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CLINICAL MICROSCOPY > Synovial Fluid > Flashcards

Synovial Fluid Flashcards

1
Q

Synovial fluid, often referred to as

A

Joint fluid

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2
Q

Viscous liquid found in the cavities of the movable joints (diarthroses) or synovial joints

A

Synovial fluid

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3
Q

The bones in the synovial joints are lined with _____ and separated by a _____ containing the _____

A

Smooth articular cartilage
Cavity
Synovial fluid

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4
Q

The joint is enclosed in a fibrous joint capsule lined by the _____

A

Synovial membrane

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5
Q

The synovial membrane contains specialized cells called

A

Synoviocytes

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6
Q

Function of smooth articular cartilage and synovial fluid

A

Lubricates joints
Reduce friction between the bones during joint movement
Provides nutrients to the articular cartilage/ vascular-deficient cartilage
Lessens shock of joint compression during walking and jogging

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7
Q

Synovial fluid is formed as nonselective ultrafiltrate of plasma across the synovial membrane except for the exclusion of high-molecular-weight proteins. True or False?

A

True

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8
Q

The synoviocytes secrete a _____ containing _____ and a small amount of _____ which contribute to the noticeable viscosity of synovial fluid

A

Mucopolysaccharide
Hyaluronic acid
Protein

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9
Q

Synovial fluid is formed as nonselective ultrafiltrate of plasma. True or False?

A

True

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10
Q

Most of the chemical constituents of synovial fluid have concentrations similar to plasma values. True or False?

A

True

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11
Q

Damage to the articular membranes produces pain and stiffness in the joints, collectively referred to as

A

Arthritis

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12
Q

Classification of joint disorder due to degenerative causes

A

Noninflammatory

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13
Q

Classification of joint disorder due to immunologic/crystal-induced causes

A

Inflammatory

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14
Q

Classification of joint disorder due to microbial causes

A

Septic

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15
Q

Classification of joint disorder due to anticoagulant overdose

A

Hemorrhagic

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16
Q

REVIEW LABORATORY FINDINGS IN JOINT DISORDERS

A

REVIEWHIN MO SA NOTES

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17
Q

Synovial fluid is collected by needle aspiration called

A

Arthrocentesis

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18
Q

Normal amount of fluid in the adult knee cavity

A

<3.5 mL

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19
Q

> 25 mL synovial fluid indicates

A

Inflammation

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20
Q

Normal synovial fluid does not clot. True or False?

A

True

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21
Q

Fluid from a diseased joint may contain _____ and will _____

A

Fibrinogen
Clot

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22
Q

Synovial fluid is often collected in a syringe that has been moistened with _____

A

Heparin

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23
Q

Powdered anticoagulants should not be used. True or False? If so, why?

A

True; because they may produce artifacts that interfere with crystal analysis

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24
Q

All testing should be done _____ to prevent _____ in crystals

A

As soon as possible
Cellular lysis and possible changes

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25
Q

Required tube type for Gram stain and culture

A

Sterile heparinized or sodium polyanethol sulfonate

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26
Q

Required tube type for Cell counts

A

Heparin or liquid ethylenediaminetetraacetic acid (EDTA)

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27
Q

Required tube type for Glucose analysis

A

Sodium fluoride

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28
Q

Required tube type for all other tests

A

Nonanticoagulated

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29
Q

Normal color and clarity of synovial fluid

A

Colorless to pale yellow

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30
Q

Turbid synovial fluid indicates

A

WBCs, Synovial cell debris, and Fibrin

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31
Q

Deeper yellow synovial fluid indicates

A

Noninflammatory and inflammatory effusions

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32
Q

Greenish synovial fluid indicates

A

Bacterial infection

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33
Q

Red synovial fluid indicates

A

Traumatic tap, Hemorrhagic arthritis

34
Q

Milky synovial fluid indicates

A

Crystal induced

35
Q

The word “synovial” comes from the Latin word for

A

Egg, ovum

36
Q

Normal viscous synovial fluid resembles

A

Egg white

37
Q

How to distinguish hemorrhagic arthritis from traumatic aspiration

A

Observe uneven distribution of blood or blood streak in the specimens

38
Q

Arthritis affects both the production of hyaluronate and its ability to polymerize. True or False?

