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Urinalysis and Body Fluids 4214 > Exam 4: Review > Flashcards

Exam 4: Review Flashcards

1
Q

Transudate or Exudate?

Occur during pressure changes; systemic disorders that disrupt fluid filtration, fluid reabsorption, or both.

A

Transudate

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2
Q

Transudate or Exudate?

Occur because of inflammation of blood vessels; body cavity membrane damage, or decreased reabsorption by the lymphatic system.

A

Exudate

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3
Q

Transudate or Exudate?

Fluid moves but not proteins

A

Transudate

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4
Q

Transudate or Exudate?

Both fluid and protein move.

A

Exudate

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5
Q

Transudate or Exudate?

Systemic disorders such as:
Congestive heart failure
Hepatic cirrhosis
Nephrotic syndrome

A

Transudate

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6
Q

Transudate or Exudate?

Pathological processes:
Infections
Inflammations
Hemorrhages
Malignancies

A

Exudate

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7
Q

What are lab tests to differentiate between Transudate and Exudate?

A

-Fluid appearance
-Specific gravity
-Amylase
-Glucose
-LD
-Proteins

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8
Q

What is the appearance of transudate fluid?

A

clear
colorless or straw

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9
Q

What is the appearance of exudate fluid?

A

cloudy
cloudy/yellow/bloody

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10
Q

What is the volume difference between transudate and exudate?

A

Transudate: smaller

Exudate: copious

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11
Q

Transudate or Exudate?

Specific gravity: < 1.015
Total protein: < 3.0 g/dL
Lactate dehydrogenase: < 200 IU

A

Transudate

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12
Q

Transudate or Exudate?

Specific gravity: > 1.015
Total protein: > 3.0 g/dL
Lactate dehydrogenase: > 200 IU

A

Exudate

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13
Q

Transudate or Exudate?

WBC count: < 1000/uL

A

Transudate

( > 1000/uL for exudate)

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14
Q

Is spontaneous clotting possible with transudate or exudate?

A

Exudate

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15
Q

Lumbar puncture is the intervertebral space between lumbar vertebrae L___ and L___.

Why is it done here?

A

3, 4

avoids damage to the spinal cord in adults because the spinal cord does not extend that far down.

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16
Q

What is the function of CSF?

A

-cushioning and lubricating the brain and spinal column.
- circulates in the space between two membranes, the arachnoid and the pia mater.
-It bathes the brain and spinal cord and serves as a nutrient and also metabolic waste exchange fluid.
-CSF adjusts its volume in response to changes in cerebral vessel changes

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17
Q

What are the two sources of CSF?

A
  • the tufts of capillary blood vessels in the cerebral ventricles, choroid plexus, that produce 70% of the CSF.
    -Approximately 30% is formed by the ependymal lining cells of the ventricles and the cerebral/subarachnoid space.
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18
Q

What is normal CSF volume in adults?
Neonates?

A

90-150 mL
10-60 mL

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19
Q

What is the rate of CSF production?

A

500 mL/day

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20
Q

CSF Bloody or hemolyzed could be due to…

A

-Traumatic tap: Inadvertent blood vessel trauma from puncture
Intracerebral or
-subarachnoid hemorrhage (ICH or SAH): MUST be differentiated from traumatic tap

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21
Q

Oily CSF could be due to…

A

radiographic contrast media

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22
Q

In __________ , overnight CSF refrigeration may cause a “weblike pellicle” (scum) to form. This is not clotting!

A

tubercular meningitis

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23
Q

Traumatic tap or Intracerebral Hemorrhage?

-Serum protein contamination may cause xanthochromic supernatant
-Uneven distribution of blood in collection tubes (Heaviest in first)
-Sample is often (not always) clotted due to plasma fibrinogen contamination; may even have bloody streaks.

A

Traumatic tap

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24
Q

Traumatic tap or Intracerebral Hemorrhage?

-Clear supernatant if recent, but xanthochromic supernatant if old!
(Good clue but not specific)
-Blood evenly distributed through collection tubes (‘Best bet’)
-NO blood clots
-Siderophages highly indicative!

