Body Fluids BOC

a CSF with a milky appearance would most likely contain an increased amount of

lipids

a synovial fluid easily forms small, discrete droplets when expelled from a syringe can be associated with

inflammation

ascites is collected by

paracentesis

CSF should normally appear clear and

colorless

stain commonly used to evaluate sperm viability

eosin-nigrosin

dark yellow amniotic fluid may indicate increased concentration of

bilirubin

green-colored amniotic fluid indicates the presence of

meconium

positive amine or "whiff" test on a vaginal secretion most likely indicates

bacterial vaginosis

study performed by aspirating seminal fluid with a Pasteur pipette and observing the formation of droplets as it is allowed to fall under only the influence of gravity

viscosity

result considered abnormal for seminal fluid

liquefaction > 60 minutes

normal is <30 minutes

what normally accounts for the largest fraction of CSF total proteins

albumin

mucin clot test for synovial fluid is performed by adding what to an aliquot of the sample

glacial acetic acid

unlabeled body fluid sent to lab

protein 3 g/dL (30 g/L)

albumin 2.1 g/dL (21 g/L)

hyaluronate 0.4 g/dL (4 g/L)

glucose 80 mg/dL (4.4 mmol/L)

lactate 10mg/dL (1.1 mmol/L)

sample is most likely

synovial fluid

an attempt to aspirate the knee joint is made, 0.1 mL of slightly bloody fluid is obtained

addition of acetic acid results in turbidity and a clot

this indicates the fluid

is synovial fluid

the principal mucin in synovial fluid is

hyaluronate

false neg guaiac-based fecal occult blood test due to the ingestion of

ascorbic acid

used as a chromogen in fecal occult blood tests

guaiac

Normal CSF contains all the following proteins except

A. Transferrin

B. Transthyretin

C. Albumin

D. Fibrinogen

fibrinogen

an increased CSF IgG index indicates

increased intrathecal IgG synthesis

an IgG index >0.70 suggests increased intrathecal production of immunoglobulins; whereas values of <0.70 indicate damage to the blood brain barrier

measurement of which enzyme can be used to confirm the presence of seminal fluid

acid phosphatase

pilocarpine iontophoresis is used to

induce sweating

a decreased CSF concentration of what, compared to a paired serum concentration, would be associated with bacterial meningitis and pleocytosis

glucose

three tubes of CSF sent to lab

which should be used for chemical analyses including glucose and total protein

tube 1

myelin basic protein is most commonly measured in CSF to evaluate the effectiveness of treatment for

multiple sclerosis

pH determinations are clinically relevant for

pleural fluids

amniocentesis is performed at 17 weeks

physician wants to confirm specimen is amniotic fluid, not urine

which tests should be most helpful in distinguishing these fluids

glucose, total protein, urea, and creatinine

an L/S ratio of 2.4 on amniotic fluid collected at 34 weeks' gestation indicates

fetal lung maturity

an L:S ratio of <2.0 suggests fetal lung immaturity

whereas a ratio of >/=2.0 suggests maturity

tumor marker useful in evaluating both pleural and peritoneal effusions for malignancy

CEA

increased presence of fetal fibronectin (fFN) in cervicovaginal secretions from a 24-year-old female at 35 weeks' gestation indicates an increased risk for

preterm delivery

a CSF/serum index of 17 would strongly suggest

damage to the blood-brain barrier

an index <9.0 is considered normal

a phosphatidylglycerol immunochemical slide test shows no visible agglutination for an amniotic fluid collected at 30 week's gestation

should be reported as

invalid

PG is undetectable in amniotic fluid until the 35th week of gestation. Performing this test on amniotic fluid collected prior to 35 weeks is inappropriate and should be considered invalid

a paired fasting plasma specimen is collected at the same time an arthrocentesis is performed

the difference in glucose concentrations between the fluids is reported as 55 mg/dL (3.05 mmol/L)

this result indicates

septic condition

in noninflammatory and hemorrhagic conditions, the difference is typically <20 mg/dL

differences >20 mg/dL suggest an inflammatory condition, and those >40 mg/dL indicate sepsis

a 10 mL suspension, in water, is made from a blood stool sample collected from a neonate.

the specimen is centrifuged and the resulting pink supernatant transferred in equal volumes to 2 tubes

the first tube serves as a reference while the second tube is alkalinized with 1 mL of 0.25 M sodium hydroxide

the second tube changes to yellow within 2 minutes. This reaction indicates the presence of

