OTHER BODILY FLUIDS

Viscous liquid found in the cavities of synovial (diarthrodial) joints

Synovial fluid (joint fluid)

This lubricates fluid, reduces friction between bones during movement, provides nutrients to avascular articular cartilage, and absorbs shock during activities like walking and jogging

Synovial fluid (joint fluid)

This is a smooth cartilage that covers the ends of bones within the joint (facilitating smooth movement)

Articular cartilage

This absorbs impact and reduce wear and tear of bones during movement

Articular cartilage

This is a tough fibrous structure that encloses the joint

Joint capsule

This provides protection and stability in the joint

Joint capsule

Joint capsule is lined with the ___ that produces synovial fluid

Synovial membrane

Synovial membrane contains specialized cells called?

Synoviocytes

These cells are vital for joint health and function

Synoviocytes

These are macrophage-like cells involved in phagocytosis, found in the superficial layer

Type A synoviocytes

Fibroblast -like cells that produce hyaluronic acid, fibronectin, and collagen, contributing to synovial fluid viscosity

Type B synoviocytes

This is formed by filtration across the synovial membrane

Ultrafiltrate of plasma

This contributes to the viscosity of synovial fluid (crucial for lubricating joint movement)

Hyaluronate

Synovial fluid analysis is important for diagnosing the?

Pathological origin of arthritis

This is use to know the type of joint disorder. Whether it is bacterial or viral infection, or whether there is just debris in the joint that causes inflammation

WBC and differential count

This is used to differentiate whether the causative agent is gram positive or gram negative

Gram stain

This is used for diagnosing conditions like gout or pseudogout

Crystal examination

WHAT IS THE NORMAL SYNOVIAL FLUID VOLUME?

<3.5 ML

WHAT IS THE NORMAL SYNOVIAL FLUID COLOR

COLORLESS TO PALE YELLOW

WHAT IS THE NORMAL SYNOVIAL FLUID CLARITY

CLEAR

WHAT IS THE NORMAL SYNOVIAL FLUID VISCOSITY

HIGH (4-6 CM LONG)

WHAT IS THE NORMAL SYNOVIAL FLUID LEUKOCYTE COUNT

<200 CELLS/UL

WHAT IS THE NORMAL SYNOVIAL FLUID NEUTROPHILS

<25% OF THE DIFFERENTIAL

WHAT IS THE NORMAL SYNOVIAL FLUID CRYSTALS

NONE PRESENT

WHAT IS THE NORMAL SYNOVIAL FLUID GLUCOSE:PLASMA DIFFERENCE

<10 MG/DL

WHAT IS THE NORMAL SYNOVIAL FLUID TOTAL PROTEIN

<3 G/DL

WHAT IS THE NORMAL SYNOVIAL FLUID LACTATE

<25 MG/DL

THIS IS THE DAMAGE TO THE ARTICULAR MEMBRANE

ARTHRITIS

DAMAGE TO ARTICULAR MEMBRANE MAY RESULT IN ___ LEADING TO ARTHRITIS

PAIN AND STIFFNESS

THIS HELPS DIFFERENTIATE AMONG TYPES OF ARTHRITIS

SYNOVIAL FLUID TESTING

A TYPE OF ARTHRITIS THAT IS CAUSED BY BACTERIAL OR VIRAL INFECTION

INFECTIOUS ARTHRITIS

A TYPE OF ARTHRITIS THAT INCLUDES CONDITIONS LIKE RHEUMATOID ARTHRITIS AND GOUT

INFLAMMATORY ARTHRITIS

A TYPE OF ARTHRITIS THAT IS PRIMARILY DUE TO WEAR AND TEAR

DEGENERATIVE ARTHRITIS (OSTEOARTHRITIS)

TYPE OF ARTHRITIS THAT IS DUE TO TRAUMA OR BLOOD DISORDERS

HEMORRHAGIC ARTHRITIS

THIS IS THE PROCEDURE USED TO COLLECT SYNOVIAL FLUID FROM JOINTS BY NEEDLE ASPIRATION

ARTHROCENTESIS

TRUE OR FALSE.

