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Clinical Microscopy
Synovial fluid - CSF
| Question | Answer |
|---|---|
| A degenerative joint disorders where the synovial fluid is clear and yellow with WBC count of <1,000/ul which is predominantly neutrophils (<30%) | Non-inflammatory Joint disorder |
| An immunologic joint disorders (RA, SLE...) where the synovial fluid is cloudy and yellow with WBC count of 2,000-75,000/ul mostly neutrophils (>50%) | Inflammatory (Immunologic) Joint disorder |
| Causes gout and pseudogout where the synovial fluid is cloudy/ milky with WBC count of up to 100,000/ul mostly (>70%) neutrophils | Inflammatory (Crystal-induced) Joint disorder |
| Causes microbial infection where the synovial fluid is cloudy and yellow green with WBC count of 50,000-100,000/ul mostly (>75%) | Septic Joint disorder |
| Causes traumatic injury, coagulation deficiencies, etc with WBC count equal to blood (neutrophils) | Hemorrhagic Joint disorder |
| A joint disorder positive for autoantibodies | Inflammatory (Immunologic) Joint disorder |
| A joint disorder positive for crystals | Inflammatory (Crystal-induced) Joint disorder |
| A joint disorder tested for culture and gram stain | Septic Joint disorder |
| A joint disorder positive for RBCs | Hemorrhagic Joint disorder |
| Chemistry test of synovial fluid: Most frequently tested chemistry test. Done in conjunction with blood glucose (8hrs fasting) | Glucose |
| Blood glucose - Synovial fluid = __________ (normal) (more than the normal value is infection) | <10 mg/dL |
| Chemistry test of synovial fluid: Normal value = <25 mg/dL (increased in infection) | Lactate |
| Chemistry test of synovial fluid: Normal value = <3 g/dL (~1/3 of plasma protein). Increased in inflammatory an d hemorrhagic disorders | Protein |
| Chemistry test of synovial fluid: Normal value = same as blood (increased in gout) | Uric acid |
| Chemistry test of synovial fluid: ACP, ALP, GGT, ADA, MURA, CD, LDH, AST = for Rheumatoid arthritis | Enzymes |
| Common microorganism that infect synovial fluid in older adults | Staphylococcus aureus |
| Common microorganism/s that infect synovial fluid in children | Streptococcus and Haemophilus |
| Common microorganism that infect synovial fluid in young and middle-aged adults | Neisseria gonorrheae |
| Serologic test for synovial fluid used to diagnose SLE and RA | Autoantibody detection |
| Serologic test for synovial fluid used to diagnose Lyme disease | Detection of antibodies to Borrekua burgdorferi |
| MSU crystals with gran running parallel to the long axis. The slow ray passes with the gran, producing __________ (yellow) birefringence | Negative |
| CPPD crystal with grain running perpendicular to the long axis. The slow ray passes against the gran and is retarded, producing ___________ (blue) birefringence | Positive |
| Causes of crystal formation: | Metabolic disorders Decreased renal excretion Degeneration of cartilage and bones Injection of medication |
| What type of crystal is present in gout? | Monosodium urate |
| What type of crystal is present in pseudogout? | Calcium pyrophosphate |
| What type of crystal is present in extracellular ##? | Cholesterol |
| What type of crystal is present in injections? | Corticosteroid |
| What type of crystal is present in renal dialysis? | Calcium oxalate |
| What type of crystal is present in osteoarthritis (OA)? | Apatite (Calcium phosphate) |
| What type of birefringence is monosodium urate crystal? | Negative |
| What type of birefringence is calcium pyrophosphate crystal? | Positive |
| What type of birefringence is cholesterol crystal? | Negative |
| What type of birefringence is corticosteroid crystal? | Positive or negative birefringence |
| What type of birefringence is calcium oxalate crystal? | Negative |
| What type of birefringence is apatite (calcium phosphate) crystal? | No birefringence |
| A microscope that detects for the presence or absence of birefringence (BR) | Polarizing microscope |
| A microscope that confirms the type of birefringence (positive or negative BR). Red compensator is placed between crystal and analyzer | Compensated Polarizing microscope |
| A control slide for MSU polarization in compensated polarizing microscope can be prepared using | Betamethasone acetate corticosteroid |
| What large mononuclear leukocyte and may be vacuolated cell found on synovial fluid? | Macrophage (monocyte) |
