MTAP 1: AUBF Flashcards
(491 cards)
1
Q
- A.k.a Joint fluid
A
SINOVIAL FLUID
2
Q
SINOVIAL FLUID
a.k.a
A
Joint fluid
3
Q
SINOVIAL FLUID
Found in ____
A
diathroses
4
Q
- Ultrafiltrate of plasma with hyaluronic acid
A
SINOVIAL FLUID
5
Q
SINOVIAL FLUID
- Ultrafiltrate of _____ with ____
A
plasma
hyaluronic acid
6
Q
→ It is derived from blood that is filtered by joint cavities (synovium)
A
hyaluronic acid
7
Q
hyaluronic acid
→ It is derived from blood that is filtered by joint cavities (____)
A
synovium
8
Q
○ The synovium is composed of ______ which produce hyaluronic acid
A
synoviocytes
9
Q
→ ____contributes to viscosity of synovial fluid
A
Hyaluronic acid
10
Q
SINOVIAL FLUID
- Came from the word ____ = _____
A
Synovia
egg white
11
Q
T/F: The characteristic viscosity of synovial fluid is the same as the viscosity of egg white
A
TRUE
12
Q
FUNCTIONS OF SYNOVIAL FLUID:
- _______
- _______________
- Provides ______ to the ______
- Lessens shock of ________ occurring during activities such as _____ and _____
A
Lubricates joints
Reduces friction between bones
nutrients, articular cartilage
joint compression, walking, jogging
13
Q
SYNOVIAL FLUID
Method of collection: ______
A
Arthrocentesis
14
Q
SYNOVIAL FLUID
Specimen collection
→ When collected, _______
A
it should NOT clot
15
Q
SYNOVIAL FLUID
Specimen collection
; if it clots, there is a presence of _____ which indicates ______ or _____
A
fibrinogen
joint damage
disease
16
Q
SYNOVIAL FLUID (Specimen Collection)
Volume:
→ Normal: _____
A
<3.5 mL
17
Q
SYNOVIAL FLUID (Specimen Collection)
Volume:
→ Inflammation: _____
A
> 25 mL
18
Q
SYNOVIAL FLUID (Specimen collection)
Tube distribution:
A
- Na Heparin (sterile)/SPS:
- Liquid EDTA/Na Heparins
- Non-anticoagulated tubes
- Sodium fluoride
19
Q
SYNOVIAL FLUID (Specimen collection)
Tube distribution:
1. Na Heparin (sterile)/SPS: ________
A
for microbiology
20
Q
SYNOVIAL FLUID (Specimen collection)
Tube distribution:
2. Liquid EDTA/Na Heparin: ______
A
for hematology
21
Q
SYNOVIAL FLUID (Specimen collection)
Tube distribution:
○ ______ A is NOT used since it may be mistaken for ______
A
Powdered EDT
crystals
22
Q
SYNOVIAL FLUID (Specimen collection)
Tube distribution:
3. Non-anticoagulated tubes: ______
A
for chemistry and other tests (serology)
23
Q
SYNOVIAL FLUID (Specimen collection)
Tube distribution:
4. Sodium fluoride: ______
A
for glucose
24
Q
SYNOVIAL FLUID
Color:
Normal
A
Colorless to pale yellow
25
SYNOVIAL FLUID
Color:
inflammation
Deeper yellow
26
SYNOVIAL FLUID
Color:
Bacterial infection (septic arthritis)
Greening tinge
27
SYNOVIAL FLUID
Color:
Traumatic tap or hemorrhagic arthritis
Red
28
Traumatic tap is due to the ____________________ during arthrocentesis, while hemorrhagic arthritis is bleeding in the _______
vessels beings punctured
cavity itself
29
TRAUMATIC TAP
Clot formation:
Dark red
(+)
30
TRAUMATIC TAP
Clot formation:
Light red
(-)
31
TRAUMATIC TAP
Clot formation:
Yellowish
(-)
32
HEMORRHAGIC ARTHRITIS
Clot formation:
Dark red
(-)
33
SYNOVIAL FLUID
Clarity:
Normal
Clear
34
SYNOVIAL FLUID
Clarity:
Turbid
* Leukocytes
* Fibrin
* Cell debris
35
SYNOVIAL FLUID
Clarity:
Radiographic contrast media (RCM)
Opaque, Oily, Shimmering
36
SYNOVIAL FLUID
Clarity:
Milky
Crystals
37
SYNOVIAL FLUID
Clarity:
Ground pepper-like inclusions
Ochronosis-degenerative bone disease
38
SYNOVIAL FLUID
Clarity:
Ground pepper-like inclusions a.k.a
ochronotic shards
39
SYNOVIAL FLUID
Clarity:
Free-floating rice bodies
* Rheumatoid arthritis
* Degenerative synovium with fibrin
40
SYNOVIAL FLUID
Viscosity:
* Normally, it should be able to form a string that is _____long
4-6 mm
41
SYNOVIAL FLUID
Viscosity:
normal hyaluronic acid level _____
0.3-0.4 g/dL
42
SYNOVIAL FLUID
Test for viscosity
* Ropes/Mucin Clot test
43
SYNOVIAL FLUID
Viscosity:
* Ropes/Mucin Clot test a.k.a ____
→ “Hyaluronate polymerization test”
44
SYNOVIAL FLUID (Viscocity)
Ropes/Mucin Clot test
Reagent: ______
2-5% acetic acid (HAC)
45
SYNOVIAL FLUID (Viscocity)
Ropes/Mucin Clot test
○ This polymerizes hyaluronic acid and forms clot
2.5% acetic acid (HAC)
46
SYNOVIAL FLUID (Viscocity)
Ropes/Mucin Clot test
○ 2.5% acetic acid (HAC) polymerizes _______ and forms ____
hyaluronic acid
clot
47
SYNOVIAL FLUID (Viscocity)
Ropes/Mucin Clot test
○ Clot = (+/-) reaction
(+) reaction
48
SYNOVIAL FLUID (Viscocity)
Ropes/Mucin Clot test (Reporting)
Good - _____
Solid clot
49
SYNOVIAL FLUID (Viscocity)
Ropes/Mucin Clot test (Reporting)
Fair - ___
soft clot
50
SYNOVIAL FLUID (Viscocity)
Ropes/Mucin Clot test (Reporting)
Low - ______
friable clot
51
SYNOVIAL FLUID (Viscocity)
Ropes/Mucin Clot test (Reporting)
Poor - ____
no clot
52
SYNOVIAL FLUID
Cell count:
Uses ____
hemocytometry
53
SYNOVIAL FLUID
Cell count:
Diluting fluids
1. NSS with methylene blue
2. Hypotonic saline (0.3%)
3. Saline with saponin
54
SYNOVIAL FLUID (Cell count)
Two methods:
→ Add a pinch of ________ to _____ synovial fluid
→ Add ____drop of ________ in ________
per mL of fluid
○ Incubate at ____ for ______
hyaluronidase, 0.5 mL
one, 0.05% hyaluronidase, phosphate buffer
37°C, 5 minutes
55
T/F: Hypotonic saline (0.3%) and saline with saponin can both cause RBC lysis.
TRUE
56
They are for counting WBCs.