A

Intracerebral Hemorrhage

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25
Q

What is the order of CSF tubes by department?

A

Tube 1 → For chem and serology
Tube 2 → Micro
Tube 3 → Hematology
Tube 4 → Frozen (‘Just in case’ tube)

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26
Q

How soon does CSF need to be tested?

A

Test STAT! If not, refrigerate!

-Cell count must be done with-in 1 hour

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27
Q

Can leftover CSF fluid be discarded?

A

Never! save in case more tests are ordered.

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28
Q

What temp for mirco CSF tubes?

A

RT and set up ASAP

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29
Q

What temp for chem/sero CSF tubes?

A

may be frozen after centrifugation

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30
Q

Lots of neutrophils in CSF indicates?

Lots of monocytes?

A

bacterial infection

viral infection

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31
Q

Plasma cells in CSF fluid could indicate…

A

Multiple Sclerosis

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32
Q

Macrophages in CSF fluid could indicate…

A

Viral and bacterial meningitides
Also, any RBCs in CSF from long-term cause

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33
Q

a protein that helps stabilize the internal skeleton of nerve cells (neurons) in the brain.

A

Tau

-Tau represents the subunit protein of one of the major hallmarks of Alzheimer disease (AD), the neurofibrillary tangles, and is therefore of major interest as an indicator of disease mechanisms.

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34
Q

Tau transferrin is made primarily by the CNS. Discovering the protein band on protein electrophoresis of fluid from the ear or nose confirms diagnosis of…

A

otorrhea and rhinorrhea

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35
Q

Protein electrophoresis - Tau transferrin:

other protein bands include…

A

transferrin and small amounts of alpha 1 antitrypsin

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36
Q

Findings of oligoclonal bands in the gamma region in CSF and not in serum may help establish a diagnosis of…

A

multiple sclerosis

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37
Q

Other CSF disorders in which oligoclonal bands are present are:

A

-Subacute sclerosing -panencephalitis
-Neurosyphilis
-Bacterial, cryptococcal, and viral meningitis
-Acute necrotizing
-encephalitis
-Human immunodeficiency virus type I infections
-Gillian-Barre syndrome

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38
Q

Guillain-Barre syndrome:

An elevation in CSF protein (_____ g/L) without an elevation in white blood cells. The increase in CSF protein is thought to reflect the widespread inflammation of the nerve roots

A

> 0.55 g/L

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39
Q

Diagnosis of Guillain-Barre syndrome depends what clinical presentation?

A

Sudden onset of acute ascending paralysis (flaccid paralysis in limbs)

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40
Q

Key indicators of MS:

A

Maybe lymphocytes, monocytes, and plasma cells
Oligoclonal bands in the gamma region in CSF
Elevated TP
Myelin basic protein (MBP)*

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41
Q

Normal levels of MBP are less than 4 ng/mL
During acute exacerbations of MS, MBP levels can be in excess of ____ ng/mL

A

8

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42
Q

How can the degree of permeability of the blood-brain barrier be evaluated?

A

quantitative measurements of albumin in the CSF compared to serum albumin
-CSF/serum albumin index

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43
Q

CSF/serum albumin index:

-An index value of <__ is considered consistent with an intact barrier.
-Values of _____ are interpreted as slight impairment
-_____ moderate impairment

A

9

9-14

14-30

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44
Q

CSF/serum albumin index:

-______ severe impairment
-Values of ______ indicate complete breakdown of barrier

A

30-100

> 100

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45
Q

Viral meningitis:

Lactate-
protein-
glucose-

A

Lactate- decreased*
protein- increased
glucose- decreased

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46
Q

Bacterial Meningitis (neutrophilic pleocytosis):

Lactate-
protein-
glucose-

A

Lactate- increased*
protein- increased
glucose- decreased

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47
Q

What is the normal appearance and viscosity of synovial fluid?

A

-Appears clear and pale yellow
-Egg-white consistency
-Forms continuous string when poured

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48
Q

The viscosity of synovial fluid is due to

A

hyaluronic acid
(Essential for proper joint lubrication)

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49
Q

What is the cause of decreased synovial fluid viscosity?