A

True

39
Q

Viscosity test for synovial fluid

A

String test
Hyaluronate Polymerization Test

40
Q

Positive result of String test

A

String measuring 4-6 cm

41
Q

Positive result of Hyaluronate Polymerization Test

A

Solid clot surrounded by clear fluid

42
Q

Describe the grading of synovial fluid viscosity

A

Good=Solid clot
Fair=Soft clot
Low=Friable clot
Poor=No clot

43
Q

How to identify a questionable fluid as synovial fluid?

A

Formation of a mucin clot after adding acetic acid

44
Q

Most frequently performed cell count on synovial fluid

A

Total leukocyte count

45
Q

Normal RBC count in synovial fluid

A

<2000 cells/µL

46
Q

Normal WBC count in synovial fluid

A

<200 cells/µL

47
Q

WBC count in synovial fluid that indicates severe infections

A

100,000 WBC/µL or higher

48
Q

Why is it that traditional WBC diluent cannot be used?

A

Because it contains acetic acid that causes the formation of mucin clots

49
Q

Neutrophil containing characteristic ingested “round body”

A

LE cell

50
Q

Vacuolated macrophage with ingested neutrophils

A

Reiter cell (Neutrophages)

51
Q

Neutrophil with small, dark cytoplasmic granules consisting precipitated rheumatoid factor

A

RA cell (Ragocyte)

52
Q

Refractile intracellular and extracellular globules

A

Fat droplets

53
Q

Ground pepper appearance inclusion

A

Ochronotic shards

54
Q

Primary crystal; found in cases of gout

A

Monosodium urate (uric acid) (MSU)

55
Q

Primary crystal; seen with pseudogout

A

Calcium pyrophosphate dihydrate (CPPD)

56
Q

Crystal associated with calcified cartilage degeneration, cholesterol crystals associated with chronic inflammation, corticosteroids after injections

A

Hydroxyapatite (basic calcium phosphate)

57
Q

Crystal seen in renal dialysis patients

A

Calcium oxalate crystals

58
Q

Crystal examination should be performed soon after fluid collection to ensure that crystals are not affected by changes in temperature and pH. True or False?

A

True

59
Q

CPPD crystals are usually located within ______ while MSU crystals _____ and therefore do not appear in vacuoles

A

Vacuoles of the neutrophils
Lyse phagosome membranes

60
Q

Positive identification of crystal is made by using

A

First order red-compensated polarized light

61
Q

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

A

Betamethasone acetate corticosteroid

62
Q

MSU crystal is more highly birefringent and appears brighter against the dark background than CPPD crystal. True or False?

A

True

63
Q

Microscope that detects for the presence or absence of birefringence

A

Polarizing microscope

64
Q

Microscope that confirms the type of birefringence (positive or negative)

A

Compensated polarizing microscope

65
Q

_____ : run parallel to the long axis = _____ Birefringence = _____ color

A

MSU
Negative
Yellow

66
Q

CPPD: run _____ to the long axis = _____ Birefringence = _____ color

A

Perpendicular
Positive
Blue

67
Q

Cholesterol, oxalate, corticosteroid crystals, and contaminants exhibit birefringence. True or False?

A

True

68
Q

Apatite crystals are birefringent. True or False?

A

False; not birefringent

69
Q

Most frequently requested chemistry test for synovial fluid

A

Glucose test

70
Q

Normal synovial fluid glucose value

A

<10 mg/dL lower than the blood value

71
Q

To prevent falsely decreased values caused by glycolysis, specimens should be analyzed within _____ or preserved with _____

A

1 hour
Sodium fluoride

72
Q

Lactic acid levels are usually increased in patients with _____ arthritis

A

Septic

73
Q

Normal synovial fluid lactic acid value

A

<30mg/dL

74
Q

> 30mg/dL lactic acid indicates

A

Septic arthritis

75
Q

Normal synovial fluid total protein value

A

<3 g/dL

76
Q

Increased levels of total protein are found in _____ and _____disorders

A

Inflammatory
Hemorrhagic

77
Q

Measured as a first evaluation in suspected cases of gout

A

Uric acid

78
Q

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

A

Lactate or acid phosphatase

79
Q

Two of the most important tests performed on synovial fluid

A

Gram stains
Cultures

80
Q

Routine bacterial cultures should include an enrichment medium, such as

A

Chocolate agar

81
Q

Common organisms that infect synovial fluid

A

Staphylococcus and Streptococcus, fastidious Haemophilus species and Neisseria gonorrhoeae

82
Q

Causative agent of Lyme disease

A

Borrelia burgdorferi

CLINICAL MICROSCOPY (20 decks)

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