Deck 12: Serous Fluid

Question 1

Elevated pleural fluid amylase can be indicative of all of the following except:

A) Pancreatitis
B) Esophageal rupture
C) Tuberculosis
D) Malignancy

Answer 1

C

Question 2

A blood-streaked pericardial exudate with an increased amount of neutrophils is indicative of:

A) Bacterial endocarditis
B) Cardiac puncture
C) Tuberculosis
D) Misuse of anticoagulant medication

Answer 2

A

Question 3

The pathologic accumulation of fluid in a body cavity is termed a/an:

A) Transudate
B) Abscess
C) Exudate
D) Effusion

Answer 3

D

Question 4

Differentiation between a hemothorax and a hemorrhagic effusion on a bloody pleural fluid is done by:

A) Observing the fluid for streaks of blood, because this indicates a hemothorax
B) Performing a hematocrit value, because a hemothorax will give a value close to that of blood
C) Performing a red blood cell (RBC) count, because a hemorrhagic effusion will have a count over 100,000/L
D) Performing both RBC and white blood cell (WBC) counts, because a hemothorax will have marked elevations of both cell types

Question 5

Peritoneal fluid is collected by a procedure called:

A) Thoracentesis
B) Asciticentesis
C) Paracentesis
D) Abdominalcentesis

Question 6

A decrease in the number of mesothelial cells seen on a pleural fluid differential indicates:

A) Malignancy
B) Tuberculosis
C) Pneumonia
D) Lupus erythematosus

Question 7

A pleural fluid delivered to the laboratory on ice would be accompanied by a requisition to test for:

A) Glucose
B) pH
C) Lactic dehydrogenase
D) Alkaline phosphatase

Question 8

A pleural fluid pH of less than 6.0 is indicative of:

A) Tuberculosis
B) Malignancy
C) Pancreatic disorders
D) Esophageal rupture

Question 9

Requests for amylase and alkaline phosphatase determinations on ascitic fluid are received in suspected cases of:

A) Peritonitis
B) Gastrointestinal perforations
C) Ruptured bladder
D) Malignancy

Question 10

Which of the following is most often associated with the formation of a transudate?

A) Malignancy
B) Congestive heart failure
C) Pancreatitis
D) Peritonitis

Question 11

Exudate fluids usually result from:

A) Cardiac insufficiency
B) Inflammation of the serous membrane
C) Abnormal electrolyte balance
D) Lack of protein in the diet

Question 12

All of the following are unique characteristics of malignant cells except:

A) Hyperchromatic nucleoli
B) Cytoplasmic molding
C) Cellular clumping
D) Abnormal nuclear-to-cytoplasm ratios

Question 13

Pleural fluid can be better classified as to transudative or exudative origin by performing a:

A) Fluid-to-serum cholesterol ratio
B) Fluid-to-serum lactate dehydrogenase (LD) ratio
C) Fluid-to-serum ketone ratio
D) Fluid-to-serum gamma-glutamyltransferase ratio

Question 14

The cells lining the pleural cavities are primarily:

A) Neutrophils
B) Mesothelial cells
C) Lymphocytes
D) Spindle-shaped cells

Question 15

Production of serous fluid is controlled by all of the following except:

A) Lymphatic secretions
B) Hydrostatic pressure
C) Oncotic pressure
D) Capillary permeability

Question 16

Peritoneal lavage is performed to:

A) Remove ascitic fluid
B) Check for the presence of bile
C) Detect intra-abdominal bleeding
D) Provide a sufficient volume of fluid for chemical analysis

Question 17

Serous fluid effusions may result from all of the following except:

A) Congestive heart failure
B) Lymphatic obstruction
C) Increased capillary permeability
D) Dehydration

Question 18

The function of serous fluid is to:

A) Provide nutrients to the serous membranes
B) Protect organs from trauma
C) Provide lubrication for the serous membranes
D) Remove excess fluid from body cavities

Question 19

A fluid obtained by thoracentesis has a cholesterol result of 100 mg/dL.This would be classified as a/an:

A) Ascitic exudate
B) Ascitic transudate
C) Pleural exudate
D) Pleural transudate