| What neutrophil containing ingested "round body" cell found on synovial fluid? | LE cell |
| What vacuolated macrophage w/ ingested neutrophils cell found on synovial fluid? | Reiter cell (neutrophage) |
| What neutrophil with dark cytoplasmic granules containing precipitated rheumatoid factor cell found on synovial fluid? | RA cell (ragocyte) |
| What macroscopically resemble polished rice cell and microscopically show collagen and fibrin found on synovial fluid? | Rice bodies |
| What debris from metal and plastic joint prosthesis with "ground pepper" appearance found on synovial fluid? | Ochronotic shards |
| What large, multinucleated cells found on synovial fluid? | Cartilage cells |
| What cell is similar to macrophage, but may be multinucleated, resembling a mesothelial cell found on synovial fluid? | Synovial lining cell |
| What refractile intracellular and extracellular globules cells that stain with Sudan dyes found on synovial fluid? | Fat droplets |
| What inclusions within clusters of synovial cells? | Hemosiderin |
| The most frequently performed cell count in synovial fluid | WBC count |
| WBC count diluting fluids on synovial fluid: | NSS with methylene blue Hypotonic saline (0.3%) Saline with saponin |
| ___________ is not used as a WBC diluting fluid for synovial fluid cell count because it can cause clot formation | Acetic acid |
| For very viscous synovial fluid add 1 drop of _____________ in phosphate buffer per mL of fluid | 0.05% hyaluronidase |
| Normal value of this cell in differential count of synovial fluid is <2,000/ul but in Turgeon is ABSENT | Red blood cells |
| Normal value of this cell in differential count of synovial fluid is <200/ul | White blood cells |
| Normal value of this WBC in differential count of synovial fluid is 65% | Monocytes and macrophages |
| Normal value of this WBC in differential count of synovial fluid is <25% | Neutrophils |
| Normal value of this WBC in differential count of synovial fluid is <15% | Lymphocytes |
| Normal synovial fluid viscosity forms a string that is _____ long | 4-6cm |
| Normal hyaluronic acid level of synovial fluid is ______ | 0.3-0.4 g/dL |
| A synovial test that uses 2-5% acetic acid and as the ability of the hyaluronate to polymerize decreases, the clot becomes less firm | Ropes or Mucin clot test (Hyaluronate Polymerization test) |
| Formation of a mucin clot after adding _______ can be used to identify a questionable fluid as synovial fluid | Acetic acid |
| Significance of color (SF): Inflammation | Deeper yellow |
| Significance of color (SF): Bacterial infection | Greenish tinge |
| Significance of color (SF): Traumatic tap; hemorrhagic arthritis | Red |
| Significance of color (SF): WBCs, synovial cell debris or fibrin | Turbid |
| Significance of color (SF): Presence of crystals | Milky |
| Method of collection of synovial fluid | Arthrocentesis |
| Normal specimen volume of synovial fluid (adult knee cavity) | <3.5 ml |
| Specimen volume of synovial fluid indicating inflammation | >25ml |
| Tube of choice for chemical and immunologic evaluation of synovial fluid | Plain red top tube |
| Tube of choice for glucose analysis of synovial fluid | Sodium fluoride |
| Tube of choice for hematology or cell count of synovial fluid | Sodium heparin or Liquid EDTA |
| Do not use powdered anticoagulants and lithium heparin because it interferes with ___________ identification | Crystal |
| Do not refrigerate samples because it can produce additional _________ | Crystals |
| Tube of choice for microbiological studies (GS and culture) of synovial fluid | Sterile anticoagulant tube (Heparin or SPS) |
| A viscous fluid circulating in diarthoses (movable joints) and viscosity is d/t polymerization of hyaluronic acid produced by Type B synoviocytes | Synovial fluid |
| A disease that affects the production of hyaluronate and its ability to polymerize, thus decreasing synovial fluid viscosity | Arthritis |
| Functions of synovial fluid: | Lubricate Reduce friction Provide nutrients Lessen shock of joint compression |
| What hormones stimulates spermatogenesis? | FSH and LH |
| These cells secrete testosterone. | Leydig cells |
| These cells secrete inhibin. | Sertoli cells |
| What clotting enzyme is responsible for the coagulation of semen shortly after ejaculation? | Prostate fluid |
| WHO recommends that 2 or 3 samples of semen be collected not less than ______ or more than ______ apart, with 2 abnormal samples considered significant | 7 days 3 weeks |
