Body Fluids

Question 1

Transudate

Answer 1

Accumulation of fluid due to filtration across an intact vascular wall due to pressure differences. CHF, Hepatic cirrhosis, nephrotic syndrome.

Question 2

Exudate

Answer 2

Accumulation of fluid due to inflammation and vascular wall damage. Infection, malignancy, inflammatory disorders. Contains more protein, WBC, LDH and less glucose.

Question 3

Triglycerides/cholesterol in an effusion

Answer 3

Chylous. Due to lymphoma, trauma or recent surgery.

Question 4

Amylase in an effusion

Answer 4

Esophageal rupture, pancreatitis, malignancy, metastasis, bowel perforation.

Question 5

CEA

Answer 5

Carcinoembryonic antigen seen in patients with a CEA producing tumor.

Question 6

Contents of normal serous fluid

Answer 6

Lymphocytes, monocytes, macrophages, mesothial lining cells.

Question 7

Contents of diseased state fluid

Answer 7

Neutrophils, eosinophils and RBCs

Question 8

Transudative Pleural effusion Etiology

Answer 8

CHF, Cirrhosis, Nephrosis.

Question 9

Exudative Pleural effusion Etiology

Answer 9

Parapneumonic: Bacterial pneumonia, lung abscess, bronchiectasis. Malignant: lung cancer, breast cancer, lymphoma.

Question 10

Hemothorax lab findings

Answer 10

RBC > 100,000 or Hct of >50%. Caused by trauma, malignancy or PE.

Question 11

Empyema definition

Answer 11

Pus within the pleural space. WBC > 50,000-100,000. Neutrophils, lymphocytes, eosinophilia.

Question 12

Empyema etiology

Answer 12

Infection, inflammation, neoplasm, TB, collagen vascular disease.

Question 13

Pleural fluid with pH

Answer 13

Infection, neoplasm, esophageal rupture.

Question 14

Pleural fluid with glucose

Answer 14

Infection

Question 15

Pleural fluid with amylase

Answer 15

pancreatitis, esophageal rupture

Question 16

Chylous Pleural fluid

Answer 16

Trauma, neoplasm, obstructed lymphatics

Question 17

Light’s Criteria

Answer 17

Determine is pleural effusion is an exudate. If any of these are true:
Protein/serum protein: >0.5
LDH/Serum LDH: > 0.6
LDH > 2/3 of the upper limit of normal serum LDH

Question 18

Thoracentesis Indications

Answer 18

The fluid layers out >25mm on lateral decubitus, it is loculated, associated with thickened parietal pleura, clearly delineated on ultrasound.

Question 19

Pericardial effusion etiologies

Answer 19

Acute pericarditis, autoimmune disorder, post-MI, Post-cardiac surgery, sharp/blunt trauma, malignancy, mediastinal radiation, renal failure, Myxedema, aortic dissection.

Question 20

Pericardial effusion work up

Answer 20

CBC/CMP, chem profile, renal function, thyroid function, ANA.

Question 21

Ascites etiologies

Answer 21

Hepatic cirrhosis, malignancy, CHF, TB, dialysis, pancreatic disease, nephrotic syndrome, severe malnutrition.

Question 22

Ascites Imaging

Answer 22

Ultrasound is the gold standard.

Question 23

Paracentesis indications

Answer 23

New onset, Fever, Abdominal tenderness, ALOC, recurrent ascites in the hospital, hypotension, peripheral leukocytosis, worsening renal function, GI bleed.

Question 24

SAAG Classification

Answer 24

Serum-to-ascites albumin gradient. SAAG=Serum albumin-ascitic fluid albumin.

Question 25

SAAG Greater than 1.1

Answer 25

Transudative. Portal hypertension. Cirrhosis, alcoholic hepatitis, CHF, liver mets, portal vein thrombosis.

Question 26

SAAG Less than 1.1

Answer 26

Exudative. Peritoneal carcinomatosis, peritoneal TB, pancreatic ascites, biliary ascites, nephrotic syndrome, bowel obstruction/infarction.

Question 27

Ascitic Fluid with WBC

Answer 27

Uncomplicated cirrhosis

Question 28

Ascitic Fluid with WBC > 500

Answer 28

Spontaneous bacterial peritonitis, TB, carcinomatosis, inflammation.

Question 29

Spontaneous Bacterial peritonitis

Answer 29

Occurs with cirrhosis and ascites. No obvious source of infection. Presents with fever, chills, abdominal pain, rebound tenderness. WBC > 500 with >50% neutrophils. Treated with antibiotics.

