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AUBF > M4: Serous Fluids (Part 2: Pleural Fluid) > Flashcards

M4: Serous Fluids (Part 2: Pleural Fluid) Flashcards

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1
Q
  • Located between Parietal & Visceral Membrane
  • Pleural cavity
A

Pleural Fluid

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2
Q

Pleural Fluid

Pleural fluid cholesterol: ?
Pleural fluid: serum cholesterol ratio: ?
Fluid: serum total bilirubin ratio: ?

Exudate

A

Pleural fluid cholesterol: > 60 mg/dL
Pleural fluid: serum cholesterol ratio: > 0.3
Fluid: serum total bilirubin ratio: 0.6 or more

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3
Q

Pleural Fluid

  • Immunologic Disease
  • Measurement of Glucose is recommended
A

Rheumatoid arthritis

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4
Q

Pleural Fluid

Clear, Pale Yellow

Appearance

CORRELATION OF PLEURAL FLUID APPEARANCE & DISEASE

A

Normal

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5
Q

Pleural Fluid

Turbid, White

Appearance

CORRELATION OF PLEURAL FLUID APPEARANCE & DISEASE

A

Microbial Infection (Tuberculosis)

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6
Q

Pleural Fluid

Bloody

Appearance

CORRELATION OF PLEURAL FLUID APPEARANCE & DISEASE

A
  • Hemothorax
  • Hemorrhagic effusion
  • Pulmonary Embolus
  • Severe TB
  • Malignancy
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7
Q

Pleural Fluid

Milky

Appearance

CORRELATION OF PLEURAL FLUID APPEARANCE & DISEASE

A
  • Chylous material (from thoracic duct)
  • Pseudochylous material (chronic inflammation)
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8
Q

Pleural Fluid

Brown

Appearance

CORRELATION OF PLEURAL FLUID APPEARANCE & DISEASE

A

Rupture of Amoebic Liver Abscess

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9
Q

Pleural Fluid

Black

Appearance

CORRELATION OF PLEURAL FLUID APPEARANCE & DISEASE

A

Aspergillus

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10
Q

Pleural Fluid

Viscous

Appearance

CORRELATION OF PLEURAL FLUID APPEARANCE & DISEASE

A

Malignant Mesothelioma (Increased Hyaluronic Acid)

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11
Q

CORRELATION OF PLEURAL FLUID APPEARANCE & DISEASE

WBC, bacterial infection, TB

a. Turbidity
b. Blood
c. Milky
d. ALL
e. NOTA

A

a. Turbidity

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12
Q

CORRELATION OF PLEURAL FLUID APPEARANCE & DISEASE

Rheumatoid arthritis

a. Turbidity
b. Blood
c. Milky
d. ALL
e. NOTA

A

a. Turbidity

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13
Q

CORRELATION OF PLEURAL FLUID APPEARANCE & DISEASE

Occurs in
Malignancy, or a Traumatic Aspiration

BLOOD

A

Membrane Damage

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14
Q

CORRELATION OF PLEURAL FLUID APPEARANCE & DISEASE

high TAG, (+) Sudan III

a. Chylous
b. Thoracic Duct Leakage
c. Pseudochylous
d. a and b
e. a and c
f. NOTA

Milky

A

d. a and b

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15
Q

CORRELATION OF PLEURAL FLUID APPEARANCE & DISEASE

Chronic Inflammatory Conditions

a. Chylous
b. Thoracic Duct Leakage
c. Pseudochylous
d. a and b
e. a and c
f. NOTA