Question 20

Structures seen in peritoneal fluid that may be associated with either benign or malignant conditions are:

A) Reactive mesothelial cells
B) Lipophages
C) Psammoma bodies
D) Macrophages

Question 21

A screening test performed on a cloudy,green ascitic fluid would be a/an:

A) Clinitest
B) Albumin
C) Reagent strip nitrite
D) Ictotest

Question 22

A milky,green-tinged pleural fluid:

A) Contains primarily lymphocytes
B) Does not contain cholesterol crystals
C) Is indicative of lymphatic drainage
D) Stains weakly with Sudan III

Question 23

Ascitic fluid from a patient with symptoms of severe abdominal pain has an elevated amylase and alkaline phosphatase,a WBC count of 30,000/µL,an absolute neutrophil count of 80%,and albumin of 3.5 mg/dL (serum albumin: 4.0 mg/dL).
Based on the information provided,calculate the serum-ascites albumin gradient.

A) 0.5
B) -0.5
C) 1.1
D) 7.5

Question 24

Pericardial fluid from a patient with the nephrotic syndrome appears pale yellow.The fluid-to-LD ratio is 3.0,fluid-to-protein ratio is 0.3,and the WBC count is 500/L.
Based on the information provided,is this fluid a transudate or an exudate?

A) Transudate
B) Exudate

Question 25

Ascitic fluid from a patient with symptoms of severe abdominal pain has an elevated amylase and alkaline phosphatase,a WBC count of 30,000/µL,an absolute neutrophil count of 80%,and albumin of 3.5 mg/dL (serum albumin: 4.0 mg/dL).
Based on the information provided,is this fluid a transudate or exudate?

A) Transudate
B) Exudate

Question 26

Ascitic fluid from a patient with symptoms of severe abdominal pain has an elevated amylase and alkaline phosphatase,a WBC count of 30,000/µL,an absolute neutrophil count of 80%,and albumin of 3.5 mg/dL (serum albumin: 4.0 mg/dL).
Based on the information provided,what disorder is suggested by these results?

A) Cirrhosis
B) Ovarian malignancy
C) Peritonitis
D) Malnutrition

Question 27

Which of the following tests is valuable in the diagnosis of esophageal rupture?

A) Pleural fluid pH
B) Ascitic fluid pH
C) Pleural fluid amylase
D) Ascitic fluid amylase

Question 28

A blood-streaked pleural fluid has a fluid-to-serum cholesterol ratio of 0.45,a WBC count of 20,000/µL,increased neutrophils,glucose: 40 mg/dL (serum 100 mg/dL),and a pH of 6.8.
Based on the information given,what is the most probable cause of the effusion?

A) Pneumonia
B) Hemothorax
C) Malignancy
D) Congestive heart failure

Question 29

A peritoneal fluid with a positive CEA and a negative CA 125 (cancer antigen)indicates:

A) Gastrointestinal malignancy
B) Ovarian malignancy
C) Tubercular peritonitis
D) Gastrointestinal perforation

Question 30

Which of the following sets of results most closely indicates an exudate?

A) Clear, fluid-to-serum LD ratio: 0.5; fluid-to-serum protein ratio: 0.5; WBC count: 900/µL
B) Cloudy, fluid-to-serum LD ratio: 0.5; fluid-to-serum protein ratio: 0.4; WBC count: 1200/µL
C) Cloudy, fluid-to-serum LD ratio: 0.8; fluid-to-serum protein ratio: 0.7; WBC count: 2500/µL
D) Clear, fluid-to-serum LD ratio: 0.55; fluid-to-serum protein ratio: 0.55; WBC count: 1000/µL

Question 31

Which statement best describes a pleural fluid as an exudate rather than a transudate?

A) Fluid-to-serum LD ratio is less than 0.6
B) Fluid-to-serum protein ratio is less than 0.5
C) WBC count is greater than1000
D) Fluid-to-serum cholesterol ratio is greater than 0.3

Question 32

The test performed on peritoneal lavage fluid is the:

A) RBC count
B) WBC count
C) Amylase
D) Carcinoembryonic antigen (CEA)

Question 33

A blood-streaked pleural fluid has a fluid-to-serum cholesterol ratio of 0.45,a WBC count of 20,000/µL,increased neutrophils,glucose: 40 mg/dL (serum 100 mg/dL),and a pH of 6.8.
Based on the information provided,is this fluid a transudate or exudate?

A) Transudate
B) Exudate

Question 34

A milky pleural fluid that stains strongly positive with Sudan III indicates:

A) Thoracic duct leakage
B) Nephrotic syndrome
C) Malignancy
D) Chronic inflammation

Question 35

Pericardial fluid from a patient with the nephrotic syndrome appears pale yellow.The fluid-to-LD ratio is 3.0,fluid-to-protein ratio is 0.3,and the WBC count is 500/L.
Based on the information provided,what complication of the nephrotic syndrome is causing this effusion?

A) Renal failure
B) Hypoalbuminism
C) Hyperalbuminism
D) Increased cholesterol

Question 36

A pericardial exudate from a patient diagnosed with AIDS might be tested with:

A) An India ink preparation
B) An acid-fast stain
C) A Gram stain
D) An immunofixation electrophoresis

Question 37

A blood-streaked pleural fluid has a fluid-to-serum cholesterol ratio of 0.45,a WBC count of 20,000/µL,increased neutrophils,glucose: 40 mg/dL (serum 100 mg/dL),and a pH of 6.8.
Based on the information provided,what is the significance of the pH result?

A) No significance
B) Esophageal rupture
C) Pancreatitis
D) Need for chest tubes

Question 38

Differentiation between an ascitic fluid transudate and exudate is most accurately made using the:

A) Fluid-to-serum bilirubin ratio
B) Serum-ascites albumin gradient
C) Absolute neutrophil count
D) Fluid-to-serum albumin ratio

Question 39

Ascitic fluid from a patient with symptoms of severe abdominal pain has an elevated amylase and alkaline phosphatase,a WBC count of 30,000/µL,an absolute neutrophil count of 80%,and albumin of 3.5 mg/dL (serum albumin: 4.0 mg/dL).
What is the probable cause of the patient's disorder?

A) Alcoholism
B) Esophageal rupture
C) Intestinal perforation
D) Bile duct obstruction

Question 40

An ascitic fluid absolute neutrophil count of 1000/µL is most indicative of:

A) Cirrhosis
B) Malignancy
C) Bacterial peritonitis
D) Blunt trauma injury

Question 41

The finding of a mesothelioma cell in pericardial fluid is indicative of:

A) Primary malignancy
B) Misuse of anticoagulants
C) Endocarditis
D) Metastatic malignancy

Question 42

Reactive mesothelial cells indicate a malignant effusion.

Question 43

Increased serous fluid can be caused by all of the following except:

A) Lymphatic obstruction
B) Inflammation
C) Increased plasma sodium
D) Increased hydrostatic pressure

Question 44

A significant finding in a serous effusion is an increase in mesothelial cells.

Question 45

Transudate serous fluid effusions are a complication of the nephrotic syndrome.

Question 46

Pleural fluid amylase is elevated in cases of pancreatitis.

Question 47

What is the significance of a peritoneal fluid with an elevated creatinine level?

A) Renal malignancy
B) Nephrotic syndrome
C) Ruptured bladder
D) No significance

Question 48

What is the significance of an ascitic fluid exudate with a positive CA 125 and a negative CEA?

A) Gastrointestinal malignancy
B) No significance
C) Tuberculosis
D) Ovarian malignancy

Question 49

Ascitic fluid WBC counts are elevated in peritonitis and decreased in cirrhosis.

Question 50

Cultures of peritoneal fluid should be routinely incubated both aerobically and anaerobically.

Question 51

Serous fluid exudates may contain malignant cells of either primary or metastatic origin.

Question 52

Normal values for chemistry tests on serous fluid are different from values obtained on serum.

Question 53

What is the significance of a pleural fluid with a hematocrit value of 30% (blood hematocrit: 34%)?

A) Hemothorax
B) Pneumonia
C) Esophageal rupture
D) Mesothelioma

Question 54

Additional testing is most frequently performed on transudates rather than exudates.