final exam Flashcards
name four reasons amniotic fluid is collected during pregnancy?
antenatal diagnosis of genetic disorders
assess fetal pulmonary maturity
sex predictions
predicting HDN
if an amniotic fluid is collected early in a pregnancy (ie. 15-18 weeks) it is most likely being collected to determine what?
genetic or congenital disorders
what is the definition of oligohydraminos?
abnormally decreased amounts of amniotic fluid
what would be the reason for protecting amniotic fluid from light?
for chemical examination of bilirubin
when present in amniotic fluid, fetal cells are adversely affected by what?
refrigeration
explain what you might find when performing a physical examination of amniotic fluid, including: color and turbidity
color: N= colorless, pale yellow bilirubin= yellow/amber mecnoium= green blood= pink/red turbidity depends on the stage of pregnancy, as it becomes later in the pregnancy turbidity increases
name the four tests done to evaluate the surfactants present to the fetal pulmonary system
- 3 phospholipids checked: L/S ratio and phosphatidylglycerol present or not present
- foam stability index (FSI)
- microviscosity tests
using and comparing the L/S ratio and the PG determination, what would indicate fetal lung maturity?
if the L/S ratio is >2.0 and PG present
Transudates
noninflammatory caused by disturbances of oncotic pressure
clear, no clots, few cells, SG <1.015, TP = 3.0
name three biochemical indicators that are used to evaluate the secretory function of the prostate. Of these three biochemical indicators, which one can positively identify a fluid as seminal fluid and is useful in cases of sexual assault?
zinc, citric acid, acid phosphatase
acid phosphatase
name four reasons for a physician to order a semen analysis
-evaluate infertility
-ensure vasectomy effectiveness
-evaluation for semen donation
-forensic applications:
presence in vag. secretions, DNA, finger printing
which structures contribute secretions to seminal fluid?
testes, epididymis, seminal vesicles, prostate gland
what is a normal concentration of a normal seminal fluid?
20 to 250 million
is the concentration of semen within a single individual constant? if not, what factors might influence concentration?
no, abstinence, viral infections, and stress
is concentration the most important factor when determining infertility?
no, motility is.
what parameter of a semen analysis is directly related to and provides a check of the motility evaluation? how?
viability, to decide if the sperm is not swimming because it’s dead or because it cannot swim
what percentage of sperm with normal morphology is considered normal or acceptable? how is sperm morphology determined?
50%
stained smear of fresh specimen
what is the normal pH of seminal fluid?
7.2-7.8
what might a pH of <7.2 indicate?
abnormality of epididymis , vas deferens, or seminal vesicles
what might a pH of >7.8 indicate?
infection in male reproductive tract
testing frucose in seminal fluid reflects the secretory function of the ____ ____ , as well as the functional integrity of the _________ and _____ ____
seminal vesicles
ejaculatory ducts and vas deferens
what is the primary function of the seminal fluid?
transport spermatoza
explain the requirements for the collection of a specimen for semen analysis?
- masturbation…. obviously…
- must be recieved within 1 hr. after collection
- kept at 20-40 C
- 2 or more samples to analyze for fertility
- take place within a 3 month period and 7 days apart
- sexual abstinence 48 hours but no more than 7 days before collection
what is a normal length of time (in minutes) for a semen specimen to liquefy?
30 min.
after liquefaction, the viscosity closely resembles that of what other fluid?
tiny bit thicker than water
what would be considered abnormal liquefaction?
outside 60 minutes.
motility should be evaluated within how many minutes following collection?
60 minutes
explain the color, clarity, viscosity, and clot formation of normal synovial fluid
color = pale yellow, colorless, or clear
clarity= clear
viscosity = very
clot formation = no clotting
is fibrinogen a normal constituent or normal synovial fluid?
no
does hyaluronate affect the turbidity of a synovial fluid specimen?
no
Name some things that might cause a synovial fluid to be turbid in appearance?
WBC RBC synoviocytes crystals fat droplets cellular debris
why should a synovial fluid be examined ASAP? what component might be most adversely affected by a delay in examination?
important to exam ASAP b/c crystals can form during storage or WBC will phagocytize crystals already present
for microscopic examination purposes, the synovial fluid should be placed in a tube containing which anticoagulant ? why should other anticoagulants be avoided?
sodium heparin
to prevent artifacts
name the diluent that should be used should a synovial fluid need to be diluted for microscopic exam?
0.85% saline
a joint disease process is indicated by what?
> 25% neutrophils
what type of miscroscopy differentiates synovial fluid crystals based on their birefringence? how is this achieved?
compensated polarizing microscopy based on the different colors produced when crystals are oriented parallel & perpendicular to the axis of the compensator
name some indicators of a synovial fluid that would be classified as septic?
- plasma-synovial glucose difference increase > 40
- yellow-green
- white cell increase > 50,000
- low viscosity
which crystal is usually seen in patient with gout?
uric acid (yellow to the parallel looking microscopically)
are monosodium urate, calcium pyrophosphate dihydrate, and cholesterol crystals all birefringent?
yes
which analytes are present in synovial fluid at concentrations equal to blood plasma levels?
glucose and uric acid
if a bloody CSF fluid is recieved in the lab, what are some steps to take to determine if it is a traumatic tap or the patient has actually had a hemorrhage?
if 1st tube has greatest amt. of blood –> traumatic tap
if equal distribution of RBCs throughout all tubes –> hemorrhage
centrifuge - colorless supernatant = traumatic tap
xanthochromic supernatant = hemorrhage
define xanthochromia
yellow discoloration
does fibrinogen NORMALLY pass through the blood-brain barrier?
no
according to the lumbar puncture procedure in your notes, the first tube collected should be used for what type of testing?
chemical and immunologic
a predominance of lymphocytes within CSF indicates which type of meningitis?
viral meningitis
what are the normal ranges of glucose within a normal CSF?
G= 50-80 mg/dl
what condition would a decreased glucose indicate?
meningitis
the amount of glucose in CSF is approximately ____% or ____ the plasma concentration
60-70
2/3
define pleocytosis as it relates to CSF
increased number of cells in CSF
does an increased number of leukocytes within CSF cause xanthochromia?
no
an uneven distribution of blood in the CSF collection tubes most likely indicates what?
traumatic tap
give the normal CSF WBC cell counts for adults, children, and newborns.
A= 0-5/ microliters C= 0-10/ microliters N= 0-30/ microliters
in adults CSF cell counts, what two cell types are considered normal if seen in the fluid?
lymphocytes and monocytes
a predominance of neutrophils within CSF indicates which type of meningitis?
bacterial meningitis
what is the normal range for lactate in CSF? Normal lactate levels are often found in patients with what type of meningitis?
N= 10-22 / dl
viral
which procedure frequently provides a rapid presumptive diagnosis of bacterial meningitis?
gram stain
is L/S ratio affected by blood and meconium?
yes
is the PG affected by blood and/or meconium?
no
exudates
inflammatory caused by process that increases capillary permeability in membrane or decrease in absorption off fluid by lymphatic system
cloudy, clots, many cells, SG > 1.015, TP > 3.0
Give a description of what three zones mean in reference to the change in alpha 450 and the Liley’s 3 zone chart
zone 1 = normal
zone 2 = moderate hemolysis
zone 3 = severe hemolysis - fetus will die without intervention
what are the normal ranges for protein within a normal CSF?
15-45 mg/ dl `
what condition would an increased protein indicated in CSF?
meningitis
