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AUBF > M6: Synovial fluid > Flashcards

M6: Synovial fluid Flashcards

1
Q

Synovial fluid

All statements are correct about synovial fluid except one.

A. Viscous liquid found in the cavities of movable joints.
B. Diarthroses
C. Provides nutrients directly to the bones in a joint.
D. Serves as a lubricant to reduce friction.

A

C

provide nutrients to the articular cartilage

inamo wakin, magsamasama kau

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2
Q

Synovial fluid is often referred to as?

A

joint fluid

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3
Q

bones in the synovial joints are lined with

A

smooth articular cartilage

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4
Q

Bones are separated by a cavity containing the

A

synovial fluid

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5
Q

All statements are correct about synovial fluid except one.

A. Joint is enclosed in a fibrous joint capsule, lined by cartilage and lubricated by synovial membrane fluid.
B. Type A cells are macrophage-like cells located in the
superficial layer.
C. Type B cells are fibroblast-like cells that produce hyaluronic
acid fibronectin, and collagen.
D. Provides nutrients to the articular cartilage.

A

A

  • cartilage lining should actually be the synovial membrane lining the capsule
  • synovial fluid is responsible for lubrication, not synovial membrane fluid.
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6
Q

TOF. Synovial fluid is formed as an ultrafiltrate of plasma across the articular cartilage.

A

F (formed as an ultrafiltrate of plasma across the synovial membrane)

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7
Q

All are correct except:

A. The filtration is nonselective except for the exclusion of high-molecular-weight proteins.
B. Most of the chemical constituents, although
seldom of clinical significance, have concentrations similar to plasma values.
C. They provide nutrients for the vascular-deficient cartilage.
D. Lessens the shock of joint friction that occurs during activities such as sitting and standing

A

D

  • shock from compression, not friction
  • impact activities, not sitting and standing
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8
Q

NORMAL SYNOVIAL FLUID VALUES

TOF. 4.5 mL volume of synovial

A

F (<3.5)

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9
Q

NORMAL SYNOVIAL FLUID VALUES

TOF. Varies from being entirely transparent to a faint shade reminiscent of yellow

Normal Color

A

T

thx chatgpt

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10
Q

NORMAL SYNOVIAL FLUID VALUES

Clarity

A

Clear

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11
Q

NORMAL SYNOVIAL FLUID VALUES

Viscosity

A

Able to form a string 4 to 6 cm long

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12
Q

NORMAL SYNOVIAL FLUID VALUES

TOF. Leukocyte count 4,000 - 6,000

A

F (<200 cell/uL)

None present

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13
Q

NORMAL SYNOVIAL FLUID VALUES

TOF. Neutrophils: <25%

A

T

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14
Q

NORMAL SYNOVIAL FLUID VALUES

TOF. Glucose: Plasma
difference: <20 mg/dL lower than the blood glucose level

A

F (10)

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15
Q

NORMAL SYNOVIAL FLUID VALUES

Total protein

A

<3 g/dL

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16
Q

SPECIMEN COLLECTION AND HANDLING

Synovial fluid is collected by needle aspiration called

A

arthrocentesis

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17
Q

TOF. The normal amount of fluid in the adult knee cavity is less
than 3.5 mL, but can increase to greater than 25 mL with
inflammation.

A

T

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18
Q

SPECIMEN COLLECTION AND HANDLING

TOF. Fluid from a
diseased joint may not clot.

A

F (Normal synovial fluid does not clot; however, fluid from a
diseased joint may contain fibrinogen and will clot)

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19
Q

SPECIMEN COLLECTION AND HANDLING

TOF. Therefore, fluid is often collected in a syringe that has been moistened with oxalate.

