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AUBF > M4: Serous Fluids (Part 2: Pleural Fluid) > Flashcards

M4: Serous Fluids (Part 2: Pleural Fluid) Flashcards

1
Q
  • Located between Parietal & Visceral Membrane
  • Pleural cavity
A

Pleural Fluid

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2
Q

Pleural Fluid

Pleural fluid cholesterol: ?
Pleural fluid: serum cholesterol ratio: ?
Fluid: serum total bilirubin ratio: ?

Exudate

A

Pleural fluid cholesterol: > 60 mg/dL
Pleural fluid: serum cholesterol ratio: > 0.3
Fluid: serum total bilirubin ratio: 0.6 or more

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3
Q

Pleural Fluid

  • Immunologic Disease
  • Measurement of Glucose is recommended
A

Rheumatoid arthritis

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4
Q

Pleural Fluid

Clear, Pale Yellow

Appearance

CORRELATION OF PLEURAL FLUID APPEARANCE & DISEASE

A

Normal

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5
Q

Pleural Fluid

Turbid, White

Appearance

CORRELATION OF PLEURAL FLUID APPEARANCE & DISEASE

A

Microbial Infection (Tuberculosis)

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6
Q

Pleural Fluid

Bloody

Appearance

CORRELATION OF PLEURAL FLUID APPEARANCE & DISEASE

A
  • Hemothorax
  • Hemorrhagic effusion
  • Pulmonary Embolus
  • Severe TB
  • Malignancy
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7
Q

Pleural Fluid

Milky

Appearance

CORRELATION OF PLEURAL FLUID APPEARANCE & DISEASE

A
  • Chylous material (from thoracic duct)
  • Pseudochylous material (chronic inflammation)
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8
Q

Pleural Fluid

Brown

Appearance

CORRELATION OF PLEURAL FLUID APPEARANCE & DISEASE

A

Rupture of Amoebic Liver Abscess

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9
Q

Pleural Fluid

Black

Appearance

CORRELATION OF PLEURAL FLUID APPEARANCE & DISEASE

A

Aspergillus

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10
Q

Pleural Fluid

Viscous

Appearance

CORRELATION OF PLEURAL FLUID APPEARANCE & DISEASE

A

Malignant Mesothelioma (Increased Hyaluronic Acid)

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11
Q

CORRELATION OF PLEURAL FLUID APPEARANCE & DISEASE

WBC, bacterial infection, TB

a. Turbidity
b. Blood
c. Milky
d. ALL
e. NOTA

A

a. Turbidity

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12
Q

CORRELATION OF PLEURAL FLUID APPEARANCE & DISEASE

Rheumatoid arthritis

a. Turbidity
b. Blood
c. Milky
d. ALL
e. NOTA

A

a. Turbidity

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13
Q

CORRELATION OF PLEURAL FLUID APPEARANCE & DISEASE

Occurs in
Malignancy, or a Traumatic Aspiration

BLOOD

A

Membrane Damage

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14
Q

CORRELATION OF PLEURAL FLUID APPEARANCE & DISEASE

high TAG, (+) Sudan III

a. Chylous
b. Thoracic Duct Leakage
c. Pseudochylous
d. a and b
e. a and c
f. NOTA

Milky

A

d. a and b

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15
Q

CORRELATION OF PLEURAL FLUID APPEARANCE & DISEASE

Chronic Inflammatory Conditions

a. Chylous
b. Thoracic Duct Leakage
c. Pseudochylous
d. a and b
e. a and c
f. NOTA

