Question 1

How must synovial fluids be handled differently than other fluids?

Accepted Answer

A) Perform a Gram stain if bacteria are seen. 
B) Dilute the fluid if the cell counts are high. 
C) Add hyaluronidase to overcome the viscous nature of fluid. 
D) Carefully search the whole cytospin preparation for malignant cells. 
A) Perform a Gram stain if bacteria are seen. 
B) Dilute the fluid if the cell counts are high. 
C) Add hyaluronidase to overcome the viscous nature of fluid. 
D) Carefully search the whole cytospin preparation for malignant cells. C

Question 2

A synovial fluid has a high white cell count and large intracellular needlelike crystals that are yellow when the crystals are parallel to the y-axis of a red compensator.What is the likely diagnosis?

Accepted Answer

A) pseudo-gout 
B) gout 
C) lupus erythematosus 
D) bacterial infection 
A) pseudo-gout 
B) gout 
C) lupus erythematosus 
D) bacterial infection B

Question 3

Which of the following is true regarding malignant cells in serous fluids?

Accepted Answer

A) All clumps of large cells should be considered malignant. 
B) Malignant cells in serous fluids are rarely seen. 
C) Malignant cells categorize the fluid as a transudate. 
D) Care must be taken to distinguish malignant cells from clumps of mesothelial cells. 
A) All clumps of large cells should be considered malignant. 
B) Malignant cells in serous fluids are rarely seen. 
C) Malignant cells categorize the fluid as a transudate. 
D) Care must be taken to distinguish malignant cells from clumps of mesothelial cells. D

Question 4

A cloudy cerebrospinal fluid (CSF)is diluted 1:20.In nine large squares,99 white cells are counted.What is the total white blood count/mm³ or /mL?

Accepted Answer

A) 99 
B) 1980 
C) 2200 
D) 22,000 
A) 99 
B) 1980 
C) 2200 
D) 22,000

Question 5

Which of the following is a feature of malignant cells in fluids?

Accepted Answer

A) small size 
B) three-dimensional clumps with no "windows" 
C) low nuclear-to-cytoplasmic (N:
C)  ratio 
D) uniformity 
A) small size 
B) three-dimensional clumps with no "windows" 
C) low nuclear-to-cytoplasmic (N:
C)  ratio 
D) uniformity

Question 6

Nucleated red blood cells (NRBCs)and immature white cells in a CSF most likely mean

Accepted Answer

A) bacterial meningitis. 
B) patient has NRBCs in the peripheral blood. 
C) subarachnoid hemorrhage. 
D) bone marrow contamination. 
A) bacterial meningitis. 
B) patient has NRBCs in the peripheral blood. 
C) subarachnoid hemorrhage. 
D) bone marrow contamination.

Question 7

Three CSF tubes are received in the laboratory numbered 1 through 3 based on the order in which they were obtained,with 1 being the first.The first tube is cloudy pink,but this color diminishes and clearing occurs with each successive tube.What does this suggest?

Accepted Answer

A) Internal bleeding into the CSF has occurred. 
B) This is blood contaminating the CSF fluid from a traumatic puncture. 
C) Bacterial infection is likely present. 
D) Metastatic tumor is likely present. 
A) Internal bleeding into the CSF has occurred. 
B) This is blood contaminating the CSF fluid from a traumatic puncture. 
C) Bacterial infection is likely present. 
D) Metastatic tumor is likely present.

Question 8

A patient has a pleural fluid with 2000 WBCs per mL.Seventy percent of the cells are neutrophils.Which of the following is most likely?

Accepted Answer

A) normal fluid 
B) transudate on a patient with a pleural bacterial infection 
C) exudate on a patient with a pleural bacterial infection 
D) exudate on a patient with heart failure 
A) normal fluid 
B) transudate on a patient with a pleural bacterial infection 
C) exudate on a patient with a pleural bacterial infection 
D) exudate on a patient with heart failure

Question 9

If most of the white cells are neutrophils on the previously discussed CSF,what additional test should be performed?