Hypotonic saline (0.3%)
Saline with saponin
57
* _______ must NOT be used for cell counting
Acetic acid
58
→ It polymerizes hyaluronic acid causing the SF to clot
Acetic acid
59
SYNOVIAL FLUID (Differential count)
RBC Normal value: _____
<2000/uL
60
SYNOVIAL FLUID (Differential count)
WBC Normal value: ______
<200/uL
61
SYNOVIAL FLUID (Differential count)
WBC Differential:
Monocytes/Macrophage Normal Value: ______
65%
62
SYNOVIAL FLUID (Differential count)
WBC Differential:
Neutrophils normal value: ____-
25%
63
SYNOVIAL FLUID (Differential count)
WBC Differential:
Lymphocytes normal value: _____
<15%
64
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
NEUTROPHILS
Description:
Polymorphonuclear leukocytes (multilobulated)
65
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
NEUTROPHILS
Significance:
* Bacterial sepsis
* Crystal-induced inflammation
66
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
Mononuclear leukocytes (no lobules)
Lymphocytes
67
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
LYMPHOCYTES
Significance:
Non-septic inflammation
68
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
Large mononuclear monocytes, may be vacuolated
Macrophages (monocytes)
69
_________ are the most abundant WBC in synovial fluid
Macrophages (monocytes)
70
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
MACROPHAGES (MONOCYTES)
Significance:
* Normal
* Increased in viral infection
71
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
Similar to macrophage, but may be multinucleated, resembling a mesothelial cell
Synovial lining cells
72
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
SYNOVIAL LINING CELLS
Similar to _____, but may be _____, resembling a _______
macrophage
multinucleated
mesothelial cell
73
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
SYNOVIAL LINING CELLS
Significance:
Normal
74
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
Neutrophil containing characteristics ingested “round body”
Lupus erythematosus cell (LE cells)
75
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
LE CELLS
Neutrophil containing characteristics ingested _______
“round body”
76
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
LE CELLS
Significance:
Lupus erythematosus
77
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
Vacuolated macrophage with ingested neutrophil
Reiter cells
78
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
REITER CELLS
Vacuolated ______ with ingested _____
macrophage
neutrophil
79
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
REITER CELLS
Significance:
* Reiter syndrome
* Non-specific inflammation
80
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
Neutrophil with dark cytoplasmic granules containing immune complexes
RA CELLS
81
RA CELLS a.k.a
Ragocytes
82
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
RA CELLS
Neutrophil with ______ containing _______
dark cytoplasmic granules
immune complexes
83
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
RA CELLS
Significance:
* Rheumatoid arthritis
* Immunologic inflammation
84
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
Macroscopically resembles polished rice; Microscopically shows collagen and fibrin
Rice bodies
85
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
RICE BODIES
(Macroscopically/Microscopically) resembles polished rice
Macroscopically
86
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
RICE BODIES
Macroscopically resembles _____
polished rice
87
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
RICE BODIES
(Microscopically/Microscopically shows collagen and fibrin
Microscopically
88
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
RICE BODIES
Microscopically shows _____ and ____
collagen
fibrin
89
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
RICE BODIES
Significance:
* Tuberculosis
* Septic and rheumatoid arthritis
90
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
* Refractive intracellular and extracellular globules
Fat droplets
91
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
FAT DROPLETS
* Refractive intracellular and extracellular _____
globules
92
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
Stained with sudan dyes
Fat droplets
93
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
FAT DROPLETS
Significance:
* Traumatic injury
* Chronic inflammation
94
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
Inclusions within clusters of synovial cells
Hemosiderin
95
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
HEMOSIDERIN
Significance:
Pigmented villonodular synovitis (PVNS)
96
SYNOVIAL FLUID (Crystal Identification)
Shape: Needles
Monosodium Urate
97
SYNOVIAL FLUID (Crystal Identification)
Shape: Rhombic square rods
Calcium pyrophosphate dihydrate (CPPD)
98
SYNOVIAL FLUID (Crystal Identification)
Shape: Notched, rhombic plates
Cholesterol
99
SYNOVIAL FLUID (Crystal Identification)
Shape: Flat, variable-shaped plates
Corticosteroid
100
SYNOVIAL FLUID (Crystal Identification)
Shape: Envelope
Calcium oxalete
101
SYNOVIAL FLUID (Crystal Identification)
Shape: Small particles; requires electron microscope
Hydroxyapatite/apatite
102
SYNOVIAL FLUID (Crystal Identification)
Hydroxyapatite a.k.a
Calcium phosphate
103
SYNOVIAL FLUID (Crystal Identification)
Monosodium urate
Shape: _____
Needles
104
SYNOVIAL FLUID (Crystal Identification)
Calcium pyrophosphate dihydrate (CPPD)
Shape: _____
Rhombic square rods
105
SYNOVIAL FLUID (Crystal Identification)
Cholesterol
Shape: _____
Notched, rhombic plates
106
SYNOVIAL FLUID (Crystal Identification)
Corticosteroid
Shape: _____
Flat, variable-shaped plates
107
SYNOVIAL FLUID (Crystal Identification)
Calcium oxalate
Shape: _____
Envelope
108
SYNOVIAL FLUID (Crystal Identification)
Hydroxyapatite/apatite a.k.a
Calcium phosphate
109
SYNOVIAL FLUID (Crystal Identification)
Hydroxyapatite/apatite
Shape: _____
Small particles;
110
SYNOVIAL FLUID (Crystal Identification)
Which crystal required Electron microscopy?
Hydroxyapatite/apatite
111
SYNOVIAL FLUID (Crystal Identification)
Enumerate the crystal/s with NEGATIVE birefringence
Monosodium urate (MSU)
Cholesterol
Calcium oxalate
112
SYNOVIAL FLUID (Crystal Identification)
Enumerate the crystal/s with POSITIVE birefringence
Calcium pyrophosphate dihydrate (CPPD)
113
SYNOVIAL FLUID (Crystal Identification)
Enumerate the crystal/s with BOTH positive and negative birefringence
Corticosteroid
114
SYNOVIAL FLUID (Crystal Identification)
Why does Corticosteroid have the ability to have both negative and positive birefringence?
Due to the variability in shape of corticosteroids
115
SYNOVIAL FLUID (Crystal Identification)
Enumerate the crystal/s with NO birefringence
Hydroxyapatite/apatite
116
SYNOVIAL FLUID (Crystal Identification)
why does Hydroxyapatite/apatite have no birefringence?
Because it is NOT visible under polarizing microscopes
117
SYNOVIAL FLUID (Crystal Identification)
Monosodium urate (MSU)
Significance:
Gout (inc uric acid)
118
SYNOVIAL FLUID (Crystal Identification)
Calcium pyrophosphate dihydrate (CPPD)
Significance:
Pseudogout
119
SYNOVIAL FLUID (Crystal Identification)
Calcium pyrophosphate dihydrate (CPPD)
Significance: Pseudogout (associated with _______)
degenerative arthritis
120
SYNOVIAL FLUID (Crystal Identification)
Cholesterol
Significance:
Extracellular
121
SYNOVIAL FLUID (Crystal Identification)
Corticosteroid
Significance:
Injections
122
SYNOVIAL FLUID (Crystal Identification)
Calcium oxalate
Significance:
Renal dialysis
123
SYNOVIAL FLUID (Crystal Identification)
Hydroxyapatite/apatite
Significance:
* Osteoarthritis
* Calcified cartilage degeneration
124
* _______ is the relationship between the velocity of ____ and the arrangement of _____.
