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Unit 2 Clin Med Lab > L6: Transudative vs Exudative > Flashcards

L6: Transudative vs Exudative Flashcards

1
Q

Does pulmonary embolism cause transudative or exudative effusion?

A

Can cause EITHER transudative or exudative effusion

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2
Q

most common causes of transudative pleural effusion

A

CHF
cirrhosis
nephrotic syndrome

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3
Q

most common causes of exudative pleural effusion

A

1st: Parapneumonic effusion
2nd: Malignancy
Autoimmune: lupus, rheumatoid arthritis
Hemothorax
Chylous effusion

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4
Q

Parapneumonic effusion

A

secondary to bacterial pneumonia, lung abscess, bronchiectasis

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5
Q

Malignancies most likely to cause exudative pleural effusion

A

lung/breast cancer, lymphoma

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6
Q

Hemothorax

A

pleural fluid has RBCs>100,000 cells/uL serousanginous appearance due to trauma, malignancy, pulmonary embolism

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7
Q

Chylous effusion

A

thoracic lymphatic duct disruption/impairment due to trauma, malignancy with lymphoma → cloudy milky effusion with triglycerides and lipids

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8
Q

Chylous effusion can occur in 2 sites

A

pleural fluid

peritoneal fluid

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9
Q

Light’s Criteria Rule for exudative pleural effusion

A
  1. Pleural fluid protein/serum protein ratio >.5
  2. Pleural fluid LDH/serum LDH ratio >.6
  3. Pleural fluid LDH > 2/3rds of upper limits of laboratory’s normal serum LDH

Any 1 of these three criteria: exudative

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10
Q

Transudative vs exudative pleural effusion: Total protein levels

A

Transudative: <3 g/dl
Exudative: > 3g/dl

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11
Q

Transudative vs exudative pleural effusion: protein fluid/protein serum ratio

A

Transudative: .5

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12
Q

Transudative vs exudative pleural effusion: Color

A

Transudative: clear, thin fluid
Exudative: cloudy, thick, viscous

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13
Q

Transudative vs exudative pleural effusion: WBC

A

Transudative: <300 cell/uL
Exudative: >500 cells/uL

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14
Q

Transudative vs exudative pleural effusion: LDH fluid/LDH serum ratio

A

Transudative: .6

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15
Q

Transudative vs exudative pleural effusion: fluid glucose vs serum glucose

A

Transudative: fluid glucose=serum glucose
Exudative: fluid glucose < serum glucose, or <60 mg/dl

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16
Q

Transudative vs exudative pleural effusion: pH

A

Transudative: 7.4-7.5
Exudative: 7.3-7.4

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17
Q

Transudative vs exudative pleural effusion: fluid amylase vs serum amylase

A

Transudative: fluid amylase=serum amylase
Exudative: fluid amylase > serum amylase

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18
Q

Peritoneal fluid aka

A

ascites

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19
Q

Causes of ascites

A

Portal hypertension: Hepatic cirrhosis (most cases), alcoholic hepatitis, acute liver failure

Malignancy (10%): most commonly ovarian

Heart failure, TB or fungal infection, hemodialysis-associated, pancreatic disease, nephrotic syndrome, severe malnutrition, myxedema (due to hypothyroidism)

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20
Q

severe hypothyroidism can cause

A

myxedema (severe edema)

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21
Q

Spontaneous bacterial peritonitis

A

Occurs in patients with cirrhosis+ascites

Infection likely originates in bowel→ abrupt onset of fevers, chills, abdominal pain, rebound tenderness

Exudative effusion

High mortality: important to recognize, treat

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22
Q

Transudative vs exudative peritoneal fluid:

Total protein levels

A

Transudative: <3g/dl
Exudative: >3g/dl

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23
Q

Transudative vs exudative peritoneal fluid:

Protein fluid/protein serum ratio

A

Transudative: .5

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24
Q

Transudative vs exudative peritoneal fluid:

