front 1 Deciphering Exudates and Transudates Algorithm: Is the specimen cloudy? No. Then... | back 1 Likely a Transudate |
front 2 Deciphering Exudates and Transudates Algorithm: Is the specimen cloudy? Yes. Then... | back 2 Likely an Exudate |
front 3 Deciphering Exudates and Transudates Algorithm: Is the glucose low and protein high? No then... | back 3 Likely a Transudate |
front 4 Deciphering Exudates and Transudates Algorithm: Is the glucose low and protein high? Yes then... | back 4 Likely an Exudate |
front 5 Deciphering Exudates and Transudates Algorithm: Is there over
5000 | back 5 Likely a Transudate |
front 6 Deciphering Exudates and Transudates Algorithm: Is there over
5000 | back 6 Likely an Exudate |
front 7 What is the definition of: Transudate - | back 7 an effusion which is a filtrate of the plasma |
front 8 What is the definition of: Exudate - | back 8 an effusion which is protein-rich and usually caused by an infection or cancer, likely contains inflammatory cells and occasionally pus |
front 9 What is the definition of: Xanthochromia | back 9 - a yellowish tinge to a CSF sample, indicating prior bleeding into the CSF |
front 10 What is the definition of: Chylous | back 10 - an effusion which is made up of pus and inflammatory cells |
front 11 What is the definition of: Pseudochylous | back 11 - an effusion which has high levels of cholesterol |
front 12 What is the definition of: Paracentesis - | back 12 obtaining fluid through a large bore needle inserted into the peritoneal cavity |
front 13 What is the definition of: Thoracentesis | back 13 - obtaining fluid through a large bore needle inserted into the pleural cavity |
front 14 What is the definition of: Arthrocentesis | back 14 - obtaining fluid through a large bore needle inserted into the joint |
front 15 What is the definition of: Ascites | back 15 - Pathologic accumulation of fluid in the peritoneal cavity |
front 16 What is the definition of: Effusion | back 16 - Pathologic accumulation of fluid in most other body cavities |
front 17 Joint aspirates and urine samples may have extra crystals in them if? | back 17 they are refrigerated |
front 18 Crystals in the sample may dissolve if? | back 18 left at room temperature |
front 19 Transport must be rapid enough to? | back 19 to not allow for degradation of the specimen |
front 20 Lactate may increase due to? | back 20 anaerobic metabolism of cells |
front 21 What is the 1st tube for a CSF order? | back 21 Storage or for Cytology analysis (can vary depending on the lab) |
front 22 What is the 2nd tube for a CSF order? | back 22 Chemistry and Serology |
front 23 What is the 3rd tube for a CSF order? | back 23 Microbiology |
front 24 What is the 4th tube for a CSF order? | back 24 Hematology |
front 25 For Pleural Effusion, what do the following suggest/indicate: Milky consistency? | back 25 chylothorax (lymphatic obstruction) |
front 26 For Pleural Effusion, what do the following suggest/indicate: Putrid odor suggests | back 26 anaerobic empyema |
front 27 For Pleural Effusion, what do the following suggest/indicate: Black Pleural Fluid | back 27 malignant melanoma, non-small cell lung carcinoma (NSCLC), ruptured pancreatic pseudocyst, or charcoal-containing empyema |
front 28 Ascites is an abnormal collection of fluid in the peritoneal cavity due to either? | back 28 portal hypertension or low serum osmolality |
front 29 What is the specific gravity for transudates? | back 29 <1.010 |
front 30 What is the specific gravity for exudates? | back 30 >1.020 |
front 31 What situations are pericardial fluid order? | back 31 1.Therapeutic pericardiocentesis for cardiac tamponade 2.Clinical suspicion of purulent, tuberculous, or neoplastic pericarditis 3.Patients with large pericardial effusions of unknown etiology |
front 32 What are the 4 categories of synovial effusions? | back 32 1.Inflammatory 2.Noninflammatory 3.Hemorrhagic 4.Septic |
