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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
Q

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
A

throacentesis

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26
Q

What imaging can help identify pleural fluid and aid in thoracentesis?

A

CXR (incl lateral decubitus)

US

contrast CT

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27
Q

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
A

sample

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28
Q

potential contraindication for thoracentesis..

A

thrombocytopenia

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29
Q

What are two important considerations to lower risk of re-expansion pulmonary edema in thoracentesis?

A

dont remove > 1L

don’t perform bilaterally

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30
Q

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
A

transudate

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31
Q

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

A

exudate

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32
Q

Parasitic infx, malignancy, or TB can be seen with _____ on pleural fluid analysis

A

eosinophilia

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33
Q

Pleural fluid analysis showing TGs or lipids indicates…

A

chylous effusion

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34
Q

Pancreatitis, esophageal rupture, malignancy could present as what on pleural fluid analysis?

A

amylase elevation

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35
Q

infection, esophageal rupture or neoplasm could present as what on pleural fluid analysis?

A

pH < 7.3

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36
Q

Light’s criteria classifies exudate if one of what three findings is present?

A

pleural/serum protein > 0.5

pleural/serum LDH > 0.6

Pleural fluid LDH > 2/3 upper limit serum LDH

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37
Q

Peritoneal fluid has the same values and appearance as…

A

pleural fluid

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38
Q

What imaging is gold standard for evaluation of peritoneal effusion?

A

abdominal US

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39
Q

abdominal paracentesis indications…

A

new onset ascites

40
Q

The below are contraindications to what procedure?

Coagulation abnormalities

small volume fluid

hx of abd. surg

massive ileus w/ bowel distension

A

abdominal paracentesis

41
Q

The following are potential complications of what procedure?

  • hypovolemia
  • hepatic coma
  • peritonitis
  • tumor seeding
  • organ perf.
A

abdominal paracentesis

42
Q

Classification of transudate vs exudate in peritoneal fluid is the same as pleural, except for…

A

albumin gradient

43
Q

transudate or exudate peritoneal fluid?

-albumin gradient > 1.1

A

transudate

44
Q

Transudate or Exudate peritoneal fluid?

-albumin gradient < 1.1

45
Q

LDH fluid/LDH serum > 0.6 in peritoneal fluid analysis can indicate…

A

bowel perf, malignancy, infx

46
Q

what would be elevated in peritoneal fluid with the following:

  • pancreatic source
  • bowel perf.
  • malignancy
  • esophageal rupture
47
Q

peritoneal fluid analysis in ruptured or strangulated bowel can show elevation of…

48
Q

a brown peritoneal effusion indicates…

A

bowel/biliary perf

49
Q

presence of urea/Cr in peritoneal fluid can indicate…

A

bladder rupture

50
Q

TGs in peritoneal fluid can indicate…

A

chylous effusion

51
Q

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

A

spontaneous bacterial peritonitis

52
Q

Which fluid?

< 50 mL volume

clear, straw colored

no RBCs or WBCs

A

pericardial fluid

53
Q

Pericardial effusion should be suspected in all cases of…

A

acute pericarditis

54
Q

The following might be indications of…

  • unexplained, new cardiomegaly w/o pulm. congestion
  • unexplained fever, no obvious infx
  • fever with other pericardial disease
A

pericardial effusion

55
Q

What is the imaging of choice for pericardial effusion?

A

US/echocardiography

56
Q

Pericardiocentesis should be avoided in most cases. When can it be considered?

A

pericardial tamponade

fluid for dx (i.e. malignancy)

57
Q

Contraindications to pericardiocentesis?

A

coagulopathy

uncooperative patients

58
Q

The following are complications for which procedure?

laceration of coronary artery/ myocardial puncture

dysrhythmia

MI

PTX

vasovagal hypotension

infx

A

pericardiocentesis

59
Q

Gram stain, cultures, cytology, AFB, PCR should be performed on what fluid?