Birefringence
light
crystals.
125
* Crystals appear yellow
POSITIVE BIREFRINGENCE
126
* Crystals appear blue
NEGATIVE BIREFRINGENCE
127
POSITIVE BIREFRINGENCE
* Light is _____
parallel
128
NEGATIVE BIREFRINGENCE
* Light is _____
perpendicular
129
→ Determine/detect Presence/Absence of birefringence
* Polarizing microscope
130
Compensated Polarizing Microscope
→ Uses _____
red compensator
131
→ The microscope used to detect type of birefringence.
* Compensated Polarizing Microscope
132
SYNOVIAL FLUID (Chemical Examination)
* Increases when SF glucose is low; because of bacterial infection
GLUCOSE
133
SYNOVIAL FLUID (Chemical Examination)
Significance:
* Most frequently tested chemistry test
Glucose
134
SYNOVIAL FLUID (Chemical Examination)
GLUCOSE
Significance:
* Blood glucose – synovial fluid glucose = _______ (normal)
<10 mg/dL
135
SYNOVIAL FLUID (Chemical Examination)
Significance:
* Increased in infections
Lactate
136
SYNOVIAL FLUID (Chemical Examination)
The byproduct of glycose during infections
Lactate
137
SYNOVIAL FLUID (Chemical Examination)
LACTATE
Significance:
* Normal: _______
<250 mg/dL
138
SYNOVIAL FLUID (Chemical Examination)
* Increased in inflammatory and hemorrhagic disorders
Protein
139
SYNOVIAL FLUID (Chemical Examination)
PROTEIN
Significance:
* Increased in _____ and _______ disorders
inflammatory
hemorrhagic
140
SYNOVIAL FLUID (Chemical Examination)
PROTEIN
Significance:
* Normal: _____
<3 g/dL
141
SYNOVIAL FLUID (Chemical Examination)
Significance:
* Increased in gout
Uric Acid
142
SYNOVIAL FLUID (Chemical Examination)
URIC ACID
Significance:
* Normal: ______
same as blood
143
SYNOVIAL FLUID (Microbiology Test)
* Common organisms that infect synovial fluid
1. Staphylococcus aureus
2. Streptococcus
3. Haemophilus
4. Neisseria gonorrhea
144
SYNOVIAL FLUID (Microbiology Test)
Which is the most predominant organism that infects the SF
Staphylococcus aureus
145
SYNOVIAL FLUID (Microbiology Test)
Which causes gonococcal arthritis?
Neisseria gonorrhea
146
SYNOVIAL FLUID (Serologic Tests)
* Autoantibody detection:
SLE
RF
147
SYNOVIAL FLUID (Serologic Tests)
Autoantibody detection:
SLE :_______
Antinuclear antibody (ANA)
148
SYNOVIAL FLUID (Serologic Tests)
Autoantibody detection:
RA :_______
Rf (Rheumatoid factor)
149
SYNOVIAL FLUID (Serologic Tests)
→ Frequent complication is arthritis
Lyme disease
150
SYNOVIAL FLUID (Serologic Tests)
LYME DISEASE
Caused by: _____
Borrelia burgdorferi
151
JOINT DISORDERS (SYNOVIAL FLUID)
Enumerate the different Group Classifications
Non-inflammatory
Inflammatory (Immunologic)
Inflammatory (Crystal-induced)
Septic
Hemorrhagic
152
JOINT DISORDERS (SYNOVIAL FLUID)
NON-INFLAMMATORY
Significance: ______
Degenerative joint disorder (osteoarthritis)
153
JOINT DISORDERS (SYNOVIAL FLUID)
INFLAMMATORY (Immunologic)
Significance: ______
Immunologic disorders (RA, SLE etc.)
154
JOINT DISORDERS (SYNOVIAL FLUID)
INFLAMMATORY (Crystal-induced)
Significance: ______
* Gout (MSU);
* Pseudogout (CPPD)
155
JOINT DISORDERS (SYNOVIAL FLUID)
SEPTIC
Significance: ______
Microbial infection
156
JOINT DISORDERS (SYNOVIAL FLUID)
HEMORRHAGIC
Significance: ______
* Traumatic injury
* Coagulation deficiencies
157
JOINT DISORDERS (SYNOVIAL FLUID)
NON-INFLAMMATORY
Color and Clarity: ______
Clear, yellow fluid
158
JOINT DISORDERS (SYNOVIAL FLUID)
INFLAMMATORY (Immunologic)
Color and Clarity: ______
Cloudy, yellow fluid
159
JOINT DISORDERS (SYNOVIAL FLUID)
INFLAMMATORY (Crystal-induced)
Color and Clarity: ______
Cloudy or milky fluid
160
JOINT DISORDERS (SYNOVIAL FLUID)
SEPTIC
Color and Clarity: ______
Cloudy, green fluid
161
JOINT DISORDERS (SYNOVIAL FLUID)
HEMORRHAGIC
Color and Clarity: ______
Cloudy, red fluid
162
163
JOINT DISORDERS (SYNOVIAL FLUID)
NON-IMFLAMMATORY
Viscosity: ______
Good
164
JOINT DISORDERS (SYNOVIAL FLUID)
IMFLAMMATORY (Immunologic)
Viscosity: ______
Poor
165
JOINT DISORDERS (SYNOVIAL FLUID)
IMFLAMMATORY (Crystal-induced)
Viscosity: ______
Low
166
JOINT DISORDERS (SYNOVIAL FLUID)
SEPTIC
Viscosity: ______
Variable
167
JOINT DISORDERS (SYNOVIAL FLUID)
HEMORRHAGIC
Viscosity: ______
Low
168
JOINT DISORDERS (SYNOVIAL FLUID)
NON-INFLAMMATORY
WBC Count: ______
<1,000/uL
169
JOINT DISORDERS (SYNOVIAL FLUID)
INFLAMMATORY (Immunologic)
WBC Count: ______
2,000-75,000/uL
170
JOINT DISORDERS (SYNOVIAL FLUID)
INFLAMMATORY (Crystal-induced)
WBC Count: ______
Up to 100,000/uL
171
JOINT DISORDERS (SYNOVIAL FLUID)
SEPTIC
WBC Count: ______
50,000-100,000/uL
172
JOINT DISORDERS (SYNOVIAL FLUID)
HJEMORRHAGIC
WBC Count: ______
Equal to blood
173
JOINT DISORDERS (SYNOVIAL FLUID)
NON-INFLAMMATORY
Neutrophils: ______
<30%
174
JOINT DISORDERS (SYNOVIAL FLUID)
INFLAMMATORY (Immunologic)
Neutrophils: ______
>50%
175
JOINT DISORDERS (SYNOVIAL FLUID)
INFLAMMATORY (Crystal-induced)
Neutrophils: ______
<70%
176
JOINT DISORDERS (SYNOVIAL FLUID)
SEPTIC
Neutrophils: ______
>75%
177
JOINT DISORDERS (SYNOVIAL FLUID)
HEMORRHAGIC
Neutrophils: ______
Equal to blood
178
JOINT DISORDERS (SYNOVIAL FLUID)
NON-INFLAMMATORY
Glucose: ______
Normal
179
JOINT DISORDERS (SYNOVIAL FLUID)
INFLAMMATORY (Immunologic)
Glucose: ______
Decreased
180
JOINT DISORDERS (SYNOVIAL FLUID)
INFLAMMATORY (Crystal-induced)
Glucose: ______
Decreased
181
JOINT DISORDERS (SYNOVIAL FLUID)
SEPSIS
Glucose: ______
Decreased (Increase in lactate)
182
JOINT DISORDERS (SYNOVIAL FLUID)
HEMORRHAGIC
Glucose: ______
Normal
183
JOINT DISORDERS (SYNOVIAL FLUID)
NON-INFLAMMATORY
Others: ______
N/A
184
JOINT DISORDERS (SYNOVIAL FLUID)
