Question 1

The presence of neutrophils containing dark granules in the synovial fluid is associated with:
A) Reiter's syndrome
B) Pigmented villonodular synovitis
C) Rheumatoid arthritis
D) Crush injuries

Accepted Answer

The answer of The presence of neutrophils containing dark granules...

Question 2

Three tubes of blood-streaked synovial fluid from the elbow of a 40-year-old tennis player are delivered to the laboratory with a request for a WBC count,differential,crystal analysis,glucose,and Gram stain.
-Based on the information provided,what type of diluting fluid should be used for the WBC count?
A) Hypotonic saline
B) Methylene blue
C) Glacial acetic acid
D) Normal saline

Accepted Answer

The answer of Three tubes of blood-streaked synovial fluid from...

Question 3

In addition to routine culture media,synovial fluid cultures should include:
A) Anaerobic media
B) Cystine dextrose agar
C) Chocolate agar
D) Löwenstein-Jenson agar

Accepted Answer

Chocolate agar is used to culture fastidious organisms, such as Neisseria gonorrhoeae and Haemophilus influenzae, which can be present in synovial fluid infections.

Question 4

A synovial fluid with a normal WBC count from a patient with a normal serum uric acid contains extracellular birefringent crystals under polarized light.A possible reason for this finding is that the:
A) Specimen was anticoagulated with heparin
B) Patient has septic arthritis
C) Patient has gout
D) Specimen was collected in powdered ethylenediaminetetraacetic acid

Accepted Answer

Powdered EDTA can introduce artifacts that appear as birefringent crystals under polarized light, leading to a false impression of crystal presence.

Question 5

Fluid obtained from the knee of a 60-year-old man who has been experiencing episodes of severe pain for several years has the following results: 
-Based on the information provided,what classification of arthritis is indicated by these results?
A) Noninflammatory
B) Inflammatory/crystal-induced
C) Septic
D) Hemorrhagic

Accepted Answer

The presence of monosodium urate crystals and elevated white blood cell count (WBC) suggest an inflammatory/crystal-induced arthritis, such as gout. Septic arthritis would likely have a significantly higher WBC count and presence of bacteria, while hemorrhagic arthritis would have a higher red blood cell count. Noninflammatory arthritis would not have the presence of crystals or elevated WBC count.

Question 6

Crystals that appear to be rhombic-shaped and are blue when aligned with the slow vibration of red compensated polarized light are:
A) Monosodium urate
B) Calcium pyrophosphate
C) Hydroxyapatite
D) Corticosteroid

Accepted Answer

Calcium pyrophosphate crystals typically appear rhombic-shaped and display a blue color when aligned with the slow vibration of red compensated polarized light. Monosodium urate crystals are typically needle-shaped and appear yellow when aligned with the same light. Hydroxyapatite crystals are typically rod-shaped and do not show polarization under compensated light. Corticosteroids are not crystals, but rather a type of medication.

Question 7

In the Ropes' or mucin clot test,normal synovial fluid:
A) Forms a solid clot when added to hyaluronidase
B) Forms a solid clot when added to glacial acetic acid
C) Forms a friable clot when added to hydrochloric acid
D) Does not form a clot when added to glacial acetic acid

Accepted Answer

Normal synovial fluid forms a solid clot when added to glacial acetic acid in the Ropes' or mucin clot test, indicating the presence of high molecular weight hyaluronan, which is characteristic of normal synovial fluid.

Question 8

Three tubes of blood-streaked synovial fluid from the elbow of a 40-year-old tennis player are delivered to the laboratory with a request for a WBC count,differential,crystal analysis,glucose,and Gram stain.
-Based on the laboratory results listed: WBC count = 1000/µL,the differential has 80% mononuclear cells and 20% neutrophils,the glucose is normal,and Gram stain is negative.What classification of joint disorders is indicated?
A) Noninflammatory
B) Inflammatory/crystal-induced
C) Septic
D) Hemorrhagic

Accepted Answer

A WBC count of 1000/µL with a differential showing mostly mononuclear cells and normal glucose indicates a noninflammatory joint disorder. The negative Gram stain also rules out a septic joint. The lack of crystals makes an inflammatory/crystal-induced joint disorder less likely. Hemorrhagic joint disorders would have a visible blood clot within the fluid.