Question 30

Decreased CSF pressure

Answer 30

Hypovolemia, chronic CSF leak.

Question 31

Increased CSF pressure

Answer 31

infection, bleeding, tumor.

Question 32

Large difference in opening/closing CSF pressure

Answer 32

Spinal cord obstruction

Question 33

Indications for CT before lumbar puncture

Answer 33

Immunocompromised, history of CNS disease, new onset of seizures, papilledema, ALOC, focal neuro deficit.

Question 34

Subarachnoid bleeding findings

Answer 34

CSF pressure is high, Bloody draw throughout LP, repeat LP is bloody.

Question 35

Neutrophils in the CSF

Answer 35

Bacerial or TB meningitis, cerebral abscess, subarachnoid bleeding, tumor.

Question 36

Lymphocytes in the CSF

Answer 36

Vrial/TB/Fungal/syohilitic meningitis or multiple sclerosis

Question 37

Eosinophils in the CSF

Answer 37

Parasitic meningitis, allergic reaction to radiopaque dyes.

Question 38

Macrophages in the CSF

Answer 38

TB/Fungal meningitis, hemorrhage, brain infarction.

Question 39

1 WBC per 500 RBC in the CSF

Answer 39

Infection or meningitis

Question 40

Xanthochromia

Answer 40

Yellow discoloration of the CSF due to bilirubin from lysed RBC. Presents in 12 hours of subarachnoid hemorrhage

Question 41

Increased Glucose in the CSF

Answer 41

Bacterial/fungal meningitis or hyperglycemia

Question 42

Increased protein in the CSF

Answer 42

Bleeding, hemolysis, infection.

Question 43

Multiple sclerosis findings

Answer 43

Oligo clonal bands with myelin basic proteins.

Question 44

Meningitis presentation

Answer 44

AMS, nuchal rigidity, fever. Can also present with N/V, photophobia, petechial rash. CSF culture is the gold standard. PCR for HSV type 1, EBV, enterovirus.

Question 45

Common Gram positive Cocci

Answer 45

Staph and Strep

Question 46

Common Gram positive Bacilli

Answer 46

Bacilus anthracis, clostridium, corynebacterium, listeria monocytogenes.

Question 47

Common Gram negative Cocci

Answer 47

Neisseria, M. catarrhalis.

Question 48

Common Gram negative bacilli

Answer 48

H. influ, psuedomonas, pertussis, Gardnerella vaginalis, legionellas, E. coli, campylobacter, shigella, salmonella, vibrio cholera.

Question 49

Tzank prep

Answer 49

Giemsa/wright stain. Show the presence of multinucleated giant cells with HSV infection.

Question 50

India Ink

Answer 50

Cryptococcus. Shows round, encapsulated, yeast organisms.

Question 51

Syphilis Identification

Answer 51

Dark field microscopy: Corkscrew shaped organism Direct immunoflourescent antibody testing: ID T. Pallidum Serologic testing: VDRL in the CSF

Question 52

Coccidiomycosis Identification

Answer 52

Direct examination will show mature spherules with endospores. Sputum culture to detect IgM and IgG responses.

Question 53

Infection

Answer 53

Invasion of normally sterile tissue

Question 54

Bacteremia

Answer 54

Presence of organisms that can be cultured from the blood.

Question 55

Sepsis

Answer 55

Presence of infection with systemic manifestations

Question 56

Septic Shock

Answer 56

Impaired organ perfusion due to sepsis. Often due to MRSA, Staph, Strp, E. coli, Enterobacter, psudomonas.

Question 57

Risk Factors for sepsis

Answer 57

Bacteremia, older than 65, immunosuppression, DM, malignancy, CAP, previous hospitalizations.

Question 58

Sepsis presentation

Answer 58

Fever, Tachycardia, Tachypnea, AMS, Significant edema

Question 59

Sepsis labs

Answer 59

WBC greater than 12,000 or less than 4,000. Increased CRP, hyperglycemia, Cr>0.5, thrombocytopenia.

Question 60

Severe sepsis presentation

Answer 60

Organ dysfunction, Ileus, decreased capillary refill, hypotension, decreased pulmonary function, oliguria.

Question 61

Severe sepsis labs

Answer 61

Increased lactate, decreased urinary output, Cr >2, Bili>4, dcreased platelets, INR >1.5.