A. Fetal hemoglobin (HgbF)

B. Maternal hemoglobin (HgbA)

C. Fetal white blood cells

D. Maternal white blood cells

maternal hemoglobin

maternal hemoglobin turns yellow or brown, while fetal hemoglobin (HbF) remains pink

results from 21-year-old patient with a back injury, otherwise healthy

whole blood glucose 77 mg/dL (4.2 mmol/L)

serum glucose 88 mg/dL (4.8 mmol/L)

CSF glucose 56 mg/dL (3.1 mmol/L)

best interpretation of these results is that

all values are consistent with a normal healthy individual

a healthy person with a blood glucose of 80 mg/dL (4.4 mmol/L) would have a simultaneously determined cerebrospinal fluid glucose value of

50 mg/dL (2.3 mmol/L)

CSF glucose concentrations are usually 60-70% that of blood

if glucose testing cannot be performed immediately, CSF should be stored

in a freezer

to avoid falsely elevated CSF cell counts, use an aliquot

from the last tube collected

which analysis is performed on seminal fluid that has been fixed and stained with Wright, Giemsa, or Papanicolaou stain

morphology

synovial fluid analyzed with a polarizing microscope shows the presence of crystals appearing as sharp needles with strong negative birefringence

these crystals should be reported as

monosodium urate crystals

MSU are negative birefringence

CPPD crystals are rhomboid or square crystals with positive birefringence

seminal fluid is diluted 1:20 and loaded onto a Neubauer counting chamber

average of 50 sperm are counted in 2 secondary squares

sperm concentration should be reported as

5,000,000/mL

(cell average x dilution factor) / (# of squares counted x quadrant volume)

(50 x 20) / (2 x 0.1) = 1000/0.2

5000 x 1000 = 5,000,000

monosodium urate crystals that are aligned with the slow vibration of the red compensator in a polarizing microscope will appear

yellow

parallel = yellow

perpendicular to the polarizer = blue

three tubes of CSF are received in lab

tube 1: light pink and clear 50,000 RBC/uL and 48 WBC/uL

tube 3: clear and colorless 10 RBC/uL and 0 WBC/uL

most likely explanation for the difference in results is that

tube 1 contains peripheral blood

three tubes of CSF sent to lab

all 3 tubes appear light pink and slightly hazy

most likely explanation

the patient has a subarachnoid hemorrhage

dimensions of a standard Neubauer hemacytometer chamber

3.0 mm x 3.0 mm x 0.1 mm

motility must be observed in at least what percentage of sperm to be considered normal

50%

synovial fluid is typically collected using a sterile needle and syringe and then transferred to collection tubes for testing

which anticoagulant would be appropriate to use for the aliquot sent for a manual cell count and crystal evaluation

liquid EDTA

sample preparation appropriate to use for evaluation of sperm agglutination

wet prep

synovial fluid from 68-year-old patient reveals rhombic crystals with weak pos birefringence when viewed using polarizing microscopy

these crystals can be identified as

calcium pyrophosphate dihydrate

MSU = fine sharp needles with strong negative birefringence

CPPD = rhomboid-shaped crystals with weak pos birefringence

evaluation of sperm morphology is performed by staining an air-dried smear with Wright, Giemsa or Papanicolaou stain and evaluating 200 sperm using

oil immersion and a 100x objective (1000x magnification)

an undiluted CSF specimen is loaded onto a Neubauer hemacytometer and the results shown in this table are recorded after counting all nine 1.0 mm^2 quadrants on both sides:

side 1 #WBC = 100

side 2 #WBC = 55

the laboratorian should

clean and reload the hemacytometer

values are normally compared at 20% or less

to qualitatively aid in differentiating malabsorption and maldigestion, 2 slides are made from the stool specimen, pretreated with ethanol (slide 1) or acetic acid (slide 2), and stained with

oil red O

in synovial fluid, most characteristic finding for patients with gout

MSU crystals

in synovial fluid, most characteristic finding for patients with pseudogout is

CPPD crystals

the tau isoform of transferrin is a carbohydrate-deficient protein found only in

CSF

fetal lung maturity test that may be performed on amniotic fluid using the platelet channel of an automated hematology analyzer

lamellar body count

substance that gives feces its normal color

urobilin

which of the following results reported for a seminal fluid would be considered abnormal

a. pH 7.5

b. total volume 1.2 mL

c. complete liquefaction in 30 minutes

d. gray-white, translucent appearance

total volume 1.2 mL

what calculation may be useful in determining if there is a breach in the blood-brain barrier

