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Aaaa > Synovial Fluid (Part II) > Flashcards

Synovial Fluid (Part II) Flashcards

1
Q

Under Microscopic Examination

A

total cell count
differential leukocyte count
crystal examination

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2
Q

Total leukocyte counts should be performed as soon as ______ following arthrocentesis

A

1 hour

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3
Q

Leukocyte counts over 50,000/uL require dilution which should be done with ______ to avoid mucin clot formation and cell clumping

A

saline, not acetic acid

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4
Q

Their use risks clogging the machine aperture or obtaining spuriously high cell counts from non-WBC particles (crystals, fat globules)

A

Flow cell-based automated cell counters

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5
Q

Pretreatment of highly viscous SF samples with ______ improves automated cell counting using instruments

A

hyraluronidase

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6
Q

Leukocyte counts greater than 10,000/uL, and often gretaer than 50,000 are characteristic of

A

crystal-induced arthritis (e.g., gout, pseudogout)
chronic inflammatory arthritis (RA, SLE, ankylosing spondylitis)
septic arthritis

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7
Q

These clinical conditions usually have total WBC counts less than 10,000/uL

A

Osteoarthritis
Osteochondritis dissecans
trauma
synovioma

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8
Q

If a large number of RBCs interferes with leukocyte count, they may be lysed with dilution with

A

0.3 normal saline or 1% saponin in saline

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9
Q

The upper reference level for SF leukocyte

A

150 to 200/uL

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10
Q

Preparation preferred over smears from centrifuged SF because the cell morphology is significantly better preserved

A

Cytospin preparations

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11
Q

Treatment with this may be necessary to produce thin smears in viscous specimens

A

Hyaluronidase

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12
Q

Used effectively to produce good-quality preparations of SF for microscopic examination

A

Liquid-based thin-layer processing instruments

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13
Q

Normally account 20% of SF leukocyte

A

Neutrophils

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14
Q

Neutrophils generally exceed 50% in

A

urate gout
pseudogout
RA

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15
Q

Neutrophils most often exceed 75% in

A

acute bacterial arthritis

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16
Q

In differential leukocyte cell count, when 75% of the neutrophils are used as a cutoff, the sensitivity for an inflammatory process is about _____ and the specificity is _____

A

sensitivity: 75%
specificity: 92%

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17
Q

Neutrophils may frequently exhibit degenerative changes and may contain ______ that is thought to consist of immune complexes

A

bacteria
crystals
lipid droplets
vacuoles
dark blue to black granular inclusions

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18
Q

The presence of ____ in patients with RA may indicate a poorer outcome

A

Ragocytes

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19
Q

Present in patients with lupus arthritis

A

Lupus erythematosus (LE) cells

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20
Q

Most often neutrophils that have phagocytosed the nuclei of degenerating cells

A

Lupus erythematosus (LE) cells

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21
Q

normally constituting about 15% of SF cells

A

Lymphocytes

22
Q

Leukocyte prominent in early RA and other autoimmune disorders, as well as in chronic infections

A

Lymphocytes

23
Q

The most common cells present in normal SF

A

Monocytes and Macrophages

24
Q

Accounting for approximately 65% of the cell count

A

Monocytes and Macrophages

25
Q

May be self-limited in viral arthritis or serum sickness, or more chronic in SLE or undifferentiated connective tissue disorders

A

Monocytosis

26
Q

Originally believed to be specific for Reiter syndrome, are macrophages containing degenerating neutrophils

A

Reiter cells

27
Q

Defined as more than 2% of the leukocyte count

A

Eosinophils

28
Q

Eosinophils has been reported in the following conditions:

A

Lyme disease
RA
Rheumatic fever
Metastatic carcinoma
Parasitic infection
Chronic urticaria
Angioedema
Following Arthtography and irridiation

29
Q

Allergy to dye

A

Arthrography

30
Q

Leukocyte that has no pathologic significance

A

Synovial cells (synoviocytes)

31
Q

They appear similar to mesothelial cells and may be difficult to distinguish from monocytes and macrophages

A

Synovial cells (Synoviocytes)

32
Q

Diseases associated with Lipid bodies

A

Trauma
Aseptic necrosis
RA

33
Q

These droplets often form Maltese Cross under polarized light, and can be associated with leukocyte response, and may cause spurious elevations of the automated WBC count

A

Lipid bodies

34
Q

This lead to acute inflammation with increased WBC cunts and a neutrophil-predominant infiltrate

A

Crystals in SF

35
Q

refers to the process of crystal deposition in articular tissue

A

Gout

36
Q

An inflammatory response to crystal depositions referred to as

A

gouty arthritis

37
Q

Most common types of endogenous crystals responsible for gouty arthritis:

A

Monosodium urate monohydrate (Urate gout)
Calcium pyrophosphate dihydrate (Pyrophosphate gout, chondrocalcinosis, or pseudogout)
Apatite and other basic calcium phosphates (BCP)
Calcium oxalate (oxalate gout)
Lipids (lipid gout)

38
Q

It is placed directly above the light source of polarizing microscope

A

Polarizer

39
Q

another polarizer filter that is placed between the specimen slide and the microscope oculars, oriented 90 degrees from the polarizer to produce a dark background

A

Analyzer

40
Q

Placed between the polarizer and analyzer, usually oriented 45 degrees (halfway) between the planes of two polarizing filters

A

Compensator

41
Q

Initial examination of crystal examination should be performed on a

A

wet preparation using polarized light

42
Q

Enhances crystal detection

A

Phase-contrast microscopy

43
Q

Most crystals are scanned with

A

10x objective

44
Q

Crystals are evaluated with at least ______ concentrating especially on cellular areas

A

40x objective

45
Q

Complete examination of crystals requires

A

100x oil immersion

46
Q

Sensitivity and Specificity of polarized microscopy for crystals for monosodium urate

A

Sensitivity: 78%
Specificity: 79%

47
Q

Sensitivity and Specificity of polarized microscopy for crystals for calcium pyrophosphate dihydrate

A

Sensitivity: 12%
Specificity: 67%

48
Q

reliable alternative to polarized microscopy

A

Diff-Quick staining method

49
Q

Specificity, sensitivity, and accuracy of Diff-Quick staining method

A

Specificity: 87.5%
Sensitivity: 94.4%
Accuracy: 91.9%

50
Q

Overall positive predictive value for Diff-Quick staining method

A

92.7%

51
Q

Overall negative predictive value for Diff-Quick staining method

A

90.3%

Aaaa (21 decks)

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