A

c. Pseudochylous

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16
Q

Chylous Effusion OR Pseudochylous Effusion

Cause: Thoracic duct damage

Appearance: Milky/White

Leukocytes: PREDOMINANTLY Lymphocytes

Cholesterol Crystals: Absent

Triglycerides: > 110 mg/dL

Sudan III Stain: Strongly
POSITIVE

A

Chylous Effusion

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17
Q

Chylous Effusion OR Pseudochylous Effusion

Cause: Chronic Inflammation, Lymphatic Obstruction

Appearance: Milky/Green tinge

Leukocytes: Mixed Cells

Cholesterol Crystals: Present

Triglycerides: < 50 mg/dL

Sudan III Stain: NEGATIVE or Weakly positive

A

Pseudochylous Effusion

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18
Q

Pleural Fluid: Hematology Tests

Macrophages

Normal Value

A

64-80%

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19
Q

Pleural Fluid: Hematology Tests

Lymphocyte

Normal Value

A

18-30%

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20
Q

Pleural Fluid: Hematology Tests

Neutrophils

Normal Value

A

1-2%

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21
Q

Pleural Fluid: Hematology Tests

Eosinophils

Normal Value

A

0

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22
Q

Pleural Fluid: Hematology Tests

Pneumothorax & Hemothorax

a. Macrophages
b. Lymphocytes
c. Neutrophils
d. Eosinophils

Differential count

A

d. Eosinophils

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23
Q

Pleural Fluid: Hematology Tests

Pancreatitis

a. Macrophages
b. Lymphocytes
c. Neutrophils
d. Eosinophils

A

c. Neutrophils

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24
Q

Pleural Fluid: Hematology Tests

Pulmonary Infarction

a. Macrophages
b. Lymphocytes
c. Neutrophils
d. Eosinophils

A

c. Neutrophils

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25
Q

Pleural Fluid: Hematology Tests

SLE

a. Macrophages
b. Lymphocytes
c. Neutrophils
d. Eosinophils

A

b. Lymphocytes

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26
Q

Pleural Fluid: Hematology Tests

Malignancy

a. Macrophages
b. Lymphocytes
c. Neutrophils
d. Eosinophils

A

b. Lymphocytes

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27
Q

Pleural Fluid: Hematology Tests

Normal even if higher

a. Macrophages
b. Lymphocytes
c. Neutrophils
d. Eosinophils

A

a. Macrophages

28
Q

Pleural Fluid: Hematology Tests

presence of blood in pleural cavity

A

Hemothorax

29
Q

Pleural Fluid: Hematology Tests

presence of excess AIR

A

Pneumothorax

30
Q

Pleural Fluid: Hematology Tests

Decreases lung pressure

a. Hemothorax
b. Pneumothorax
c. both
d. NOTA

A

d. NOTA

Both increases pressure in lungs making it hard to inflate & breathe

31
Q

Pleural Fluid

These are called malignancy of mesothelial cells

A

Mesothelioma

32
Q

Pleural Fluid

T or F

It is normal to find single layer of Mesothelial cells in the lining of membranes of our serous cavities

A

T

33
Q

Pleural Fluid

Appear as single, small, round cells with abundant blue cytoplasm with rounded nuclei

A

Mesothelial Cells

34
Q

Pleural Fluid

  • Abnormal Mesothelial
    cells – Larger than usual
  • Appear in clusters
  • Eccentric Nuclei (sometimes
    multi-nucleated)
  • Not diagnostically significant
A

Reactive mesothelial cells

35
Q

Reactive mesothelial cells are not diagnostically significant unless in cases of what (2) conditions?

A

Malignancy & Pneumonia,

mesothelial cell count is higher

36
Q

Which of the following is not included in chemistry tests for pleural fluid?

a. Glucose
b. pH
c. ADA
d. Amylase
e. Triglyceride

which is indicative of chylous effusion

A

LAHAT KASAMA RAHHH

37
Q

Pleural Fluid: Chemistry Tests

Volume of glucose which represent decreased glucose

A

<60 mg/dL

38
Q

Pleural Fluid: Chemistry Tests

(Increase or Decrease in Glucose in Pleural Fluid?)

  • Tuberculosis
  • Rheumatoid Inflammation,
  • Malignant Effusion
  • Esophageal Rupture
  • Lupus Pleuritis
  • Purulent Infections
A

Decrease

39
Q

Pleural Fluid: Chemistry Tests

Increase lactate levels = ?

inidicate whay condition

A

Bacterial Infections

40
Q

Pleural Fluid: Chemistry Tests

If the pH is lower than 7.3, what condition is it associated with ?

A

Chest-Tube Drainage (Pneumonia)

41
Q

Pleural Fluid: Chemistry Tests

If the pH is 0.30 degrees lower, what condition is it associated with ?

A

Acidosis

42
Q

Pleural Fluid: Chemistry Tests

If the pH is 6.0, what condition is it associated with ?