INFLAMMATORY (Immunologic)
Others: ______
Autoantibodies
185
JOINT DISORDERS (SYNOVIAL FLUID)
INFLAMMATORY (Crystal-induced)
Others: ______
(+) Crystals
186
JOINT DISORDERS (SYNOVIAL FLUID)
SEPTIC
Others: ______
(+) gram stain; (+) culture
187
JOINT DISORDERS (SYNOVIAL FLUID)
HEMORRHAGIC
Others: ______
(+) RBCs
188
Ultrafiltrate of plasma
SEROUS FLUID
189
* Fluid between parietal and visceral membranes
SEROUS FLUID
190
SEROUS FLUID
* Fluid between ______ and _____ membranes
parietal
visceral
191
lines the cavity wall
PARIETAL MEMBRANCE
192
Covers the organs
VISCERAL MEMBRANE
193
THREE TYPS OF SEROUS FLUIDS:
→ Pleural fluid
→ Pericardial fluid
→ Peritoneal fluid
194
THREE TYPS OF SEROUS FLUIDS:
→ Pleural fluid (_____)
lungs
195
THREE TYPS OF SEROUS FLUIDS:
→ Pericardial fluid (________)
cardiac muscles/heart
196
THREE TYPS OF SEROUS FLUIDS:
→ Peritoneal fluid (______)
abdominal area
197
SEROUS FLUID
Main function: to provide ______between _____ and __________
lubrication
parietal
visceral membranes
198
* Accumulation of excess fluid between the membranes
Effusion
199
SEROUS FLUID (Effusion)
Two types:
Transudate
Exudate
200
SEROUS FLUID (Effusion)
* Caused by systemic conditions
Transudate
201
SEROUS FLUID (Effusion)
* Caused by membrane damage
Exudate
202
SEROUS FLUID (Effusion)
* Affects ALL serous fluids
Transudate
203
SEROUS FLUID (Effusion)
* Affects ONLY ONE serous fluid
Exudate
204
SEROUS FLUID (Effusion)
TRANSUDATE
Causes:
* Hypoproteinemia
* Congestive heart failure
* Nephrotic syndrome
* Cirrhosis
* Malnutrition
205
SEROUS FLUID (Effusion)
EXUDATE
Causes:
Causes:
* Infection
→ Pneumonia (pleural)
→ TB
→ Endocarditis (Pericardial)
* Inflammation
* Malignancy (e.g., Adenoma)
206
T/F: The values of exudate effusions are often ‘less than’ or decreased
FALSE; The values of TRANSUDATE effusions are often ‘less than’ or decreased
207
* Differentiates exudates(+) from transudates(-)
Rivalta’s Test
208
Rivalta’s Test
a.k.a
* “Serosamucin clot test”
209
Rivalta’s Test
Procedure: ______
→ Unknown fluid (effusion) + water + acetic acid
210
Rivalta’s Test
○ If (+) heavy precipitation = (transudate/exudate)
EXUDATE
211
SEROUS FLUID (Specimen Collection)
PLEURAL FLUID
MOC: ________
Thoracentesis
212
SEROUS FLUID (Specimen Collection)
PERICARDIAL FLUID
MOC: ________
Pericardiocentesis
213
SEROUS FLUID (Specimen Collection)
PERITONEAL FLUID
MOC: ________
Paracentesis
214
SEROUS FLUID (Specimen Collection)
T/F: All three methods are different/unique on its own
FALSE; All three methods are the same and called as ‘needle aspiration’
215
SEROUS FLUID (Specimen Collection)
EDTA
Tests/laboratory section: ______
Cell count; differential count
216
SEROUS FLUID (Specimen Collection)
STERILE HEPARIN TUBE
Tests/laboratory section: ______
Microbiology; cytology
217
SEROUS FLUID (Specimen Collection)
HEPARIN TUBE
Tests/laboratory section: ______
Chemistry
218
SEROUS FLUID (Specimen Collection)
PLAIN TUBE
Tests/laboratory section: ______
Clotting test
219
SEROUS FLUID (Specimen Collection)
* If testing for ____, store fluid _____ in _____ during transport
pH
anaerobically
ice
220
* Normal volume is <30 mL
PLEURAL FLUID
221
PLEURAL FLUID
* Normal volume is _____
<30 mL
222
PLEURAL FLUID (Color)
NORMAL
Clear, pale yellow
223
PLEURAL FLUID (Color)
Microbial infection
Turbid, white
224
PLEURAL FLUID (Color)
Ruptured amoebic abscess
Brown
225
Type of extraintestinal amoebiasis
Ruptured amoebic abscess
226
PLEURAL FLUID (Color)
Brown (_________)
Anchovy-sauce like
227
PLEURAL FLUID (Color)
Aspergillosis
Black
228
PLEURAL FLUID (Color)
Malignant mesothelioma
Viscous
229
Produced hyaluronic acid causing viscous pleural fluid
Malignant mesothelioma
230
Produced hyaluronic acid causing viscous pleural fluid
Produced _______ causing viscous pleural fluid
hyaluronic acid
231
PLEURAL FLUID (Color)
Chylous material, pseudochylous material
Milky
232
PLEURAL FLUID (Color)
Hemothorax, hemorrhagic effusion
Bloody
233
MILKY PLEURAL FLUID
Inc. TAG
Chylous Effusion
234
MILKY PLEURAL FLUID
inc. CHOLE
Pseudochylous Effusion
235
MILKY PLEURAL FLUID
CHYLOUS EFFUSION
Cause: ____
Thoracic duct leakage
236
The thoracic duct is a lymphatic duct, thus, it is rich in ______ and _______
lymphocytes
chylomicrons
237
* Lipoproteins with high concentrations of TAG
lymphocytes
chylomicrons
238
MILKY PLEURAL FLUID
PSEUDOCHYLOUS EFFUSION
Cause: ____
Chronic inflammation/infection
239
MILKY PLEURAL FLUID
CHYLOUS EFFUSION
Appearance: ____
Milky/white
240
MILKY PLEURAL FLUID
PSUEDOCHYLOUS EFFUSION
Appearance: ____
Milky/green tinge/”gold paint”
241
MILKY PLEURAL FLUID
CHYLOUS EFFUSION
Leukocytes: ____
Lymphocytes
242
MILKY PLEURAL FLUID
PSEUDOCHYLOUS EFFUSION
Leukocytes: ____
Mixed cells
243
MILKY PLEURAL FLUID
CHYLOUS EFFUSION
Cholesterol crystal: ____
Absent
244
MILKY PLEURAL FLUID
PSEUDOCHYLOUS EFFUSION
Cholesterol crystal: ____
PRESENT
245
MILKY PLEURAL FLUID
CHYLOUS EFFUSION
TAG: ____
>100 mg/dL
246
MILKY PLEURAL FLUID
PSEDOCHYLOUS EFFUSION
TAG: ____
<50 mg/dL
247
Primarily stains TAG
Sudan III staining
248
MILKY PLEURAL FLUID
CHYLOUS EFFUSION
Sudan III staining: ____
(+)
249
MILKY PLEURAL FLUID
PSEDOCHYLOUS EFFUSION
Sudan III staining: ____
(-)
250
T/F: Psuedochylous effusion can sometimes stain weakly (+) in Sudan III Staining
TRUE
251
BLOOD PLEURAL FLUID
Conditions:
Hemothorax
Hemorrhagic effusion
252
BLOOD PLEURAL FLUID
* Normal amount of pleural fluid but with blood
HEMOTHORAX
253
BLOOD PLEURAL FLUID
Examples of Hemothorax
Truamatic tap injury
254
