Chapter 15 - Serous Fluid

Question 1

The fluid between parietal and visceral membranes

Answer 1

Serous fluid

Question 2

Fxn of serius fluid: to provide ____ between the 2 membranes as the surfaces move against each other

Answer 2

Lubrication

Question 3

Accumulation of fluid bet membranes

Answer 3

Effusion

Question 4

Effusion may be classified as ___ or ____

Answer 4

Exudate or transudate

Question 5

Effusion that is caused by a direct dmg to the membrane of a particular cavity

Answer 5

Exudate

Question 6

Effusion that is caused by a disruption of fluid production and regulation bet membranes

Answer 6

Transudate

Question 7

Transudate may be caused by changes in ____ pressure and ____ pressure

Answer 7

Hydrostatic or oncotic

Question 8

Identify whether the ff are transudate or exudate

1. Congestive heart failure
2. Malignancy
3. Hypoproteinemia
4. Inflammation
5. Nephrotic syndrome
6. Infection
7. Liver cirrhosis
8. Malnutrition
9. Empyema

Answer 8

1. T
2. E
3. T
4. E
5. T
6. E
7. T
8. T
9. E

Question 9

Identify whether the ff transudate have inc oncotic pressure, dec OP, inc hydrostatic pressure or dec HP

1. Congestive heart failure
2. Hypoproteinemia
3. Nephrotic syndrome

Answer 9

1. Dec OP
2. Inc HP
3. Dec OP

Question 10

Transudate vs exudate

1. Appearance
2. Fluid:serum protein ratio
3. Fluid:serum LD ratio
4. WBC ct
5. Spontaneous clotting
6. Pleural fluid chole
7. Pleural fluid:serum chole ratio
8. Pleural fluid:bilirubin ratio
9. Serum-ascites albumin gradient
10. Glucose
11. Protein
12. Rivalta’s test

Answer 10

1. Clear;cloudy
2. <0.5;>0.5
3. <0.6;>0.6
4. <1000/uL;>1000/uL
5. No;possible
6. <45-60;>45-60
7. <0.3;>0.3
8. <0.6;>0.6
9. > /=1.1;<1.1
10. Equal to serum;possible low
11. <3.0;>3.0
12. Neg;pos

Question 11

Other name for rivalta’s test

Answer 11

Serosamucin clot test

Question 12

Positive rxn for Rivalta’s test

Answer 12

Heavy precipitation

Question 13

Recommended test to detect transudate of hepatic origin

Answer 13

SAAG

Question 14

Most reliable tests for diff trans from exu

Answer 14

Fluid:serum protein ratio and fluid:serum LD ratio

Question 15

How to get SAAG value

Answer 15

Serum albumin minus peritoneal fluid albumin

Question 16

SAAG value for transudate

Answer 16

> or = 1.1

Question 17

SAAG value for exudates

Answer 17

<1.1

Question 18

Normal appearance of serous fluid

Answer 18

Clear, pale yellow

Question 19

Method of collection for each of the ff

1. Pleural f
2. Pericardial f
3. Peritoneal fluid / ascitic fluid

Answer 19

1. Thoracentesis
2. Pericardiocentesis
3. Paracentesis

Question 20

Normal volumes of each of the ff:

1. Pleural f
2. Pericardial f
3. Peritoneal f

Answer 20

1. <30mL
2. <50mL
3. <100mL

Question 21

Serous fluid spx is distributed in what tube given the ff purposes:

1. For microbio and cytology
2. For chem
3. For cell counts and differential

Answer 21

1. Sterile heparin or SPS
2. Plain or heparin tubes
3. EDTA

Question 22

Expected appearance/color of the ff pleural fluid conditions

1. Aspergillosis
2. Rupture of amoebic liver abscess
3. Microbial infection (TB)
4. Malignant mesothelioma (inc hyaluronic acid)
5. Chylous material
6. Hemorrhagic effusion
7. Hemothorax
8. Pseudochylous material