A

heparin

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20
Q

Required Tube Type

  1. Gram Stain and culture
  2. Glucose analysis
  3. Cell counts
  4. All other tests

A. Sodium Fluoride or Non-anticoagulated tube
B. EDTA or Heparin
C. SPS or sterile heparinized
D. Sodium Oxalate or Non-anticoagulated tube
E. Nonanticoagulated tube

A

C, A, B, E

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21
Q

SPECIMEN COLLECTION AND HANDLING

A
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22
Q

SPECIMEN COLLECTION AND HANDLING

ALL ARE CORRECT EXCEPT ONE:

A. Powdered anticoagulants should not be used.
B. The anticoagulated tube for other tests must be centrifuged and separated.
C. Specimens for crystal analysis should not be refrigerated.
D. All testing should be done as soon as possible to prevent cellular lysis and possible changes in crystals.

A

B (nonanti)

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23
Q

The word “synovial” comes from the Latin word for?

A

egg, ovum

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24
Q

Normal viscous synovial fluid resembles

A

egg white

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25
Q

COLOR AND CLARITY

color becomes a deeper yellow

anong clinical significance

A

noninflammatory and inflammatory effusions

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26
Q

COLOR AND CLARITY

greenish tinge

A

bacterial infection

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27
Q

COLOR AND CLARITY

Turbidity is frequently associated with the following except:

A. Synoviocytes
B. Fat droplets
C. Minerals
D. Synovial cell debris
E. NOTA

A

C

WBCs, RBCs, synoviocytes, crystals, fat droplets, synovial cell debris, and fibrin

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28
Q

COLOR AND CLARITY

When crystals are present the fluid may appear

A

Milky fluid

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29
Q

Synovial fluid viscosity comes from?

A

polymerization of the hyaluronic acid

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30
Q

VISCOSITY

This affects both the production of hyaluronate and its ability to polymerize, thus decreasing the fluid viscosity.

A

Arthritis

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31
Q

VISCOSITY

Hyaluronate polymerization can be measured using a?

A

Ropes, or mucin clot, test

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32
Q

VISCOSITY

Reagents of Ropes

A

2% to 5% acetic acid

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33
Q

VISCOSITY

When added to a solution of 2% to 5% acetic acid, normal synovial fluid forms a?

A

solid clot surrounded by clear fluid

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34
Q

VISCOSITY

The mucin clot test is reported in terms of (match good, fair, low, poor):

  • Friable clot
  • Soft clot
  • No clot
  • Solid clot
A
  • Low
  • Fair
  • Poor
  • Good
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35
Q

VISCOSITY

TOF. The mucin clot test is not routinely performed, because
all forms of arthritis decrease viscosity and little diagnostic information is obtained.

A

T

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36
Q

most frequently performed cell
count on synovial fluid

A

Total Leukocyte Count

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37
Q

CELL AND DIFFERENTIAL COUNTS

TOF. White blood cell (WBC) counts are seldom requested.

A

F (RBC)

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38
Q

CELL AND DIFFERENTIAL COUNTS

This is performed as soon as possible or the specimen should be refrigerated to prevent cellular disintegration.

A

Cell counts

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39
Q

CELL AND DIFFERENTIAL COUNTS

Very viscous fluid may need to be done, except:

A. Pretreated by adding one drop of 5% hyaluronidase in phosphate buffer per milliliter
B. Incubating at 37°C for 5 minutes
C. Pretreated by adding one drop of 0.05% hyaluronidase in phosphate buffer per milliliter

A

A

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40
Q

CELL AND DIFFERENTIAL COUNTS

Manual counts on thoroughly mixed specimens are done
using?

A

Neubauer counting chamber

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41
Q

CELL AND DIFFERENTIAL COUNTS

TOF. Clear fluids can usually be counted undiluted, but dilutions are necessary when fluids are turbid or bloody

A

T

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42
Q

CELL AND DIFFERENTIAL COUNTS

TOF. Traditional WBC diluting fluid can be used

A

F (contains acetic acid, it may produce a clot)

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43
Q

CELL AND DIFFERENTIAL COUNTS

TOF. 0.9g of NaCl dissolved in 100mL of sterile water can be used as a diluent.

