UA Exam 4

A Cryptococcus neoformans infection of the CSF of a patient that is severely immunocompromised is most readily identified using what technique?

 

India ink stain

A normal CSF sample (from a healthy patient) will appear:

 

Clear and colorless

A normal cell count in CSF is:

 

0-5 WBC's; no RBC's

A patient has a plasma glucose of 100 mg/dL. The patient is healthy and has no issues that would lead to altered CSF chemistry values.

Of the following, which is the most likely/normal value of CSF glucose for the patient? 

70

You have performed a cell count on a CSF sample.

On side A of the hemacytometer you count 76 cells across 9 squares. On side B of the hemacytometer you count 86 cells.

What would you report for cells per microliter?

Enter your answer as a whole number, no places past the decimal.

810

CSF is a(n):

Selective filtrate formed by the choroid plexus

If blood is observed in a CSF sample, and the amount of blood appears to remain the same across all 4 tubes, what is most likely indicated?

 

Damage to the blood brain barrier

If present in CSF, which of the following cells have a pathological significance.

Eosinophils

WBC that would be present/present in elevated levels: Medical shunt across the BBB

Eosinophils

WBC that would be present/present in elevated levels: Viral meningitis

Lymphocytes

WBC that would be present/present in elevated levels: Bacterial meningitis

Neutrophils

WBC that would be present/present in elevated levels: Fungal meningitis

Eosinophils

Match the tube in order of draw to the department it is delivered for testing.

1: Chemistry

2: Microbiology

3: Hematology

4: Reserve

The first line, quickest test performed in microbiology to identify a bacterial meningitis is done by performing what test?

 

Gram stain

What is the main concern about CSF that is not tested within the prescribed timeframe?

WBC's (if present) will lyse

What term means increased numbers of white blood cells in CSF?

Pleocytosis

Which of the following would NOT lead to an increased protein level in CSF?

Water intoxication

A traumatic tap can be distinguished from other conditions by:

Subsequent tubes will clear up (the first may appear bloody)

A bacterial infection is most likely to lead to what type of effusion?

Exudative

A fluid sample is collected by thoracentesis and compared to serum values.

The fluid:serum ratio for LD is 0.2.

This fluid would be categorized as:

 

Pleural transudate

A pericardial effusion with a WBC count > 1000/uL is most indicative of:

 

Bacterial endocarditis

An net movement of fluid in one direction due to differences in protein concentration (in the context of serous fluid formation) is defined as:

 

Oncotic pressure

Ascitic fluid that is green-brown is likely due to presence of:

Bile

A pleural fluid sample has a turbid and white appearance.

Glucose levels are decreased.

WBC count is > 1000/uL

Neutrophils are markedly increased.

Lymphocytes are normal.

ADA negative.

What is the most likely condition of the patient?

 

Bacterial infection

Chemistry values obtained from tests on serous fluids are compared to what for reference?

 

The patient's plasma chemistry values for the same entity tested

Congestive heart failure is likely to result in which effusion?

Transudative

Elevated lymphocytes in serous fluid are most likely due to:

 

Viral and/or fungal infections

Exudate effusions have higher concentrations of components and tend to be cloudy compared to transudate effusions. 

True

Exudates differ from transudates in that exudates have:

 

fluid:serum protein ratio > 0.5

Pleural fluid that is black is a likely indicator of:

 

Aspergillus infection

Serous fluid in the abdomen is which membranes?

Peritoneal

Transudates differ from exudates in that transudates have:

 

A white blood cell count < 1000/uL

Which of the following is a specific indicator of tuberculosis?

ADA

pH determinations are clinically relevant for which of the following?

 

Both pleural fluid and peritonial fluid

An accumulation of body fluid in a body cavity is called a(n):

Effusion

Pleural fluid that is turbid and white is a likely indicator of:

Microbial infections

Which of the following is NOT a cause of ascitic fluid classified as an exudate?

