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Clin Med Lab Med > Exam #2: Body Fluids > Flashcards

Exam #2: Body Fluids Flashcards

1
Q

If an effusion is transudative, what will the blood vessels look like?

A

INTACT vessel walls

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2
Q

What is generally the underlying cause of accumulation in transudative effusions?

A

Due to pressure differences between compartments

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3
Q

If an effusion is exudative, what will the blood vessels look like?

A

DAMAGED vessel walls

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4
Q

What is generally the underlying cause of accumulation in exudative effusions?

A

Secondary to malignancy, infection, inflammatory disorder, trauma

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5
Q

Does transudative effusion or exudative effusion require further testing?

A

Exudative effusion to determine cause

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6
Q

What are the three most common causes of Transudative Pleural Effusion?

A
  • CHF
  • Cirrhosis
  • Nephrotic Syndrome
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7
Q

What is the most common cause of Exudative Pleural Effusion?

What is the 2nd most common cause?

A

Parapneumonic (bacterial PNA, lung abscess, bronchiectasis)

  • 2nd most: malignancy
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8
Q

What condition involves RBCs in pleural space?

A

Hemothorax

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9
Q

If there is a chylous effusion, what does this look like and what two components cause this appearance?

A

Appear cloudy/milky

- Contains TGs and lipids

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10
Q

What can be caused by either Transudative Pleural Effusion or Exudative Pleural Effusion?

A

PE!!!

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11
Q

Is a Protein Fluid/Protein Serum ratio >0.5 indicative of Transudative Pleural Effusion or Exudative Pleural Effusion?

A

Exudative Pleural Effusion

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12
Q

Is a Protein Fluid/Protein Serum ratio <0.5 indicative of Transudative Pleural Effusion or Exudative Pleural Effusion?

A

Transudative Pleural Effusion

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13
Q

Is WBCs >500 cells/uL indicative of Transudative Pleural Effusion or Exudative Pleural Effusion?

A

Exudative Pleural Effusion

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14
Q

Is WBCs <300 cells/uL indicative of Transudative Pleural Effusion or Exudative Pleural Effusion?

A

Transudative Pleural Effusion

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15
Q

Is LDH Fluid/LDH Serum >0.6 indicative of Transudative Pleural Effusion or Exudative Pleural Effusion?

A

Exudative Pleural Effusion

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16
Q

Is LDH Fluid/LDH Serum <0.6 indicative of Transudative Pleural Effusion or Exudative Pleural Effusion?

A

Transudative Pleural Effusion

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17
Q

Is glucose < serum glucose OR <60 mg/dL indicative of Transudative Pleural Effusion or Exudative Pleural Effusion?

A

Exudative Pleural Effusion

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18
Q

Is a basic pH indicative of Transudative Pleural Effusion or Exudative Pleural Effusion?

A

Transudative Pleural Effusion

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19
Q

Is an acidic pH indicative of Transudative Pleural Effusion or Exudative Pleural Effusion?

A

Exudative Pleural Effusion

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20
Q

Is Amylase Fluid > Amylase Serum indicative of Transudative Pleural Effusion or Exudative Pleural Effusion?

A

Exudative Pleural Effusion

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21
Q

What imaging should be obtained before performing a Thoracentesis?

A

CXR with PA, lateral, lateral decubitus views

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22
Q

Under what conditions would you obtain a sample for Thoracentesis (4)?

A
  • Layers out >25 mm on lateral decubitus view
  • Loculated
  • Associated with thickened pleura on CT
  • Clearly delineated by US
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23
Q

What does Eosinophilia on Pleural Fluid Analysis indicate?

A

Parasitic infection

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24
Q

What is Light’s Criteria Rule used for?

A

Differentiate between transudate and exudate pleural effusion

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25
Q

For Light’s Criteria Rule, what criteria must be met to be considered exudative pleural effusion?

A

1+ of 3…

  • Pleural fluid protein/serum protein ratio is 0.5+
  • Pleural fluid LDH/serum LDH ratio is 0.6+
  • Pleural fluid LDH is more than 2/3 of upper limits of lab’s normal serum LDH
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26
Q

What is a contraindication of Thoracentesis?

A

Significant thrombocytopenia

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27
Q

What are the two most common causes of Peritoneal Effusion (Ascites)?

A
  • Portal HTN (cirrhosis)

- Malignancy

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28
Q

What test can help differentiate Transudative Peritoneal Effusion from Exudative Peritoneal Effusion?

A

Albumin gradient (SAAG)

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29
Q

What does an Albumin gradient (SAAG) is >1.1 g/dL indicate?

A

Transudative Peritoneal Effusion

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30
Q

What does an Albumin gradient (SAAG) is<1.1 g/dL indicate?

A

Exudative Peritoneal Effusion = HIGH Albumin

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31
Q

What is the gold standard diagnostic test for Peritoneal Effusion?

A

Abdominal US

32
Q

When is a Paracentesis indicated?

A

New onset ascites

Also +/-

  • Fever
  • Abd. pain
  • AMS
  • Hypotension
  • Trauma
  • Severe cirrhosis
33
Q

What should you be careful of when performing a Paracentesis?

A

Careful not to puncture inferior epigastric artery

34
Q

What four labs can be HIGH when evaluating Peritoneal Fluid?

A
  • HIGH Bilirubin/brown effusion = bowel/biliary perforation
  • HIGH Amylase = pancreatitis, esophageal rupture, malignancy
  • HIGH Ammonia = rupture/strangulated bowel
  • HIGH Urea/Cr = possible bladder rupture (trauma)
35
Q

What does a HIGH Amylase indicate (3)?

