30. Body Fluid Examination: The Qualitative, Quantitative, and Morphologic Analysis of Serous, Cerebrospinal, and Synovial Fluids

Question 1

1. A specimen is sent to the laboratory labeled “synovial fluid.”What procedure was used to obtain the specimen?
   a.Thoracentesis
   b.Paracentesis
   c.Arthrocentesis
   d. Lumbar puncture

Answer 1

c.Arthrocentesis

Question 2

2. The presence of MSU crystals is pathognomonic for which disorder?
   a.Pseudogout
   b.Osteoarthritis
   c. Rheumatoid arthritis
   d.Gout

Answer 2

d.Gout

Question 3

3.All of the following are serous fluids except:
a.Synovial
b.Peritoneal
c.Pleural
d.Pericardial

Answer 3

a.Synovial

Question 4

4.The anticoagulant used for hematological body fluid analysis is:
a.Heparin
b.Oxalate
c.EDTA
d.Citrate

Answer 4

c.EDTA

Question 5

Another term for “ascites”is a. Pleural fluid
b.Thoracentesis fluid
c.Peritoncal fluid
d.Pericardial fluid

Answer 5

c.Peritoncal fluid

Question 6

6. The cell typethatforms the lining of the pleural,pericar-dial, and peritoncal cavities is:
   a. Epithclial
   b,Endothelial
   c.Mesothelial
   d.Ependymal

Answer 6

c.Mesothelial

Question 7

7. Which of the following best characterizes a transudate ?

a. Total protein greater than 3.0 g/dL;total WBC less
than 1000/μL

b. Total protein less than 3.0 g/dL;total WBC less than 1000/μL

c. Total protein less than 3.0 g/dL;total WBC greater than 1000/μL

d.Total protein greater than 3.0 g/dL;total WBC greater than 1000/μL

Answer 7

b. Total protein less than 3.0 g/dL;total WBC less than 1000/μL

Question 8

8. A turbid peritoneal fluid is collected from a patient with suspected peritonitis and a cell count is performed. A 1:100 dilution is prepared and 6 cells are counted in each of the 4 WBC corner squares of the hemacytometer chamber.The final WBC count would be:

a.37,500/μL
b.1500/μL
c.150/μL
d.6000/μL

Answer 8

d.6000/μL

Question 9

9. Which of the following is a disadvanage of cytocen-trifugation for the preparation of body fluid slides?

a. Cell differentiation is determined by Wright stain
b.Cell differentiation is done on a concentrated preparation
c.Peripheralization, distortion,and segmentation of nuclei
d.Normal,reactive, and malignant cells can be identified

Answer 9

c.Peripheralization, distortion,and segmentation of nuclei

Question 10

10.Normal CSF contains:
a.Lymphocytes and ependymal cells
b.Ependymal and choroidal cells
c.Mesothelial and ependymal cells
d.Erythrocytes and leukocytes

Answer 10

a.Lymphocytes and ependymal cells

Question 11

11.Match the following gross examination findings of CSF with the appropriate diagnosis:
1.Cloudy and turbid
2.Grossly bloody specimen
3.Xanthochromia
4. Gel formation

a.Increased fibrinogen
b.Subarachnoid hemorrhage
c. Subarachnoid hemorrhage (more than 12 hours after the bleed)
d.Pleocytosis

Answer 11

1.Cloudy and turbid
-> d.Pleocytosis

2.Grossly bloody specimen
->b.Subarachnoid hemorrhage

3.Xanthochromia
->c. Subarachnoid hemorrhage (more than 12 hours after the bleed)

4. Gel formation
   ->a.Increased fibrinogen

Question 12

12.When should a pathologist review a fluid smear?

Answer 12

Whenever any suspicious or inidentifiable cell(s) is (are) seen on the Wright stained slide.

Question 13

13. Differentiate between a traumatic LP and a CNS hemor-rhage. What is xanthochromia?

Answer 13

A traumatic LP contains peripheral blood contaminating the fluid during the collection procedure; centrifugation of the fluid will produce a clear sepernatnant; Bloodiness decreases with succesive tubes collected.
In a true CNS hemorrhage, all tubes will be uniformly bloody; will produce a bloody fluid with a colored supernatant. Xanthochromia is the presence of a pink, orange, or yellow color of the CSF supernatant due to the breakdown of RBCs/hemoglobin.

Question 14

14. What is birefringence? Why is a polarizing microscope necessary when examining synovial fluid for crystals?

Answer 14

Birefringence is the ability of a material to refract light. A polarizing microscope contains filters that align light in one plane so that crystals with birefringent qualities can be detected and identified.

Question 15

15.What types of cells are normally found in synovial fluids?

Answer 15

The cells that are normally present include lymphocytes, monocytes, macrophages, and synovial cells. Neutrophils are also present, but do not exceed 25% of the total nucleated cells present.