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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
Q

Test for synovial fluid viscosity

A

Ropes or Mucin clot test or Hyaluronate polymerization test

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26
Q

Rgt of Ropes or Mucin clot test or Hyaluronate polymerization test

A

2-5% acetic acid

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27
Q

In Ropes test, as the ability of the hyaluronate to polymerize ____ (inc or dec), the clot become less firm

A

Decreases

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28
Q

Identify grading in hyaluronate polymerization test

  1. Friable clot
  2. No clot
  3. Solid clot
  4. Soft clot
A
  1. Low
  2. Poor
  3. Good
  4. Fair
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29
Q

Used to identify a questionable fluid as a synovial fluid

A

Formation of mucin clot after addig acetic acid

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30
Q

Most freq performed count in synovial fluid

A

WBC count

31
Q

Diluting fluids for synovial fluid Wbc count

A

NSS w/ methylene blue, hypotonic saline (0.3%), saline w/ saponin

32
Q

Wbc count of synovial fluid, for very viscous fluid, add a pinch of _____ to _____ fluid

A

Hyaluronidase; 0.5 mL

33
Q

For very viscous fluid (wbc ct of synovial fluid) add ____ (how much) of _____ in phosphate buffer per mL of fluid

A

1 drop; 0.05% hyaluronidase

34
Q

For very viscous fluid (wbc ct of synovial fluid) after adding hyaluronidase, incubate at ___(temp) for ____(how long)

A

37 deg C; 5 mins

35
Q

Normal value of rbc in synovial fluid

A

< 2000/uL (in Turgeon, it should be absent)

36
Q

Normal value of wbc in synovial fluid

A

< 200 / uL

37
Q

Wbc diff for synovial fluid

___% mono and macro
___% neutro
___% lympho

A

65%
<25%
<15%

38
Q

Polymorphonuclear leukocyte seen in bacterial sepsis & crystal induced inflammation

A

Neutro

39
Q

Mononuclear lympho seen in nonseptic inflammation

A

Lympho

40
Q

Large mononuclear leukocyte, may be vacuolated seen normally or during viral infxn

A

Macrophage / monocyte

41
Q

Neutrophil containing ingested “round body”

A

LE cell

42
Q

Vacuolated macrophage w/ ingested neutro seen in Reiter syndrome and reactive arthritis

A

Reiter cell

43
Q

Neutrophil w/ dark cytoplasmic granules containing immune complexes present in RA and immunologic inflammation

A

RA cell / ragocyte

44
Q

Macroscopically resemble polished rice, microscopically show collagen and fibrin present in TB, septic and rheumatoid arthritis

A

Rice bodies

45
Q

Debris from metal and plastic joint prosthesis, ground pepper appearance, present in onchronotic arthropathy, alkaptonuria, ochronosis

A

Onchronotic shards

46
Q

Large, multinucleated cells present in osteoarthritis

A

Cartilage cells

47
Q

Similar to macrophage but may be multinucleated resembling a mesothelial cell normally present or disruption from arthrocentesis

A

Synovial lining cell

48
Q

Refractile intravellular and extracellular globules stained w/ Sudan dyes present in traumatic injury and chronic inflammation

A

Fat droplets

49
Q

Inclusions within clusters of synovial cells present in pigmented villonodular synovitis

A

Hemosiderin

50
Q

Causes of crystal formation

A

Metabolic disorders, decreased renal excretion that produce increased blood levels of crystallizing chemicals, degeneration of cartilage and bones, injection of medications (corticosteroid)

51
Q

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
A
  1. Calcium pyrophosphate
  2. Calcium oxalate
  3. Cholesterol
  4. Monosodium urates
  5. Apatite (calcium phosphate)
  6. Corticosteroid
52
Q

Identify the crystals described by their significance

  1. gout
  2. Pseudogout
  3. Injections
  4. Osteoarthritis
  5. Extracellular
  6. Renal dialysis
A
  1. Monosodium urate
  2. Calcium pyrophosphate
  3. Corticosteroid
  4. Apatite (calcium phosphate)
  5. Cholesterol
  6. Calcium oxalate
53
Q

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
A
  1. Neg
  2. Pos or neg
  3. None
  4. Pos
  5. Neg
  6. Neg
54
Q

Microscope that detects for the presence or absence of birefringence

A

Polarizing microscope

55
Q

Type of microscope that confirma the type of birefringence (positive or negative BR)

A

Compensated polarizing microscope

56
Q

Regarding compensated polarizing microscope, the _____ (color) compensator is placed between crystal & analyzer

A

Red

57
Q

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

A

Perpendicular; blue; positive

58
Q

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.

A

Parallel, yellow, negative

59
Q

Most frequently tested chem test for synovial fluid

A

Glucose

60
Q

A px with synovial fluid glucose of 90 mg/dL and FBS of 99 mg/dL have _____

A

Normal synovial fluid glucose

61
Q

A px with synovial fluid glucose of 40 mg/dL and FBS of 99 mg/dL have _____

A

The px have infection

62
Q

Normal value for synovial fluid glucose

A

Blood glucose minus SF glucose should be <10 mg/dL

63
Q

Normal lactate value in SF

A

<250 mg/dL

64
Q

Normal protein value in SF

A

<3 g/dL

65
Q

Normal uric acid value in SF

A

Same as blood uric acid

66
Q

Predominant, common organism that infect SF

A

S. aureus

67
Q

Bacteria that can cause SF infxn

A

S. aureus, Streptococcus, Haemophilus, N. gonorrheae

68
Q

Sero test for SF include

A

AutoAb detection (SLE, RA), detection of Ab to Borrelia burgdorferi (Lyme dse)

69
Q

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
A
  1. IIb
  2. IV
  3. III
  4. I
  5. IIa
  6. I
  7. IIa
  8. IIb
  9. IV
  10. IIa
70
Q

Color & clarity expected from each of the ff:

  1. Non-inflammatory
  2. Type IIa
  3. Type IIb
  4. Septic
  5. Type IV
A
  1. Clear, yellow fluid
  2. Cloudy, yellow fluid
  3. Cloudy, or milky fluid
  4. Cloudy, yellow-green fluid
  5. Cloudy, red fluid
71
Q

expected viscosity from each of the ff:

  1. Type I
  2. Inflammatory (crystal-induced)
  3. Inflammatory (immunologic)
  4. Type III
  5. Hemorrhagic
A
  1. Good
  2. Low
  3. Poor
  4. Variable
  5. Low
72
Q

Spx for crystal analysis should not be ____

A

Refrigerated

73
Q

Arthritis _____ (increases or decreases) SF viscosity

A

Dec

74
Q

A control slide for polarization properties of MSU can be prepared using _____

A

Betamethasone acetate corticosteroid

Analysis of Urine and Other Body Fluids (18 decks)

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