CSF/serum albumin index

yellow, cloudy pleural fluid from a 56-year-old male

fluid WBC count = 1550/uL (neutrophils predominate)

fluid glucose = 45 mg/dL (2.5mmol/L)

fluid/serum total protein = 0.9

fluid/serum LD = 0.7

these results indicate the fluid is

an exudate

which of the following seminal fluid results would be evidence of a successful vasectomy?

a. pH 7.8

b. 50% motility

c. azoospermia

d. negative agglutination

azoospermia

if amniocentesis fluid is to be collected for fetal lung maturity testing, amniocentesis should be performed at

30-42 weeks' gestation

the opening pressure for a CSF collection is low, so only 1 mL of fluid is collected into a labeled, sterile tube and sent to lab

which test should be performed first

gram stain and culture

results from a milky peritoneal fluid demonstrate an elevated triglyceride content and presence of chylomicrons

these results indicate the fluid is

chylous

amniotic fluid is collected at 33 weeks' gestation

specimen arrives in a clear, plastic container that has been exposed to light for over an hour

which analyses may be affected by error in specimen transport?

a. lamellar body count

b. alpha-fetoprotein

c. deltaA450 determination

d. foam stability index

deltaA450 determination

a xanthochromic CSF specimen is centrifuged resulting in a pink-colored supernatant

this indicates presence of

hemoglobin

presence of what may result in a CSF specimen with an oily appearance

radiographic contrast media

pleural transudates differ from pleural exudates in that transudates have

a white blood cell count <1000/uL

pleural fluid from a patient with congestive heart failure would be expected to

appear clear and pale yellow

an accumulation of fluid in a body cavity is referred to as a(an)

effusion

fluid sample is collected by thoracentesis and a paired serum sample is collected immediately after

the fluid-to-serum LD ratio is determined to be 0.9

this fluid would be categorized as

pleural exudate

amniotic fluid may be tested to determine the concentration of lamellar bodies to evaluate for

fetal lung maturity

amniocentesis should be performed to

confirm a high maternal serum AFP

an elevated sweat chloride is associated with

cystic fibrosis

the most common genetic defect associated with cystic fibrosis is called

CFTR delta-F508

presence of oligoclonal bands in a CSF specimen but not in the paired serum sample is associated with

multiple sclerosis

presence of macrophages in CSF is associated with a

subarachnoid hemorrhage

CSF result most consistent with bacterial meningitis?

A: glucose 20 mg/dL; protein 200 mg/dL; lactate 40 mg/dL

B: glucose 75 mg/dL; protein 35 mg/dL; lactate 15 mg/dL

C: glucose 75 mg/dL; protein 45 mg/dL; lactate 30 mg/dL

D: glucose 20 mg/dL; protein 90 mg/dL; lactate 10 mg/dL

sample A

glucose 20 mg/dL; protein 200 mg/dL; lactate 40 mg/dL

presence of small, dark, pepper-like granules in a synovial fluid is strongly associated with

alkaptonuria

result associated with malabsorption syndrome

increased fecal fat

qualitative methods used as screening tests for cystic fibrosis employ

chloridometry

amniotic fluid may be measured spectrophotometrically to determine the change in absorbance at 450nm in order to monitor progression of

hemolytic disease of the newborn

acteylcholinesterase activity may be measured on amniotic fluid when a positive alpha-fetoprotein result is obtained to evaluate for

open neural tube defects

a mildly increased CSF lactate (25-30 mg/dL) is generally associated with

fungal meningitis

decreased CSF total protein concentration may indicate the occurrence of

CSF leakage

an alcoholic or pale/clay-colored stool is characteristic of

a post-hepatobiliary obstruction

results from a CSF cell differential are as follows

neutrophils: 3%

lymphocytes: 62%

monocytes: 23%

eosinophils: 12%

these results suggest

fungal meningitis

wet prep for vaginal swab shows presence of numerous clue cells

most likely indicates the patient has

bacterial vaginosis

wet prep is made from a fresh fecal specimen and stained with Wright stain

presence of 3-5 WBC/HPF

cells are neutrophils

these results may indicate the patient has

ulcerative colitis

WBC diff on CSF of adolescent patient suspected of meningitis are as follows:

neutrophils: 89%

lymphocytes: 7%

monocytes: 3%

eosinophils: <1%

these results suggest

bacterial meningitis

presence of rice bodies in a synovial fluid is strongly associated with

rheumatoid arthritis

stool specimen appears black and tarlike should be tested for the presence of

occult blood