A
  • Pancreatitis
  • Esophageal rupture
  • Malignancy
36
Q

What does HIGH TGs/Lipids indicate?

A

Chylous effusion

37
Q

In what two population is Spontaneous Bacterial Peritonitis (SBP) seen?

A

Patients with:

  • Hepatic cirrhosis
  • Ascites
38
Q

What type of Effusion is Spontaneous Bacterial Peritonitis (SBP), and what is the prognosis?

A

SBP = EXUDATIVE effusion

- HIGH mortality

39
Q

What condition involves no obvious source of infection BUT abrupt onset fever/chills, abd. pain, rebound tenderness?

A

Spontaneous Bacterial Peritonitis (SBP)

40
Q

If acute pericarditis is present, what etiology should ALWAYS be considered?

A

Pericardial effusion

41
Q

What is the gold standard diagnostic test to evaluate for Pericardial Effusion?

A

Echocardiogram/US

42
Q

What condition involves “ water bottle sign”, and what diagnostic test does it appear with?

A

Pericardial Effusion

- CXR

43
Q

When is a Pericardiocentesis indicated?

A

Pericardial effusion with tamponade

44
Q

What four lab components CANNOT reliably differentiate exudate from transudate with Pericardial Effusion?

A
  • Protein
  • LDH
  • RBCs
  • WBCs
45
Q

What is the “classic triad” of Meningitis?

A
  • AMS
  • Nuchal rigidity
  • Fever (HIGH)
46
Q

What is the gold standard diagnostic test for evaluating CSF?

A

CSF Culture

47
Q

When is a Lumbar Puncture (LP) indicated?

A

INFECTION

  • Meningitis
  • Encephalitis
48
Q

What three complications are “common” with an LP?

A
  • Back pain/leg paresthesias
  • HA
  • CSF leak
49
Q

What is a major contraindication of a Lumbar Puncture (LP)?

A

Increased ICP

50
Q

When checking opening/closing pressure, if it is decreased, what might this indicate (2)?

A
  • Hypovolemia (dehydration, shock)

- Chronic CSF leak

51
Q

When checking opening/closing pressure, if it is increased, what might this indicate (4)?

A
  • Infection
  • Intracranial bleed
  • Tumor
  • Hydrocephalus
52
Q

When checking opening/closing pressure, if there is a difference between the two, what might this indicate?

A

Spinal cord obstruction/tumor

53
Q

WHEN would you order a CT BEFORE performing a Lumbar Puncture (LP) (6)?

A
  • IC
  • History of CNS disease
  • New onset seizure
  • Papilledema
  • ALOC
  • Focal neuro deficit
54
Q

When evaluating CSF, if CNS infection is a concern, what should be ordered/done (2)?

A
  1. Obtain TWO blood cultures immediately

2. Start empirical abx

55
Q

What should NOT be delayed while waiting for a CT?

A

ABX

56
Q

If CSF is cloudy, what does this indicate (2)?

A
  • Infection

- High proteins

57
Q

If CSF is pink/red, what does this indicate (2)?

A

Bleeding from procedure
vs.
Subarachnoid bleeding

58
Q

If CSF is yellow, what does this indicate?

A

Xanthochromia (RBC lysis)

59
Q

What level of WBCs is abnormal in CSF?

A

WBCs >5 cells/uL

60
Q

What level of RBCs is abnormal in CSF?

A

RBCs >5 cells/uL

61
Q

If you have Neutrophilia of CSF, what might this indicate?

A

Bacterial meningitis

62
Q

If you have Lymphocytosis of CSF, what might this indicate?

A

Viral meningitis

63
Q

If you have high Macrophages in CSF, what might this indicate (2)?

A
  • TB

- Fungal meningitis

64
Q

If you have Eosinophilia of CSF, what might this indicate (2)?

A
  • Parasitic meningitis

- Allergic reaction to dye

65
Q

If there is increased CSF pressure and NO clotting, what might this indicate?

A

Subarachnoid Hemorrhage (SAH)

66
Q

If there is xanthochromia on centrifuge of CSF, what might this indicate? What should be considered though???

A 
Subarachnoid Hemorrhage (SAH)
- Xanthochromia very common within 12 hours of SAH onset but can also be from infection
67
Q

+Oligoclonal gamma globulin bands in CSF Protein is indicative of what?

A

Multiple Sclerosis (MS)

68
Q

When ordering CSF Glucose, what should also be ordered?

A

Serum Glucose to compare

69
Q

If CSF glucose LESS THAN 2/3 serum glucose, what might this indicate (2)?

A
  • Meningitis

- Tumor

70
Q

If there is HIGH lactic acid or HIGH CRP on CSF, what can be ruled out?

A

Viral meningitis

71
Q

HIGH lactic acid on CSF can indicate (2)?

A
  • Bacterial meningitis

- Fungal meningitis

72
Q

HIGH CRP on CSF can indicate?

A

Bacterial meningitis

73
Q

What diagnostic test should be ordered to evaluate for Cryptococcus neoformans Meningitis?

A

India Ink

74
Q

What diagnostic test should be ordered to evaluate for Syphilis?

A

VDRL

75
Q

What are the four tubes for CSF collection used for?

A
  • Tube 1: chemistry (protein, glucose)
  • Tube 2 = microbiology (stains, C&S, PCR)
  • Tube 3 = hematology
  • Tube 4 = your choice

Clin Med Lab Med (13 decks)

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