A

T (Normal saline pa rin ‘yan)

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44
Q

CELL AND DIFFERENTIAL COUNTS

Suitable diluent necessary to lyse the RBCs

A

hypotonic saline
(0.3%) or saline that contains saponin

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45
Q

CELL AND DIFFERENTIAL COUNTS

Methylene blue added to the normal saline stains the?

A

WBC nuclei

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46
Q

CELL AND DIFFERENTIAL COUNTS

This diluent permits the separation of the RBCs and WBCs during counts performed on mixed specimens

A

Methylene blue

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47
Q

CELL AND DIFFERENTIAL COUNTS

Normal WBC count

A

WBC counts less than 200 cells/uL

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48
Q

CELL AND DIFFERENTIAL COUNTS

Differential counts should be performed on?

A

cytocentrifuged
preparations or on thinly smeared slides

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49
Q

CELL AND DIFFERENTIAL COUNTS

Prior to slide prep, fluid should be incubated with

A

hyaluronidase

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50
Q

CELL AND DIFFERENTIAL COUNTS

TOF. Neutrophils should account for less than 25% of the differential count and monocytes less than 15%.

A

F (lymphocytes <15%)

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51
Q

CELL AND DIFFERENTIAL COUNTS

Increased neutrophils indicate a

A

septic condition

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52
Q

CELL AND DIFFERENTIAL COUNTS

an elevated cell count with a predominance of
lymphocytes suggests a

A

nonseptic inflammation

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53
Q

CELL AND DIFFERENTIAL COUNTS

In both normal and abnormal specimens, cells may appear

A

more vacuolated

54
Q

CELL AND DIFFERENTIAL COUNTS

primary cells seen in normal synovial fluid

A

Mononuclear cells

monocytes, macrophages, and synovial tissue cells

55
Q

CELL AND DIFFERENTIAL COUNTS

may be present after crush injuries

A

lipid droplets

56
Q

CELL AND DIFFERENTIAL COUNTS

seen in cases of pigmented villonodular synovitis

A

Hemosiderin

57
Q

MATCH DESCRIPTIONS

  1. Reiter cell
  2. LE cell
  3. Synovial lining cell
  4. Macrophage (monocyte)
  5. Lymphocyte

A. Similar to macrophage, but
may be multinucleated, resembling a mesothelial cell
B. Mononuclear leukocyte
C. Vacuolated macrophage with
ingested neutrophils
D. Large mononuclear leukocyte, may be vacuolated
E. Neutrophil containing
characteristic ingested “round
body”

A
  1. C
  2. E
  3. A
  4. D
  5. B
58
Q

MATCH SIGNIFICANCE

  1. Reiter cell
  2. LE cell
  3. Synovial lining cell
  4. Macrophage (monocyte)
  5. Lymphocyte

A. Lupus erythematosus
B. Normal Disruption from
arthrocentesis
C. Crystal-induced
inflammation & Non-septic inflammation
D. Reactive arthritis
(infection in another part
of the body)
E. Normal Viral infections

A

D, A, B, E, C

59
Q

MATCH CELL/INCLUSION

  1. Neutrophil
  2. RA cell
  3. CartilaGe cells
  4. Rice bodies
  5. Fat Droplets
  6. Hemosiderin

A. Vacuolated macrophage with
ingested neutrophils
B. Microscopically show collagen and fibrin
C. Neutrophil with dark
cytoplasmic granules
containing immune
complexes
D. Refractile intracellular and
extracellular globules
E. Inclusions within clusters of
synovial cells
F. Large, multinucleated cell

A
  1. C
  2. A
  3. F
  4. B
  5. D
  6. E
60
Q

MATCH SIGNIFICANCE

  1. Neutrophil
  2. RA cell
  3. Cartilage cells
  4. Rice bodies
  5. Fat Droplets
  6. Hemosiderin

A. Bacterial sepsis
B. Rheumatoid arthritis
Immunologic inflammation
C. Osteoarthritis
D. Traumatic injury Chronic
inflammation
E. Tuberculosis Septic and rheumatoid arthritis
F. Pigmented villonodular
synovitis

A

ABCEDF

61
Q

CRYSTAL IDENTIFICATION

Microscopic examination of synovial fluid for the presence of
crystals is an important diagnostic test in evaluating?