front 33 Normal synovial fluid is? | back 33 viscous |
front 34 What is routine for Synovial Testing? | back 34 Gross examination (color, clarity) Leukocyte counts Gram stain and bacterial culture (aerobic and anaerobic) Crystal examination with polarizing filters Uric acid |
front 35 What is the presence of LDH associated with in synovial fluid? | back 35 Leukocytes, WBCs |
front 36 Amniocentesis is traditionally taken at 15-18 weeks gestation to assess for? | back 36 genetic disorders |
front 37 When testing for Preeclampsia what does the following indicate: Hemolysis | back 37 Elevated AST, ACP, LD |
front 38 When testing for Preeclampsia what does the following indicate: AST, ALT, ALP | back 38 Elevated Liver enzymes |
front 39 When testing for Preeclampsia what does the following indicate: Profound thrombocytopenia, (<60,000/uL) | back 39 Low Platelets |
front 40 The only reason for seminal fluid assessment is to? | back 40 evaluate for infertility |
front 41 What is evaluated in Seminal Fluid? | back 41 Ejaculate volume, total sperm count, concentration, shape of the head, and movement of the sperm are all assessed under a microscope |
front 42 When dealing with a bloody tap, What is a Traumatic Tap? | back 42 The first tube is quite bloody and the blood lessens in each subsequent tube |
front 43 When dealing with a bloody tap, What is a Subarachnoid Hemorrhage? | back 43 The first tube is quite bloody and the last tube is just as bloody |
front 44 When dealing with a bloody tap, What does a Yellow or Brown CSF indicate? | back 44 that old, oxidized blood is present in the CSF |
front 45 For CSF Glucose and Protein Culture is ALWAYS performed to rule-out? | back 45 a bacterial source because >10% of bacterial meningitides begin with a lymphocytosis |
front 46 With CSF Glucose and Protein. What lab values indicate: Bacterial meningitis | back 46 Glucose ↓↓ WBCs ↑↑ Neutrophils ↑ Protein ↑ |
front 47 With CSF Glucose and Protein. What lab values indicate:Viral infection | back 47 Glucose ↓ WBCs ↑ Lymphocytes ↑ Protein ↑ |
front 48 With CSF Glucose and Protein. What lab values indicate: Brain Tumor | back 48 Glucose N WBCs N Malignant Cells Protein ↑ |
front 49 With CSF Glucose and Protein. What lab values indicate: Traumatic tap | back 49 Glucose N WBCs ↑ All cells ↑ Protein ↑ |
front 50 With CSF Glucose and Protein. What lab values indicate: Multiple Sclerosis - | back 50 Glucose N WBCs N T cells ↑ Protein ↑ (IgG) |
front 51 The presence of oligoclonal bands in the CSF is indicative of? | back 51 multiple sclerosis |
front 52 For the IgG index to aid in diagnosis of demyelinating diseases such as multiple sclerosis: CSF IgG index = | back 52 (CSF IgG/serum IgG) / (CSF albumin/serum albumin) Normal CSF IgG index is <0.73 |
front 53 For Integrity of the Blood Brain Barrier Assessment: CSF/serum Albumin index = | back 53 CSF albumin (mg/dL) / serum albumin (g/dL) An index <9 indicates an intact blood brain barrier |
front 54 What is the meaning of an elevated CSF-serum albumin index? | back 54 There is more protein in the CSF than there should be. This tells you that the blood brain barrier is potentially compromised because protein is leaking from the serum into the CSF. |
front 55 The lab findings for Normal Pleural Fluid are? | back 55 Clear ultrafiltrate Protein < 2 g/dL < 1000 WBCs /mm3 Glucose at normal serum levels Pleural LDH < 50% Plasma LDH |
front 56 The lab findings for Bacterial Pleural Effusion are? | back 56 Cloudy ultrafiltrate Protein >> 2 g/dL >> 1000 WBCs /mm3 Glucose << 120 mg/dL Pleural LDH >> 50% Plasma LDH |
front 57 Pleural fluid glucose <30-50 mg/dL suggests ? | back 57 malignant effusion and very few other diseases |
front 58 Pleural LDH levels >1000 mg indicate? | back 58 rheumatoid effusion, malignant effusion, Pneumocystis jiroveci, or empyema |
