Exam 5 Flashcards
What are the names of the 3 main cavities in the body
lungs- pleural
heart- pericardial
abdominal-peritoneal
What is serous fluid
fluid that are an ultrafiltrate of plasma, lubricates membranes and allows for movement of enclosed organs
What are the 4 factors that control serous fluid formation
-permeability of capillaries in parietal membrane
-Hydrostatic pressure in capillaries
-oncotic pressure by presence of plasma proteins in capillaries
-absorption of fluid by lymph system
What is effusion
accumulation of fluid in a body cavity, abnormal or pathologic
What is paracentesis
percutaneous puncture of a body cavity to pull out the fluid
What is thoracentesis
pericardiocentesis
peritonecentesis
thora- collection of plueral fluid
pericardio-collection of pericardial fluid
peritoneal- collection of peritoneal fluid
What is ascites
an effusion/ accumulation of fluid in the peritoneal cavity
What is abnormal to see in serous fluid
blood or fibrinogen
What type of fluids are transudate and exudate ?
pleural and peritoneal
Distinguish if transudate or exudate
increased hydrostatic pressure
decreased oncotic pressure
In pleural fluid
transduate
Distinguish if transudate or exudate
increased capillary permeability
decreased lymphatic absorption
Exudate
Transudate or exudate?
CHF
hepatic cirrhosis
nephrotic syndrome
transudate
Transudate or exudate
infections
neoplasms
trauma
inflammatory conditions
exudate
Transudate is ___ in protein and LDH
Exudate is ___ in protein and LDH
Both cause
trans- low
exu- high
fluid in pleural space
Transudate or exudate
clear, yellow, no clots
transduate
Transudate or exudate
cloudy, yellow to red, clotted
exudate
A cloudy paracentesis fluid indicates
a large number of WBCs, chyle, lipids
pleural or peritoneal fluid it a milky appearance indicates
chyle
What is chyle
an emulsion of lymph and chylomicrons
What is a chylous effusion
caused by an obstruction of or damage to the lymphatic system
What are chylous effusions associated with in the pleural cavity? and the peritoneal?
pleural- tumors
peritoneal- thrombosis, obstruction to lymphs
____ elevated triglyceride level with chylomicrons present
______ low triglyceride level with NO chylomicrons
chylous or pseudochylous
chylous
pseudochylous
How to tell if blood in serous fluid is due to traumatic tap or hemorrhage
traumatic tap- blood decreases and clots
hemorrhage- distributed blood, no clotting
What is the normal WBC count in transudate and exudate
trans- <1000
exudate > 1000
___ predominate in exudates and ____ predominate in effusions
neutrophils
lymphocytes
it is ___ to see macrophages and mesothelial cells in serous fluid
It is ___ to see plasma cells
normal
abnormal
What patients tend to have malignant cells in effusions
pts with neoplastic disease
What are the characteristics of malignant cells that help ID them
can be clumped
jagged nuclei
uneven chromatin
many nuclei
basophilic and has vacuoles
What are the TP and LD ratios
total protein and lactate dehydrogenase
help determine if transudate or exudate
What are the TP and LD formulas
TP= TP fluid/ TP serum
LD= LD fluid/ LD serum
What ratio of TP and LD mean transudate
TP<0.5 and LD < 0.6
What ratio of TP and LD mean exudate
TP >0.5 and LD > 0.6
What are glucose levels supposed to be in serous fluid
shouldnt be too low,
if less than 60 or difference between serum and fluid is more than 30 - means the fluid is an exudate
What does a fluid triglyceride of > 100 mean
chylous effusion
What does a triglyceride of < 50 mean
it is not a chylous fluid,
What does the presence of cholesterol crystals in serous fluid mean
pseudochylous effusion
What can cholesterol of pleural fluid help determine
differentiate between chylous and pseudochylous effusion
If a fluid to serum cholesterol ratio is > 1, this indicates
pseudochylous effusion
What does the pH of pleural fluid help determine
if patient hasa parapneumonic effusions
pH <7.30
If the pH of pleural fluid is >7.30
effusion will resolve with antibiotics
T or F pericardial and peritoneal fluid pH have a high clinical significance
F
Why do serous fluid stains include a acid fast stain