ARTHROCENTESIS IS ULTRASOUND-GUIDED

TRUE

WHAT IS THE NORMAL AMOUNT OF FLUID IN THE ADULT KNEE CAVITY

<3.5 ML

WHAT IS THE AMOUNT OF FLUID IN THE ADULT KNEE CAVITY WHEN THERE IS INFLAMMATION

>25 ML

WHAT SHOULD BE PRIORITIZE WHEN THERE ARE ONLY FEW DROPS OF FLUID OBTAINED?

CULTURE

SINCE JOINT FLUID IS VISCOUS DUE TO HYALURONIC ACID, WHEN TESTING WE SHOULD LIQUEFY IT BY USING?

HYALURONIDASE

THIS WILL HELP DETERMINE IF THE CAUSE OF THE BLOODY APPEARANCE OF SYNOVIAL FLUID IS DUE TO TRAUMA OR HEMORRHAGIC CONDITIONS

RBC CELL COUNT

THIS IS USED TO DIFFERENTIATE THE ARTHRITIS CATEGORY OR JOINT DISORDER

WBC CELL COUNT

A NORMAL SYNOVIAL FLUID

A. DOES NOT CLOT

B. MAY CLOT DUE TO PRESENCE OF FIBRINOGEN

A

SYNOVIAL FLUID WITH DISEASED JOINT

A. DOES NOT CLOT

B. MAY CLOT DUE TO PRESENCE OF FIBRINOGEN

B

SYNOVIAL FLUID WITH DISEASED JOINT CLOTS DUE TO THE PRESENCE OF?

FIBRINOGEN

THIS IS USED IN THE COLLECTION SYRINGE IN ORDER FOR THE SYNOVIAL FLUID TO NOT CLOT

HEPARIN

TUBE 1 FOR SYNOVIAL FLUID

A. PLAIN, NON-ANTICOAGULATED, RED STOPPER

B. HEPARIN OR EDTA, GREEN OR LAVENDER STOPPER

C. STERILE, GREEN OR YELLOW STOPPER

A

TUBE 2 FOR SYNOVIAL FLUID

A. PLAIN, NON-ANTICOAGULATED, RED STOPPER

B. HEPARIN OR EDTA, GREEN OR LAVENDER STOPPER

C. STERILE, GREEN OR YELLOW STOPPER

B

TUBE 3 FOR SYNOVIAL FLUID

A. PLAIN, NON-ANTICOAGULATED, RED STOPPER

B. HEPARIN OR EDTA, GREEN OR LAVENDER STOPPER

C. STERILE, GREEN OR YELLOW STOPPER

C

THE PURPOSE OF THIS TUBE IS FOR CHEMICAL OR IMMUNOLOGIC ANALYSIS

A. TUBE 1

B. TUBE 2

C. TUBE 3

A

THE PURPOSE OF THIS TUBE IS FOR CELL COUNTS (WET MOUNT), DIFFERENTIAL COUNT, AND CRYSTAL IDENTIFICATION

A. TUBE 1

B. TUBE 2

C. TUBE 3

B

THE PURPOSE OF THIS TUBE IS FOR MICROBIOLOGICAL STUDIES

A. TUBE 1

B. TUBE 2

C. TUBE 3

C

WHEN PERFORMING TUBE 1 OF SYNOVIAL FLUID, AFTER CENTRIFUGATION, ___ IS USED FOR CHEMICAL OR IMMUNOLOGIC ANALYSIS

SUPERNATANT

TRUE OR FALSE.