front 59 For Paracentesis Serum to Ascites Albumin Gradient (SAAG) If the ratio is ≥ 1.1? | back 59 portal hypertension |
front 60 For Paracentesis Serum to Ascites Albumin Gradient (SAAG) - If the ratio is < 1.1 | back 60 NOT portal hypertension |
front 61 The correct order to perform Paracentesis is | back 61 1.remove serous fluids from compressing a vital organ 2.determine the pathologic cause of an effusion classify the effusion as either a transudate or exudate |
front 62 Ascites is formed by these methods: | back 62
|
front 63 For Peritoneal Fluid Assays, What are the expected findings for: Amylase - | back 63 “Normal” is ~40 IU/L, but is increased due to pancreatitis or bowel perforation up to 2000 IU/L |
front 64 For Peritoneal Fluid Assays, What are the expected findings for: LDH - | back 64 Normal ratio for peritoneal fluid:serum LDH is 0.4. Spontaneous Bacterial Peritonitis (SBP) can approach a ratio of 1, but if the ratio increases above 1, the cause is likely either infection, bowel perforation, or tumor |
front 65 For Peritoneal Fluid Assays, What are the expected findings for: CEA - | back 65 Elevated if peritoneal carcinomatosis is due to a primary colon cancer |
front 66 For Peritoneal Fluid Assays, What are the expected findings for: Serum Pro-BNP | back 66 - Elevated if the ascitic fluid is due to heart failure |
front 67 what is Pericardial Effusion Generally ordered with? | back 67 1.Serum electrolytes 2.CBC c diff 3.Cardiac biomarker levels (e.g. Tn-I, CK-MB, LDH) Other markers of inflammation (e.g. ESR) |
front 68 A 55-year-old male has a SAAG of 0.9, neutrophil count of 260 cells/um. What is the likely cause of his effusion? | back 68 The effusion is some sort of exudate, so the most common reasons would be an infection or malignancy. |
front 69 When testing for uric acid crystals or calcium phosphate crystals, care must be taken to provide the lab with the sample immediately otherwise? | back 69 the crystals may dissolve |
front 70 Synovial fluid samples should be diluted in? | back 70 normal saline if necessary |
front 71 Gout is made up of? | back 71 monosodium urate crystals |
front 72 Pseudogout is made up of ? | back 72 Calcium pyrophosphate crystals |
front 73 Elevated results of Δ A450 are seen in | back 73 Hemolytic Disease of the Fetus and Newborn |
front 74 ___is commonly performed and is generally the primary indication for obtaining AF "Amniotic Fluid" between 13-15 weeks | back 74 genetic testing |
front 75 What tests may help you to differentiate between urine and amniotic fluid? | back 75 1.Urea 2.Glucose 3.Creatinine 4.Protein note: Urine should have lower values of glucose and protein and higher values for urea and creatinine |
front 76 Name four tests used to assess fetal lung maturity | back 76 FSI, Lamellar body counts, L/S ratio, and Phosphatidylglycerol |
front 77 Infants with a positive CFTR screen should undergo a sweat chloride test. An elevated sweat chloride is seen in? | back 77 cystic fibrosis, but is not sufficient for diagnosis. A genetic confirmation of the mutation is necessary for diagnosis. |
front 78 In order to officially diagnose an exudate, the specimen MUST have? | back 78 an elevated total protein ratio and LD ratio |
front 79 What are the indicators of: Transudate | back 79 straw-colored to amber clear normal glucose normal protein normal WBC |
front 80 What are the indicators of: Exudate | back 80 Brown, yellow, green, etc. Milky low glucose high protein high WBC |
front 81 What are the Causes of Transudate? | back 81 Caused by something like increased oncotic pressure (ascites), increased hydrostatic pressure (congestive heart failure), or renal failure |
front 82 What are the Causes of Exudate? | back 82 Caused by an infection, autoimmune diseases, and occasionally cancer. An exudate may have a large amount of pus and inflammatory cells. Remember, an exudate must have an elevated CSF:Serum protein ratio and LD ratio to be diagnosed properly |