A

Unhealthy joints secrete malfunctioning hyaluronic acid (unable to polymerize), so viscosity is decreased – and this can be measured

50
Q

What can be mixed into synovial fluid to make for easier handling?

A

Hyaluronidase

51
Q

What is normal WBC count in synovial fluid?

A

< 200 mononuclear cells/uL

Lymphs, monos, macrophages, and a few synovial lining cells

52
Q

Synovial fluid:

Segs should make up ______% of N. differential.

A

<30

-FYI – WBCT count may reach > 100,000 cells/uL in severe infection

53
Q

What is normal string test results?

Synovial fluid

A

5cm long before breaking

-low viscosity indicates inflammation

54
Q

What are the four major categories of joint diseases?

A

-Non-inflammatory
-inflammatory
-Septic
-Hemorrhagic

55
Q

category of Joint disease:

Degenerative joint disorders
Ex. osteoarthritis***

A

non-inflammatory

56
Q

category of Joint disease:

Immunologic or crystal problems
Ex. RA & SLE, gout, and pseudogout

A

Inflammatory

57
Q

category of Joint disease:

Microbial infections

A

Septic

58
Q

category of Joint disease:

Traumatic injury, coagulation deficiencies

A

Hemorrhagic

59
Q

What are the lab findings with non-inflammatory joint disorders?

A

-Clear, yellow fluid*
-Pretty good viscosity ↓ with ↑ severity
-WBCs < 5000/uL, Segs < 30%
-N. glucose

60
Q

What are the lab findings with inflammatory joint disorders?

A

-Cloudy, yellow fluid
-Poor viscosity
-Mod. - mkd. ↑ WBCs (2k-100k/uL)
Segs > 50%
-↓ glucose
-Possible auto-Abs present (RF & ANAs)
-Possible “LE cells”

61
Q

What are the lab findings with septic joint disorders?

A

-Cloudy, yellow-green* fluid
-Poor viscosity
-Mkd. ↑ WBCs (10k - 200k/uL)
Segs > 90%
-↓ glucose Positive culture!

62
Q

What are the lab findings with hemorrhagic joint disorders?

A

-Cloudy, red fluid
-Poor viscosity
-Mod.↑ WBCs (< 5,000/uL)
Segs < 50%
-N. glucose Numerous RBCs present!!

63
Q

What are the 3 most common crystal causing arthritis?

A

-Monosodium urate (MSU) – gout
-Ca pyrophosphate (CPPD) – pseudogout
-Cholesterol (chronic effusions such as RA)

64
Q

Large, needle-shaped crystals that may be inside or outside the cells

A

Monosodium urate (MSU) – gout

65
Q

Small rhombic-shaped or rod-shaped crystals, inside cells

A

Ca pyrophosphate (CPPD) – pseudogout

66
Q

Cholesterol (chronic effusions such as RA)

A

Large, flat, extracellular notched plates

67
Q

Polarized microscopy with red compensator:

MSU crystals have “___________ birefringence” – pale yellow when aligned parallel with the axis.

A

negative

68
Q

Polarized microscopy with red compensator:

CPPD crystals have “____________ Birefringence” – BLUE when aligned parallel with axis

A

positive

69
Q

One membrane lines cavity wall = _________

Other membrane covers the organ inside the body cavity = ___________

A

Parietal

Visceral

70
Q

What is the fluid between membranes?

A

serous fluid (provides lubrication)

71
Q

any abnormal accumulation of serous fluid is called…

A

Effusion

72
Q

Abnormal accumulation of peritoneal fluid

A

Ascites

73
Q

What is the most common cause of ascites?

A

ascites in liver disease due to pressure changes (transudate). Specimen will be clear and may be yellow

74
Q

In general, transudates means what conditions?

A

congestive heart failure, cirrhosis, nephrotic syndrome

75
Q

In general, exudates means what conditions?

A

infection, malignancy, pancreatitis or other inflammatory conditions.

76
Q

What does chylous (milky fluid) indicate?

A

-Chylous appearance is due to an emulsion of lymph and chylomicrons.
-Obstruction or damage of lymphatic vessels contribute to the development of a chylous effusion.
-Sheets of cholesterol crystals may be present in serous fluids when a lymphatic vessel located near a cavity is damaged.

