4.2.3

Question 1

The most frequent causative organism of septic arthritis is
S. pyogenes.
S. aureus.
Haemophilus influenzae.
• Escherichia coli.

Answer 1

S. aureus.

Question 2

Which of the following classifications of disease processes is paired incorrectly?
Septic-fungal infection
• Hemorrhagic-traumatic arthritis
• Inflammatory-systemic lupus erythematosus
• Noninflammatory-osteoarthritis

Answer 2

Hemorrhagic-traumatic arthritis

Question 3

All of these statements are true with regard to uric acid except
.the uric acid concentration in synovial fluid is equivalent to that of blood plasma.
•a diagnosis of gout can be made based on an increased plasma uric acid level
and the patient’s symptoms.
•the presence of MSU crystals in synovial fluid is diagnostic of gout.
•increased plasma levels of uric acid are required for the diagnosis of gout.

Answer 3

increased plasma levels of uric acid are required for the diagnosis of gout.

Question 4

Which statement is not true with regard to the total protein in synovial fluid?
• The concentration is approximately one-third that of the total protein of blood plasma.
•The total protein level of the synovial fluid is elevated in conditions of increased permeability of the synovial membrane.
• An increase in the total protein level of the synovial fluid is useful for differentiating between rheumatoid arthritis and septic arthritis.
• Increased synthesis within the joint results in an increased total protein concentration.

Answer 4

An increase in the total protein level of the synovial fluid is useful for differentiating between rheumatoid arthritis and septic arthritis.

Question 5

A 38-year-old woman sees her orthopedic physician about fluid buildap on her knee.
The physician aspirates the fluid and puts it into labeled tubes for pickup by the courier in about 1 hour for delivery to the laboratory. The physician has put equal amounts of fluid into which tubes?
1. Red plain
2. EDTA
3. SPS
4. Sodium fluoride
1 and 2
1, 3, and 4
2, 3, and 4
• All of the above

Answer 5

• All of the above

Question 6

The following results are obtained from analysis of a synovial fluid specimen:
• Red-brown fluid of decreased viscosity
• Total leukocyte count of 7000 cells/uL
• Plasma-synovial fluid glucose difference of 10 mg/dL
Based on this information, the specimen most likely reflects which type of condition?
•Noninflammatory
Inflammatory
Septic
Hemorrhagic

Answer 6

Hemorrhagic

Question 7

Which of the following appear as flat, rectangular plates with notched corners and variable birefringence based on the thickness of the crystal?
• Corticosteroid crystals
• Hydroxyapatite crystals
• Cholesterol crystals
• Starch granules

Answer 7

• Cholesterol crystals

Question 8

Which statements about monosodium urate (MSU) crystals and calcium pyrophosphate dehydrate (CPPD) crystals are true?
1. MSU crystals are needlelike and have pointed ends; CPPD crystals are smaller and blunter.
2. MSU crystals appear bright against a black background; CPPD crystals appear weak.
3. MSU crystals are negative birefringent and appear blue when their longitudinal axes are parallel to the axis of the red compensator plate; CPPD crystals are yellow when their longitudinal axes are parallel to the axis of the red compensator plate.
4. MSU crystals and CPPD crystals are present in chronic inflammatory disease.
1 and 2
) 1, 2, and 3

• 1 and 4
All of the above

Answer 8

All of the above

Question 9

Use of direct and compensated polarizing microscopy in the identification of crystals allows for differentiation based on all of the following except
•birefringence against a black background.
) intensity of birefringence.
• positive and negative birefringence.
• diagonal orientation of crystals to the compensator axis.

Answer 9

diagonal orientation of crystals to the compensator axis.

Question 10

The use of liquid EDTA in synovial fluid specimens prevents
1. formation of crystalline structures.
2. bacterial growth.
3. clotting of fibrinogen.
4. enzymatic action of hyaluronidase.
1 and 3
1, 2, and 3
3 and 4
All of the above

Answer 10

1 and 3

Question 11

The differential count on a synovial fluid specimen shows 6% monocytes, 85% neutrophils, and 9% lymphocytes. This count indicates which joint condition?
Parasitic infection
) Bacterial arthritis
Traumatic arthritis
Metastatic carcinoma

Answer 11

) Bacterial arthritis

Question 12

WBC counts of less than 200 WBCs/uL indicate
aseptic inflammation.
gouty arthritis.
) bacterial arthritis.
a normal count.

Answer 12

a normal count

Question 13

Which of the following solutions cannot be used to dilute synovial fluid when it is significantly turbid?
2% acetic acid
Hyaluronidase buffer
0.85% saline
B and C

Answer 13

2% acetic acid

Question 14

Which of the following can result in depolymerization of hyaluronic acid in synovial fluid?
2% acetic acid -
Clostridium perfringens
EDTA
Rice bodies

Answer 14

Clostridium perfringens

Question 15

Which of the following contribute to turbidity of synovial fluid and can be seen upon gross visual examination?
Hyaluronic acid
Rice bodies
Crystals
• WBCs

Answer 15

Rice bodies

Question 16

Upon aspiration of synovial fluid and transfer to the collection tube, small drops of liquid drip slowly from the tip of the syringe, indicating that the viscosity is
normal.
• decreased.
) increased.
equivalent.

Answer 16

decreased.

Question 17

Which pairing of condition with synovial fluid color is incorrect?
• Pale yellow-noninflammatory
• Colorless—normal
•Yellow-white-inflammatory
Red-brown-hemorrhagic

Answer 17

Pale yellow-noninflammatory

Question 18

The technologist receives a turbid synovial fluid specimen from the OR for microscopic examination. Based on clarity of the specimen, he decides to make a dilution prior to performing the cell count. He mixes the specimen well and dilutes it with
) 2% acetic acid.
• hyaluronidase buffer.
hypertonic saline (70%).
Bor C

Answer 18

hyaluronidase buffer.

Question 19

Acceptable transport and analysis conditions of synovial fluid include

•transport on ice; warm to room temperature for analysis.
•transport at room temperature; refrigerate until analyzed, warm to room temperature to analyze.
) transport at 37 °C and place in a 37 °C incubator until analyzed.
• transport and analyze at room temperature.

Answer 19

transport and analyze at room temperature.

Question 20

Which of the three collection tubes for synovial fluid is/are examined for color, clarity, and viscosity and reported out by the technologist?
Tube #1
• Tube #2
• Tube #3
A and B

Answer 20

Tube #2

Question 21

Collection tubes for synovial fluid include all of the following except
red plain.
• citrate.
• EDTA.
) SPS.

Answer 21

citrate.

Question 22

Which synovial fluid test results) allow definitive diagnosis of joint diseases?
1. Bacteria
2. Color
3. Crystals
1 and 2
1 and 3
2 and 3
1, 2, and 3

Answer 22

1 and 3

Question 23

All of these statements are true with regard to synovial fluid except
•it is the sole nutrient source for articular cartilage.
• it is formed by the ultrafiltration of plasma across the synovial membrane. •its glucose, uric acid, and total protein concentrations are equivalent to those of blood plasma.
) it is secreted by synoviocytes.

Answer 23

•its glucose, uric acid, and total protein concentrations are equivalent to those of blood plasma.