Question 9

Three tubes of blood-streaked synovial fluid from the elbow of a 40-year-old tennis player are delivered to the laboratory with a request for a WBC count,differential,crystal analysis,glucose,and Gram stain.
-Based on the information provided,what is the significance of the blood-streaked fluid?
A) Elbow trauma
B) Infection
C) Traumatic collection
D) Membrane damage

Accepted Answer

The presence of blood-streaked synovial fluid is often due to a traumatic collection, where blood is introduced into the sample during the procedure of drawing the fluid.

Question 10

Fluid obtained from the knee of a 60-year-old man who has been experiencing episodes of severe pain for several years has the following results: 
-Based on the information provided,what is the most probable diagnosis?
A) Infection
B) Inflammation
C) Gout
D) Pseudogout

Accepted Answer

The answer of Fluid obtained from the knee of a...

Question 11

Synovial fluid for crystal examination should be:
A) Stained with Wright's stain and examined with bright-field microscopy
B) Stained with methylene blue and examined under polarized light
C) Examined unstained under direct and red compensated polarized light
D) Examined unstained with phase microscopy

Accepted Answer

Crystal examination in synovial fluid is best done using direct and red compensated polarized light without staining. This allows for the identification and characterization of different crystal types based on their birefringence properties. Staining can sometimes interfere with crystal identification, and the use of polarized light allows for increased sensitivity and specificity in crystal identification. Bright-field microscopy, methylene blue staining, and phase microscopy are not commonly used methods for crystal examination in synovial fluid.

Question 12

Crystals frequently seen in patients' joints with chronic inflammation are:
A) Monosodium urate
B) Cholesterol
C) Calcium pyrophosphate
D) Calcium oxalate

Accepted Answer

The answer of Crystals frequently seen in patients' joints with...

Question 13

Fluid obtained from the knee of a 60-year-old man who has been experiencing episodes of severe pain for several years has the following results: 
-Based on the information provided,what crystals are most probably present?
A) Monosodium urate
B) Calcium pyrophosphate
C) Calcium oxalate
D) Corticosteroid

Accepted Answer

The results suggest that the fluid contains calcium pyrophosphate crystals, which are commonly associated with conditions such as pseudogout. Monosodium urate crystals are typically associated with gout, while calcium oxalate crystals are associated with conditions such as kidney stones. Corticosteroids are a medication and not a crystal type.

Question 14

Fluid obtained from the knee of a 60-year-old man who has been experiencing episodes of severe pain for several years has the following results: 
-Based on the information provided,does this patient have a metabolic or degenerative disorder?
A) Metabolic
B) Degenerative

Accepted Answer

The provided information is insufficient to determine the exact nature of the disorder. However, the fact that the patient has been experiencing severe pain for several years suggests a degenerative disorder, rather than a metabolic disorder. Further tests and analysis of the fluid may be necessary to identify the specific disorder.

Question 15

Examination of synovial fluid under direct polarized light reveals intracellular needle-shaped crystals that appear white against the black background.When a red compensator is added and the crystals are aligned with the slow vibration,they appear yellow against the red background.These crystals are:
A) Monosodium urate showing positive birefringence
B) Monosodium urate showing negative birefringence
C) Calcium pyrophosphate showing positive birefringence
D) Calcium pyrophosphate showing negative birefringence

Accepted Answer

Monosodium urate crystals show negative birefringence, appearing yellow when aligned parallel to the slow vibration direction of the compensator.

Question 16

Delayed analysis of synovial fluid affects the results of all of the following tests except the:
A) Mucin clot test
B) Glucose
C) Crystal examination
D) WBC count

Accepted Answer

The mucin clot test is not affected by delayed analysis because it assesses the quality of hyaluronic acid, which remains stable over time.