77
Q

Peritonitis is a bacterial infection in the peritoneal fluid (cloud exudate). Often in patients with _________ disease.

A

liver

-Peritonitis is diagnosed in microbiology labs with stains and cultures

78
Q

A condition in which excess amniotic fluid accumulates during pregnancy

A

Hydramnios or polyhydramnios

79
Q

when you have too little amniotic fluid

A

Oligohydraminos

80
Q

Fetal age can be estimated by creatinine:

< 36 weeks →
> 36 weeks →

A

1.5 - 2.0 mg/dL

2.0

81
Q

What are the lab values that indicate mature fetal lungs?

A

-Foam stability > 0.47 indicates fetal lung maturity
-L/S ratio of 2 or higher indicates safe preterm delivery
-Lamellar body count of more than 50,000/uL indicate fetal lung maturity

82
Q

What is the reference method for fetal lung maturity testing?

A

Lecithin-Sphingomyelin (L/S) Ratio

83
Q

Fetal lung maturity test:

-Lung surface lipid phosphatidyl glycerol is needed for lung maturity
-Amniostat-FLM is an immunologic agglutination test for PG using antibody specific for phosphatidyl glycerol that can replace the L/S ratio (no special equipment needed)
-Blood and meconium do not interfere with the test

A

Phosphatidylglycerol

84
Q

Fetal lung maturity test:

-Performed at bedside
-Amniotic fluid is mixed with 95% ethanol, shaken for 15 seconds, and allowed to sit undisturbed for 15 minutes
-A continuous line of bubbles around the outside edge indicates the presence of a sufficient amount of surfactant to maintain alveolar stability (alcohol is an antifoaming agent, and fluid can overcome this)

A

Foam stability

85
Q

Fetal lung maturity test:

-Lamellar bodies are the storage form of surfactant
Approximately 90% phospholipid and 10% protein
-Secreted by the type II pneumocytes of the fetal lung to the alveolar space at about 24 weeks of gestation
-Increase in amniotic concentration from 50,000 to 200,000/L by the end of the third trimester

A

Lamellar Bodies

86
Q

-Plots ΔA40 against gestational age
-Consists of 3 zones based on hemolytic severity

A

Liley graph

87
Q

What are the 3 zones on the Liley graph?

A

Zone I – mildly affected fetus
Zone II – requires careful monitoring
Zone III – severely affected fetus, may require induction of labor or intrauterine exchange transfusion

88
Q

Liley graph:

normal scan —> bilirubin peak at ____nm

A

450

89
Q

What can be examined for the presence of amniotic fluid as evidence of fetal membrane rupture?

A

vaginal secretions

Premature rupture of membrane (PROM) can happen before full term and is a situation that must be managed quickly to avoid fetal and maternal complications.

90
Q

How will the pH change if there is amniotic leakage?

A

vaginal fluid will be higher than normal

Normal vaginal pH is between 4.5 and 6.0
Amniotic fluid has a higher pH of 7.1 to 7.3

91
Q

How does the Ph test- Nitrazine work?

A

-A drop of vaginal fluid is put on paper strips containing nitrazine dye
-The strips will turn blue if the pH is greater than 6.0*
-A blue strip means it’s more likely the membranes have ruptured.

92
Q

Used to differentiate amniotic fluid from maternal urine

A

Fern test

93
Q

How is the Fern test performed?

A

-This test is where vaginal fluid is spread out on a glass slide and allowed to dry at RT.
-The slide is observed for fern like crystals that are a positive SCREEN test for amniotic fluid

94
Q

-Placental alpha microglobulin-1 is a protein produced by the placenta and is present throughout pregnancy in low levels.
-It appears in vaginal secretions upon PROM.

A

Amnisure – detects PAMG-1

95
Q

-fFN (fetal fibronectin) binds the fetal sac to the uterine lining and begins to break down toward the end of pregnancy.
-If it has leaked into the vagina, preterm birth is likely although a positive result may be inconclusive
-A negative test means little chance of preterm labor

A

Fetal fibronectin

96
Q

is an inflammation of the vagina that can result in discharge, itching, and pain. The cause is usually a change in the balance of vaginal bacteria or an infection.