front 83 What are Light’s Criteria for: Pleural Fluid Exudates? | back 83 1.Pleural fluid protein : Serum protein = > 0.5 2.Pleural fluid protein >2.9 g/dL 3.Pleural fluid LDH : Serum LDH = > 0.45 4.Pleural fluid LDH > 0.45 x the upper limit of normal for Serum LDH 5.Pleural fluid Cholesterol > 45 mg/dL If none of these are true, then the fluid is classified as a transudate |
front 84 What are the reference ranges for Seminal Fluid Analysis? | back 84 Volume 1.5 - 5 mL Hyperviscosity may impair sperm motility pH should be between 7.2-7.8 Zinc allows for the sperm to develop properly ACP is present in prostatic secretions |
front 85 A newly-minted resident physician tries his luck to get a clean tap
on an elderly | back 85 Don’t be fooled just because the concentration of blood appears to be decreasing. It is likely decreasing because the patient has a subarachnoid hemorrhage, but the resident also nicked an artery with the needle. So, the first couple tubes had the hemorrhage blood in the CSF and the additional blood from the venous system. Tube 3 has less additional blood, and Tube 4 had even less. So this would still be a subarachnoid hemorrhage with a traumatic tap superimposed on top. |
front 86 | back 86 |
front 87 | back 87 |
front 88 What disease is associated with an elevated sweat chloride? | back 88 Cystic Fibrosis |
front 89 1. A 74-year-old female complains of knee pain. She is taking
Warfarin, Aspirin currently, and | back 89 She is taking Warfarin and the Metronidazole which will interact.
Metronidazole will increase the Warfarin levels, causing bleeding
that |
front 90 A 28-year-old female presents to the physician with a fever and
kidney stones. She is 35-weeks along her current pregnancy and is
worried about the health of the baby. The physician is as well and
schedules her for an urgent induction of labor. Before this is begun,
she is given steroids to help the baby survive. Even though amniotic
fluid will likely not be taken before deliver, the administration of
steroids will likely most directly affect the results of
which | back 90 This is a test that measures fetal lung maturity. Mature fetal lungs
produce more Lecithin than they do Sphingomyelin and a ratio >2
is |
front 91 A 22-year-old female has otorrhea (clear fluid flowing out of her
hear) after a motorcycle crash with her boyfriend. She presents to the
emergency department very confused. The emergency physician needs to
determine if he needs to refer her to neurosurgery and decides to get
a CSF serum albumin index. Her CSF Albumin is 11 mg/dL and her Serum
Albumin is 4.7 | back 91 Her CSF serum albumin index is 2.3 which is less than 9 and indicates that the blood brain barrier is keeping an adequate amount of proteins out of the cerebrospinal fluid in the subarachnoid space |
front 92 what kind of panel would you get for the following synovial fluid testing: Normal | back 92 Clarity: Transparent Color: Clear WBCs: 0-150 PMNs: <25 RBCs: None Glucose (mg/dL):0-10 |
front 93 what kind of panel would you get for the following synovial fluid testing: Group I Noninflammatory | back 93 Clarity: Transparent Color: Xanthochromic WBCs: <3000 PMNs: <30 RBCs: None Glucose (mg/dL): 0-10 |
front 94 what kind of panel would you get for the following synovial fluid testing: Group II Inflammatory | back 94 Clarity: Transparent/Opaque Color: Xanthochromic to bloody WBCs: 3000-75,000 PMNs: >50 RBCs: None Glucose (mg/dL): 0-40 |
front 95 what kind of panel would you get for the following synovial fluid testing: Group III Infectious | back 95 Clarity: Opaque Color: White WBCs: 50,000-200,000 PMNs: >90 RBCs: Yes Glucose (mg/dL): 20-100 |
front 96 what kind of panel would you get for the following synovial fluid testing: Group IV Hemorrhagic | back 96 Clarity: Opaque Color: Red/Brown to Xanthochromic WBCs: 50-10,000 PMNs: <50 RBCs: Yes Glucose (mg/dL): 0-20 |