A

arthritis

62
Q

This formation in a joint frequently results in an acute, painful inflammation

A

Crystal

63
Q

CRYSTAL IDENTIFICATION

Causes of crystal formation include metabolic disorders
and decreased renal excretion that produce the following, EXCEPT:

A. Elevated blood levels of crystallizing chemicals
B. Oral administration of medications, such as antihistamines
C. Degeneration of cartilage and bone
D. Injection of medications, such as corticosteroids
E. NOTA

A

B

64
Q

CRYSTAL IDENTIFICATION

primary crystals seen in synovial fluid are (2)?

A
  • monosodium urate (uric acid): gout
  • calcium phosphate dihydrate: pseudogout
65
Q

CRYSTAL IDENTIFICATION

most frequent causes of gout, increased serum uric acid results from, except:
A. Impaired metabolism of purines
B. Increased consumption of low-purine-content foods
C. Alcohol, and fructose
D. Chemotherapy treatment of leukemias
E. Decreased renal excretion of uric acid

A

B

66
Q

CRYSTAL IDENTIFICATION

most often associated with degenerative arthritis, producing cartilage calcification and endocrine disorders that produce elevated serum calcium levels

A

Pseudogout

67
Q

CRYSTAL IDENTIFICATION

present may include talcum powder and starch from gloves, precipitated anticoagulants, dust, and scratches on slides and cover slips. Slides and cover slips should be examined and if necessary, cleaned again before use

A

Artifacts

68
Q

CHARACTERISTICS OF SYNOVIAL FLUID CRYSTALS

Needles

A

Monosodium urate

69
Q

CHARACTERISTICS OF SYNOVIAL FLUID CRYSTALS

?:Rhomboid square, rods

A

Calcium pyrophosphate Dihydrate

70
Q

CHARACTERISTICS OF SYNOVIAL FLUID CRYSTALS

Notched, rhomboid plates

A

Cholesterol

71
Q

CHARACTERISTICS OF SYNOVIAL FLUID CRYSTALS

Flat, variable-shaped plates

A

Corticosteroid

72
Q

CHARACTERISTICS OF SYNOVIAL FLUID CRYSTALS

?:Envelopes

A

Calcium
oxalate

73
Q

CHARACTERISTICS OF SYNOVIAL FLUID CRYSTALS

Small particles
Require electron microscopy

A

Apatite (calcium phosphate)

74
Q

CHARACTERISTICS OF SYNOVIAL FLUID CRYSTALS

Negative birefringence

A
  • Monosodium urate
  • Cholesterol
  • Corticoteroid
  • Caox
75
Q

CHARACTERISTICS OF SYNOVIAL FLUID CRYSTALS

Positive birefingence

A
  • Calcium pyrophosphate
  • Corticosteroid (siya ay both posi and nega)
76
Q

CHARACTERISTICS OF SYNOVIAL FLUID CRYSTALS

No birefringence

A

Apatite (calcium phosphate)

77
Q

CHARACTERISTICS OF SYNOVIAL FLUID CRYSTALS

Match the clinical significance
1. Monosodium urate
2. Calcium pyrophosphate
3. Cholesterol
4. Corticosteroid
5. Calcium oxalate
6. Apatite

A. osteoathritis
B. renal dialysis
C. injections
D. extracellular
E. pseudogout
F. gout

A

FEDCBA

78
Q

SLIDE PREPARATION

TOF. Both MSU and CPPD crystals are reported as being located extracellularly and intracellularly (within neutrophils); therefore, fluid must be examined after WBC disintegration.

A

before WBC disintegration

79
Q

SLIDE PREPARATION

TOF. Fluid is examined as an unstained wet preparation.

A

T

80
Q

SLIDE PREPARATION

The slide is examined under what magnification? using what microscope?