BLOOD PLEURAL FLUID
* Due to membrane damage
Hemorrhagic Effusion
255
BLOOD PLEURAL FLUID
* Increased pleural fluid with blood
Hemorrhagic Effusion
256
BLOOD PLEURAL FLUID
HEMOTHROAX
Distribution of blood: _____
Uneven
257
BLOOD PLEURAL FLUID
HEMORRHAGIC EFFUSION
Distribution of blood: _____
Even
258
BLOOD PLEURAL FLUID
Differentiates hemothorax from hemorrhagic effusion
Hematocrit
259
BLOOD PLEURAL FLUID
HEMOTHORAX
Hematocrit: PF Hct is ____ of WB Hct
≥1/2
260
BLOOD PLEURAL FLUID
HEMORRHAGIC EFFUSION
Hematocrit: PF Hct is ____ of WB Hct
<1/2
261
PLEURAL FLUID CELLS
Enumerate:
Neutrophil
Lymphocyte
Mesothelial cells
Plasma cells
Malignant cells
Eosinophil
262
PLEURAL FLUID CELLS
NEUTROPHIL
Significance:
* Pneumonia
* Pancreatitis
* Pulmonary infarction
263
PLEURAL FLUID CELLS
LYMPHOCYTE
Significance:
* Tuberculosis
* Viral infections
* Autoimmune disorders
* Malignancy
264
PLEURAL FLUID CELLS
* Normally present regardless of form
Mesothelial cells
265
PLEURAL FLUID CELLS
* If it is decreased, indicative of tuberculosis
Mesothelial cells
266
Lines the serous membrane lining; it has two forms: normal and reactive
MESOTHELIAL CELLS
267
MESOTHELIAL CELLS
Lines the ______; it has two forms: ____ and ____
serous membrane lining
normal; reactive
268
PLEURAL FLUID CELLS
PLASMA CELLS
Significance:
Tuebrculosis
269
PLEURAL FLUID CELLS
MALIGNANT CELLS
Significance:
* Primary adenocarcinoma
* Small cell carcinoma
* Metastatic carcinoma
270
PLEURAL FLUID CELLS
Eosinophil must be ____
(>10%)
271
PLEURAL FLUID CELLS
* Trauma resulting from presence of air or blood in pleural fluid sample
Eosinophil (>10%)
272
PLEURAL FLUID CELLS
EOSINOPHIL (>10%)
Significance:
* May be due to ____ or ____infection
allergy
parasitic
273
Tumor Markers for Effusions of Malignant Origin
ENUMERATE
CEA
CA125
CA 15-3, CA 549
CYFRA 21-1
274
Meaning of CEA
Carcino Embryonic Antigen
275
Meaning of CYFRA
Cytokeratin fragment
276
Tumor Markers for Effusions of Malignant Origin
Tumor marker for COLON CANCER
CEA
(Carcino Embryonic Antigen)
277
Tumor Markers for Effusions of Malignant Origin
Tumor marker for METASTATIC URINE CANCER
CA125
278
Tumor Markers for Effusions of Malignant Origin
Tumor marker for BREASTCANCER
CA 15-3, CA 549
279
Tumor Markers for Effusions of Malignant Origin
Tumor marker for LUNG CANCER
CYFRA 21-1
(Cytokeratin fragment)
280
PLEURAL FLUID (Chemistry)
What are the different test/panels?
Glucose
Lactate
TAG
pH
Adenosine deaminase
Amylase
281
PLEURAL FLUID (Chemistry)
Significance:
Decreased in cases of rheumatoid inflammation, tuberculosis, and purulent infections
GLUCOSE
282
PLEURAL FLUID (Chemistry)
GLUCOSE
Significance:
Decreased in cases of ____, ___, and _______
rheumatoid inflammation
TB
purulent infections
283
PLEURAL FLUID (Chemistry)
Significance:
Increased in bacterial infection
LACTATE
284
PLEURAL FLUID (Chemistry)
Significance:
Chylous effusion
TAG
285
PLEURAL FLUID (Chemistry)
Significance:
* Decreased/acidic in cases of:
→ when pneumonia is NOT responding to antibiotics
→ complicated parapneumonic effusion (associated with emphyema)
pH
286
PLEURAL FLUID (Chemistry)
pH
Significance:
* ______ in cases of:
→ when ____ is NOT responding to antibiotics
→ complicated _______ (associated with _____)
Decreased/acidic
pneumonia
parapneumonic effusion; emphyema
287
PLEURAL FLUID (Chemistry)
Significance:
Malignancy, tubercular effusion
ADENOSINE DEAMINASE
288
PLEURAL FLUID (Chemistry)
ADENOSINE DEAMINASE
Significance:
______, _____
Malignancy
tubercular effusion
289
PLEURAL FLUID (Chemistry)
Significance:
Esophageal rupture, malignancy, increased in pancreatitis
AMYLASE
290
PLEURAL FLUID (Chemistry)
AMYLASE
Significance:
____, _______, increased in _____
Esophageal rupture
malignancy
pancreatitis
291
PLEURAL FLUID (Microbiologic Test)
* Common causes of pleural effusion are:
→ S. aureus
→ Enterobacteriaceae
→ M. tuberculosis
→ Anaerobic bacteria
292
PLEURAL FLUID (Microbiologic Test)
○ These can cause septic pleural effusion
→ Anaerobic bacteria
293
* Normal volume is <50 mL
PERICARDIAL FLUID
294
PERICARDIAL FLUID
* Normal volume is ____
<50 mL
295
PERICARDIAL FLUID (Appearance)
* Normal
* Transudate presence
Clear, pale yellow
296
PERICARDIAL FLUID (Appearance)
* Infection
* Malignancy
Blood-streaked
297
PERICARDIAL FLUID (Appearance)
* Cardiac puncture
* Anticoagulant medication
Grossly bloody
298
PERICARDIAL FLUID (Differential Count)
Bacterial endocarditis
Increased neutrophils
299
PERICARDIAL FLUID (Differential Count)
Metastatic carcinoma
Malignant cells
300
PERICARDIAL FLUID (TESTS/PANELS)
Purpose:
* Bacterial infection
* Malignancies
Decreased glucose
301
PERICARDIAL FLUID (TESTS/PANELS)
Purpose:
Bacterial endocarditis
Gram stain and culture
302
PERICARDIAL FLUID (TESTS/PANELS)
Purpose:
Tubercular effusion (MTB)
Acid-fast stain
303
PERICARDIAL FLUID (TESTS/PANELS)
Purpose:
Tubercular effusion
Adenosine deaminase
304
Common Causes of Pericardial Effusion
* Haemophilus
* Staphylococcus
* Streptococcus
* Viruses: Adenovirus and coxsackievirus
305
PERITONEAL FLUID
a.k.a
* “Ascitic fluid”
306
PERITONEAL FLUID
effusion in the peritoneal cavity
Ascites
307
PERITONEAL FLUID
* Normal volume: ____
<100 mL
308
→ Most abundant serous fluid due to size of ______
PERITONEAL FLUID
abdominal area
309
PERITONEAL FLUID (Appearance)
Normal
Clear, pale yellow
310
PERITONEAL FLUID (Appearance)
Microbial infection
Turbid
311
PERITONEAL FLUID (Appearance)
Gall bladder or pancreatic disorder
Green
312
PERITONEAL FLUID (Appearance)