Accepted Answer

A) cytology 
B) flow cytometry 
C) lactate dehydrogenase 
D) Gram stain and bacterial cultures 
A) cytology 
B) flow cytometry 
C) lactate dehydrogenase 
D) Gram stain and bacterial cultures

Question 10

A CSF is equally bloody in all tubes collected and has a yellowish supernatant.On the differential,macrophages with hemosiderin are noted.Which of the following is most likely?

Accepted Answer

A) bacterial meningitis 
B) viral meningitis 
C) subarachnoid hemorrhage 
D) traumatic tap 
A) bacterial meningitis 
B) viral meningitis 
C) subarachnoid hemorrhage 
D) traumatic tap

Question 11

What determines the amount of fluid used for a cytocentrifuge preparation?

Accepted Answer

A) type of fluid 
B) desired speed of centrifugation 
C) number of cells 
D) amount of fluid collected 
A) type of fluid 
B) desired speed of centrifugation 
C) number of cells 
D) amount of fluid collected

Question 12

What determines whether or not body fluids are diluted before counting?

Accepted Answer

A) appearance of the fluid 
B) type of fluid 
C) patient's diagnosis 
D) whether or not the fluid needs to go to other sections of the laboratory for additional testing 
A) appearance of the fluid 
B) type of fluid 
C) patient's diagnosis 
D) whether or not the fluid needs to go to other sections of the laboratory for additional testing

Question 13

Which of the following is true regarding bronchoalveolar lavage (BAL)fluids?

Accepted Answer

A) The differential is not done on these fluids. 
B) It is often received from patients suspected of having asthma. 
C) Moving ciliated cells suggest that the patient has Pneumocystis carinii. 
D) A mask should be worn when performing tests. 
A) The differential is not done on these fluids. 
B) It is often received from patients suspected of having asthma. 
C) Moving ciliated cells suggest that the patient has Pneumocystis carinii. 
D) A mask should be worn when performing tests.

Question 14

Why should spinal fluid tests be performed within 30 minutes of collection?

Accepted Answer

A) Cells begin to deteriorate quickly. 
B) The conditions detected by the tests are often life threatening. 
C) They are often ordered "stat." 
D) All of the above are true. 
A) Cells begin to deteriorate quickly. 
B) The conditions detected by the tests are often life threatening. 
C) They are often ordered "stat." 
D) All of the above are true.

Question 15

A hazy spinal fluid has 400 white cells per mm³ that are mostly lymphocytes and reactive lymphocytes.Which of the following is most likely?

Accepted Answer

A) bacterial meningitis 
B) viral meningitis 
C) infectious mononucleosis 
D) multiple myeloma 
A) bacterial meningitis 
B) viral meningitis 
C) infectious mononucleosis 
D) multiple myeloma

Question 16

Which of the following is normal in a CSF?

Accepted Answer

A) ependymal cells 
B) 100 white cells per mm3 
C) blasts 
D) mesothelial cells 
A) ependymal cells 
B) 100 white cells per mm3 
C) blasts 
D) mesothelial cells

Question 17

Which of the following are normal in serous fluids?

Accepted Answer

A) macrophages 
B) bacteria 
C) eosinophils (EOs) 
D) LE cells 
A) macrophages 
B) bacteria 
C) eosinophils (EOs) 
D) LE cells

Question 18

One clinical laboratory scientist is covering the "manual bench" in the hematology laboratory,which is where body fluid examinations are done.Just as she is preparing to go on break,she simultaneously receives two specimens,one a CSF and one a BAL fluid.Both are marked "stat." What should she do first?

Accepted Answer

A) Analyze the BAL. 
B) Analyze the CSF. 
C) Go on break and then return and do the BAL. 
D) Go on break and then return and do the CSF. 
A) Analyze the BAL. 
B) Analyze the CSF. 
C) Go on break and then return and do the BAL. 
D) Go on break and then return and do the CSF.