Color

A

Transudative: thin, clear
Exudative: cloudy, thick, viscous

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25
Q

Transudative vs exudative peritoneal fluid:

WBC

A

Transudative: <300 cells/uL
Exudative: >500 cells/uL

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26
Q

Transudative vs exudative peritoneal fluid:

LDH fluid/LDH serum ratio

A

Transudative: .6

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27
Q

Transudative vs exudative peritoneal fluid:

Glucose

A

Transudative: fluid glucose=serum glucose
Exudative: fluid glucose < serum glucose, or <60 mg/dl

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28
Q

Transudative vs exudative peritoneal fluid:

Serum:ascitic fluid albumin gradient

A

Transudative: >1.1 g/dL
Exudative: <1.1 g/dL

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29
Q

SAAG=

A

Serum:ascitic fluid albumin gradient

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30
Q

Causes of pericardial effusion

A

Acute pericarditis (viral, bacterial, TB, idiopathic)
autoimmune disease
post-MI
post cardiac surgery
sharp/blunt chest trauma,
cardiac diagnostics/interventional procedures
malignancy (esp. metastatic)
mediastinal radiation
renal failure
myxedema
aortic dissection extending into the pericardium

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31
Q

How to tell if pericardial effusion is transudative or exudative

A

Protein, LDH, glucose, RBC, WBC do not reliably differentiate an exudate from a transudate

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32
Q

Rapid/acute pericardial effusion

A

small effusions 200-300 ml

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33
Q

Chronic pericardial effusion

A

larger effusions, >300 ml or so

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34
Q

When to suspect pericardial effusion

A

All cases of acute pericarditis

Unexplained, new cardiomegaly on CXR without pulmonary congestion

Unexplained persistent fever

Fever + disease process which could involve the pericardium

35
Q

Meningitis

A

Altered mental status + nuchal rigidity + fever
Often rapid onset, patients are quite ill
Requires rapid assessment and treatment → high mortality and long term morbidity

36
Q

Encephalitis

A

brain infection

37
Q

CSF

A

Between pia and arachnoid mater (subarachnoid space)

Blood brain barrier allows only lipid-soluble very small molecules to pass

38
Q

Pleural fluid normal values

A

50 ml, clear/serous/light yellow
RBCs: none
WBCs: <300/ml
<50 ml

39
Q

Peritoneal fluid normal values

A

Clear, serous, light
RBCs: none
WBCs: <300/ml
<50 ml

40
Q

Pericardial fluid normal values

A

Clear, straw colored
RBCs: none
WBCs: none

41
Q

CSF normal values

A 
150-200 ml
Thin,clear
Pressure <20 cm H2O* 
RBC: 0-5 cells/uL
WBC: 0-5 cells/uL
Protein: 15-45 mg/dL
Glucose: 50-75 mg/dL (approx 2/3 serum glucose) 
LDH <40 units/L
42
Q

Order CEA to test for

43
Q

Serum vs pleural fluid: compare:

A

Protein, glucose, amylase

44
Q

Serum vs peritoneal fluid: compare:

A

Protein, glucose, LDH, albumin

45
Q

Method of choice for pericardial fluid imaging

A

Ultrasound

46
Q

What to order if your patient has pericardial fluid

A

Troponin, ESR, CRP
ANA
EKG

PCR

47
Q

Test for TB in

A

all body fluids

48
Q

pleural fluid pH >7.3

A

infection
esophageal rupture
neoplasm

49
Q

Increase pleural fluid amylase

A

pancreatitis
esophageal rupture
malignancy

50
Q

Pleural fluid eosinophilia

A

Parasitic infection
Malignancy
TB

51
Q

Peritoneal fluid LDH fluid/LDH serum ratio >.6

A

bowel perforation
malignancy
infection

52
Q

Peritoneal fluid: Elevated amylase

A 
pancreatic
bowel perforation
malignancy
infection
esophageal rupture
53
Q

Peritoneal fluid: Elevated ammonia

A

ruptured/strangulated bowel

54
Q

Peritoneal fluid: Elevated bilirubin (brown effusion)

