of cells

Question 57

Can an increased number of white cells within CSF cause xanthochromia?

Answer 57

no

Question 58

What are the normal white cell counts of CSF in adults, children, and newborns?

Answer 58

adults: 0-5 cells/uL, children: 0-10 cells/uL, newborns: 0-30 cells/uL

Question 59

What two cell types are considered normal if seen in the CSF from an adult?

Answer 59

lymphocytes and monocytes

Question 60

A predominance of neutrophils within CSF indicates which type of meningitis?

Answer 60

bacterial

Question 61

What is the normal range for lactate in CSF?

Answer 61

10-22 mg/dL

Question 62

Normal lactate levels can be found in the CSF of patients with what type of meningitis?

Answer 62

viral

Question 63

Which procedure frequently provides a rapid presumptive diagnosis of bacterial meningitis?

Answer 63

Gram stain