Exam 18: Body Fluid Analysis in the Hematology Laboratory

How must synovial fluids be handled differently than other fluids?

A synovial fluid has a high white cell count and large intracellular needlelike crystals that are yellow when the crystals are parallel to the y-axis of a red compensator.What is the likely diagnosis?

Which of the following is true regarding malignant cells in serous fluids?

A cloudy cerebrospinal fluid (CSF)is diluted 1:20.In nine large squares,99 white cells are counted.What is the total white blood count/mm³ or /mL?

Which of the following is a feature of malignant cells in fluids?

Nucleated red blood cells (NRBCs)and immature white cells in a CSF most likely mean

Three CSF tubes are received in the laboratory numbered 1 through 3 based on the order in which they were obtained,with 1 being the first.The first tube is cloudy pink,but this color diminishes and clearing occurs with each successive tube.What does this suggest?

A patient has a pleural fluid with 2000 WBCs per mL.Seventy percent of the cells are neutrophils.Which of the following is most likely?

If most of the white cells are neutrophils on the previously discussed CSF,what additional test should be performed?

A CSF is equally bloody in all tubes collected and has a yellowish supernatant.On the differential,macrophages with hemosiderin are noted.Which of the following is most likely?

What determines the amount of fluid used for a cytocentrifuge preparation?

What determines whether or not body fluids are diluted before counting?

Which of the following is true regarding bronchoalveolar lavage (BAL)fluids?

Why should spinal fluid tests be performed within 30 minutes of collection?

A hazy spinal fluid has 400 white cells per mm³ that are mostly lymphocytes and reactive lymphocytes.Which of the following is most likely?

Which of the following is normal in a CSF?

Which of the following are normal in serous fluids?

An Overview of Clinical Laboratory Hematology

Safety in the Hematology Laboratory

Blood Specimen Collection

Care and Use of the Microscope

Quality Assurance in Hematology and Hemostasis Testing

Cellular Structure and Function

Hematopoiesis

Erythrocyte Production and Destruction

Erythrocyte Metabolism and Membrane Structure and Function

Hemoglobin Metabolism

Iron Kinetics and Laboratory Assessment

Leukocyte Development, Kinetics, and Functions

Platelet Production, Structure, and Function

Manual, Semiautomated and Point-of-Care Testing in Hematology

Automated Blood Cell Analysis

Examination of the Peripheral Blood Film and Correlation with the Complete Blood Count

Bone Marrow Examination

Anemias: Red Blood Cell Morphology and Approach to Diagnosis

Disorders of Iron Kinetics and Heme Metabolism

Anemias Caused by Defects of DNA Metabolism

Bone Marrow Failure

Introduction to Increased Destruction of Erythrocytes

Intrinsic Defects Leading to Increased Erythrocyte Destruction

Extrinsic Defects Leading to Increased Erythrocyte Destruction Nonimmune Causes

Extrinsic Defects Leading to Increased Erythrocyte Destruction Immune Causes

Hemoglobinopathies (Structural Defects in Hemoglobin)

Thalassemias

Nonmalignant Leukocyte Disorders

Cytogenetics

Molecular Diagnostics in Hematopathology

Flow Cytometric Analysis in Hematologic Disorders

Myeloproliferative Neoplasms

Myelodysplastic Syndromes

Acute Leukemias

Mature Lymphoid Neoplasms

Normal Hemostasis and Coagulation

Hemorrhagic Disorders and Laboratory Assessment

Thrombotic Disorders and Laboratory Assessment

Thrombocytopenia and Thrombocytosis

Qualitative Disorders of Platelets and Vasculature

Laboratory Evaluation of Hemostasis

Antithrombotic Therapies and their Laboratory Assessment

Hemostasis and Coagulation Instrumentation

Pediatric and Geriatric Hematology and Hemostasis

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