IN TUBE 2, FLUID IS OBSERVED FOR CLOTTING, THEN CENTRIFUGED TO REMOVE CELLS AND DEBRIS

FALSE

THIS TUBE CONTAINS SODIUM HEPARIN (25U/ML) OR EDTA TO PREVENT CLOTTING

TUBE 2

THIS TUBE IS COLLECTED INTO A STERILE TUBE WITH SODIUM HEPARIN (25U/ML) OR SODIUM POLYANETHOL SULFONATE TO PRESERVE MICROORGANISMS

TUBE 3

WHAT SHOULD BE AVOIDED AND IS ONE OF THE IMPORTANT COLLECTION GUIDELINES BECAUSE THIS WILL PRODUCE ARTIFACTS

POWDERED ANTICOAGULANTS

WE SHOULD NOT USE THIS AS THIS CAN INTERFERE WITH CRYSTAL ANALYSIS. THIS WILL PRODUCE ARTIFACTS THAT CAN BE CONFUSED FOR CRYSTALS

POWDERED EDTA

WHAT SHOULD BE DONE FOR THE NON-ANTICOAGULATED SAMPLES THAT IS TESTED IN CHEMICAL AND SEROLOGICAL ANALYSIS

CENTRIFUGE AND SEPARATE

IDEALLY, ANALYSIS FOR SYNOVIAL FLUID ARE PERFORMED ASAP TO PREVENT?

CELLULAR LYSIS AND CHANGES IN CRYSTAL STRUCTURE

SYNOVIAL FLUID ARE COLORLESS TO PALE YELLOW, RESEMBLING ___ DUE TO ITS VISCOSITY

EGG WHITE

ABNORMAL COLOR OF SYNOVIAL FLUID.

ASSOCIATED WITH NON-INFLAMMATORY AND INFLAMMATORY EFFUSIONS

DEEPER YELLOW

ABNORMAL COLOR OF SYNOVIAL FLUID.

SUGGESTIVE OF BACTERIAL INFECTION

GREENISH TINGE

ABNORMAL COLOR OF SYNOVIAL FLUID.

PRESENCE OF THIS COULD INDICATE HEMORRHAGIC ARTHRITIS OR BE FROM A TRAUMATIC ASPIRATION

BLOOD

IF THE DISTRIBUTION OF BLOOD IS HOMOGENOUS, THIS MAY INDICATE?

A. HEMORRHAGIC DISTRIBUTION

B. TRAUMATIC ASPIRATION

A

IF THE DISTRIBUTION OF BLOOD IS UNEVEN OR SINGLE BLOOD STREAK, THIS MAY INDICATE?

A. HEMORRHAGIC DISTRIBUTION

B. TRAUMATIC ASPIRATION

B

APPEARANCE OF SYNOVIAL FLUID THAT MAY BE DUE TO WBCS, RBCS, SYNOVIOCYTES, CRYSTALS, FAT DROPLETS, FIBRIN AND CELLULAR DEBRIS

TURBIDITY

APPEARANCE OF SYNOVIAL FLUID THAT IS OFTEN DUE TO THE PRESENCE OF CRYSTALS

MILKY

MILKY APPEARANCE OF SYNOVIAL FLUID MAY BE DUE TO THE PRESENCE OF?

CRYSTALS

THE VISCOSITY OF SYNOVIAL FLUID IS DUE TO THE?

HYALURONIC ACID

DECREASED VISCOSITY MAY BE SEEN IN ___ DUE TO IMPAIRED HYALURONATE PRODUCTION OR POLYMERIZATION

ARTHRITIS

THIS TEST IS WHEN SYNOVIAL FLUID IS MIXED WITH 2-5% ACETIC ACID, FORMING A CLOT

MUCIN CLOT TEST

MUCIN CLOT TEST IS ALSO KNOWN AS?