looks for tb
Where is synovial fluid located
areas where skeleton friction can occur, joints, bursae and tendons
What is the function of synovial fluids what texture does it have
sole nutrient source for the metabolically active articular cartilage
viscous
What are the 4 categories of joint disorders
noninflammatory
inflammatory
septic
hemorrhagic
What is arthrocentesis
percutaneous aspiration fluid from a joint using aseptic technique
What is the normal volume of synovial fluid in a joint
0.1-3.5mL
What are the tubes used in synovial fluid analysis and what tests are they used for
1 chemistry- lactate, lipids, protein, uric acid, glucose
#2 Microscopic exam, cytology- cell count, diff, crystal ID
#3 Micro- culture
What is the normal color of synovial fluid
pale yellow or colorless
What does it mean for synovial fluid to be red or brown
trauma
What does it mean for synovial fluid to be green
bacterial infection
What are rice bodies and what do they indicate
white- free floating particles made of collagen, associated with rheumatoid arthritis
What are ochronotic shards
dark pepper looking particles of cartilage that have broken off and are loose in the fluid
What gives synovial fluid its viscosity
hyaluronate
What does hyaluronidase do
depolymerizes hyaluronate, makes synovial fluid less viscous, Can be used prior to analysis
Is it normal to see fibrinogen in synovial fluid
No, synovial fluid should not be clotting, no fbg allowed
What is the normal RBC count in synovial fluid
<2000
What is the normal WBC count in synovial fluid
<200 WBC
What do increased RBCs in synovial fluid indicate
hemorrhage, traumatic procedure
What do increased WBCs in synovial fluid indicate
bacterial arthritis
and urate gout
What are the normal WBC % in synovial fluid diff
60% mono
30% lymphs
10% neutrophils
What do increased lymphs in synovial fluids mean
early RA
What do monosodium urate crystals mean in synovial fluid
gouty arthritis
needle like crystals
yellow parallel
blue perpendicular
MSU
gouty arthritis
What do calcium pryophosphate dihydrate crystals mean
CCPD crystals mean pseudogout
What do CPPD crystals look like
rhomboid, smaller and blunter than MSU
rhomboid crystals that are
blue parallel
yellow perpendicular
CPPD crystals
pseudogout
What do cholesterol crystals look like, what do they indicate
notched corners
chronic inflammation
irregular, jagged or serrated edged crystals that look broken in varied sizes, what crystals are these and what do they indicate
corticosteroid crystals
indicate previous drug injection into joint
What tube tops are used to do synovial fluid specimen
sodium heparin or liquid EDTA, these do not form crystals themselves
What are do these glucose levels in synovial fluid mean
<20
>20
>40
< 20 non inflammation or hemorrhagic
>20 inflammatory
>40 septic condition
What are the normal uric acid levels in synovial fluid
the same as the levels in blood plasma
What does an increased uric acid level in plasma vs synovial fluid mean
gout
What organism is the most frequent cause of septic arthritis
staph aureus
What organism is the second most common organism to cause septic arthritis
step species
What is the difference between vuvlovaginitis and vaginitis
vulvo- inflammation of vulva and vagina or vulvovaginal glads
vag- inflammation of vagina only
What are the 3 most common causes of
bacterial vaginosis
candidiasis
trichomoniasis
What tool do we use to collect vaginal secretions and what part of the vagina do we collect from
collected with sterile polyester Dacron swaps with a plastic shaft
taken from vaginal fornix and vaginal pool
What not to do when collecting vaginal secretion sample
dont refrigerate
no cotton or wood shaft swabs
What organisms are affected by cotton tipped swabs and wood shafts
Chlamydia and Neisseria
What is the normal pH of the vagina
3.8-4.5
What are the predominant bacteria in healthy vaginas
lactobacilli
What does a vaginal ph that is more than 4.5 mean
bacterial vaginosis, trichomoniasis, atrophic vaginitis
What is measured in wet mounts for vaginal secretions
