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MTAP1: AUBF > CHAPTER 12: SYNOVIAL FLUID > Flashcards

CHAPTER 12: SYNOVIAL FLUID Flashcards

1
Q

Synovial fluid or otherwise known as?

A

Joint fluid

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2
Q

The synovial membrane contains specialized cells called?

A

synoviocytes

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3
Q

These secrete hyaluronic acid & a small amount of protein into the fluid

A

synoviocytes

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4
Q

Damage to the articular membranes produces
pain and stiffness in the joints, collectively referred to as

A

Arthritis

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5
Q

Synovial fluid is collected by needle aspiration called

A

arthrocentesis

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6
Q

In collecting synovial fluid, the barrel of the syringe is?

A

moistened with heparin (fluid)

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7
Q

Why is using powdered anticoagulant not recommended for athrocentesis?

A

because powdered coagulant could interfere during microscopic examinations (false positive for presence of crystals)

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8
Q

What are the main functions of synovial fluid?

A
  • Reduce friction between the bones during joint movement by providing lubrication
  • Provides nutrients to articulating cartilages
  • Lessen shock of joint compression during activities (walking/jogging)
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9
Q

It is the wear & tear of joints; common in elder patients

A

Ostearthritis

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10
Q

It is an arthritis which causes autoimmune disorder

A

Rheumatoid arthritis

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11
Q

What tube type is used for gram stain and culture

A

Sterile heparinized or sodium polyanethol sulfonate (SPS)

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12
Q

What tube type is used for all other tests?

A

Nonanticoagulated

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13
Q

What tube type is used for glucose analysis?

A

Sodium fluoride

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14
Q

What tube type is used for cell counts?

A

Heparin or liquid ethylenediaminetetraacetic acid (EDTA)

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15
Q

What is the normal volume of synovial fluid? But the fluid level can increase to ________ with inflammation

A

<3.5 mL; >25 mL

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16
Q

What is the normal leukocyte count of synovial fluid?

A

<200 cells/ uL

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17
Q

What is the normal color of synovial fluid?

A

Colorless to pale yellow

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18
Q

What is the normal glucose-plasma difference of synovial fluid?

A

<10 mg/dL, lower than the blood glucose level

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19
Q

What is the normal value of crystals of synovial fluid?

A

none present

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20
Q

What is the normal value of the total protein for synovial fluid?

A

<3 g/dL

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21
Q

What is the normal viscosity of synovial fluid?

A

Able to form a string 4 to 6 cm long

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22
Q

What is the normal value of neutrophils for synovial fluid?

A

<25% of the differential

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23
Q

What are the routing laboratory testing done with the synovial fluid?

A
  • WBC Differential count
  • Gram staining and culture
  • Microscopic examination for presence of crystals
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24
Q

Its laboratory findings are: Clear, yellow fluid
Good viscosity
WBCs <1000 L
Neutrophils <30%
Similar to blood glucose.

A

Noninflammatory

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25
Q

Its laboratory findings are:
Cloudy or milky fluid
Low viscosity
WBCs up to 100,000 L
Neutrophils <70%
Decreased glucose level
Crystals present

A

Crystal-induced
origin (Inflammatory)

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26
Q

Its laboratory findings are:
Cloudy, red fluid
Low viscosity
WBCs equal to blood
Neutrophils equal to blood
Normal glucose level

A

Hemorrhagic

27
Q

What are the possible laboratory findings if the joint disorder is immunologic origin (inflammatory)?

A
  • Cloudy, yellow fluid
  • Poor viscosity
  • WBCs 2,000 to 75,000 L
  • Neutrophils >50%
  • Decreased glucose level
  • Possible autoantibodies present
28
Q

What are the possible laboratory findings if the joint disorder is septic?

A
  • Cloudy, yellow-green fluid
  • Variable viscosity
  • WBCs 50,000 to 100,000L
  • Neutrophils >75%
  • Decreased glucose level
  • Positive culture and Gram stain
29
Q

What is the color of the synovial fluid if its hemorrhagic?

A

there’s presence of blood (Determine if from traumatic tap)

30
Q

Its has a greenish tinge commonly due to Pseudomonas aeruginosa

A

Septic

31
Q

If the synovial fluid is deeper yellow in color it is possibly:

A

Non-inflammatory
and inflammatory

32
Q

What are the pathologic significance of a noninflammatory joint disorder?