A

LPO and HPO; regular light microscope

81
Q

SLIDE PREPARATION

Crystals (such as MSU and CPPD) can be seen in?

anong smear

A

Wright’s-stained smears

82
Q

SLIDE PREPARATION

TOF. Wright-stained smears can be solely relied on for accurate identification.

A

F (the wet prep examination
and the use of polarized and red-compensated polarized light for identification)

83
Q

SLIDE PREPARATION

  • They may be extracellular or
    located within the cytoplasm of
    neutrophils.
  • They are frequently seen sticking
    through the cytoplasm of the cell.
  • they lyse phagosome membranes and therefore do not appear in vacuoles.
A

Monosodium urate (uric acid) (MSU)

84
Q

SLIDE PREPARATION

They are usually located within vacuoles of the neutrophils

A

CPPD

85
Q

SLIDE PREPARATION

To avoid misidentification of CPPD crystals, the classic rhomboid shape should be observed and confirmed with?

A

red compensated polarized microscopy

86
Q

Once the presence of the crystals has been determined using direct polarization, positive identification is made using?

A

first-order red-compensated polarized light

87
Q

CRYSTAL POLARIZATION

A control slide for the polarization properties of MSU can be prepared using?

A

betamethasone acetate corticosteroid light

88
Q

CRYSTAL POLARIZATION

this is is more highly birefringent and appears brighter against the dark background.

A

Monosodium urate

89
Q

CRYSTAL POLARIZATION

What is placed in the microscope between the crystal and the analyzer, when compensated polarized light is used?

A

red compensator

90
Q

CRYSTAL POLARIZATION

separates the light ray into slow-moving and fast-moving vibrations and produces a red background

A

compensator

91
Q

CRYSTAL POLARIZATION

  • molecules run parallel to the long axis of the crystal
  • when aligned with the slow vibration, the velocity of the slow light passing through the crystal is not impeded as much as the fast light, which runs against the grain and produces a yellow color
  • This is considered negative birefringence (subtraction of velocity from the fast ray).
A

MSU crystals

92
Q

CRYSTAL POLARIZATION

  • molecules run perpendicular to the long axis of the crystal
  • when aligned with the slow axis of the compensator, the velocity of the fast light passing through the crystal is much quicker, producing a blue color
  • positive birefringence.
A

CPPD crystals

93
Q

CRYSTAL POLARIZATION

When the crystals are aligned perpendicular to the slow vibration, the color is?

A

reversed

94
Q

CRYSTAL POLARIZATION

MSU: Direction of compensator ray is parallel to the crystal
and is what color

A

yellow

95
Q

CRYSTAL POLARIZATION

MSU: Direction of compensator
ray is perpendicular to the crystal and is?

A

Blue

96
Q

CRYSTAL POLARIZATION

CPPD: Direction of compensator ray
is parallel to the crystal and is?

A

Blue

97
Q

CRYSTAL POLARIZATION

Direction of compensator ray is perpendicular to the crystal and is?

A

Yellow

98
Q

CHEMISTRY TESTS

most frequently requested test

A

glucose determination

99
Q

CHEMISTRY TESTS

markedly decreased glucose values indicate

A

inflammatiory (g2) and septic (g3)

100
Q

CHEMISTRY TESTS

TOF. Normal synovial fluid glucose values are based on the blood glucose level.

A

T

101
Q

CHEMISTRY TESTS

Fasting hours for glucose

A

8 hours

102
Q

CHEMISTRY TESTS

Normal values:

  1. Synovial fluid glucose
  2. Total protein
  3. Uric Acid

A. less than 2.0 mmol/L
B. 6 to 8 mg/dL
C. not exceed 10 mg/dL below the blood value
D. less than 3 g/dL

A

CDB

103
Q

CHEMISTRY TESTS

Glucose: 10 and 20 mg/dL

indicator for

A

Non-inflammatory and hemorrhagic joint disorders

104
Q

CHEMISTRY TESTS

Glucose: 0 to 40 mg/dL below plasma level

A

Inflammatory disorders

105
Q

CHEMISTRY TEST

20 to 100 mg/dL or 0 to 80Glucose: mg/dL less than the plasma level

A

Infectious and crystal-induced

106
Q

CHEMISTRY TEST

Because the large protein molecules are not filtered through the synovial membranes, normal synovial fluid contains