count RBCs, WBCs, any bacteria, yeast, trichs, clue cells, parabasal, baa, squamous
What is normal in a vaginal wet mount
WBCs- few
RBCs- none
yeast- occasional
bacteria- lactobacilli only
Decribe what lactobacilli look like
large, nonmotile GPR
How do lactobacilli benefit bagina
H2O2 for pH balance protect against proliferation of bacteria
What are clue cells
epithelial cells that are covered in bacteria, bearded appearance
How much of a cell should be covered to be considered a clue cell
75%
What do clue cells diagnose
bacterial vaginosis
What are parabasal cells
are just bellow the surface of mucosa in vagina, if too many could mean inflammation
What are basal cells
from the basal layer of the vagina, never normal to see, usually also high WBCs, definitely inflammation
pear shaped, unicellular bodies, with an undulating membrane
trichomonads
Where do trichomonads like to live
anaerobic pH of 6
T or F- you can diagnose trichomonads on a stained slide
F- you can only see them on a non stained wet mount
What does a fishy odor after an amine test mean
trimethylamine is present changes pH, positive for bacterial vaginosis
What is the most common cause of vaginal infections
bacterial vaginosis
What organisms are most often the cause of BV
G. vaginalis and Mobiluncus
What is a KOH test for
to ID fungal infections
What is the most important indicator of BV
clue cells
What is the second most common cause of vaginitis
candidiasis
– vulvovaginal itching and soreness, external dysuria, white curdlike discharge
candidiasis
What does a strawberry looking exocervix mean
trichamoniasis
in severe cases, patients complain of vaginal dryness, vaginal soreness, dyspareunia, and spotting
atrophic vaginitis
thin, diffusely red vaginal mucosa with little to no vaginal folding on pelvic exam
atrophic vaginitis
What is a fetal fibronectic test for
to ID women who are at risk of preterm labor
What is a PAMG1 test for
to find premature rupture of membrane, water breaking
What are the 3 reasons we test amniotic fluid
find genetic disorders
test pulmonary maturity
monitor fetal anemia caused by infection or isoimmunization
The liquid medium that bathes a fetus throughout gestation
amniotic fluid
membrane composed of a single layer of epithelial cells that surround the fetus
amnion
what is polyhydramnios
abnormally increased amounts of amniotic fluid >1200
What is oligohydramnios
abnormally decreased amniotic fluid
<800
What is the normal amount of amniotic fluid at 37 weeks of gestation
800-1200
what is amniocentesis
procedure for collection of amniotic fluid
When do we need to do amniocentesis
if a mother is older than 35
if there is a suspected issue with a metabolic disorder, deformity or lung immaturity
How should amniotic fluid be transported
must be in billirubin light protected container
ASAP
refrigerated
What is the normal color of amniotic fluid
colorless or pale yellow
What does amber yellow colored amniotic fluid indicate
HDFN
What does green amniotic fluid mean
meconium
What is RDS
respiratory distress syndrome
What are lamellar bodies
aveolar epithelial cells secrete them
What are surfactants
lamalar bodies secrete them into aveolar space
prevent aveoli from collapsing, reduce pressure
What does an LS ratio tell us
<2 immaturity of lungs
>2 maturity of lungs
What do PG levels tell us
negative- immature
positive low or high- mature
What does a lamellar body count tell us
> 50,000 mature lungs
< 15,000 immature lungs
What does an FSI test tell us
shake test
if foam is present when ethanol is added, then adequate surfactants are present, must be stable for 15 min
>0.47 mature
What does delta A450 tell us
365-550 normal
>450 increased billirubin
What are the 3 zones of the liley chart
1- normal
2- moderate hemolysis
3- severe hemolysis
What are the 4 zones of the Queenan chart
lowest- unaffected or mild
intermediate- increased severe anemia
Rh positive- affected
intrauterine death risk- severe hemolytic disease
Do we want delta A450 to increase or decrease
decreasing is good
What 2 things interefere with delta A450 test results
meconium
light exposure-billirubin
Practice slides
Bodyfluids exam PP