A

pericardial effusion

60
Q

AMS, Nuchal rigidity, fever

rapid onset

This indicates…

A

meningitis

61
Q

what is the gold standard dx test for meningitis?

A

CSF culture

62
Q

Indications for LP…

A

infx, malignancy, MS, cerebral/subarachnoid hemorrhage

63
Q

The following are contraindications for what procedure?

  • infx near site
  • anticoagulation
  • vertebral degenerative joint disease
  • increased intracranial pressure
A

lumbar puncture

64
Q

The following are complications of…

CSF leak, HA, meningitis

brain herniation

spinal cord puncture

aorta, VC puncture

back pain, parasthesia

65
Q

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

A

CT before LP

66
Q

If CNS infx is concern, before LP and abx what should be done?

A

2x blood cx then empiric abx

67
Q

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
68
Q

cloudy CSF can indicate:

A

infx, elevated prot

69
Q

pink/red CSF can indicate

A

bleeding from procedure or subarachnoid bleed

70
Q

xanthochromia, lysis of RBCs will show up as what color in LP?

71
Q

What effect on lumbar pressure?

hypovolemia

chronic leak

nasal fx with dural tear

72
Q

What effect on lumbar pressure?

infx

intra-cranial bleed

tumor

hydrocephalus

73
Q

What effect on lumbar pressure?

spinal cord obstruction

screaming/breath holding baby with subsequent relaxation

A

diff in opening/closing pressure

74
Q

WBCs > ______ is abnormal in CSF

75
Q

What type of WBCs in CSF?

bacterial/tubercular meningitis

cerebral abscess

subarachnoid bleed

tumor

A

neutrophilia

76
Q

What type of WBCs in CSF?

viral, tubercular, fungal, syphilitic meningitis

MS

Guillain Barre

A

lymphocytosis

77
Q

What type of WBCs in CSF?

tubercular, fungal meningitis

subarachnoid bleed

brain infarction

A

macrophages

78
Q

What type of WBCs in CSF?

parasitic meningitis
allergic rxn to radiopaque dye

A

eosinophilia

79
Q

ratio of ___ WBC per ____ RBCs is pathologic, should consider infx/meningitis

A

1 WBC: 500 RBCs

80
Q

Traumatic puncture or subarachnoid bleed?

  • normal CSF pressure
  • bleeding decreased w/ CSF draw
  • no blood on repeal LP
  • clotting present
  • clear fluid on centrifuge
A

traumatic puncture

81
Q

Traumatic puncture or subarachnoid bleed?

  • increased CSF pressure
  • color remains same throughout draw
  • blood on repeat LP
  • no clotting
  • xanthochromia on centrifuge
A

subarachnoid bleed

82
Q

Protein in CSF can be seen in what three things?

A
  • infx/inflammatory processes
  • bleeding/hemolysis
  • autoimmune disease
83
Q

oligoclonal gamma globulin bands in CSF indicates…

84
Q

CSF < 2/3 of serum glucose is indicative of..

A

meningitis, neoplasm

85
Q

What else must be ordered to check CSF glucose?

A

serum glucose for comparison

86
Q

LDH in CSF can indicate what 3 things?

A

bacterial meningitis

malignancy

intracranial hemorrhage

87
Q

Lactic Acid in CSF indicates…

A

bacterial/fungal meningitis

88
Q

Glutamine in CSF indicates…

A

hepatic failure

89
Q

CRP is increased in the CSF in what type of meningitis?

90
Q

india ink prep of CSF tests for…

A

cryptococcus neoformans

91
Q

VDRL or FTA-ABS of CSF tests for…

92
Q

Giemsa/Wright stain of CSF tests for…

A

toxoplasmosis

93
Q

Tubes 1-4 uses…

A

chemistry, microbio, hematology, hold

94
Q

CSF Tube 1 tests:

A

protein, glucose

95
Q

CSF tube 2 tests:

A

gram and AFB stains
C & S
PCR

96
Q

CSF tube 3 tests

A

CBC with diff

Clinical Laboratory Medicine (9 decks)

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