A

Vaginitis

-Reduced estrogen levels after menopause and some skin disorders also can cause vaginitis

97
Q

What are the most common types of vaginitis?

A

-Bacterial
-Yeast infections
-Tricomoniasis

98
Q

BV – Bacterial Vaginosis
Normal flora is usually predominantly composed of lactobacilli.
If the pH increases, organisms present at low levels will proliferate.
Organisms that increase at higher pH include…

A

-Gardnerella vaginalis
-Mobiluncus spp.
-Other anaerobes

99
Q

What is the significance of clue cells?

A

-Good indication of BV
-Higher pH causes bacteria to adhere to epithelial cells in a biofilm
-Look for epi cells with “fuzzy” appearance; nucleus may be obscured

100
Q

What are other indicators of BV?

A

-Malodorous vaginal discharge or ‘wiff” test (add KOH to specimen)
-Vaginal pH will be > 4.5

101
Q

-Caused by a parasite that is often sexually transmitted.
-Women often have itching and a yellow-green discharge or may be asymptomatic.
-Males are often asymptomatic.
-Easy to see on wet mount due to characteristic “jerky” motility.
-May also be seen in urine

A

Trichomoniasis

102
Q

-is normally present in the vagina but can proliferate due to antimicrobial use, elevated estrogen (pregnancy), immunosuppression, diabetes
-Can see yeast on wet mount
-WBC usually present

A

Candidiasis

103
Q

What does it mean if semen is….

Grey/white?
Turbid?
Red?
Yellow?

A

Grey/white: normal
Turbid: WBCs, infection
Red: RBCs, trauma
Yellow: urine contamination, prolonged abstinence, certain medications

104
Q

Normal volume of semen?
viscosity?

A

2-5 mL

pours in droplets

105
Q

What is the normal pH of semen?
Concentration?

A

7.2-7.78

20-250 million/mL

106
Q

What is the normal morphology of semen?

A

laboratory dependent (>70%)

107
Q

What is the normal Motility of semen?

Viability?

A

> 50% within 1 hour, 60% progressively motile,

75%

108
Q

How do you dilute semen to do a count?

A

-Concentration – 20 million
-Count – (Concentration x volume)
-Use hemocytometer
-Counts per mL
-Dilute 1:20*
-Count 5 small squares
-Multiply by 106

109
Q

What are the reagents used in the occult blood test?

A

(guiac and hydrogen peroxide)

110
Q

Occult blood testing…

A

Tests for the presence of blood in stool
Helps diagnose:
-Infection
-Trauma
-Colorectal cancer
-Ulcers, esophageal bleeding

111
Q

Why is Guiac used in the Occult test?

A

less sensitive than urinalysis reagent because up to 2.5 mL of blood in stool is normal, therefore, it eliminates false positives from vegetable and bacterial peroxidases and diet.

112
Q

Occult blood testing:

what does a weak positive look like?

Negative?

A

Weak positive → look for blue color spreading away from specimen

Negative → may see faint blue color due to the specimen, but NO spreading

113
Q

Steatorrhea

A

increased fat in stools

114
Q

What can cause steatorrhea?

A

Pancreatic insufficiency
Decreased pancreatic enzymes for lipid breakdown
Lack of bile salts
Malabsorption
Cystic fibrosis
Pancreatitis
Malignancy

115
Q

What are the stains for fat in stool?

A

Sudan III or IV
Oil red O

116
Q

What can bulky/frothy stools indicate?

A

pancreatic disorder

117
Q

What can Mucous/bloody streaked stools indicate?

A

colitis, dysentery, malignancy, constipation

118
Q

What can Ribbon-like stools indicate?

A

Obstruction

119
Q

Microscopic fecal exam:

What bacteria are associated with fecal leukocytes?

A

Salmonella, Shigella, Campylobacter, yersinia, E. coli0157

120
Q

Microscopic fecal exam:

A

Urinalysis and Body Fluids 4214 (14 decks)

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