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Clin Lab Med > Exam 2: Body Fluids > Flashcards

Exam 2: Body Fluids Flashcards

1
Q

Why is KOH prep a good test for fungal infections?

A

The KOH dissolves host cells and bacteria, but spares the fungi and elastin fibers

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2
Q

What do multinucleated giant cells indicate on a Tzank prep?

A

HSV

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3
Q

What kind of testing do you use for cryptococci in CSF?

A

India ink

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4
Q

What is dark field microscopy and with what kind of infection is it useful for?

A

Used to evaluate bacteria that are too thin to absorb light from traditional microscopy.
Useful for diagnosing T. Pallidum (Syphilis)

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5
Q

Other than dark field microscopy, what other tests are useful for diagnosing Syphilis?

A
  • Venereal Disease Research Laboratory (VDRL)

- Rapid plasma Reagin

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6
Q

CSF test and Fluorescent treponema antibody absorption Test (FTA-ABS) fall under what category of testing?

A

VDRL

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7
Q

What is the latex agglutination assay and what is it commonly used for?

A
  • Detect pathogen specific antibodies and antigens.

- Used for CSF for meningococcal capsular antigen

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8
Q

What does Enzyme linked immunoassay do?

A

-Detect antibodies in the serum (requires previous infection) and used for multiple body fluids

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9
Q

What does indirect immunofluorescence assay do and what is it the primary test for?

A
  • Detects antibodies in the serum or other body fluid

- primary test for ANA antibody

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10
Q

What is the minimun inhibitory concentration?

A

The lowest concentration of an Abx necessary to inhibit the visible growth of a specific organism

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11
Q

What is the procedure for obtaining blood cultures?

A
  • Two different specimens must be ordered from at least two different sites that are not from the IV
  • If one is positive and one is negative, the postive result is likely contaminant
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12
Q

What are the two types of effusions?

A

Transudative and exudative

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13
Q

What is a transudative effusion?

A

Accumulation of fluid in the body cavity due to filtration of blood serum across a physiologically intact vascular wall

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14
Q

What usually causes transudative effusions?

A

Pressure differences between body compartments (Hydrostatic and oncotic pressure) usually caused by systemic disease (CHF, hepatic cirrhosis, and nephrotic syndrome)

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15
Q

What is a exudative effusion?

A

Accumulation of fluid within a body cavity due to inflammation and vascular wall damage.

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16
Q

What are some common causes of exudative effusions?

A

Infection, malignancy, inflammatory disorder (RA, lupus), and trauma

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17
Q

What is the normal pleural fluid amount?

A

50ml

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18
Q

What is the normal WBC for pleural fluid?

A

<300ml

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19
Q

What are the most common cause of transudative pleural effusions?

A

CHF, cirrhosis, and nephrotic syndrome

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20
Q

What is the most common cause of exudative effusions and what most commonly causes that condition?

A

Exudative effusion most commonly caused by parapneumonic effusion, which is most commonly caused by bacterial PNA, Lung abscess, and bronchiectasis

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21
Q

What it the second most common cause of exudative pleural effusions?

A

Malignancy (Lung CA, breast CA, and lymphoma

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22
Q

What kind of effusion can a pulmonary embolism cause?

A

Both transudative and exudative

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23
Q

What kind of effusions are hemothorax and chylothorax?

A

Exudative effusion

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24
Q

What is the contraindication of thoracentesis?

A

Caution with significant thrombocytopenia

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25
Q

How can you prevent re-expansion pulmonary edema when performing a thoracentesis?

A
  • Do remove more than 1 L

- Do not perform bilaterally

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26
Q

How does the protein fluid/protein serum ratio of pleural fluid differ in transudative and exudative pleural effusions?

A

Transudative: Protein fluid/protein serum ration <0.5

Exudative: Protein fluid/protein serum ratio >0.5

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27
Q

How does the LDH fluid/LDH serum ratio in pleural fluid differs in transudative and exudative pleural effusions?

A

Transudative: LDH fluid/LDH serum ratio <0.6

Exudative: LDH fluid / LDH serum ratio >0.6

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28
Q

What are the possible causes of pleural fluid with a pH of <7.3?

A

Infection, esophageal rupture, and neoplasm

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29
Q

What are the possible causes of amylase elevation in pleural fluid?

A

Pancreatitis, esophageal rupture, and malignancy

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30
Q

What are the possible causes of triglycerides or lipids in the pleural fluid?

A

Chylous effusion

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31
Q

What are the possible causes of eosinophilia in pleural fluid?

A

Parasitic infection, malignancy, TB

32
Q

What is Lights criteria?

A

If one of the following is present, the patient has a exudative effusion:

  • Pleural fluid protein/serum protein ratio >0.5
  • pleural fluid LDH/Serum LDH ratio >0.6
  • Pleural fluid LDH >2/3rds of the upper limits of the labs normal serum LDH
33
Q

How much peritoneal fluid is present normally?

A

<50ml

34
Q

Wha are the causes of ascites?

A

-Portal hypertension (most common), which is most commonly caused by hepatic cirrhosis

35
Q

What is the gold standard for evaluation of peritoneal effusion?

A

Abdominal US

36
Q

What are the indications for a paracentesis?