| Motile sperm can be detected for up to ____ after intercourse, whereas nonmotile sperm can persist for _______ | 24 hours 3 days |
| As the sperm die off, only the ____ remain and may be present for 7 days after intercourse | Head |
| What term is used to describe no semen or ejaculate? | Aspermia |
| What term is used to describe the absence of spermatozoa in the ejaculate? | Azoospermia |
| What term is used to describe the presence of blood in the ejaculate? | Hematospermia |
| What term is used to describe the increase number of leukocytes in the ejaculate? | Leukospermia |
| What term is used to describe the increased number of immotile or dead spermatozoa in the ejaculate? | Necrozoospermia |
| What term is used to describe the decreased in sperm concentration? | Oligoospermia |
| A sperm function test where sperms are incubated with species-nonspecific hamster eggs and penetration is observed microscopically | Hamster egg penetration |
| A sperm function test where observing sperm penetration ability of partner's midcycle cervical mucus | Cervical mucus penetration |
| A sperm function test where sperms exposed to low-sodium concentrations are evaluated for membrane integrity and sperm viability | Hypo-osmotic swelling |
| A sperm function test where evaluation of the acrosome to produce enzymes essential for ovum penetration | In vitro acrosome reaction |
| A test for abnormal semenanalysis where there is a decrease motility with normal count with the possible abnormality of vitality | Eosin-nigrosin stain |
| A test for abnormal semenanalysis where there is decrease sperm count with the possible abnormality of lack of seminal vesicle support medium | Fructose level |
| A test for abnormal semenanalysis where there is decreased motility with clumping with the possible abnormality of male antisperm antibodies | MAR and Immunobead tests Sperm agglutination with male serum |
| A test for abnormal semenanalysis where there is normal analysis with continued infertility with possible abnormality of female antisperm antibodies | Sperm agglutination with female serum |
| It is a surgical cutting of vas deferens so that the ejaculate will not contain any sperm cell. After the procedure, sperm count ideally should be zero within 12 weeks | Vasectomy |
| The only concern is the presence of absence of sperm | Post-vasectomy semen analysis |
| Post-vasectomy semen analysis is done _____ after vasectomy, continue until 2 consecutive monthly specimens show no sperm | 2 months |
| If wet preparation is ____, centrifuge specimen for 10 minutes and examine the sediment | Negative |
| Vasectomy is irreversible. True or False | False |
| Chemical test for semen where decrease values (<20 mU/ejaculate) indicates epididymis disorder | Neutral a-glucosidase |
| Immunologic sperm test: It can cause sperm agglutination; detected in semen, cervical mucosa or serum | Antisperm antibodies |
| Immunologic sperm test: It detects the presence of IgG antibodies. Semen sample + AHG + latex particles or treated RBCs coated with IgG | Mixed Agglutination reaction (MAR) |
| Immunologic sperm test: It detects the presence of IgG, IgM and IgA antibodies. It demonstrates what area of sperm (head, neck, tail) the autoantibodies are affecting | Immunobead test |
| Microbial sperm test: Routine aerobic and anaerobic cultures and tests for C. trachomatis, __________ and U. urealyticum | M. hominis |
| These cells can be WBCs or spermatids (immature sperm cells) found on semen. To differentiate, use peroxidase. | Round cells |
| Microbial sperm test result: >1 million WBCs/mL indicates | Infection |
| Microbial sperm test result: >1 million spermatids/mL indicates | Disruption of spermatogenesis |
| A test for detection of semen that is more specific to detect semen | Glycoprotein p30 (aka PSA) |
| A test for detection of choline in the semen (not specific). Iodine crystals + Potassium Iodide -> (+) Dark brown rhombic crystals | Florence test |
| A test for detection of spermine (very specific) in the semen. Saturated picric acid + Trichloroacetic acid -> (+) Yellow leaf-like crystals | Barbiero's test |
| A seminal fluid test performed within 2 hours or frozen to prevent fructolysis | Seminal fluid fructose |
| A screening test for seminal fluid fructose is Resorcinol test aka _______ = (+) Orange-red color | Seliwanoff's test |
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strwbrryrmt