Answer 22

1. Black
2. Brown
3. Turbid white
4. Viscous
5. milky
6. Bloody
7. Bloody
8. Milky

Question 23

How to diff chylous effusion and pseudochylous effusion:

1. Cause
2. Appearance
3. Leukocytes
4. Chole crystals
5. Triglycerides
6. Sudan III staining

Answer 23

1. Thoracic duct leakage ; chronic inflammation
2. Milky/white ; milky/green tinge/‘gold paint’
3. Inc lympho ; mixed cells
4. Absent ; present
5. > 110 mg/dL ; <50 mg/dL
6. +++ ; - / weakly +

Question 24

How to diff hemothorax from hemorrhagic effusion based on the ff:

1. Distribution of blood
2. Hematocrit

Answer 24

1. Uneven ; even

2. Pleural fluid hct is > or = 1/2 of whole blood hct ; pleural fluid hct is <1/2 of whole blood hct

Question 25

Identify whether the ff is hemothorax or hemorrhagic effusion 1. WB hct = 50% , PF hct = 25% 2. WB hct = 50% , PF hct = 35% 3. WB hct = 50% , PF hct = 35%

Answer 25

1. Hemothorax 2. Hemothorax 3. Hemorrhagic diffusion

Question 26

Significance of the ff cell in PF 1. Neutrophil 2. Mesothelial cell 3. Plasma cells

Answer 26

1. Pancreatitis (pneumonia, pulmonary infarction) 2. Decreased in TB 3. TB

Question 27

Identify the tumor markers for the ff: 1. Colon cancer 2. Ovarian/metastatic uterine cancer 3. Breast cancer 4. Lung cancer 5. Urinary bladder cancer 6. Breast cancer

Answer 27

1. CEA 2. CA 125 3. CA 15-3, CA 549 4. CYFRA 21-1

Question 28

Significance of testing pleural fluid: 1. Glucose 2. Lactate 3. Trigly 4. pH 5. Adenosine deaminase (ADA) 6. Amylase

Answer 28

1. Dec in rheumatoid inflammation, purulent infection 2. Inc in Bacterial infection 3. Inc in Chylous effusions 4. dec in pneumonia, super dec in esophageal rupture, dec in complicated parapneumonic effusion 5. TB, malignancy 6. Inc in pacreatitis, esophageal rupture, malignancy

Question 29

Pericardial fluid appearance for the ff significances 1. Cardiac puncture 2. Normal, transudate 3. Infection 4. Chylous and pseudochylous material 5. Anticoag medications 6. Malignancy

Answer 29

1. Grossly bloody 2. Clear, pale yellow 3. Blood-streaked 4. Milky 5. Grossly bloody 6. Blood-streaked

Question 30

Appearance of the ff peritonela fluid significances 1. Microbial infection 2. Lymphatic trauma 3. Pancreatic disorders 4. Blockage 5. Trauma 6. Infection 7. Malignancy 8. Gall bladder disorders

Answer 30

1. Turbid 2. Milky 3. Green 4. Milky 5. Blood-streaked 6. Blood-streaked 7. Blood-streaked 8. Green

Question 31

Normal WBC ct in peritoneal fluid

Answer 31

<500 cells/uL

Question 32

Peritoneal lavage containing _____ RBCs/uL indicates blunt trauma injury (intra-abdominal bleeding)

Answer 32

>100,000

Question 33

Contain concentric striations of collagen-like material

Answer 33

Psammoma bodies

Question 34

____ mesothelial cells appear in clusters, have varying amt of cytoplasm, eccentric nuclei, and prominent nucleoli

Answer 34

Reactive

Question 35

_____ mesothelial cells appear as single small or large round cells with abundant blue cytosplasm and round nuclei with uniform dark purple cytoplasm

Answer 35

Normal

Question 36

Pleural fluid neutrophils are ____ (inc or dec) in effusions due to pancreatitis and pulmonary infarction

Answer 36

Inc