A

less than 3g/dL protein

107
Q

CHEMISTRY TEST

Increased levels of total protein

A

inflammatory and hemorrhagic disorders

108
Q

CHEMISTRY TEST

TOF. Synovial fluid protein measurement does not contribute greatly to the classification of these disorders, inflammatory and hemorrhagic

A

T

109
Q

CHEMISTRY TEST

demonstration of an elevated this may be used to confirm the diagnosis when the presence of crystals cannot be demonstrated in the fluid

A

uric acid level

110
Q

CHEMISTRY TESTS

often measured as a first evaluation in suspected cases of gout.

A

Uric acid

111
Q

CHEMISTRY TESTS

Increased in septic arthritis caused by gram-positive cocci
and gram-negative bacilli

A

lactate

112
Q

CHEMISTRY TESTS

Arthritis caused by

lactate values are normal or low

A

Neisseria gonorrhoeae

113
Q

CHEMISTRY TESTS

Lactate: Levels greater than 9 mmol/L (81 mg/dL) indicate

A

bacterial arthritis
and immediate onset of treatment

114
Q

CHEMISTRY TESTS

to monitor the severity and prognosis of rheumatoid arthritis (RA).

A

Enzymes

115
Q

MICROBIOLOGIC TESTS

may occur as a secondary complication of inflammation caused by trauma or through dissemination of a systemic infection

A

infection

116
Q

MICROBIOLOGIC TESTS

two of the most important tests performed on synovial fluid.

A

culture & g/s

117
Q

MICROBIOLOGIC TESTS

organisms are often missed on what test

A

g/s

118
Q

MICROBIOLOGIC TESTS

most frequently seen infection

A

bacterial

119
Q

MICROBIOLOGIC TESTS

Routine bacterial cultures should include an?

A

enrichment

120
Q

MICROBIOLOGIC TESTS

the common organisms
that infect synovial fluid are the

A

fastidious Haemophilus
species and Neisseria gonorrhoeae.

121
Q

MICROBIOLOGIC TESTS

For instance, the organism is difficult to grow in a culture,
molecular method is performed using?

A

PCR

122
Q

MICROBIOLOGIC TESTS

PCR: Lyme Disease Arthritis

give genus and spp

A
123
Q

MICROBIOLOGIC TESTS

PCR: osteoarticular tuberculosis

give the genus and spp

A
123
Q

MICROBIOLOGIC TESTS

PCR: Chlamydia trachomatis and N. gonorrhoeae

give the disease

A

venereal arthritis

124
Q

SEROLOGIC TESTS

present in the serum of most patients with RA

A

RF (rheumatoid factor)

125
Q

SEROLOGIC TESTS

TOF. RF is present in the serum of most patients with RA, whereas just more than half of these patients will demonstrate RF in synovial fluid

A

T

126
Q

SEROLOGIC TESTS

o Cause very serious joint inflammation
o Diagnosed in the serology laboratory by demonstrating the presence of their autoantibodies in serum.

A

Rheumatoid Arthritis and Systemic Lupus Erythematosus

127
Q

SEROLOGIC TESTS

Arthritis is a frequent complication of Lyme disease.
Therefore, demonstrating antibodies to the?

A

Borrelia burgdorferi

128
Q

Microbiological test

Causative agent of lyme disease arthritis

A

Borrelia burgdorferi

129
Q

Microbiological test

Causative agent of osteoraticular tuberculosis

A

M. tuberculosis

130
Q

Microbiological test

Causative agent of venereal arthritis

A

Chlamydia trachomatis & N. gonorrhoeae

AUBF (34 decks)

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