Question 1

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.

Accepted Answer

A traumatic tap is caused by injury to the meninges during the collection of the CSF. This causes blood from the surrounding tissues to enter the sample, leading to an artificially high red cell count in the initial tubes. As the technician progresses towards Tube 4, the red cell count decreases due to the dilution of the sample with each tube. In the case of a hemorrhage, the red cell count would remain consistently high across all tubes, while in a traumatic tap, the red cell count would decrease as the sample is collected. Therefore, Tube 1 would have a higher red cell count than Tube 4, indicating a traumatic tap.

Question 2

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.

Accepted Answer

An exudate typically has a specific gravity greater than 1.015, a total protein level of greater than 3.0 g/dL, a ratio of total fluid protein to serum protein of greater than 0.5, a ratio of fluid LD to serum LD of greater than 0.6, and a total leukocyte count usually greater than 1000/mcL. Therefore, choice D is the best answer as it meets all the criteria of an exudate.

Question 3

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

Accepted Answer

Smooth nuclear membranes are a feature of reactive mesothelial cells, but not of malignant cells. Malignant cells tend to have irregular nuclear contours and nuclear membranes.

Question 4

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

Accepted Answer

Normal synovial fluid typically has a total nucleated cell count of less than 200 cells per microliter (mcL) and is predominantly composed of mononuclear cells (lymphocytes and monocytes).

Question 5

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

Accepted Answer

The answer of What morphological characteristics of the following cell...

Question 6

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

Accepted Answer

The answer of Explain how the following are formed:
a. Transudate
b....

Question 7

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.

Accepted Answer

The presence of large lymphoblasts with irregular nuclear membranes on cytospin differential suggests that the patient may have leukemia that has spread to the spinal column. Leukemia is a type of cancer that affects the blood and bone marrow, and can spread to other parts of the body, including the central nervous system. Febrile seizures may be a complication of leukemia, as high fever and infections are common in these patients. It is important to pursue further diagnostic testing and treatment for leukemia if this is suspected.

Question 8

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

Accepted Answer

The answer of How would the technologist differentiate between a...

Question 9

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

Accepted Answer

The high RBC count in the first tube and subsequent decrease in subsequent tubes suggests a traumatic specimen collection where blood from the surrounding tissues contaminated the first tube. The absence of xanthochromia and minimal presence of neutrophils and lymphocytes rule out cerebral hemorrhage or infection. The clear appearance and lack of bacteria suggest no contamination.

Question 10

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

Accepted Answer

Bronchial lining cells have rows of cilia on one end of the cell, which helps with respiratory function. The description in option A is more characteristic of a malignant cell, option B describes a more abnormal appearance, and option D is not a characteristic feature of bronchial lining cells.

Question 11

Which procedure is used to collect the pleural fluid from the pleural cavity?
A) Pericardial aspiration
B) Paracentesis
C) Thoracentesis
D) Spinal tap

Accepted Answer

Thoracentesis is the procedure used to collect pleural fluid from the pleural cavity. Pericardial aspiration is used to collect fluid from the sac surrounding the heart, paracentesis is used to collect fluid from the abdominal cavity, and spinal tap is used to collect cerebrospinal fluid from the spinal cord.

Question 12

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

Accepted Answer

Erythrophagocytosis, the ingestion of red blood cells by macrophages, is a typical finding in CNS hemorrhage. Increased RBC count may be present but is not a definitive sign, significant increase in WBC and presence of histiocytes are not specific to hemorrhage in the CNS.

Question 13

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

Accepted Answer

The answer of An overweight 73-year-old man sees his orthopedic...

Question 14

List common morphologic changes associated with cytocentrifugation.

Accepted Answer

The answer of List common morphologic changes associated with cytocentrifugation....

Question 15

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

Accepted Answer

Rhomboid-shaped crystals with positive birefringence are characteristic of calcium pyrophosphate crystals, which are commonly found in pseudogout. Monosodium urate crystals typically have a needle-like appearance, while starch particles and cholesterol crystals do not exhibit birefringence.

Question 16

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

Accepted Answer

Examination with polarized light is the best technique to differentiate starch particles from pathogenic crystals in fluids. Starch particles rotate polarized light in a circular pattern, while pathogenic crystals do not have this effect. Therefore, starch particles will exhibit characteristic cross-polarization under a microscope, making it easy to differentiate them from pathogenic crystals.

Question 17

The ability to bend light rays against both fixed and rotating filters is:
A) Xanthochromia
B) Birefringence
C) Thermal reactivity
D) Nephelometry

Accepted Answer

The ability to bend light rays against fixed and rotating filters is called birefringence. Xanthochromia refers to the presence of yellowish discoloration in cerebrospinal fluid, thermal reactivity refers to the change in reaction rate with temperature, and nephelometry measures the amount of light scattered by particles in a solution.

Question 18

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

Accepted Answer

Pseudochylous fluid is milky in appearance and results from the breakdown of cellular components in long-standing effusions, often associated with chronic conditions. Unlike chylous fluid, which is also milky but results from lymphatic disruption, pseudochylous fluid does not contain high levels of triglycerides.

Question 19

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

Accepted Answer

Cholesterol crystals are known for their notched-plate shape and birefringence under polarized light, which matches the description given.

Question 20

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.

Accepted Answer

The presence of xanthochromia and macrophages with black crystals and round, pink intracellular bodies suggests an old hemorrhage, such as a subdural hemorrhage, where blood has been present in the CSF for some time, allowing for breakdown and phagocytosis by macrophages.

Quiz 30: Morphologic Analysis of Body Fluids in the Hematology

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

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?

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

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

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

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

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:

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

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

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

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

List common morphologic changes associated with cytocentrifugation.

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

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

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

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

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: