BF U2 Flashcards
pleural cavity
lungs
pericardial cavity
heart
peritoneal cavity
abdominal organs
serous fluid
fluids that are an
ultrafiltrate of plasma
fluid formation is controlled by what 4 factors?
permeability in the parietal membrane
hydrostatic pressure
oncotic pressure in plasma proteins
absorption in the lymphatic system
effusion
accumulation of fluid in a cavity and indicates an abnormal or pathologic process
paracentesis
the percutaneous puncture of a body cavity for the
aspiration of fluid
thoracentesis
puncture of the chest wall into the pleural cavity to collect
pleural fluid
pericardiocentesis
puncture of the pericardial cavity to collect pericardial
fluid
peritoneocentesis
puncture of the peritoneal cavity to collect peritoneal
fluid/ascitic fluid
ascites
effusion specifically in the peritoneal cavity
transudates and exudates are classified as what?
pleural and peritoneal effusions
what causes transudates?
increased hydrostatic pressure and decreased oncotic pressure
what diseases are transudates seen in?
CHF, hepatic cirrhosis, nephrotic syndrome
what are some significant characteristics of transudates?
looks clear, pale yellow, and no spontaneous clots, <1000 WBCs/ul
what causes exudates?
increased capillary permeability and decrease lymphatic absorption
what diseases are exudates seen in?
seen in infections, neoplasms, systemic disorders, trauma, and inflammatory conditions
what are some significant characteristics of exudates?
looks yellow/green/red/pink, cloudy, and has spontaneous clots, >1000 WBCs/ul
chyle
emulsion of lymph and chylomicrons
has a milky appearance
chylous effusion
obstruction of or damage to the lymphatic system
has elevated triglyceride levels with present chylomicrons
pseudochylous effusion
has high cholesterol content with a similar appearance to cellular breakdown
has low triglyceride levels with NO chylomicrons
traumatic tap
blood decreases during collection with small clot formation
hemorrhagic effusion
homogenously distributed blood with no clotting
which WBC is predominant in exudates? in effusions caused by TB, neoplasms, and systemic diseases?
neutrophils, lymphocytes
what cells are seen in body fluid differentials?
neutrophils, eosinophils, lymphocytes, monocytes
small amounts of macrophages, mesothelial cells, plasma cells, and malignant cells
which cells indicate that there is a disease?
plasma cells and malignant cells
what are the TP ratio and LD ratio for transudates?
<0.5 and <0.6
what are the TP ratio and LD ratio for exudates?
0.5> and 0.6>
what level of glucose demonstrates an exudative process?
serous fluid of <60 mg/dl and serum fluid of >30 mg/dl
*low glucose levels are significant
what is the triglyceride fluid level that indicates chylous effusion?
110 mg/dl >
what is the triglyceride fluid level that rules out chylous effusion?
< 50 mg/dl
pseudochylous effusion has the presence of what?
cholesterol crystals
what is the fluid-to-serum ratio that indicates pseudochylous effusion?
cholesterol ratio 1.0>
parapneumonic effusions
exudates caused by pneumonia or lung abscess
has abnormally low pH of pleural fluid
what does a pH of <7.3 indicate?
placement of drainage tubes is necessary for resolution of the effusion
what does a pH of 7.3> indicate?
effusion will resolve after antibiotic treatment alone
synovial fluid
present in areas of the skeleton where friction could develop, such as the joints, bursae, and tendon sheaths
synoviocytes
surface of the synovial membrane surrounding the joint consists of numerous microvilli with a layer, 1-3 cells deep of synovial cells
what are the 4 joint disorders?
noninflammatory, inflammatory, septic, and hemorrhagic
group I noninflammatory
volume: 3.5ml >
color: yellow
WBCs: < 3000
associated disease: osteoarthritis
group II inflammatory
volume: 3.5ml >
color: yellow-white
WBCs: 2000 - 100000
associated disease: crystal synovitis - gout and pseudogout
group III septic
volume: 3.5ml >
color: yellow-green
WBCs: 10000-100000
associated disease: bacterial infection
group IV hemorrhagic
volume: 3.5ml >
color: red-brown
WBCs: 5000 >
associated disease: blood disease or tumor trauma
arthrocentesis
percutaneous aspiration of fluid from a joint using aseptic technique
normal volume of synovial fluid in a joint
0.1-3.5ml
what do all tubes examine?
physical features like color, clarity, and viscosity of 1ml
what does tube #1 examine? in which tubes?
chemicals like glucose, lactate, lipids, protein, and uric acid of 1-3ml
all: red top
glucose specific: gray top
what does tube #2 examine? in which tubes?
microscopic elements like total cell count, differentials, and crystals of 2-5ml and cytological studies of 5-50ml
all: sodium heparin
total cell, diffs, crystals: liquid EDTA
what does tube #3 examine? in which tubes?
microbiological studies like cultures of 3-10ml
sterile tube, red top, yellow top, sodium heparin
rice bodies
white free-floating particles made of collagen, seen commonly in RA
ochronotic shards
dark pepperlike particles, pieces of pigmented cartilage
hyaluronate
high concentration of the mucoprotein = high viscosity
hyaluronidase
depolymerizes hyaluronate, which is present in neutrophils and bacteria
what are the normal counts of synovial fluids?
RBC = < 2000
WBC = < 200
differentials = 60% mono, 30% lymphs, 10% neutro
no crystals
MSU crystals
indicates gouty arthritis, looks like a needle with pointy ends, demonstrates a strong negative birefringence
yellow = parallel
blue = perpendicular
CPPD crystals
indicates pseudogout, looks like a blunt needle and rhomboid, demonstrates a weakly positive birefringence
yellow = perpendicular
blue = parallel
birefringence
ability of a substance to refract light and split the incident
light into two rays, a fast and a slow ray
cholesterol crystals
flat, rectangular plates and notched corners with positive birefringence and associated with chronic inflammatory conditions
corticosteroid crystals
seen after intraarticular injection, looks irregular, jagged, serrated and associated with injection of drug in the joint
fasting patients have what glucose P-SF difference?
</= 10 mg/dl
nonfasting patients have what glucose P-SF difference?
10 mg/dl >/=
what has a glucose P-SF of </= 20mg/dl?
noninflammatory or hemorrhagic conditions
what has a glucose P-SF of >20mg/dl?
inflammatory conditions
what has a glucose P-SF of >40mg/dl?
septic conditions
what does increased plasma uric acid level with patient symptoms indicate? what presence leads to the diagnosis of the condition?
presumptive diagnosis of gout, presence of MSU crystals
what organism is the most common cause of septic arthritis?
Staph aureus
second most is Streptococcus
vaginitis
inflammation of the vagina
vulvovaginitis
inflammation of the vulva and vagina or of the vulvovaginal glands
how should vaginal secretions be collected, handled, and stored?
collect from a vaginal fornix and pool with a polyester-tipped/Dacron swab with a plastic shaft, transport ASAP after collection, store at room temp and do not refrigerate
cotton tips are toxic to N. gonorrhea
wooden shafts are toxic to C. trachomatis
refrigeration can recover N. gonorrhea and T. vaginalis
normal vaginal pH
3.8-4.5
pH 4.5> indicates bacterial vaginosis, trichomoniasis, atrophic vaginitis
which bacteria is predominant in a healthy vagina? what do they make?
lactobacilli (makes up 50-90%), they create lactic acid and H2O2
large, nonmotile, GPR
H2O2 maintains balance and prevents proliferation of other bacteria
which blood cell is normal to see? which is not usually seen and when would they be seen?
WBCs are normally seen, RBCs are not, but only during menstruation
what other organism is normally seen? which organism in increased presence is abnormally seen? what does it indicate?
yeast, hyphae or pseudohyphae, indicates candidiasis/yeast infection
what is the purpose of the KOH test? the amine test?
KOH identifies fungal elements, amine will release a fishy odor which indicates bacterial vaginosis
which cell indicates bacterial vaginosis? what do they look like? how much cell surface should it cover?
clue cells, epithelial cells with bearded edges, 75%
what are parabasal cells? basal cells?
reside below the surface of the vaginal mucosa, indicates atrophic vaginitis and desquamative inflammatory vaginitis
derived from the basal layer of the vaginal
epithelium which indicates inflammatory vaginitis
trichomonads
flagellated pear shaped protozoans that infect and cause inflammation of the vaginal epithelium, optimal growth at pH of 6.0
identified by flitting or jerking motion
bacterial vaginosis
most common cause of vaginal infection, important indicator are clue cells which causes complications in pregnant women
significant bacteria: G. vaginalis and Mobiluncus
amine pos
KOH neg
candidiasis
second most common cause of vaginal infection, seen because of contraceptive use, uncontrolled DM, pregnancy, HIV
significant bacteria: C. albicans
amine neg
KOH pos (budding yeast and pseudohyphae)
trichomoniasis
most common parasitic gynecologic infection, known as an STD in both women and men, symptoms are asymptomatic with frothy, malodorous yellow-green discharge
amine pos
atrophic vaginitis
reduced estrogen production with thinning of vaginal epithelium with decrease glycogen production and decreased lactobacilli
amine neg
KOH neg
purpose of fFN test? PAMG-1 test?
fFN aids in IDing women at risk for preterm delivery, lateral flow of >50 ng/ml (before 37 weeks of gestation)
PAMG-1 deals with cervicovaginal secretions consistent with premature rupture of the membranes (PROM), lateral flow of 5 ng/ml
amniotic fluid
liquid medium that bathes a fetus throughout gestation
amnion
membrane composed of a single layer of cuboidal epithelial cells, surrounds the fetus, filled with amniotic fluid
purpose of amniotic fluid? what are some indications for amniocentesis?
enable antenatal diagnosis of genetic and congenital disorders
assess fetal pulmonary maturity
estimate and monitor the degree of fetal anemia caused by isoimmunization or infection
fetal lung maturity and fetal anemia
polyhydramnios
abnormally increased amounts of amniotic fluid, 1200 mL>
indicates congenital fetal malformations
oligohydramnios
abnormally decreased amounts of amniotic fluid, <800 mL
indicates congenital malformation and conditions like PROM
indications for amniocentesis
mother older than 35 years, previous child with chromosomal abnormality, parent carrier of a metabolic disorder, assessed fetal stress or fetal lung maturity
RDS
most common cause of death in the newborn, a primary concern when a preterm delivery is imminent
which presences indicate urine?
no glucose, no protein, high urea, high creatinine
which presences indicate amniotic fluid?
glucose, significant amount of protein, small urea, creatinine levels similar to plasma
what does each color of urine indicate?
pale yellow = normal
yellow/amber = presence of bilirubin
green = presence of meconium (baby’s first poo)
surfactants
prevent alveoli from collapsing during expiration and reduced amount of pressure needed to reopen them during inspiration
what does a mature result indicate?
strong absence of RDS
lamellar bodies
alveolar epithelial cells of the lungs produce and secrete
phospholipids (90%) and proteins (10%)
L/S ratio
what are lecithin and sphingomyelin?
phospholipids required to decrease the surface tension within the alveoli; *assesses the fetal’s lung maturity
L: major pulmonary surfactant
S: phospholipid found in numerous cell membranes
which value of the L/S ratio indicates immaturity? maturity? what are the limitations?
immature = < 2.0
mature = 2.0 >
blood = false decrease of maturity, false increase of immaturity
meconium = unreliable results
phosphatidylglycerol (PG)
phospholipid that enhances the spread of surfactants across the alveolar surface
what do the PG results mean?
negative = immature
low and high positive = mature
lamellar body counts
rapidly and reliably obtained using the PLT channel of an automated hematology cell counter
which value of the LBC indicates immaturity? maturity? what are the limitations?
immature = < 15000
mature = 50000
meconium and mucus = false increase
foam stability index (FSI), what value results in fetal lung maturity?
“shake test,” based on physical characteristics that surfactants impart to amniotic fluid
0.47 >/=
change of A 450
increased RBC destruction occurs and unconjugated bilirubin enters the amniotic fluid
normal amniotic fluid
spectral curve is essentially a straight line that gradually
decreases in absorbance between 365 and 550 nm
amniotic fluid with bilirubin present
detects the amount of bilirubin
increased levels of bilirubin = increased absorbance of the spectral curve at 450 nm
liley chart and the 3 zones
represent the severity of hemolytic disease the fetus is experiencing in utero; used for gestational age of > 27 weeks
zone I = normal, minimally affected fetus
zone II = moderate hemolysis
zone III = severe hemolysis, will die without intervention
queenan chart and the 4 zones
used for gestational age of 14-40 weeks
lowest zone = unaffected or mildly affected fetus
indeterminate and affected zones = increasing severity of fetal anemia
uppermost zone = severe hemolytic disease, high risk for mortality