Cirrhosis

Along with a blood agar plate, what other culture media MUST be included when performing a synovial fluid culture?

Chocolate

Blood may clot in synovial fluid under normal conditions.

False

Cartilage degeneration may result in gout like inflammation.

True

Damage from immune complex deposition is caused by:

Neutrophils

Inflammatory and septic conditions will have what effect on hyaluronic acid?

 

Decreased viscosity

Match each statement to whether it applies MSU or CPPD: Blue under compensated polarized light

CPPD

Match each statement to whether it applies MSU or CPPD: Pseudogout

CPPD

Match each statement to whether it applies MSU or CPPD: Blunter, short rods

CPPD

Match each statement to whether it applies MSU or CPPD: Gout

MSU

Match each statement to whether it applies MSU or CPPD: Yellow under compensated polarized light

MSU

Match each statement to whether it applies MSU or CPPD: Sharper, longer needle like

MSU

Match each statement to whether it applies MSU or CPPD: May present with multiple myeloma

CPPD

Match each statement to whether it applies MSU or CPPD: Occurs when patients have too high levels of calcium

CPPD

Most microbial infections of serous fluids are due to:

Bacteria

Normal values of WBC’s and RBC’s in synovial fluid are:

 

WBC’s < 200/uL; RBC’s < 2000/uL

SLE and rheumatoid arthritis affect joints through what main mechanism?

Autoantibodies

Serous fluid that is yellow-white relates to a condition that is most likely classified as:

Inflammatory

The predominant WBC type in synovial fluid is the:

Macrophage

Which crystals are a product of cartilage degeneration?

Hydroxyapatite

Which of the following is a liquid compound responsible for lubrication of joints?

 

Hyaluronic acid

Which of the following pathological conditions would present with the greatest number of neutrophils?

 

Group III, septic

Synovial fluid that is white would be classified how?

Group II, inflammatory

Synovial fluid that is red-brown would be classified how?

Group IV, hemorrhagic

Which statement is INCORRECT as it applies to rheumatoid arthritis?

Rheumatoid factor is an IgG antibody against IgG antibodies

A normal fecal leukocyte count is:

0 (none)

A pale colored stool sample may correlate with what urinalysis finding?

 

Presence of urobilinogen

A positive fecal occult blood test is indicated by:

 

Appearance of blue spots after addition of the chemical reagent

Black stool may be indicative of what condition?

Upper GI tract bleed

Fats in stool when a person maintains a balanced healthy diet may be indicative of:

 

Pancreatic insufficiency

Osmotic diarrhea would occur in the event:

 

Electrolyte concentrations are higher within the large colon compared to circulation within the intestinal tissue

Presence of mucus AND blood in stool is characteristic of:

 

V. cholerae infections

Presence of mucus in a stool sample is indicative of:

 

Intestinal irritation/wall damage

Secretory diarrhea is most likely indicative of:

 

Bacterial infection

A patient is admitted to the ED with severe diarrhea.

A gram stain indicates the presence of bacteria, but no neutrophils.

Of the following, which is the most likely entity causing the diarrhea?

(assume that it is a bacterial entity responsible)

 

Staphylococcus sp.

Steatorrhea is an indicator of:

 

Pancreatic insufficiency

Stool has a characteristic brown color due to:

Stercobilin

V. cholera will cause diarrhea through what mechanism?

Secretion

What form of leukocyte is most likely to be found in fecal samples?

Neutrophils

Which of the following is NOT an enzyme specific to pancreatic insufficiency testing?

LDH

Which of the following stains would be useful for identifying fat in stool?

 

Sudan IV

Stool that is pale is a likely indicator of what?

Blocked bile duct

Which of the following enzymes is best suited for testing of pancreatic insufficiency?

Trypsin

True or false. Bacteria may cause diarrhea that presents with a lack of leukocytes.

True

Pale/frothy/bulky stool is likely the result of?

Fats in the stool