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Clinical Laboratory Medicine > Evaluation of Body Fluids > Flashcards

Evaluation of Body Fluids Flashcards

1
Q

this is used to visualize HSV with lesion scrapings and Giemsa or Wright stains.

A

Tzank Prep

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2
Q

This is used to visualize yeast via skin scrapings under low power microscopy…

A

KOH prep

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3
Q

the presence of multinucleated giant cells on tzank prep indicates…

A

HSV

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4
Q

What test is used to visualize cryptococci in CSF?

A

india ink

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5
Q

What type of microscopy can be useful in identifying T. Pallidum (syphilis)

A

dark field microscopy

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6
Q

VDRL (CSF) and RPR (serum) are tests that can detect…

A

syphilis

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7
Q

This microbiologic tests:

  • detects specific Abs/Antigens
  • CSF for meningococcal capsular antigen
A

latex agglutination assay

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8
Q

This microbiologic tests:

detects Abs in serum

used for multiple body fluids

needs immune response, which can take up to 2 weeks

A

ELISA

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9
Q

This microbiologic tests:

detects Abs in serum or other body fluid

Primary test for ANA Abs

A

IFA

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10
Q

This microbiologic tests:

detects small quantities of DNA/RNA

serum, CSF, other fluids used

Faster than ELISA

A

PCR (NAAT)

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11
Q

This microbiologic tests:

specific for TB, rapid inexpensive

less sensitive than NAAT

A

AFB stain

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12
Q

This is the lowest concentration of Abx necessary to inhibit visible growth of specific organism..

A

minimum inhibitory concentration (MIC)

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13
Q

This test should be taken twice in at least two different sites, not from the IV

A

blood culture

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14
Q

When should a blood culture be drawn in reference to tx?

A

before abx

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15
Q

The following indicate what protocol for taking blood cultures?

staph bacteremia

endocarditis

difficult antimicrobial penetration

persistent leukocytosis

prosthetic vascular graft, ICD

resistance

unknown bacteremia

A

repeat blood cx, 48 hrs

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16
Q

Two types of effusion…

A

transudate, exudate

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17
Q

What type of effusion?

  • vascular wall intact
  • result of pressure differences
  • caused by CHF, liver cirrhosis, nephrotic syndrome
  • fluid doesn’t need testing
A

transudative

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18
Q

What type of effusion?

  • result of vascular wall damage
  • malignancy, infx, inflammatory disorder, trauma
  • requires testing of fluid
A

exudative

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19
Q

What type of fluid?

50 ml

clear, serous, light yellow

no RBCs

WBCs < 300

A

pleural fluid

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20
Q

Bacterial PNA, lung abscess and bronchiectasis are the MC cause of exudative pleural effusion. This type of effusion is known as…

A

parapneumonic

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21
Q

what is the second most common cause of pleural effusion?

A

CA: lung, breast, lymphoma

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22
Q

RBCs > 100,000 and serosanguinous appearance of exudative pleural effusion is called…

A

hemothorax

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23
Q

What type of exudative pleural effusion?

  • can be pleural or peritoneal
  • secondary to lymphatic duct disruption
  • cloudy, milky appearance
  • TGs and lipids
A

chylous effusion

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24
Q

What are two common causes of chylous effusion?