A

bowel/biliary perforation

55
Q

gold standard for analyzing CSF

56
Q

Cloudy CSF

A

infection

elevated protein

57
Q

Pink/red CSF

A

bleeding from procedure vs. subarachnoid bleeding

58
Q

Yellow CSF

A

xanthochromic: lysis of RBCs

59
Q

Increased CSF pressure

A

infection
intra-cranial bleeding
tumor
hydrocephalus

60
Q

Decreased CSF pressure

A

hypovolemia (dehydration, shock), chronic CSF leak, nasal fracture with dural tear

61
Q

Large differences in opening and closing pressure

A

spinal cord obstruction (tumor)

screaming/breath holding in baby/child who then relaxes

62
Q

CSF neutrophils

A

bacterial/tubercular meningitis, cerebral abscess, subarachnoid bleeding, tumor

63
Q

Abnormal CSF WBCs

A

> 5 cells/uL

64
Q

CSF Lymphocytes

A

viral/TB/fungal/syphilitic meningitis. Multiple sclerosis, Guillain-Barre syndrome

65
Q

CSF Eosinophils

A

parasitic meningitis, allergic reaction to radiopaque dyes

66
Q

CSF Macrophages

A

tubercular/fungal meningitis, hemorrhage, brain infarction

67
Q

Abnormal CSF RBCs

A

> 5 cells/uL

68
Q

abnormal WBC:RBC ratio in CSF

A

Ratio of 1 WBC:500 RBCs → pathologic: infection/meningitis

69
Q

Xanthochromia in CSF

A

lysis of RBCs→ hemoglobin→ oxyhemoglobin → methemoglobin → bilirubin

Present in >90% of patients within 12 hours of subarachnoid hemorrhage onset, but also can be present in infectious/inflammatory process

70
Q

Increased CSF protein

A 
infection/inflammatory processes
meningitis
encephalitis
myelitis
autoimmune disease
\+/- bleeding/hemolysis
71
Q

Oligoclonal gamma globulin bands (CSF)

A

Multiple sclerosis

72
Q

CSF glucose 2/3 of serum glucose

A

meningitis

neoplasm

73
Q

CSF glucose is increased in

A

hyperglycemic atates

74
Q

Increased CSF lactate dehydrogenase

A

bacterial meningitis
malignancy
intracranial hemorrhage

75
Q

Increased CSF Lactic Acid

A

bacterial/fungal meningitis, but not in viral

76
Q

Increased CSF Glutamine

A

hepatic encephalopathy

coma

77
Q

Increased CSF C-reactive protein (CRP)

A

bacterial meningitis

78
Q

Test CSF for

A

syphilis (VDRL/FTA-ABS)
Cryptococcus (india ink)
Toxoplasmosis (Giema/wright stain)

79
Q

Positive latex agglutination of CSF

A

meningococcal meningitis

80
Q

Traumatic puncture vs subarachnoid bleed:

CSF pressure

A

Traumatic puncture: normal

Subarachnoid bleed: increased

81
Q

Traumatic puncture vs subarachnoid bleed:

Duration of bleeding

A

Traumatic puncture: decreases as CSF is drawn

Subarachnoid bleed: remains the same color throughout draw

82
Q

Traumatic puncture vs subarachnoid bleed:

Repeat lumbar puncture

A

Traumatic puncture: no blood

Subarachnoid bleed: blood

83
Q

Traumatic puncture vs subarachnoid bleed:

Clotting

A

Traumatic puncture: present

Subarachnoid bleed: absent

84
Q

Traumatic puncture vs subarachnoid bleed:

Centrifuge

A

Traumatic puncture: clear fluid

Subarachnoid bleed: xanthochromia

Unit 2 Clin Med Lab (8 decks)

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