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Analysis of Urine and Other Body Fluids > Chapter 14 - Synovial Fluid > Flashcards

Chapter 14 - Synovial Fluid Flashcards

1
Q

Synovial fluid aka

A

Joint fluid

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2
Q

Synovial = Latin word for _____

A

Egg

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3
Q

Synovial fluid circulates in ____

A

Diarthroses (movable joints)

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4
Q

Viscosity of synovial fluid is due to to polymerization of ____

A

Hyaluronic acid

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5
Q

Hyaluronic acid is produced by

A

synoviocytes

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6
Q

Fxns of synovial fluid

A

Lubricates joints, reduce friction between bones, provides nutrients to the articular cartilage, lessen shock of joint compression occurring during activities such as walking and jogging

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7
Q

Method of collection for synovial fluid

A

Arthrocentesis

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8
Q

Normal synovial fluid _______ (does or does not) clot

A

Does not

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9
Q

Normal synovial fluid volume

A

<3.5 mL

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10
Q

Synovial fluid volume during inflammation

A

> 25 mL

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11
Q

In which tube should you place synovial fluid when evaluating chem and immuno

A

Plain red top without anticoag

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12
Q

What tube additive is necessary when testing synovial fluid glucose?

A

Sodium fluoride

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13
Q

In which tube should you place synovial fluid when you need to perform microscopic exam?

A

Sodium heparin / liquid EDTA

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14
Q

In which tube should you place synovial fluid when testing for hema or cell count?

A

Sodium heparin or liquid EDTA

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15
Q

Do NOT use _____ and _____ in tubes bec they interfere w/ crystal ID

A

Powdered anticoag and lithium heparin

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16
Q

Tube used for microbio studies (GS and culture)

A

Sterile anticoag tube (heparin or SPS)