A

c. Pseudochylous

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16
Q

Chylous Effusion OR Pseudochylous Effusion

Cause: Thoracic duct damage

Appearance: Milky/White

Leukocytes: PREDOMINANTLY Lymphocytes

Cholesterol Crystals: Absent

Triglycerides: > 110 mg/dL

Sudan III Stain: Strongly
POSITIVE

A

Chylous Effusion

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17
Q

Chylous Effusion OR Pseudochylous Effusion

Cause: Chronic Inflammation, Lymphatic Obstruction

Appearance: Milky/Green tinge

Leukocytes: Mixed Cells

Cholesterol Crystals: Present

Triglycerides: < 50 mg/dL

Sudan III Stain: NEGATIVE or Weakly positive

A

Pseudochylous Effusion

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18
Q

Pleural Fluid: Hematology Tests

Macrophages

Normal Value

A

64-80%

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19
Q

Pleural Fluid: Hematology Tests

Lymphocyte

Normal Value

A

18-30%

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20
Q

Pleural Fluid: Hematology Tests

Neutrophils

Normal Value

A

1-2%

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21
Q

Pleural Fluid: Hematology Tests

Eosinophils

Normal Value

A

0

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22
Q

Pleural Fluid: Hematology Tests

Pneumothorax & Hemothorax

a. Macrophages
b. Lymphocytes
c. Neutrophils
d. Eosinophils

Differential count

A

d. Eosinophils

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23
Q

Pleural Fluid: Hematology Tests

Pancreatitis

a. Macrophages
b. Lymphocytes
c. Neutrophils
d. Eosinophils

A

c. Neutrophils

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24
Q

Pleural Fluid: Hematology Tests

Pulmonary Infarction

a. Macrophages
b. Lymphocytes
c. Neutrophils
d. Eosinophils

A

c. Neutrophils

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25
# Pleural Fluid: Hematology Tests SLE a. Macrophages b. Lymphocytes c. Neutrophils d. Eosinophils
b. Lymphocytes
26
# Pleural Fluid: Hematology Tests Malignancy a. Macrophages b. Lymphocytes c. Neutrophils d. Eosinophils
b. Lymphocytes
27
# Pleural Fluid: Hematology Tests Normal even if higher a. Macrophages b. Lymphocytes c. Neutrophils d. Eosinophils
a. Macrophages
28
# Pleural Fluid: Hematology Tests presence of blood in pleural cavity
Hemothorax
29
# Pleural Fluid: Hematology Tests presence of excess AIR
Pneumothorax
30
# Pleural Fluid: Hematology Tests Decreases lung pressure a. Hemothorax b. Pneumothorax c. both d. NOTA
d. NOTA ## Footnote Both increases pressure in lungs making it hard to inflate & breathe
31
# Pleural Fluid These are called malignancy of mesothelial cells
Mesothelioma
32
# Pleural Fluid T or F It is normal to find single layer of Mesothelial cells in the lining of membranes of our serous cavities
T
33
# Pleural Fluid Appear as single, small, round cells with abundant blue cytoplasm with rounded nuclei
Mesothelial Cells
34
# Pleural Fluid * Abnormal Mesothelial cells – Larger than usual * Appear in clusters * Eccentric Nuclei (sometimes multi-nucleated) * Not diagnostically significant
Reactive mesothelial cells
35
Reactive mesothelial cells are not diagnostically significant unless in cases of what (2) conditions?
Malignancy & Pneumonia, | mesothelial cell count is higher
36
Which of the following is not included in chemistry tests for pleural fluid? a. Glucose b. pH c. ADA d. Amylase e. Triglyceride | which is indicative of chylous effusion
LAHAT KASAMA RAHHH
37
# Pleural Fluid: Chemistry Tests Volume of glucose which represent decreased glucose
<60 mg/dL
38
# Pleural Fluid: Chemistry Tests (Increase or Decrease in Glucose in Pleural Fluid?) * Tuberculosis * Rheumatoid Inflammation, * Malignant Effusion * Esophageal Rupture * Lupus Pleuritis * Purulent Infections
Decrease
39
# Pleural Fluid: Chemistry Tests Increase lactate levels = ? | inidicate whay condition
Bacterial Infections
40