ROPES TEST

IN MUCIN CLOT TEST, SYNOVIAL FLUID IS MIXED WITH ____ THAT FORMS A CLOT

2-5% ACETIC ACID

GOOD CLOT IN MUCIN CLOT TEST IS:

A. NORMAL VISCOSITY

B. INDICATES DECREASED VISCOSITY

A

POOR CLOT IN MUCIN CLOT TEST IS:

A. NORMAL VISCOSITY

B. INDICATES DECREASED VISCOSITY

B

THIS IS NOT ROUTINELY PERFORMED, BUT IS USEFUL FOR DISTINGUISHING SYNOVIAL FLUID FROM OTHER FLUIDS

MUCIN CLOT TEST

THIS IS THE MOST FREQUENTLY PERFORMED CELL COUNT IN SYNOVIAL FLUID

WBC CELL COUNT

IF SYNOVIAL FLUID SAMPLE FOR WBC COUNT IS DELAYED, WHERE SHOULD IT BE PLACED?

REFRIGERATE

TRUE OR FALSE. DILUTION IS NECESSARY EVEN WHEN SYNOVIAL FLUID IS CLEAR BEFORE CELL COUNTING

FALSE

IF SYNOVIAL FLUID IS TURBID/BLOODY, YOU HAVE TO PERFORM A?

DILUTION

WHAT IS THE DILUTING FLUID USED FOR SYNOVIAL FLUID BEFORE CELL COUNTING

NORMAL SALINE

THIS IS USED TO LYSE RBC IN SYNOVIAL FLUID

HYPOTONIC SALINE SOLUTION (0.3%)

ELEVATED COUNTS OF WBCS ARE SEEN IN?

INFECTIONS AND INFLAMMATORY CONDITIONS

IN MANUAL COUNTING, FOR <200 WBCS/UL, WHERE SHOULD WE COUNT ON NEUBAUER COUNTING CHAMBER

9 LARGE SQUARES

TRUE OR FALSE.

DILUTIONS ARE ONLY DONE IF FLUID IS BLOODY, TURBID, OR WHEN YOU STARTED YOUR COUNTING AND YOU CANNOT BECAUSE THE CHAMBER IS PACKED WITH CELLS

TRUE

THIS MAY BE USED BUT CAN BE HINDERED BY VISCOSITY AND DEBRIS

AUTOMATED COUNTING

IN DIFFERENTIAL COUNT, SPECIMEN SHOULD BE ____ SO WE CAN OBTAIN A NORMAL STRUCTURE AND SHOWS A GOOD YIELD OF CELLS

CYTOCENTRIFUGED

TRUE OR FALSE.

IF CYTOCENTRIFUGATION IS NOT AVAILABLE, WE CAN USE NORMAL CENTRIFUGATION

FALSE

THESE CELLS PRESENT IN SYNOVIAL FLUID IN DIFFERENTIAL COUNT PREDOMINATE

MONONUCLEAR CELLS

NORMAL NUMBER OF NEUTROPHILS IN SYNOVIAL FLUID ARE?

LESS THAN 25% OF THE TOTAL WBC COUNT

NORMAL NUMBER OF LYMPHOCYTES IN SYNOVIAL FLUID ARE?

LESS THAN 15%

INCREASED NEUTROPHILS IN THE SYNOVIAL FLUID SUGGESTS?

SEPTIC ARTHRITIS

INCREASED LYMPHOCYTES IN THE SYNOVIAL FLUID MAY INDICATE?

NON-SEPTIC INFLAMMATORY CONDITIONS

THESE CELLS ARE SEEN IN CRUSH INJURIES

LE, REITER, RA CELLS, AND LIPID DROPLETS

THIS IS A POLYMORPHONUCLEAR LEUKOCYTE

NEUTROPHILS

SIGNIFICANCE OF NEUTROPHILS IN SYNOVIAL FLUID?

BACTERIAL SEPSIS AND CRYSTAL-INDUCED INFLAMMATION

MONONUCLEAR LEUKOCYTE

LYMPHOCYTE

SIGNIFICANCE OF LYMPHOCYTE IN SYNOVIAL FLUID

NONSEPTIC INFLAMMATION

LARGE MONONUCLEAR LEUKOCYTE, MAY BE VACUOLATED

MACROPHAGE (MONOCYTE)