Question 17

Crystals seen in the synovial fluid from a patient previously diagnosed with gout exhibit positive birefringence when observed under red compensated polarized light.The most probable cause of this discrepancy is:
A) Failure to use a blue compensator
B) Aligning the crystals parallel to the slow vibration
C) Aligning the crystals perpendicular to the slow vibration
D) The crystals are artifacts

Accepted Answer

When crystals are aligned perpendicular to the slow vibration, they exhibit positive birefringence. This is the case with urate crystals found in gout synovial fluid. Using a blue compensator would not correct the discrepancy, as it would only enhance the visibility of the birefringence. Aligning the crystals parallel to the slow vibration would result in negative birefringence, which is not seen in urate crystals. The crystals are not artifacts, as they are consistent with the diagnosis of gout.

Question 18

Vacuolated macrophages containing ingested neutrophils are called:
A) Ragocytes
B) Rice bodies
C) Reiter's cells
D) LE cells

Accepted Answer

Vacuolated macrophages containing ingested neutrophils are called Reiter's cells, named after the physician Hans Reiter who first described them in the context of reactive arthritis. Ragocytes, Rice bodies, and LE cells refer to other types of cellular inclusions seen in various disease states.

Question 19

Fluid obtained from the knee of a 60-year-old man who has been experiencing episodes of severe pain for several years has the following results: 
-Based on the information provided,when aligned with the slow vibration of red compensated polarized light,what is the most probable color of the crystals?
A) White
B) Yellow
C) Blue
D) Red

Accepted Answer

The given result (11ea202f_6413_75a7_bbba_03755ef858f1_TB5989_00_TB5989_00_TB5989_00_TB5989_00_TB5989_00) does not provide any information about the crystals present in the knee fluid. However, when polarized light is applied to crystals, they exhibit specific colors depending on their molecular structure. When aligned with the slow vibration of red-compensated polarized light, the most probable color of crystals found in knee fluid is blue. Therefore, option C is the correct answer.

Question 20

All of the following diseases are frequently associated with joint disorders except:
A) Lyme disease
B) Tuberculosis
C) Lupus erythematosus
D) Rheumatoid arthritis

Accepted Answer

Tuberculosis is primarily a respiratory disease caused by the bacterium Mycobacterium tuberculosis and is not typically associated with joint disorders. The other diseases listed are often associated with joint disorders.

Quiz 11: Synovial Fluid

The presence of neutrophils containing dark granules in the synovial fluid is associated with:

In addition to routine culture media,synovial fluid cultures should include:

A synovial fluid with a normal WBC count from a patient with a normal serum uric acid contains extracellular birefringent crystals under polarized light.A possible reason for this finding is that the:

Fluid obtained from the knee of a 60-year-old man who has been experiencing episodes of severe pain for several years has the following results: -Based on the information provided,what classification of arthritis is indicated by these results?

Crystals that appear to be rhombic-shaped and are blue when aligned with the slow vibration of red compensated polarized light are:

In the Ropes' or mucin clot test,normal synovial fluid:

Three tubes of blood-streaked synovial fluid from the elbow of a 40-year-old tennis player are delivered to the laboratory with a request for a WBC count,differential,crystal analysis,glucose,and Gram stain. -Based on the information provided,what is the significance of the blood-streaked fluid?

Fluid obtained from the knee of a 60-year-old man who has been experiencing episodes of severe pain for several years has the following results: -Based on the information provided,what is the most probable diagnosis?

Synovial fluid for crystal examination should be:

Crystals frequently seen in patients' joints with chronic inflammation are:

Fluid obtained from the knee of a 60-year-old man who has been experiencing episodes of severe pain for several years has the following results: -Based on the information provided,what crystals are most probably present?

Fluid obtained from the knee of a 60-year-old man who has been experiencing episodes of severe pain for several years has the following results: -Based on the information provided,does this patient have a metabolic or degenerative disorder?

Delayed analysis of synovial fluid affects the results of all of the following tests except the:

Crystals seen in the synovial fluid from a patient previously diagnosed with gout exhibit positive birefringence when observed under red compensated polarized light.The most probable cause of this discrepancy is:

Vacuolated macrophages containing ingested neutrophils are called:

All of the following diseases are frequently associated with joint disorders except: