Deck 30: Morphologic Analysis of Body Fluids in the Hematology

Question 1

Which of the following is responsible for producing cerebrospinal fluid?

A) Arachnoid cells
B) Choroid plexus cells
C) Pia mater
D) Ventricles

Answer 1

Choroid plexus cells

Question 2

Malignant tissue cells have which of the following morphologic features?

A) Irregular nuclear membrane
B) Evenly distributed chromatin
C) Prominent nucleoli with regular nuclear membrane
D) All of the above

Answer 2

Irregular nuclear membrane

Question 3

An effusion can accumulate as the result of a systemic disease and with congestive heart failure. The correct term for this fluid is:

A) Transudate.
B) Exudates
C) Chylous
D) Pleural fluid

Answer 3

Transudate.

Question 4

A specimen labeled "ascites" is sent to the laboratory. What type of procedure was used to obtain this fluid?

A) Thoracentesis
B) Lumbar puncture
C) Arthrocentesis
D) Paracentesis

Question 5

A crystal with long, thin, needlelike, pointed ends is identified in synovial fluid. The crystals are located inside and outside the cells. A quartz compensator is used, and it determines that the crystals are negatively birefringent and are a yellow color when parallel to the axis of the compensator. The crystal is blue when turned perpendicular to the axis of the compensator. What is the type of crystal?

A) Monosodium urate
B) Calcium pyrophosphate
C) Cholesterol crystals
D) Pseudogout

Question 6

What type of fluid is collected from the spinal tap or lumbar puncture procedure?

A) Pleural
B) Pericardial
C) Synovial
D) Cerebrospinal

Question 7

Joint fluid from a patient with knee pain revealed many monosodium urate crystals. These crystals are associated with:

A) Gout
B) Pseudogout
C) Rheumatoid arthritis
D) Recent treatment with steroids

Question 8

Examination of joint fluid on a 60-year-old patient with right knee pain reveals many intracellular needlelike crystals that polarize yellow to blue. What is the most likely identification of the crystal?

A) Calcium pyrophosphate
B) Cholesterol crystal
C) Monosodium urate
D) Talc particle

Question 9

The following results are obtained from a 38-year-old woman with congestive heart failure: • Specimen: pleural fluid
• Fluid protein = 4.5 g/dl
• Serum protein = 9.5 g/dl
• Serum LD = 110 U/L
• Fluid LD = 60 U/L
These results are most consistent with which of the following?

A) Chylous effusion
B) Exudate
C) Transudate
D) Normal pleural fluid

Question 10

Artifacts that can be seen with cytocentrifuge-prepared slides can be interpreted as a clinically significant finding by mistake. Which of the following can be an artifact leading to a mistaken interpretation of bacterial organisms in a fluid?

A) Cytoplasmic projections of lymphocytes
B) Starch particles
C) Stain precipitate
D) Degenerating tissue cells

Question 11

A peritoneal dialysate fluid is sent to the laboratory for analysis. Patient history reveals an 85-year-old woman with a previous history of duodenal cancer that is in remission. The laboratician reviews the cytospin and notices many large cells that are smooth in appearance and have abundant, basophilic cytoplasm with smooth nuclear membrane, evenly distributed chromatin, and no nucleoli. What is the most probable identification of those cells?

A) Small-cell duodenal carcinoma
B) Reactive mesothelial
C) Adenocarcinoma
D) Ependymal

Question 12

Lamellar bodies can be counted on a hematology analyzer because they are similar in size to what cell type?

A) Neutrophils
B) Reticulocytes
C) Platelets
D) Lymphocytes

Question 13

A laboratician is scanning a cytospin slide from a CSF specimen and notices a few solid-staining wrinkled bodies on the cytospin prep. A follow up India ink prep is positive. What is the most likely identification of this?

A) Histoplasma
B) Cryptococcus
C) Candidiasis
D) Bacterial contamination

Question 14

Morphologic evaluation of body fluids prepared by using the cytocentrifuge is an excellent method of concentrating cells for microscopic review. When the pleural fluid is cytocentrifuged for staining, what type of normal cells would one expect to see?

A) Ependymal
B) Mesothelial
C) Synovial
D) Choroid plexus

Question 15

An unknown cell in a body fluid possesses the following morphologic characteristics: 35 mcM in size, partially clumped chromatin, prominent nucleoli, jagged nuclear membrane, and clumped cell with nuclear molding. What is the most likely identification of the unknown cell?

A) Mesothelial cell
B) Small-cell carcinoma cell
C) Adenocarcinoma cell
D) Leukemic blast cell

Question 16

Interpret the following results: • Specimen: pleural effusion on a 45-year-old lung cancer patient:
• Specific gravity = 1.025
• Total protein = 4.5 g/dl
• F:Se protein = 0.9
• Fluid LD/serum LD = 0.8
• Total WBC count = 2,205/mcL (μL)
What is the classification of this fluid?

A) Transudate
B) Exudate

Question 17

All of the following can be found in normal body fluid except:

A) Neutrophils
B) Lymphocytes
C) Histiocytes
D) Budding yeast

Question 18

Necrotic PMNs in a cytospin can be easily mistaken for which of the following?

A) Nucleated RBCs
B) Hairy cells
C) Leukemic blasts
D) Hypersegmented PMNs

Question 19

Accumulation of fluid as a result of systemic disease is defined as:

A) Exudate
B) Chylous fluid
C) Transudate
D) Peritoneal ascites

Question 20

What fluid is collected from the subarachnoid space?

A) Pleural
B) Pericardial
C) Synovial
D) Cerebrospinal

Question 21

When evaluating a CSF for a hemorrhage or a traumatic tap, what laboratory results would be expected if it were a traumatic tap?

A) Tube 1 would have a lower red cell count than Tube 4.
B) Tube 1 would have a higher red cell count than Tube 4.
C) Tube 1 would show xanthochromia, and Tube 4 would show no xanthochromia.
D) Tube 1 would not have any cells, but tube 4 would have many crenated cells.

Question 22

An exudative effusion can cause many different pathologic processes, such as bacterial infections, viral infections, neoplasms, and collagen vascular diseases. What are the typical laboratory results of an exudate?

A) Specific gravity is less than 1.015, total protein is >3.0 g/dL, a ratio of total fluid protein to serum protein is >0.5, a ratio of fluid LD to serum LD is >0.6, and a total leukocyte count usually is >1000/mcL.
B) Specific gravity is <1.015, a total protein is < 3.0 g/dL, a ratio of total fluid protein to serum protein is <0.5, ratio of fluid LD to serum LD is <6.0, and a total leukocyte count usually is <1000/mcL.
C) Specific gravity is <1.015, a total protein is < 3.0 g/dL, a ratio of total fluid protein to serum protein is more than 0.5, ration of fluid LD to serum LD is <6.0, and a total leukocyte count usually is >5000/mcL.
D) Specific gravity is >1.015, a total protein is >3.0 g/dL, a ratio of total fluid protein to serum protein is >0.5, a ratio of fluid LD to serum LD is >0.6, and a total leukocyte count usually is> 1000/mcL.

Question 23

Cells found in fluids can be reactive mesothelial cells or malignant cells. Which features are found in reactive cells but not in malignant cells?

A) Smooth nuclear membranes
B) Chromatin unevenly distributed
C) Nucleoli prominent and frequently multiply
D) Nuclear molding

Question 24

Normal synovial fluid should have a total nucleated cell count of ________ with predominantly what type of cell?

A) 200-400/mcL; mononuclear
B) <200/mcL; mononuclear
C) <50/mcL; neutrophils
D) <2000/mcL; histiocytes

Question 25

What morphological characteristics of the following cell types will help the technologist differentiate them?
a. Mesothelial cells
b. Adenocarcinoma
c. Leukemic blasts
d. Small-cell carcinoma

Question 26

Explain how the following are formed:
a. Transudate
b. Exudate
c. Chylous fluid

Question 27

A 3-year-old boy is admitted with febrile seizures. A lumbar puncture is performed to rule out meningitis. The cytospin differential shows many large lymphoblasts with irregular nuclear membranes. This means that the patient:

A) Might be suffering from leukemia that is in the spinal column
B) Has febrile seizures because of a prevalent septicemia that has traveled to the spinal column
C) Has brain cancer that has metastasized from the lymphatic system.
D) Is normal.

Question 28

How would the technologist differentiate between a traumatic specimen collection tap and a cerebral hemorrhage? Provide at least three macroscopic and three microscopic findings.

Question 29

Interpret the following results: • Specimen: cerebrospinal fluid (CSF)
• Tubes sent: 1-4
O Tube 1 RBC count: 30,000/mcL
O Tube 2 RBC count: 1500/mcL
O Tube 3 RBC count: 200/mcL
O Tube 4 RBC count: 4/mcL
• Gross examination:
O Tube 1: moderate hemolysis, clear
O Tube 2: slight hemolysis, clear
O Tube 3: no hemolysis, clear
O Tube 4: no hemolysis, clear
• Xanthochromia: absent in all four tubes
• Microscopic findings:
O Many intact RBCs
O 0-5 neutrophils
O 0-5 lymphocytes
O 0-5 MNCs
What do these data most likely represent?

A) A cerebral hemorrhage
B) A traumatic specimen collection
C) A possible infection in the CSF
D) A bacterial contamination from an external source

Question 30

A cell commonly seen in BAL specimens is the bronchial lining cell which can be distinguished by the presence of:

A) Prominent nucleoli with a regular nuclear membrane
B) Partially clumped nuclear chromatin and jagged nuclear membrane
C) Row of cilia on one end of the cell
D) Abundant deeply basophilic cytoplasm with man vacuoles

Question 31

Which procedure is used to collect the pleural fluid from the pleural cavity?

A) Pericardial aspiration
B) Paracentesis
C) Thoracentesis
D) Spinal tap

Question 32

One of the definitive signs of hemorrhage in the CNS is:

A) Increased RBC count
B) Significant increase in WBC
C) Erythrophagocytosis
D) Presence of histiocytes

Question 33

An overweight 73-year-old man sees his orthopedic specialist because of recurrent right knee pain. The physician performs an arthrocentesis and sends it to the laboratory for analysis. The technologist notes many crystals with notched edges, exhibiting strong birefringence. Based on this information, from what is the patient most likely suffering?

A) Systemic lupus
B) Gout
C) Rheumatoid arthritis
D) Bacterial infection in the joint

Question 34

List common morphologic changes associated with cytocentrifugation.

Question 35

An unknown crystal exhibits positive birefringence. It is rhomboid in appearance. What is its most likely identification?

A) Monosodium urate
B) Starch particles
C) Cholesterol crystals
D) Calcium pyrophosphate

Question 36

The technique that should be performed to differentiate starch particles from pathogenic crystals in fluids is:

A) Examination with polarized light
B) Examination with fluorescent light
C) Examination with Wright stain
D) Calculation of RBC to WBC ratio

Question 37

The ability to bend light rays against both fixed and rotating filters is:

A) Xanthochromia
B) Birefringence
C) Thermal reactivity
D) Nephelometry

Question 38

Which type of fluid is milky in appearance and is formed from long-standing effusions resulting from chronic conditions?

A) Transudate
B) Pseudochylous
C) Exudates
D) Chylous

Question 39

A patient with rheumatoid arthritis has fluid collected from his knee. The fluid has crystals that have a notched-plate shape. They are also birefringent. These crystals are most likely:

A) Calcium pyrophosphate
B) Monosodium urate
C) Steroid
D) Cholesterol

Question 40

A technologist is performing a body fluid analysis on a CSF specimen recently received in the laboratory. Four CSF tubes were sent to the body fluids bench. The tech notices that all four specimens seem moderately blood tinged equally. Moderate xanthochromia was also noted. The tech performs the cytospin differential and notices many macrophages with black crystals and round, pink intracellular bodies. What is the most likely reason for these findings?

A) This was a traumatic specimen collection.
B) The patient has a CNS lymphoma.
C) The patient is suffering from a subdural hemorrhage.
D) The wrong patient was drawn.

Question 41

List the basic battery of tests for a routine semen analysis and cite the reference range for each.

Question 42

What is the significance of micro-organisms present in the cytospin?