A

New onset ascites with or without:

  • fever
  • abdominal tenderness
  • Mental status change
  • hypotension
  • Peripheral leukocytosis
  • worsening renal function
  • Trauma/ severe cirrhosis
37
Q

What are the potential contraindications for paracentesis?

A
  • coagulation abnormalities
  • patients with small amount of fluid
  • previous abdominal surgeries
  • massive ileus with bowel distention
38
Q

What are the potential complications of a paracentesis?

A
  • hypovolemia
  • hepatic coma
  • peritonitis
  • tumor seeding
  • organ perforation
39
Q

How does the alubumin gradient of peritoneal fluid differ in transudative or exudative effusions?

A

Transudative: Albumin gradient >1.1

Exudative: Albumin gradient <1.1

40
Q

What can a LDH fluid/LDH serum ratio of >0.6 in peritoneal fluid indicate?

A

Bowel perforation, malignancy, or infection

41
Q

What can elevated amylase in peritoneal fluid indicate?

A

Pancreatic source, bowel perforation, malignancy, and esophageal rupture

42
Q

What can elevated ammonia in peritoneal fluid indicate?

A

Ruptured or strangulated bowel

43
Q

What can elevated bilirubin in peritoneal fluid indicate?

A

Bowel/biliary perforation

44
Q

What can urea and creatinine in the peritoneal fluid indicate?

A

Possible bladder rupture

45
Q

What can triglycerides in the peritoneal fluid indicate?

A

Possible chylous effusion

46
Q

Patient presets with an abrupt onset of fever, chills, and abdominal pain. Patient has rebound abdominal tenderness and labs reflect an exudative effusion. What are you concerned about?

A

Spontaneous bacterial peritonitis

47
Q

What is the normal RBC and WBC count in pericardial fluid?

A

None for both

48
Q

What is a normal amount of pericardial fluid?

A

<50ml

49
Q

What is the diagnostic method of choice or a periocardial effusion?

A

US

50
Q

When should a pericardiocentesis not be performed?

A
  • Most of the time!
  • Contraindicated in patients with pericarditis if there is no effusion
  • if patient has an effusion, is stable, and source is known, can treat cause with serial follow up echos
51
Q

What are the therapeutic indications for pericardiocentesis?

A

Pericardial effusion with tamponade

52
Q

What are the contraindications of pericardiocentesis?

A
  • Coagulopathy

- Uncooperative patients

53
Q

What is the normal amount of CSF?

A

150-200ml

54
Q

What is the classic triad of meningitis?

A

AMS, nuchal rigidity, and fever

55
Q

What is the gold standard in diagnosing the causative organism of meningitis?

A

CSF culture

56
Q

What are the indications for an LP?

A
  • Infection (meningitis, encephalitis)
  • Malignancy
  • MS
  • Cerebral/subarachnoid hemorrhage
57
Q

What are the contraindications for an LP?

A
  • Patients with increased intracranial pressure
  • Severe vertebral degenerative joint disease
  • infection near LP site
  • Patients taking anticoagulants
58
Q

What is the normal pressure for CSF?

A

<20 CM H2O

59
Q

What is the normal RBC and WBC count of CSF?

A

0-5 cells/uL for both

60
Q

What is a normal protein count for CSF?

A

15-45

61
Q

What is a normal glucose count for CSF?

A

50-75

62
Q

What is a normal LDH for CSF?

A

<40

63
Q

What does it mean if the CSF is yellow?

A

Xanthochromia, lysis of RBCs, which releases hemoglobin, converted to oxyhemoglobin, converted to methemoglobin, and ultimately to bilirubin

64
Q

What does decreased opening pressure indicate?

A

Hypovolemia, chronic CSF leak, or nasal fracture with dural tear

65
Q

What does increased opening pressure indicate?

A

Infection, intracranial bleeding, tumor, or hydrocephalus

66
Q

What are the possible causes of neutrophilia in CSF?

A
  • Bacterial meningitis
  • cerebral abscess
  • Subarachnoid bleed
  • tumor
67
Q

What are the possible causes of lymphocytosis in CSF?

A
  • Viral, tubercular, fungal, or syphilitic meningitis

- MS, Guillain-Barre

68
Q

What are the possible causes of increased macrophages in CSF?

A
  • Tubercular or fungal meningitis
  • subarachnoid bleed
  • brain infarction
69
Q

What are the possible causes of eosinophilia in CSF?

A
  • Parasitic meningitis

- allergic reaction to radiopaque dyes

70
Q

What are the possible causes of increased RBCs in CSF?

A

-Traumatic tap or subarachnoid hemorrhage

71
Q

What is present in 90% of patients with a subarachnoid hemorrhage within 12 hours?

A

Xanthochromia

72
Q

What can be found in the CSF that is indicative of MS?

A

Oligoclonal gamma globulin bands

73
Q

What is a CSF glucose <2/3s of the serum glucose indicative of?

A
  • Meningitis

- neoplasm

74
Q

What can increased LDH in CSF indicate?

A

Bacterial meningitis, malignancy, and intracranial hemorrhage

75
Q

What can increased lactic acid in CSF indicate?

A

Bacterial/fungal meningitis, but not viral

76
Q

What does increased glutamine in CSF indicate?

A

Hepatic failure

77
Q

What does elevated C-reactive protein in CSF indicate?

A

Bacterial meningitis, not viral

Clin Lab Med (8 decks)

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