* Trauma
* Infection
* Malignancy
Blood-streaked
313
PERITONEAL FLUID (Appearance)
Lymphatic trauma and leakage
Milky
314
PERITONEAL FLUID (Cell Count)
WBC COUNT
Normal: ___
<500 uL
315
PERITONEAL FLUID (Cell Count)
WBC COUNT: 500 uL
Significance: ____
* Bacterial peritonitis
* Cirrhosis
316
PERITONEAL FLUID (Cell Count)
DIFFERENTIAL COUNT
Bacterial peritonitis
Increased neutrophils
317
PERITONEAL FLUID (Cell Count)
DIFFERENTIAL COUNT
Malignancy
Malignant cells
318
PERITONEAL FLUID (Tests)
Enumerate the Tests/Panels
Peritoneal lavage
CEA
CA 125
Glucose
Amylase
Alkaline phosphatase
BUN/Creatinine
Gram stain and culture
Acid-fast stain
Adenosine deaminase
319
PERITONEAL FLUID (Tests)
a sensitive test to detect intraabdominal bleeding
Peritoneal lavage
320
PERITONEAL FLUID (Tests)
Significance: 100,000 RBC/uL
Peritoneal lavage
321
PERITONEAL FLUID (Tests)
PERITONEAL LAVAGE
Significance: _____ indicances blunt trauma injury
100,000 RBC/uL
322
PERITONEAL FLUID (Tests)
Significance: Malignancy - GI origin
CEA
323
PERITONEAL FLUID (Tests)
Significance: Malignancy - Ovarian origin
CA 125
324
PERITONEAL FLUID (Tests)
Significance: Decreased in tubercular peritonitis, malignancy
Glucose
325
PERITONEAL FLUID (Tests)
Significance: Increased in pancreatitis
Amylase
326
PERITONEAL FLUID (Tests)
Significance: Increased in GI perforation
Alkaline phosphatase
327
PERITONEAL FLUID (Tests)
Significance: Ruptured/punctured bladder
BUN/Creatinine
328
PERITONEAL FLUID (Tests)
Significance: Bacterial peritonitis
Gram stain and culture
329
PERITONEAL FLUID (Tests)
Significance: Tubercular peritonitis
Adenosine deaminase
330
* Contains concentric striations of collagen-like material
Psammoma Bodies
331
Psammoma Bodies
* Seen in benign conditions associated with
→ ____; and
→ ____malignancies
Ovarian
Thyroid
332
3rd major body fluid
CSF
333
CSF
Functions:
* Supplies nutrients to the ____
* Removes _____ in the brain
* Produces a _____ to cushion the brain and ___ against ___.
nervous system
metabolic waste
mechanical barrier; spinal cord; trauma
334
* Brain is lined/covered by
Meninges
335
MENINGES
* Singular is ___
meninx
336
MENINGES
* Consists of three layers: ________
dura mater
arachnoid mater
pia mater
337
MENINEGS
* Outermost layer
Dura Mater
338
MENINEGS
Dura mater a.k.a
Tough mother
339
MENINEGS
* ‘Spider-like’ appearance because it is filamentous
Arachnoid Mater
340
MENINEGS
* Filamentous inner membrane
Arachnoid Mater
341
MENINEGS
→ Filaments are known as ____
trabeculae
342
MENINEGS
* Innermost layer
Pia Mater
343
MENINEGS
* Literally means “______”
Pia Mater
* tender mother
344
MENINEGS
* Directly lines the brain and the spinal cord
Pia Mater
345
* Space between the arachnoid mater and the pia mater where the CSF flows
Subarachnoid Space
346
ultrafiltrate of plasma
csf
347
CSF PRODUCTION
* ____ is filtered by the ____, producing CSF
Plasma
choroid plexus
348
CSF PRODUCTION
Choroid Plexus
Rate of production/filtration: ________
20 mL/hr (~500 mL/day; 0.3-0.4 mL/min)
349
CSF PRODUCTION
→ Rate of production is regulated by arachnoid villi
Choroid Plexus
350
CSF PRODUCTION
Choroid Plexus:
→ Rate of production is regulated by ____
arachnoid villi
351
CSF PRODUCTION
* Composed of tight junctions of endothelial cells
Choroid Plexus
352
CSF PRODUCTION
Choroid Plexus
* Composed of tight junctions of ______
endothelial cells
353
CSF PRODUCTION
→ Make up the blood brain barrier
tight junctions of endothelial cells
354
CSF PRODUCTION
* Prevents passage of many molecules, protecting the brain from toxins or other harmful materials that can harm the brain
Blood Brain Barrier (BBB)
355
CSF PRODUCTION
Arachnoid Villi a.k.a
* “Arachnoid granulation”
356
CSF PRODUCTION
* Granulations that reabsorb circulating CSF back to the peripheral circulation
Arachnoid Villi
357
CSF PRODUCTION
Arachnoid Villi
Rate or reabsorption: ____
20 mL/hr
358
CSF COLLECTION AND HANDLING
Method of Collection:
* Lumbar/External puncture
* Cisternal puncture
359
CSF COLLECTION AND HANDLING
Method of Collection:
* Lumbar/External puncture a.k.a
spinal tap
360
CSF COLLECTION AND HANDLING
Method of Collection:
* Cisternal puncture a.k.a
suboccipital puncture
361
CSF COLLECTION AND HANDLING
Method of Collection:
→ Needle is inserted between the 3rd and 4th vertebra or between the 4th and 5th vertebra
* Lumbar/External puncture or spinal tap
362
CSF COLLECTION AND HANDLING
Lumbar/External puncture or spinal tap
→ Needle is inserted between the ____ and ____ vertebra or between the ___ and ____ vertebra
3rd
4th
4th
5th
363
CSF COLLECTION AND HANDLING
Method of Collection:
→ Puncture is directly below the occipital bone
* Cisternal puncture or suboccipital puncture
364
CSF COLLECTION AND HANDLING
Method of Collection:
→ More dangerous since it is near the brain stem
* Cisternal puncture or suboccipital puncture
365
CSF COLLECTION AND HANDLING
Cisternal puncture or suboccipital puncture:
→ Puncture is directly (above/below) the ______
below
occipital bone
366
CSF COLLECTION AND HANDLING
Maximum amount of volume to be collected: ____
20 mL
367
CSF tubes
First tube:
Chemistry/Serology
368
T/F: The first tube is brought to the chemistry and serology section because the tests performed are least affected by blood or bacteria that is present or introduced during collection
TRUE
369
CSF Tubes
Second tube:
Microbiology
370
T/F: The second tube is brought to the microbiology section because it is no longer at risk of bacterial contamination due to collection of CSF.
