Deck 11: Synovial Fluid

Question 1

Vacuolated macrophages containing ingested neutrophils seen in synovial fluid are called:

A) Reiter's cells
B) Ragocytes
C) LE cells
D) RA cells

Answer 1

A

Question 2

A clear,pale yellow synovial fluid with good viscosity and a WBC count of 1000 should be classified as:

A) Noninflammatory
B) Inflammatory
C) Septic
D) Hemorrhagic

Answer 2

A

Question 3

Before performing a cell count on highly viscous synovial fluid,it may be necessary to incubate the fluid with:

A) Glacial acetic acid
B) Normal saline
C) Hypotonic saline
D) Hyaluronidase

Answer 3

D

Question 4

Crystals that are found in synovial fluid during attacks of gout are most likely:

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

Question 5

A cloudy,yellow-green synovial fluid with 100,000 white blood cells (WBCs),a predominance of neutrophils,and a decreased glucose should be classified as:

A) Noninflammatory
B) Inflammatory
C) Septic
D) Crystal-induced

Question 6

All of the following can cause crystals to be present in the synovial fluid except:

A) Metabolic disorders
B) Increased ingestion of dairy products
C) Degeneration of cartilage
D) Injection of medications

Question 7

Which of the following crystals would most likely be present in conjunction with calcium pyrophosphate crystals in synovial fluid?

A) Hydroxyapatite
B) Calcium oxalate
C) Monosodium urate
D) Cholesterol

Question 8

The recommended diluting fluid for synovial fluid cell counts is:

A) Glacial acetic acid
B) Distilled water
C) 0.1 N hydrochloric acid
D) Saline

Question 9

A turbid synovial fluid with yellow-green color indicates:

A) Inflammation
B) Infection
C) Crystals
D) Increased bilirubin

Question 10

The concentration of which of the following chemicals found in synovial fluid differs most noticeably from the plasma concentration?

A) Protein
B) Glucose
C) Lactate
D) Uric acid

Question 11

A milky-appearing synovial fluid can be associated with the presence of:

A) Staphylococcus aureus
B) Increased lymphocytes
C) Increased protein
D) Monosodium urate crystals

Question 12

All of the following primary cells are seen in normal synovial fluid except:

A) Macrophages
B) Neutrophils
C) Monocytes
D) Synovial tissue cells

Question 13

Synovial fluid is produced by:

A) Selective filtration of plasma
B) Ultrafiltration of plasma
C) Metabolic waste products from synoviocytes
D) Reabsorption of interstitial fluid

Question 14

All of the following statements on synovial fluid are true except that it:

A) Surrounds all joints in the body
B) Is found only in the knee
C) Acts as a lubricant
D) Supplies nourishment to cartilage

Question 15

Neutrophils that contain precipitated rheumatoid factor in their cytoplasm are called:

A) LE cells
B) Reiter's cells
C) Ragocytes
D) Macrophages

Question 16

In gout,both serum and synovial fluid will have increased levels of:

A) Glucose
B) Protein
C) Uric acid
D) Complement

Question 17

An arthrocentesis is performed on a patient with lupus erythematosus that produces a cloudy yellow fluid with 2000 WBCs,of which 55% is neutrophils.This fluid should be classified as:

A) Noninflammatory
B) Inflammatory
C) Septic
D) Crystal-induced

Question 18

To determine if an unknown fluid is synovial fluid,the fluid can be tested:

A) By performing a differential
B) Using compensated polarized light
C) By adding acetic acid and observing clot formation
D) By measuring the concentration of uric acid

Question 19

Which of the following descriptions of synovial fluid does not correlate?

A) Normal: clear, pale yellow
B) Crystals: milky
C) Traumatic tap: blood streaks
D) Sepsis: uniform blood

Question 20

All of the following are tests frequently performed on synovial fluid except:

A) Gram stain
B) WBC count
C) Uric acid
D) Differential

Question 21

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

Question 22

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

Question 23

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

Question 24

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

Question 25

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

Question 26

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

Question 27

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

Question 28

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

Question 29

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

Question 30

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

Question 31

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

Question 32

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

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

Question 33

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

Question 34

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

Question 35

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

Question 36

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

Question 37

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

Question 38

Vacuolated macrophages containing ingested neutrophils are called:

A) Ragocytes
B) Rice bodies
C) Reiter's cells
D) LE cells

Question 39

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

Question 40

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

A) Lyme disease
B) Tuberculosis
C) Lupus erythematosus
D) Rheumatoid arthritis

Question 41

Automated cell counters should not be used for synovial fluid cell counts.

Question 42

The predominant cell in normal synovial fluid is the lymphocyte.

Question 43

Red compensated polarized microscopy separates light into slow and fast rays.

Question 44

Monosodium urate crystals are found both extracellularly and intracellularly.

Question 45

Synovial fluid crystals seen in patients undergoing renal dialysis most commonly are:

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

Question 46

Synovial fluid viscosity is caused by the presence of filtered serum proteins.

Question 47

Normal synovial fluid glucose values are 60% to 70% of the blood glucose.

Question 48

Synovial fluid should be routinely cultured for the presence of Borrelia burgdorferi.

Question 49

The polymerization of hyaluronic acid is decreased when arthritis is present.

Question 50

Monosodium urate crystals may be present in synovial fluid from patients receiving chemotherapy for leukemia.

Question 51

Fat droplets seen in synovial fluid are associated with:

A) Crush injuries
B) Chronic inflammation
C) Sepsis
D) Both A and B