A

Esophageal Rupture (Contamination of Gastric fluid)

43
Q

Pleural Fluid: Chemistry Tests

T or F

Gastric secretion in esophagus and goes into serous fluid which makes it alkaline

A

F (ACIDIC)

44
Q

Pleural Fluid: Chemistry Tests

Requirements for pH testing for pleural fluid?

A
  • Anaerobic Heparinized Syringe
  • Blood Gas Analyzer at 37°C.
45
Q

Pleural Fluid: Chemistry Tests

> 40 U/L of ADA are highly indicative of

a. Acidosis
b. Tuberculosis
c.Malignancy
d. a and c
e. b and c

A

e. b and c

46
Q

Pleural Fluid: Chemistry Tests

(2) factors elevated in cases of Esophageal Rupture
and Malignancy

A

Amylase, Salivary Amylase

47
Q

Pleural Fluid: Chemistry Tests

If specimen is milky, what (3) parameters should be observed to check if Chylous or Pseudochylous

A
  • Color & Presence of triglyceride
  • SUDAN III staining
48
Q

Significance of Chemical Testing

  • Decreased Rheumatoid Inflammation
  • Decreased Purulent infection

Based on significance, give what test it correlates with

A

Glucose

49
Q

Significance of Chemical Testing

Elevated Bacterial infection

Based on significance, give what test it correlates with

A

Lactate

50
Q

Significance of Chemical Testing

Elevated Chylous effusions

Based on significance, give what test it correlates with

A

Triglyceride

51
Q

Significance of Chemical Testing

  • Decreased Pneumonia NOT Responding to Antibiotics
  • Markedly Decreased Esophageal rupture

Based on significance, give what test it correlates with

A

pH

52
Q

Significance of Chemical Testing

  • Elevated TB & Malignancy

Based on significance, give what test it correlates with

A

ADA

53
Q

Significance of Chemical Testing

Elevated Pancreatitis, Esophageal rupture, & Malignancy

Based on significance, give what test it correlates with

A

Amylase

Based on significance, give what test it correlates with

54
Q

Pleural Fluid: Microbiological Tests

Microbiological tests are used to determine primarily what (3) bacteria?

A
  • STAPH A
  • E. ANAEROBE
  • M. TUBERCULOSIS
55
Q

Pleural Fluid: Microbiological Tests

Which microrbiological test are used to detect presence of bacteria especially M. tuberculosis

a. Gram Stains
b. Cultures
c. AFS
d. Mycobacterium cultures
e. a and b
f. a and c
g. ALL

A

g. ALL

56
Q

Pleural Fluid: Microbiological Tests

  • more sensitive
    test to detect M. tuberculosis
A

Polymerase chain reaction (PCR)

57
Q

Test used to differentiate Effusions of Immunologic origin from NON-inflammatory process

A

Serological tests

58
Q

Pleural Fluid: Serological Tests

(2) tests under serological tests?

A
  • ANA (Antinuclear antibody)
  • RF (Rheumatoid factor)
59
Q

Pleural Fluid: Serological Tests

tests used with patient with SLE

a. ANA
b. RF
c. both
d. NOTA

A

a. ANA

60
Q

Pleural Fluid: Serological Tests

Familiarize the tumor markers for pleural fluid which is associated with cancer

A
  • Carcinoembryonic Antigen (CEA)
  • CA 125 (Metastatic Uterine Cancer)
  • CA 15.3 and CA 549 (Breast Cancer)
  • CYFRA 21-1 (Lung Cancer)
61
Q

Pleural Fluid: Serological Tests

CA 125

Identify which condition is associated with the tumor marker

A

Metastatic Uterine Cancer

62
Q

Pleural Fluid: Serological Tests

CA 15.3 and CA 549

Identify which condition is associated with the tumor marker

A

Breast Cancer

63
Q

Pleural Fluid: Serological Tests

CYFRA 21-1

Identify which condition is associated with the tumor marker

A

Lung Cancer

64
Q

Pleural Fluid Testing

IF U SEE THIS CARD PAKICHECK YUNG PHOTO ABOUT FLUDI TESTING THX

A

ok

65
Q

Pleural Fluid Testing

Familiarize steps for pleural fluid testing

A
  1. Check appearance
  2. Analyze Fluid:protein serum ratio; protein:LD ratio
  3. Check what type of Infection or Inflammation

AUBF (45 decks)

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