True
371
CSF Tubes
Third tube
Hematology
372
The third tube is delivered to the hematology section because it is least likely to have ___
skin cells
373
CSF TUBES
T/F: Fourth tubes are optional
Truth
374
CSF TUBES
Fourth tube:
Microbiology
Chemistry
Serology
375
The fourth tube is brought to ____ to further ensure the absence of bacteria
microbiology
376
Chemistry/Serology
Storage: ______
Frozen
377
Microbiology
Storage: ____
RT
378
Hematology
Storage: ___
Refrigirated
379
* If one tube only due to insufficient amount of sample, deliver CSF first to ____ --> _____ --> ____
microbiology
hematology
chemistry and serology
380
CSF GROSS ANALYSIS
CSF Normal Volume
Adults: ____
90-150 mL
381
CSF GROSS ANALYSIS
CSF Normal Volume
Neonates: ____
10-60 mL
382
CSF APPEARANCE
Normal
Crystal clear
383
CSF APPEARANCE
Hazy/Turbid/Milky/Cloudy
* WBCs (>200/uL)
* RBCs (>400/uL)
* Microorganisms
* Proteins
* Lipids
* Infection (meningitis)
384
Abnormal discoloration of CSF
Xanthochromia
385
CSF APPEARANCE
* Presence of RBC degradation products (pink, orange, and yellow CSF)
Xanthochromia
386
CSF APPEARANCE
Xanthochromia
* Presence of RBC degradation products (__, ___, and ___CSF)
pink
orange
yellow
387
CSF APPEARANCE
XANTOCHROMIA
* Pink – Slight amount of ___
O2Hgb
388
CSF APPEARANCE
XANTOCHROMIA
* Orange – _____
Heavy hemolysis
389
CSF APPEARANCE
XANTOCHROMIA
Yellow (2):
→ ____ conversion to ___
→ Presence of ____ in CSF is known as ____
Oxyhemoglobin; bilirubin
bilirubin; bilirachia
390
supernatant
Xanthochromia
Other causes:
→ Increase in protein (>150 mg/dL)
→ Presence of melanin
→ Presence of carotene
→ Presence of anti-TB drugs (Rifampicin)
→ Anti-septic contamination (iodine)
391
CSF APPEARANCE (Checking for xanthochromia)
* Centrifuge CSF sample and check _____ against ____
supernatant
white background
392
CSF APPEARANCE
XANTOCHROMIA:
Increase in ___ may be due to damage of ___ and may lead to ___
protein
BBB
yellowish discoloration
393
CSF APPEARANCE
XANTOCHROMIA:
Presence of ____ may be due to _____
melanin
meningeal melanosarcoma
394
* Vitamin A precursor
Carotene
395
* May be seen during hypervitaminosis A
Carotene
396
CAROTENE
* May be seen during _______
hypervitaminosis A
397
* Gives an orange discoloration to CSF
Carotene
398
CSF APPEARANCE
XANTOCHROMIA
_____ gives a red-orange color
Rifampicin
399
CSF APPEARANCE
XANTOCHROMIA
____ gives a yellowish discoloration to CSF
Iodine
400
CSF APPEARANCE
Increased RBCs (____)
BLOODY
>6000/uL
401
CSF APPEARANCE
BLOODY
Increased RBCs (>6000/uL) which may be due to:
* Traumatic tap
* Intracranial hemorrhage
402
CSF APPEARANCE
Radiographic contrast media
Oily
403
CSF APPERANCE
* Main reason is due to fibrinogen
Clotted
404
CSF APPEARANCE
* Meningitis
* Froin syndrome
* Blockage of CSF circulation
* Traumatic tap
Clotted
405
a mixture of xanthochromia, increased protein, and hypercoagulability
Froin syndrome
406
FROIN SYNDROME
a mixture of ____, increased ___, and ____
xanthochromia
protein
hypercoagulability
407
CSF APPEARANCE
Tubercular meningitis
Pellicle (web-like surface)
408
CSF APPEARANCE
In tubercular meningitis, ___ appear only if CSF is stored ___ in a ____
pellicles
overnight
refrigerator
409
BLOODY CSF
May be caused by 2 conditons:
Traumatic trap
Intracranial Hemorrhage
410
BLOODY CSF
Distributuon of blood: uneven
TRAUMATIC TAP
411
BLOODY CSF
Even distrubution
Intracranial Hemorrhage
412
BLOODY CSF (Traumatic tap)
Clot formation: ___
(+)
413
BLOODY CSF (Intracranial Hemorrhage)
Clot formation: ____
(-)
414
BLOODY CSF (Traumatic tap)
Supernatant: ___
Clear
415
BLOODY CSF (Intracranial Hemorrhage)
Supernatant: ____
Reddish (Xantrochromic)
416
Macrophages with ingested RBC
Erythrophages
417
BLOODY CSF (Traumatic tap)
Erythropages: ___
(-)
418
BLOODY CSF (Intracranial Hemorrhage)
Eryhthrophages: ___
(+)
419
BLOODY CSF (Intracranial Hemorrhage)
ERYHTROPHAGES (-):
Aside from RBCs, ____ and _____ can be seen in the macrophage
hemosiderin
hematoidin crystals
420
an RBC degradation pigment
Hematodin
421
BLOODY CSF (Traumatic tap)
D-dimer: ___
(-)
422
BLOODY CSF (Intracranial Hemorrhage)
D-dimer: __
(-)
423
a fibrin degradation product
D-dimer
424
CSF (Viscocity)
Normal
Water-like
425
CSF (Viscosity)
Viscous CSF
Clinical significance:
* Metastatic mucin-producing adenocarcinoma
* Cryptococcal meningitis
* Liquid nucleus pulposus
426
* Polysaccharide capsule of C. neoformans contributes to the viscosity of CSF
Fungal meningitis
427
Fungal meningitis
* ____ of ____contributes to the viscosity of CSF
Polysaccharide capsule
C. neoformans
428
CSF CELL COUNT
* Any cell count procedures must be performed _____
IMMEDIATELY
429
CSF CELL COUNT
→ WBC and RBC begin to lyse within____ after collection
1 hour
430
CSF CELL COUNT
→ ____ of WBCs disintegrate within ___
40%
2 hours
431
* Routinely performed on CSF
WBC count
432
WBC COUNT
Normal values
→ Adults: ___
0-5 WBC/uL
433
WBC COUNT
Normal values:
→ Neonates: _____
0-30 WBC/uL
434
WBC COUNT
Diluting fluid: ___
3% HAc with methylene blue
435
WBC COUNT (diluting fluid)
→ ____ lyses RBCs (it is ___)
3% HAc
hypotonic
436
WBC COUNT (diluting fluid)
to stain the WBC for easier visualization
Methylen blue
437
* NOT routinely done in CSF since it is is NOT normally present in CSF
RBC Count
438
→ Done in cases of traumatic tap
RBC Count
439
* To correct for WBC count and total protein concentration
RBC Count
440
RBC Count
To correct:
→ Subtract __ WBC (in the WBC count) for every ___RBCs seen
1 WBC
700
441
RBC COUNT
To correct:
→ Subtract _____in total protein concentration for every _____
8 mg/dL
10,000 RBCs/uL
442
* Performed on a stained CSF smear
CSF DIFFERNTIAL COUNT
443
* Specimen should be concentrated first before preparing a smear
CSF DIFFERNTIAL COUNT
444
CSF DIFFERNTIAL COUNT
* Ways to concentrate CSF
→ Routine centrifugation
→ Cytocentrifugation
→ Sedimentation
→ Filtration
445
CSF (Routine Centrifugation)
* CSF is centrifuged for ____
5-10 minutes
446
CSF (Routine Centrifugation)
→ ____is removed; can be used for other tests (___)
Supernatant
chemistry
447
CSF (Routine Centrifugation)
→ ____ is used for smear preparation
Sediment
448
CSF (Routine Centrifugation)
SEDIMENT:
After making a smear, the sediment should be air dried in what temperature?