A

Degenerative joint disorders,
osteoarthritis

33
Q

What is the pathologic significance of a septic joint disorder?

A

Microbial infection

34
Q

What are the pathologic significance of a hemorrhagic joint disorder?

A
  • Traumatic injury
  • tumors
  • hemophilia
  • other coagulation
    disorders
  • Anticoagulant overdose
35
Q

Its pathologic significance are:

Immunologic disorders, rheumatoid arthritis, systemic lupus
erythematosus, scleroderma, polymyositis, ankylosing
spondylitis, rheumatic fever, Lyme arthritis
Crystal-induced gout,
pseudogout

A

Inflammatory

36
Q

Milky synovial fluid could indicate presence of?

A

Cyrstals

37
Q

It comes from the polymerization of the hyaluronic acid and is essential for the proper lubrication of the joints

A

Viscosity

38
Q

This is the test for observing the ability of the synovial fluid to form a string

A

String test

39
Q

Measurement of the amount of hyaluronate polymerization

A

Ropes or mucin clot test

40
Q

Why should counts be performed as soon as possible?

A

To prevent cellular disintegration

41
Q

Clear fluids can usually be counted ________, but dilutions are necessary when fluids are _____ or ______

A

undiluted and turbid or bloody, respectively

42
Q

Differential counts should be performed on ______ preparations or on thinly smeared slides

A

cytocentrifuged

43
Q

Prior to slide preparation, Fluid should be incubated with?

A

hyaluronidase

44
Q

If the synovial fluid is very viscous, it is pretreated by?

A

adding a pinch of hyaluronidase to 0.5 mL
of fluid or one drop of 0.05% hyaluronidase in
phosphate buffer per milliliter of fluid

45
Q

What are the primary cells found in differential count of synovial fluid?

A

Mononuclear cells
(monocytes, macrophages) and synovial tissue
cells

46
Q

It is a macrophage that has phagocytosed one or more neutrophil

A

Reiter cell (center)

47
Q

Also known as RA cells. Has neutrophil-like characteristics w/ dark cytoplasmic granules which contains immune complexes

A

Ragocytes

48
Q

It is associated with Rheumatoid Arthritis & immunologic inflammations

A

Ragocytes

49
Q

What are the primary crystals seen in synovial fluid?

A
  • monosodium urate (uric acid) (MSU) found in
    cases of gout
  • calcium pyrophosphate (CPPD) seen with
    pseudogout
50
Q

This crystal is associated with calcified cartilage degeneration

A

Apatite (basic calcium phosphate)

51
Q

This crystal is found in the synovial fluid following injections

A

corticosteroids

52
Q

This crystal is found in renal dialysis patients

A

calcium oxalate crystals

53
Q

This crystal is associated with chronic inflammation

A

cholesterol crystals

54
Q

What are the possible artifacts that can be found in synovial fluid?

A
  • talcum powder
  • starch from gloves
  • precipitated anticoagulants
  • dust
  • scratches on slides and coverslips
55
Q

Why should crystal examination be performed right after fluid collection?

A

to ensure that crystals are not affected by changes in temperature and pH

56
Q

Fluid must be examined prior to?

A

WBC disintegration

57
Q

For Tube 1: The first 4 to 5 mL of the synovial fluid obtained should be placed into?

A

plain, nonanticoagulated red
tube and observed for clotting

58
Q

For Tube 2: The next 4 to 5 mL is collected into a tube to
which 25 units (U) of?

A

sodium heparin per mL which is then added to an EDTA tube

59
Q

For Tube 3: The last 4 to 5 mL is placed into?

A

a sterile tube to which 25 U per mL heparin is added or to a sodium polyanethol sulfonate (SPS) tube

60
Q

The supernatant of this tube is used for chemical or immunologic analysis.

A

Tube 1

61
Q

Which tube is used for cell count, differential count, and crystal identification

A

Tube 2

62
Q

Which tube is used for microbiological studies?

A

Tube 3

63
Q

Why used you not use fluids that contain acetic acid to dilute synovial fluids?

A

because the acetic acid can cause mucin clot formation and cell
clumping

MTAP1: AUBF (17 decks)

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