# Pleural Fluid: Chemistry Tests If the pH is **lower than 7.3**, what condition is it associated with ?
Chest-Tube Drainage (Pneumonia)
41
# Pleural Fluid: Chemistry Tests If the pH is **0.30 degrees** lower, what condition is it associated with ?
Acidosis
42
# Pleural Fluid: Chemistry Tests If the pH is **6.0**, what condition is it associated with ?
Esophageal Rupture (Contamination of Gastric fluid)
43
# Pleural Fluid: Chemistry Tests T or F Gastric secretion in esophagus and goes into serous fluid which makes it alkaline
F (ACIDIC)
44
# Pleural Fluid: Chemistry Tests Requirements for pH testing for pleural fluid?
* Anaerobic Heparinized Syringe * Blood Gas Analyzer at 37°C.
45
# Pleural Fluid: Chemistry Tests > 40 U/L of ADA are highly indicative of a. Acidosis b. Tuberculosis c.Malignancy d. a and c e. b and c
e. b and c
46
# Pleural Fluid: Chemistry Tests (2) factors elevated in cases of Esophageal Rupture and Malignancy
Amylase, Salivary Amylase
47
# Pleural Fluid: Chemistry Tests If specimen is milky, what (3) parameters should be observed to check if Chylous or Pseudochylous
* Color & Presence of triglyceride * SUDAN III staining
48
# Significance of Chemical Testing * Decreased Rheumatoid Inflammation * Decreased Purulent infection | Based on significance, give what test it correlates with
Glucose
49
# Significance of Chemical Testing Elevated Bacterial infection | Based on significance, give what test it correlates with
Lactate
50
# Significance of Chemical Testing Elevated Chylous effusions | Based on significance, give what test it correlates with
Triglyceride
51
# Significance of Chemical Testing * Decreased Pneumonia NOT Responding to Antibiotics * Markedly Decreased Esophageal rupture | Based on significance, give what test it correlates with
pH
52
# Significance of Chemical Testing * Elevated TB & Malignancy | Based on significance, give what test it correlates with
ADA
53
# Significance of Chemical Testing Elevated Pancreatitis, Esophageal rupture, & Malignancy | Based on significance, give what test it correlates with
Amylase | Based on significance, give what test it correlates with
54
# Pleural Fluid: Microbiological Tests Microbiological tests are used to determine primarily what (3) bacteria?
* STAPH A * E. ANAEROBE * M. TUBERCULOSIS
55
# Pleural Fluid: Microbiological Tests Which microrbiological test are used to detect presence of bacteria especially M. tuberculosis a. Gram Stains b. Cultures c. AFS d. Mycobacterium cultures e. a and b f. a and c g. ALL
g. ALL
56
# Pleural Fluid: Microbiological Tests * more sensitive test to detect M. tuberculosis
Polymerase chain reaction (PCR)
57
Test used to differentiate Effusions of Immunologic origin from NON-inflammatory process
Serological tests
58
# Pleural Fluid: Serological Tests (2) tests under serological tests?
* ANA (Antinuclear antibody) * RF (Rheumatoid factor)
59
# Pleural Fluid: Serological Tests tests used with patient with SLE a. ANA b. RF c. both d. NOTA
a. ANA
60
# Pleural Fluid: Serological Tests Familiarize the tumor markers for pleural fluid which is associated with cancer
* Carcinoembryonic Antigen (CEA) * CA 125 (Metastatic Uterine Cancer) * CA 15.3 and CA 549 (Breast Cancer) * CYFRA 21-1 (Lung Cancer)
61
# Pleural Fluid: Serological Tests CA 125 | Identify which condition is associated with the tumor marker
Metastatic Uterine Cancer
62
# Pleural Fluid: Serological Tests CA 15.3 and CA 549 | Identify which condition is associated with the tumor marker
Breast Cancer
63
# Pleural Fluid: Serological Tests CYFRA 21-1 | Identify which condition is associated with the tumor marker
Lung Cancer
64
# Pleural Fluid Testing IF U SEE THIS CARD PAKICHECK YUNG PHOTO ABOUT FLUDI TESTING THX
ok
65
# Pleural Fluid Testing Familiarize steps for pleural fluid testing
1. Check appearance 2. Analyze Fluid:protein serum ratio; protein:LD ratio 3. Check what type of Infection or Inflammation

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