A

trauma

malignancy (lymphoma

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25
This procedure... - tx for transudative or exudative - therapeutic use to relieve pain/dyspnea, allows better lung radiograph - diagnostic use to ID infx, inflammatory, malignant process
throacentesis
26
What imaging can help identify pleural fluid and aid in thoracentesis?
CXR (incl lateral decubitus) US contrast CT
27
What should be done with a parapneumonic effusion with the following criteria? - layers > 25mm on lateral decubitus - loculated - thickened parietal pleura on CT - delineated by US
sample
28
potential contraindication for thoracentesis..
thrombocytopenia
29
What are two important considerations to lower risk of re-expansion pulmonary edema in thoracentesis?
dont remove > 1L don't perform bilaterally
30
Transudate or exudate? - totat PROT < 3g - prot fluid/prot serum ratio < 0.5 - LDH fluid/LDH serum ratio < 0.6 - clear thin fluid - equal glucose and amylase between fluids - pH 7.4-7.5
transudate
31
Transudate or exudate? - total prot > 3 g - protein fluid/protein serum > 0.5 - LDH fluid/LDH serum > 0.6 - WBCs > 500 - pH 7.3-7.4 - cloudy, thick, viscous amylase fluid > amylase serum Glucose fluid < glucose serum
exudate
32
Parasitic infx, malignancy, or TB can be seen with _____ on pleural fluid analysis
eosinophilia
33
Pleural fluid analysis showing TGs or lipids indicates...
chylous effusion
34
Pancreatitis, esophageal rupture, malignancy could present as what on pleural fluid analysis?
amylase elevation
35
infection, esophageal rupture or neoplasm could present as what on pleural fluid analysis?
pH < 7.3
36
Light's criteria classifies exudate if one of what three findings is present?
pleural/serum protein > 0.5 pleural/serum LDH > 0.6 Pleural fluid LDH > 2/3 upper limit serum LDH
37
Peritoneal fluid has the same values and appearance as...
pleural fluid
38
What imaging is gold standard for evaluation of peritoneal effusion?
abdominal US
39
abdominal paracentesis indications...
new onset ascites
40
The below are contraindications to what procedure? Coagulation abnormalities small volume fluid hx of abd. surg massive ileus w/ bowel distension
abdominal paracentesis
41
The following are potential complications of what procedure? - hypovolemia - hepatic coma - peritonitis - tumor seeding - organ perf.
abdominal paracentesis
42
Classification of transudate vs exudate in peritoneal fluid is the same as pleural, except for...
albumin gradient
43
transudate or exudate peritoneal fluid? -albumin gradient > 1.1
transudate
44
Transudate or Exudate peritoneal fluid? -albumin gradient < 1.1
exudate
45
LDH fluid/LDH serum > 0.6 in peritoneal fluid analysis can indicate...
bowel perf, malignancy, infx
46
what would be elevated in peritoneal fluid with the following: - pancreatic source - bowel perf. - malignancy - esophageal rupture
amylase
47
peritoneal fluid analysis in ruptured or strangulated bowel can show elevation of...
ammonia
48
a brown peritoneal effusion indicates...
bowel/biliary perf
49
presence of urea/Cr in peritoneal fluid can indicate...
bladder rupture
50
TGs in peritoneal fluid can indicate...
chylous effusion
51
Patient presents with the following s/s, indicating possible... hx cirrhosis/ascites no obvious infx abrupt onset fever, chills, abd. pain (+) rebound tenderness labs showing exudative effusion
spontaneous bacterial peritonitis
52
Which fluid? < 50 mL volume clear, straw colored no RBCs or WBCs
pericardial fluid
53
Pericardial effusion should be suspected in all cases of...
acute pericarditis
54
The following might be indications of... - unexplained, new cardiomegaly w/o pulm. congestion - unexplained fever, no obvious infx - fever with other pericardial disease
pericardial effusion
55
What is the imaging of choice for pericardial effusion?
US/echocardiography
56
Pericardiocentesis should be avoided in most cases. When can it be considered?
pericardial tamponade fluid for dx (i.e. malignancy)
57
Contraindications to pericardiocentesis?
coagulopathy uncooperative patients
58
The following are complications for which procedure? laceration of coronary artery/ myocardial puncture dysrhythmia MI PTX vasovagal hypotension infx
pericardiocentesis
59
Gram stain, cultures, cytology, AFB, PCR should be performed on what fluid?
pericardial effusion
60
AMS, Nuchal rigidity, fever rapid onset This indicates...
meningitis
61
what is the gold standard dx test for meningitis?
CSF culture
62
Indications for LP...
infx, malignancy, MS, cerebral/subarachnoid hemorrhage
63
The following are contraindications for what procedure? - infx near site - anticoagulation - vertebral degenerative joint disease - increased intracranial pressure
lumbar puncture
64
The following are complications of... CSF leak, HA, meningitis brain herniation spinal cord puncture aorta, VC puncture back pain, parasthesia
LP
65
The IDSA guidelines below describe need for ____ before LP... immunocompromised hx of CNS dz new onset seizure w/in 1 week papilledema ALOC focal neuro deficit
CT before LP
66
If CNS infx is concern, before LP and abx what should be done?
2x blood cx then empiric abx
67
The following describe what fluid? clear, colorless Pressure < 20 cm H2O ``` RBC: 0-5 WBC: 0-5 PROT: 15-45 GLU: 50-75 LDH: < 40 ```
CSF
68
cloudy CSF can indicate:
infx, elevated prot
69
pink/red CSF can indicate
bleeding from procedure or subarachnoid bleed
70
xanthochromia, lysis of RBCs will show up as what color in LP?
yellow
71
What effect on lumbar pressure? hypovolemia chronic leak nasal fx with dural tear
decreased
72
What effect on lumbar pressure? infx intra-cranial bleed tumor hydrocephalus
increased
73
What effect on lumbar pressure? spinal cord obstruction screaming/breath holding baby with subsequent relaxation
diff in opening/closing pressure
74
WBCs > ______ is abnormal in CSF
5
75
What type of WBCs in CSF? bacterial/tubercular meningitis cerebral abscess subarachnoid bleed tumor
neutrophilia
76
What type of WBCs in CSF? viral, tubercular, fungal, syphilitic meningitis MS Guillain Barre
lymphocytosis
77
What type of WBCs in CSF? tubercular, fungal meningitis subarachnoid bleed brain infarction
macrophages
78
What type of WBCs in CSF? parasitic meningitis allergic rxn to radiopaque dye
eosinophilia
79
ratio of ___ WBC per ____ RBCs is pathologic, should consider infx/meningitis
1 WBC: 500 RBCs
80
Traumatic puncture or subarachnoid bleed? - normal CSF pressure - bleeding decreased w/ CSF draw - no blood on repeal LP - clotting present - clear fluid on centrifuge
traumatic puncture
81
Traumatic puncture or subarachnoid bleed? - increased CSF pressure - color remains same throughout draw - blood on repeat LP - no clotting - xanthochromia on centrifuge
subarachnoid bleed
82
Protein in CSF can be seen in what three things?
- infx/inflammatory processes - bleeding/hemolysis - autoimmune disease
83
oligoclonal gamma globulin bands in CSF indicates...
MS
84
CSF < 2/3 of serum glucose is indicative of..
meningitis, neoplasm
85
What else must be ordered to check CSF glucose?
serum glucose for comparison
86
LDH in CSF can indicate what 3 things?
bacterial meningitis malignancy intracranial hemorrhage
87
Lactic Acid in CSF indicates...
bacterial/fungal meningitis
88
Glutamine in CSF indicates...
hepatic failure
89
CRP is increased in the CSF in what type of meningitis?
bacterial
90
india ink prep of CSF tests for...
cryptococcus neoformans
91
VDRL or FTA-ABS of CSF tests for...
syphilis
92
Giemsa/Wright stain of CSF tests for...
toxoplasmosis
93
Tubes 1-4 uses...
chemistry, microbio, hematology, hold
94
CSF Tube 1 tests:
protein, glucose
95
CSF tube 2 tests:
gram and AFB stains C & S PCR
96
CSF tube 3 tests
CBC with diff

Clinical Laboratory Medicine (9 decks)

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