7.3 Cerebrospinal, Serous, and Synovial Fluids

Question 1

Cerebrospinal fluid (CSF) is formed by ultrafiltration of plasma through the:

Answer 1

Choroid plexus

Question 2

Which statement regarding CSF is true?

Answer 2

Normal values for mononuclear cells are higher for infants than for adults

Question 3

When collecting CSF, a difference between opening and closing fluid pressure greater than 100 mm H2O indicates:

Answer 3

Low CSF volume

Question 4

Which of the following findings is consistent with a subarachnoid hemorrhage rather than a traumatic tap?

Answer 4

Xanthochromia

Question 5

The term used to denote a high WBC count in the CSF is:

Answer 5

Pleocytosis

Question 6

Which of the adult CSF values in the table below are consistent with bacterial meningitis?

Answer 6

C) 2,000/uL; 5%; 15%; 0%; 80%; 0%

Question 7

Given the following data, determine the corrected CSF WBC count.

Answer 7

142/µL

Question 8

SITUATION: What is the most likely cause of the following CSF results:

CSF glucose 20 mg/dL; CSF protein 200 mg/dL;

CSF lactate 50 mg/dL (reference range 5–25 mg/dL)

Answer 8

Acute bacterial meningitis

Question 9

Which of the following conditions is most often associated with normal CSF glucose and protein?

Answer 9

Viral meningitis

Question 10

The diagnosis of MS is suggested by which finding?

Answer 10

The presence of oligoclonal bands by electrophoresis

Question 11

Which of the following results is consistent with fungal meningitis?

Answer 11

Pleocytosis of mixed cellularity

Question 12

In what suspected condition should a wet prep using a warm slide be examined?

Answer 12

Amoebic meningoencephalitis

Question 13

Which of the following CSF test results is most commonly increased in patients with MS?

Answer 13

IgG index

Question 14

Which of the following is an inappropriate procedure for performing routine CSF analysis?

Answer 14

A differential is done only if the total WBC count is greater than 10/µL

Question 15

Which cell is present in CSF in greater numbers in newborns than in older children or adults?

Answer 15

Monocytes

Question 16

Neutrophilic pleocytosis is usually associated with all of the following except:

A. Cerebral infarction
B. Malignancy
C. Myelography
D. Neurosyphilis

Answer 16

Neurosyphilis

Question 17

Which statement about CSF protein is true?

Answer 17

CSF IgG is increased in panencephalitis, malignancy, and neurosyphilis

Question 18

Which of the following statements regarding routine microbiological examination of CSF is true?

Answer 18

All CSF specimens should be cultured using sheep blood agar, chocolate agar, and supplemented broth

Question 19

Which organism is the most frequent cause of bacterial meningitis in neonates?

Answer 19

Group B Streptococcus

Question 20

Following a head injury, which protein will identify the presence of CSF leakage through the nose?

Answer 20

Tau protein

Question 21

Which of the following statements regarding serous fluids is true?

Answer 21

Mesothelial cells, PMNs, lymphocytes, and macrophages may be present in normal fluids

Question 22

The term effusion refers to:

Answer 22

An increased volume of serous fluid

Question 23

Which of the following laboratory results is characteristic of a transudative fluid?

Answer 23

LD fluid/serum ratio = 0.25

Question 24

Which observation is least useful in distinguishing a hemorrhagic serous fluid from a traumatic tap?

Answer 24

The formation of a clot

Question 25

Which of the following laboratory results on a serous fluid is most likely to be caused by
a traumatic tap?

Answer 25

An RBC count of 8,000/µL

(Normal fluids have a WBC count less than 1,000/µL, but counts between 1,000 and
2,500/µL may be seen in both exudates or transudates)

Question 26

Which of the following conditions is commonly associated with an exudative effusion?

Answer 26

Malignancy

Question 27

Which of the following conditions is associated with a chylous effusion?

Answer 27

Lymphatic obstruction

Question 28

Which of the following conditions is most often associated with a pleural fluid glucose below 30 mg/dL?

Answer 28

Rheumatoid arthritis

Question 29

In which condition is the pleural fluid pH likely to be above 7.3?

Answer 29

Pneumothorax

Question 30

Which of the following hematology values best frames the URLs for peritoneal fluid?

Answer 30

A. 300/μL 25%; 100,000/μL

Question 31

Which of the following characteristics is higher for synovial fluid than for the serous fluids?

Answer 31

Viscosity

Question 32

In which type of arthritis is the synovial WBC count likely to be greater than 50,000/ µL?

Answer 32

Septic arthritis

Question 33

What type of cell is a “ragocyte”?

Answer 33

A PMN with inclusions formed by immune complexes

Question 34

Which of the following crystals is the cause of gout?

Answer 34

Uric acid or monosodium urate

Question 35

Which crystal causes “pseudogout”?

Answer 35

Calcium pyrophosphate

Question 36

A synovial fluid sample is examined by using a polarizing microscope with a red compensating filter. Crystals are seen that are yellow when the long axis of the crystal is parallel to the slow vibrating light. When the long axis of the crystal is perpendicular to the slow vibrating light, the crystals appear blue. What type of crystal is present?

Answer 36

Uric acid

Question 37

In which condition is the synovial fluid glucose most likely to be within normal limits?

Answer 37

Hemorrhagic arthritis

Question 38

Which statement about synovial fluid in RA is true?

Answer 38

Synovial:serum IgG is usually 1:2 or higher

Question 39

Which of the following organisms accounts for the majority of septic arthritis cases in
young and middle-age adults?

Answer 39

Neisseria gonorrhoeae

Question 40

Which of the following hematology values best frames the URLs for synovial fluid?

Answer 40

A. 200/μL 25%; 2,000/μL