Body Fluids: CSF,Pleural,Ascites,Synovial

Question 1

CSF: Pink Xanthochromia indicates what?

Answer 1

Free hemoglobin

-Subarachnoid hemorrhage

Question 2

CSF: Yellow Xanthochromia indicates what?

Answer 2

Bilirubin derived from Hg metabolism

Question 3

Following a CNS bleed, when is yellow xanthochromia seen?

Answer 3

12 hours
-Peaks at 72 hours
Disappears in 2-4 weeks

Question 4

What two findings provide evidence of a truly bloody spinal tap?

Answer 4

• Erythrophagocytosis

- Hemosierin laden macrophages

Question 5

What is the normal CSF protein level?

Answer 5

15-45 mg/dL

Question 6

When the blood brain barrier is intact, what is the CSF:Serum Albumin ratio?

Answer 6

<1:230

Question 7

What is the Light Criteria (Transudative Vs Exudative Pleural Effusion)?

Answer 7

Transudative Vs Exudative Pleural Effusion:

• Pleural fluid: Serum protein ratio >0.5
• Pleural fluid: Serum LD ratio >0.6
• Pleural fluid >2/3 of the upper limit of normal for serum LD

*Presence of any criterion = Exudate

Question 8

What usually causes Transudative pleural effusion? (3)

Answer 8

• Congestive Heart Failure
• Cirrhosis
• Nephrotic syndrome

Question 9

What causes Exudative pleural effusions?

Answer 9

Essentially everything EXCEPT:

• CHF
• Cirrhosis
• Nephrotic syndrome

Question 10

Chylous effusions (chylothorax) are caused by what?

Answer 10

Lymphatic (thoracic duct) obstruction

Question 11

Pseudochylous effusions are caused be what?

Answer 11

Gradual accumulation of lipids from cellular breakdown:

• TB
• Rheumatoid
• Myxedema

Question 12

Chylous Vs. Pseudochylous Effusions:

-Triglycerides

Answer 12

Triglycerides:

• Chylous - >110 mg/dL
• Psuedochylous - <50 mg/dL

Question 13

Chylous Vs. Pseudochylous Effusions:

-Chylomicrons (by electrophoresis)

Answer 13

Chylomicrons (by electrophoresis):

• Chylous - PRESENT
• Psuedochylous - Absent

Question 14

What is true regarding Pleural Effusions caused by CHF?

• Treated effect
• Location/Size

Answer 14

• Transudate may be “converted” to Exudate following treatment
• Larger, or confined to RIGHT Hemithorax

Question 15

What is elevated in TB associated pleural effusions?

Answer 15

Adenosine Deaminase (ADA)

Question 16

What % of PEs are asociated with pleural effusions?

Answer 16

50%

Question 17

In what conditions are Mesothelial cells conspicuously decreased or absent in pleural fluid microscopy? (3)

Answer 17

• Rheumatoid pleuritis
• TB pleuritis
• Postpleurodesis pleuritis

Question 18

What cells may be found in pleural fluid if there has been prior instrumentation or introduction of air into the pleural space?

Answer 18

Eosinophils

Question 19

What is the most useful index for distinguishing portal HTN related ascites from others?

Answer 19

Serum Ascites Albumin gradient

-Difference between the albumin measured in serum and that mesured in ascites fluid

Question 20

In portal HTN, what is the serum Ascites Albumin concentration?

Answer 20

> 1.1 g/dL

Question 21

What is the synovial fluid chemistry pattern in Septic Arthritis?

• Glucose
• pH
• Lactate

*Similar findings seen in what conditions?

Answer 21

• Glucose - Low
• pH - Low (Acidic)
• Lactate - High

*RA and Gout

Question 22

What crystals are found in Gout?

Answer 22

Monosodium Urate crystals

Question 23

Gout (monosodium urate) crystal morphology. (3)

Answer 23

• Needle shaped Rods
• 2-20 um in length
• Negative Birefringence (Strong)

Question 24

What does Negative Birefringence mean?

*GOUT

Answer 24

Crystal appears Yellow when Parallel to compensator

-Blue when perpendicular

Question 25

What crystals are seen in Pseudogout?

Answer 25

Calcium Pyrophosphate crystals

Question 26

Calcium Pyrophosphate Deposition Disease (Pseudogout) crystal morphology. (3)

Answer 26

• Rods/Rhomboids
• 2-20 um
• Positive Birefringence (Weak)

Question 27

What does Positive Birefringence mean?

*Pseudogout

Answer 27

Crystal appears Blue when Parallel to compensator

-Yellow when perpendicular