Room temperature
449
CSF (Routine Centrifugation)
SEDIMENT:
After airdrying, the sediment is stained with ___
Wright stain
450
CSF (Routine Centrifugation)
* ___cells are classified
100
451
CSF (Routine Centrifugation)
* Reported in terms of ___-
percentage
452
CSF (Cytocentrifugation)
* Fluid is added to a ____
conical chamber
453
CSF (Cytocentrifugation)
* Cells are forced into a ____ within a ___ diameter circle on the slide
monolayer
6mm
454
CSF (Cytocentrifugation)
* Addition of _____
30% albumin
455
CSF (Cytocentrifugation)
The addition of 30% albumin promotes:
→ Increases ____
→ Decreases ______
→ Increases cell yield or recovery
→ Decreases cellular distortion
456
Predominant Cells in CSF
Enumerate
Lymphocytes and monocytes
Neutrophils
Macrophage
Blast forms
Lymphoma cells
plasma cells
Ependymal, choroidal and spindle-shaped cells
Malignant cells
457
Predominant Cells in CSF
* Normal[
Lymphocyes and monocyetes
458
Predominant Cells in CSF
Normal lymphocytes and monocytes:
* Adults: __ lymphocytes, __ monocytes
70%
30%
459
Predominant Cells in CSF
Normal lymphocytes and monocytes:
* Neonates: ___lymphocytes, _____ monocytes
30%
70-80%
460
Predominant Cells in CSF
increased in lymphocytes and monocytes called:
pleocytosis
461
Predominant Cells in CSF
PLEOCYTOSIS
Clincial signfiicance:
→ Viral, tubercular, and fungal meningitis
→ Multiple sclerosis
462
Predominant Cells in CSF
NEUTROPHILS
Clinical significance:
* Normal
* Bacterial meningitis
* Early case of viral, tubercular, and fungal meningitis
* Cerebral hemorrhage
463
Predominant Cells in CSF
Intracranial hemorrhage
Macrophage
464
Predominant Cells in CSF
Acute leukemia
Blast forms
465
Predominant Cells in CSF
Examples fo blast forms are:
lymphoblasts
myeloblasts
monoblasts.
466
Predominant Cells in CSF
Disseminated lymphoma
Lymphoma cells
467
Predominant Cells in CSF
PLASMA CELLS
Clinical significance:
* Multiple sclerosis
* Lymphocyte reactions
468
Predominant Cells in CSF
Diagnostic procedures performed in the brain
Ependymal, choroidal, and spindle-shaped cells
469
Predominant Cells in CSF
Examples of procedures performed in the brain:
Neurosurgery
Pneumoencephalography
470
is the removal of CSF from the meninge/brain to make the brain more visible in x-rays
Neurosurgery
Pneumoencephalography
471
Predominant Cells in CSF
MALIGNANT CELLS
Clinical Significance:
* Metastatic carcinoma
* Primary CNS carcinoma
472
* Most frequently performed CSF chemistry test
CSF CHEMISTRY
473
CSF CHEMISTRY
Normal values:
→ Adults: _____
15-45 mg/dL
474
CSF CHEMISTRY
Normal values:
→ Infants: ____
150 mg/dL
475
CSF CHEMISTRY
Normal values:
→ Immature: _____
500 mg/dL
476
CSF CHEMISTRY
Normal values:
→ Infants and immature babies have higher ____ values since their ____ is not well intact
protein
BBB
477
* The major CSF protein is _____
albumin
478
* The 2nd most prevalent CSF protein is _____
pre-albumin
479
OTHER CSF PROTEINS
ALPHA-GLOBULINS:
Haptoglobin
ceruloplasmin
480
OTHER CSF PROTIENS
BETA-GLOBULINS:
ß2-transferrin
“Tau” protein
481
OTHER CSF PROTEINS
GAMMA-GLOBULINS:
IgG and IgA
482
___ is a carbohydrate-deficient transferrin; it is only present in CSF
Tau
483
Proteins NOT found in CSF:
IgM
FIBRINOGEN
LIPORPTOEINS
484
Why is IgM Not found in the CSF?
filtered out by ____
→ Is a ___ (bigger molecular size)
→ Cannot pass through the ___
BBB
485
CLINICAL CAUSES OF ABNORMAL CSF PROTEIN VALUES
ELEVATED RESULTS:
* Meningitis
* Hemorrhage
* Primary CNS tumors
* Multiple sclerosis
* Guillain-Barre syndrome
* Neurosyphilis
* Polyneuritis
* Myxedema
* Cushing diseases
* Connective tissue disease
* Polyneuritis
* Diabetes
* Uremia
486
CLINICAL CAUSES OF ABNORMAL CSF PROTEIN VALUES
Most common cause of elevated results is damage to ____ (___ and _____)
BBB
meningitis
hemorrhage
487
CLINICAL CAUSES OF ABNORMAL CSF PROTEIN VALUES
results to an increase in plasma cells;
Multiple Sclerosis
488
CLINICAL CAUSES OF ABNORMAL CSF PROTEIN VALUES
MULTIPLE SCLEROSIS
results to an increase in ____
plasma cells
489
plasma cells produce ____
immunoglobulins
490
CLINICAL CAUSES OF ABNORMAL CSF PROTEIN VALUES
DECREASED RESULTS
* CSF leakage/trauma
* Recent puncture
* Rapid CSF production
* Water intoxication
491
