synovial fluid

Question 1

• VISCOUS FLUID SEEN IN DIARTHROSES (JOINTS/MOVABLE JOINTS)
• joint fluid
• latin word: egg

Answer 1

synovial fluid

Question 2

• Lubrication for the movable joints
• Nutrients for articular cartilage
• Lessens shock of joint compression
• Ultrafiltrate of plasma across synovial membrane
• No high weight molecules

Answer 2

synovial fluid

Question 3

secrete hyaluronic acid that makes the fluid viscous (lubrication)

Answer 3

synoviocytes

Question 4

TO DECREASE FRICTION AND INCREASE VISCOSITY = NEEDS (?)

Answer 4

HYALURONIC ACID

Question 5

• Needle aspiration called (?)
• Normal knee fluid amount (?)
• Normal fluid (?); diseased fluid (?)

Answer 5

• arthrocentesis
• <3.5 mL
• does not clot
• clots

Question 6

spx collection

• chemistry: (?)
• immunologic eval: (?)
• microbio: (?)
• hema: (?)

Answer 6

• red top/heprinized
• red top/heparinized
• heparin/sps
• liquid EDTA

Question 7

liquid or solid

versene

Answer 7

liquid edta

Question 8

liquid or solid

sequestrene

Answer 8

solid edta

Question 9

powdered edta will create (?)

Answer 9

artifacts (crystals)

Question 10

presence of chronoctic shards (black pepper appearance)

Answer 10

ochronosis

Question 11

apperance

• normal: (?)
• infection: (?)
• hemorrhagic/traumatic tap: (?)
• crystal induced: (?)
• turbodity: (?)

Answer 11

• clear/pale yellow
• deeper yellow, green tinge
• red
• milky
• wbc, cellular debris, fibrin

Question 13

used to identify synovial fluid

Answer 13

acetic acid

Question 14

decreses polymerization

Answer 14

ahrthritis

Question 15

infection decreases (?), and high chances of (?)

Answer 15

• hyaluronidase
• clotting

Question 16

prevents clooting of S.F.

Answer 16

hyaluronidase

Question 17

(?) cm string from aspirating needle

Answer 17

4-6

Question 18

rope/mucin clot test

Add fluid to (?) acetic acid to form clot

Answer 18

2%–5%

Question 19

cell counts

• (?) most common
• Do not use normal WBC diluting fluid; use normal (?)
• May have to treat viscous fluid with hyaluronidase first: pretreat with a pinch of hyaluronidase to (?) mL of fluid or one drop of (?) hyaluronidase in phosphate buffer per mL of fluid àt (?) for (?) minutes
• Perform in same manner as cerebrospinal fluid counts
• Normal: (?) WBCs/μL, septic may reach (?)

Answer 19

• wbc
• saline/methylene blue
• 0.5,
• 0.05%
• 37ºC
• 5
• <200
• > 100,000

Question 20

differential count

• Incubate with (?), then (?)
• Normal cells: monocytes, macrophages, synovial tissue cells
• Neutrophils: (?)%
• Lymphocytes: (?)%, noninflammatory higher
• All cells may appear more (?)

Answer 20

• hyaluronidase, cytocentrifuge
• <25
• <5
• vacuolated

Question 21

Similar to macrophage, but may be multinucleated, resembling a mesothelial cel

Answer 21

synovial lining cell

Question 22

Neutrophil containing characteristic ingested: “round body”

Answer 22

LE cell

Question 23

Vacuolated macrophage with ingested neutrophils

Answer 23

reiter cell

Question 24

Neutrophil with dark cytoplasmic granules containing immune complexes

Answer 24

RA cell (ragocyte)

Question 25

Pigmented villonodular synovitis

Answer 25

hemosiderin granules

Question 26

crystals

• needle:
• rhombic square, rods:
• notched, rombic plates:
• flat, variable-shaped plates:
• envelope:
• small particles, require electron microscopy:

Answer 26

• monosdium urate
• calcium pyrophosphate
• cholesterol
• corticosteroid
• calcium oxalate
• apatite

Question 27

needle-shaped; seen intra- and extracellularly; may be seen sticking through cytoplasm

Answer 27

MSU crystals

Question 28

rhombic, square shaped, or short rods; often seen in vacuoles of neutrophils

Answer 28

CPPD crystals

Question 29

slide ecamination

Continued examination is done under (?) and compensated (?) light of wet preparation

Answer 29

polarized

Question 30

compensated polaraized light

• MSU molecules run (?) to the long axis, aligned with slow vibration; (?) light is impeded, producing a (?) color (negative birefringence)
• CPPD molecules run (?) to long axis and impede the (?) light producing a (?) color (positive birefringence)

Answer 30

• parallel
• fast
• yellow
• perpendicular
• slow
• blue

Question 31

chem test

• Plasma-synovial fluid glucose difference = within 10mg/dL
• Decreased in various joint diseases (Bacterial infection)

Answer 31

glucose

Question 32

chem test

• Normal: <3g/dL
• Increased in inflammatory (RA, crystal synovitis) & septic arthritis

Answer 32

protein

Question 33

chem test

• Establishes the presence of gout
• Elevated result should correlate with serum uric acid

Answer 33

uric acid

Question 34

chem test

Provides rapid differentiation between inflammatory and septic arthritic

Answer 34

lactate test

Question 35

normal SF values

• volume:
• color:
• clarity:
• viscosity:
• leukocyte count:
• NEUT:
• crystals:
• glucose:
• total protein:

Answer 35

• <3.5
• colorless to pale yellow
• clear
• form 4-6 cm string
• <200 cells/ul
• <25% of differential
• none
• <10 mg/dl
• <3 g/dl

Question 36

are the most common autoimmune causes of arthritis

Answer 36

RA and LE

Question 37

arthritis is frequent complication; test serum for Borrelia burgdorferi antibodies

Answer 37

lyme disease