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17
Q

Normal synovial fluid appearance

A

Colorless to pale yellow

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18
Q

Appearance of synovial fluid during inflammation

A

Deeper yellow

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19
Q

Appearance of synovial fluid in bacterial inf

A

Greenish tinge

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20
Q

Appearance of synovial fluid during Traumatic tap or hemorrhagic arthritis

A

Red

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21
Q

Appearance of synovial fluid during inc wbcs, synovial cell debris or fibrin

A

Turbid

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22
Q

Appearance of synovial fluid during presence of crystals

A

Milky

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23
Q

Normal synovial fluid viscosity

A

Forms a string that is 4-6 cm long

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24
Q

Normal hyaluronic level

A

0.3 to 0.4 g/dL

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25
Test for synovial fluid viscosity
Ropes or Mucin clot test or Hyaluronate polymerization test
26
Rgt of Ropes or Mucin clot test or Hyaluronate polymerization test
2-5% acetic acid
27
In Ropes test, as the ability of the hyaluronate to polymerize ____ (inc or dec), the clot become less firm
Decreases
28
Identify grading in hyaluronate polymerization test 1. Friable clot 2. No clot 3. Solid clot 4. Soft clot
1. Low 2. Poor 3. Good 4. Fair
29
Used to identify a questionable fluid as a synovial fluid
Formation of mucin clot after addig acetic acid
30
Most freq performed count in synovial fluid
WBC count
31
Diluting fluids for synovial fluid Wbc count
NSS w/ methylene blue, hypotonic saline (0.3%), saline w/ saponin
32
Wbc count of synovial fluid, for very viscous fluid, add a pinch of _____ to _____ fluid
Hyaluronidase; 0.5 mL
33
For very viscous fluid (wbc ct of synovial fluid) add ____ (how much) of _____ in phosphate buffer per mL of fluid
1 drop; 0.05% hyaluronidase
34
For very viscous fluid (wbc ct of synovial fluid) after adding hyaluronidase, incubate at ___(temp) for ____(how long)
37 deg C; 5 mins
35
Normal value of rbc in synovial fluid
< 2000/uL (in Turgeon, it should be absent)
36
Normal value of wbc in synovial fluid
< 200 / uL
37
Wbc diff for synovial fluid ___% mono and macro ___% neutro ___% lympho
65% <25% <15%
38
Polymorphonuclear leukocyte seen in bacterial sepsis & crystal induced inflammation
Neutro
39
Mononuclear lympho seen in nonseptic inflammation
Lympho
40
Large mononuclear leukocyte, may be vacuolated seen normally or during viral infxn
Macrophage / monocyte
41
Neutrophil containing ingested “round body”
LE cell
42
Vacuolated macrophage w/ ingested neutro seen in Reiter syndrome and reactive arthritis
Reiter cell
43
Neutrophil w/ dark cytoplasmic granules containing immune complexes present in RA and immunologic inflammation
RA cell / ragocyte
44
Macroscopically resemble polished rice, microscopically show collagen and fibrin present in TB, septic and rheumatoid arthritis
Rice bodies
45
Debris from metal and plastic joint prosthesis, ground pepper appearance, present in onchronotic arthropathy, alkaptonuria, ochronosis
Onchronotic shards
46
Large, multinucleated cells present in osteoarthritis
Cartilage cells
47
Similar to macrophage but may be multinucleated resembling a mesothelial cell normally present or disruption from arthrocentesis
Synovial lining cell
48
Refractile intravellular and extracellular globules stained w/ Sudan dyes present in traumatic injury and chronic inflammation
Fat droplets
49
Inclusions within clusters of synovial cells present in pigmented villonodular synovitis
Hemosiderin
50
Causes of crystal formation
Metabolic disorders, decreased renal excretion that produce increased blood levels of crystallizing chemicals, degeneration of cartilage and bones, injection of medications (corticosteroid)
51
Identify the ff crystals in synovial fluid: 1. Rhombic square, rods 2. Envelopes 3. Notched, rhombic plates 4. Needles 5. Small particles; requires electron microscopy 6. Flat, variable-shaped plates
1. Calcium pyrophosphate 2. Calcium oxalate 3. Cholesterol 4. Monosodium urates 5. Apatite (calcium phosphate) 6. Corticosteroid
52
Identify the crystals described by their significance 1. gout 2. Pseudogout 3. Injections 4. Osteoarthritis 5. Extracellular 6. Renal dialysis
1. Monosodium urate 2. Calcium pyrophosphate 3. Corticosteroid 4. Apatite (calcium phosphate) 5. Cholesterol 6. Calcium oxalate
53
Identify whether the ff crystals produce positive or negative birefringence 1. Monosodium urate 2. Corticosteroid 3. Apatite 4. Calcium pyrophosphate 5. Cholesterol 6. Calcium oxalate
1. Neg 2. Pos or neg 3. None 4. Pos 5. Neg 6. Neg
54
Microscope that detects for the presence or absence of birefringence
Polarizing microscope
55
Type of microscope that confirma the type of birefringence (positive or negative BR)
Compensated polarizing microscope
56
Regarding compensated polarizing microscope, the _____ (color) compensator is placed between crystal & analyzer
Red
57
The molecules in the CPPD crystals run ______ to the long axis of the crystal, when aligned w/ the slow axis of compensator, the velocity of fast light passing through the crystal is much quicker, producing _____ color & _____ birefringence
Perpendicular; blue; positive
58
The molecules of MSU crystals run _____ to the long axis of the crystal & when aligned w/ the slow vibration, the velocity of slow light passing through the crystal is not impeded as much as the fast light, which runs against the grain & produces ____ color. This is a ____ birefringence.
Parallel, yellow, negative
59
Most frequently tested chem test for synovial fluid
Glucose
60
A px with synovial fluid glucose of 90 mg/dL and FBS of 99 mg/dL have _____
Normal synovial fluid glucose
61
A px with synovial fluid glucose of 40 mg/dL and FBS of 99 mg/dL have _____
The px have infection
62
Normal value for synovial fluid glucose
Blood glucose minus SF glucose should be <10 mg/dL
63
Normal lactate value in SF
<250 mg/dL
64
Normal protein value in SF
<3 g/dL
65
Normal uric acid value in SF
Same as blood uric acid
66
Predominant, common organism that infect SF
S. aureus
67
Bacteria that can cause SF infxn
S. aureus, Streptococcus, Haemophilus, N. gonorrheae
68
Sero test for SF include
AutoAb detection (SLE, RA), detection of Ab to Borrelia burgdorferi (Lyme dse)
69
Identify which group of joint disorders do the ff belong: 1. Gout 2. Traumatic injury 3. Microbial infection 4. Degenerative joint disorders 5. Immunologic disorders 6. Osteoarthritis 7. RA 8. Pseudogout 9. Coagulation deficiencies 10. SLE
1. IIb 2. IV 3. III 4. I 5. IIa 6. I 7. IIa 8. IIb 9. IV 10. IIa
70
Color & clarity expected from each of the ff: 1. Non-inflammatory 2. Type IIa 3. Type IIb 4. Septic 5. Type IV
1. Clear, yellow fluid 2. Cloudy, yellow fluid 3. Cloudy, or milky fluid 4. Cloudy, yellow-green fluid 5. Cloudy, red fluid
71
expected viscosity from each of the ff: 1. Type I 2. Inflammatory (crystal-induced) 3. Inflammatory (immunologic) 4. Type III 5. Hemorrhagic
1. Good 2. Low 3. Poor 4. Variable 5. Low
72
Spx for crystal analysis should not be ____
Refrigerated
73
Arthritis _____ (increases or decreases) SF viscosity
Dec
74
A control slide for polarization properties of MSU can be prepared using _____
Betamethasone acetate corticosteroid

Analysis of Urine and Other Body Fluids (18 decks)

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