Question 1

Which of the following is responsible for producing cerebrospinal fluid?

Accepted Answer

The choroid plexus cells, located in the ventricles of the brain, are responsible for producing cerebrospinal fluid.

Question 2

Malignant tissue cells have which of the following morphologic features?

Accepted Answer

Malignant tissue cells often have an irregular nuclear membrane, while benign cells typically have a smooth and even membrane. Evenly distributed chromatin and prominent nucleoli can also be seen in both malignant and benign cells, so these features are not specific to malignant cells.

Question 3

An effusion can accumulate as the result of a systemic disease and with congestive heart failure. The correct term for this fluid is:

Accepted Answer

Transudate is a term used to describe an effusion that occurs as a result of a systemic disease or congestive heart failure. This fluid is typically a clear or pale yellow liquid that has a low protein content and is caused by an imbalance in the pressure within the blood vessels and surrounding tissues. Exudates, on the other hand, have a higher protein content and are usually the result of inflammation or infection. Chylous refers to a type of lymphatic fluid that is milky in color due to the presence of chylomicrons, while pleural fluid specifically refers to fluid that accumulates in the pleural cavity of the chest.

Question 4

A specimen labeled "ascites" is sent to the laboratory. What type of procedure was used to obtain this fluid?

Accepted Answer

The term "ascites" refers to the abnormal accumulation of fluid in the peritoneal cavity, which may result from various conditions such as liver disease, heart failure, or cancer. Paracentesis is a procedure in which a needle is inserted through the abdominal wall to remove excess fluid in the peritoneal cavity, and it is commonly performed to diagnose or treat ascites. Thoracentesis involves removal of fluid from the pleural cavity, lumbar puncture involves removing cerebrospinal fluid from the spinal canal, and arthrocentesis involves removing synovial fluid from a joint.

Question 5

A crystal with long, thin, needlelike, pointed ends is identified in synovial fluid. The crystals are located inside and outside the cells. A quartz compensator is used, and it determines that the crystals are negatively birefringent and are a yellow color when parallel to the axis of the compensator. The crystal is blue when turned perpendicular to the axis of the compensator. What is the type of crystal?

Accepted Answer

The description of long, thin, needlelike, pointed ends crystals that are negatively birefringent and turn a yellow color when parallel to the axis of the compensator indicates monosodium urate crystals. These are characteristic of gout.

Question 6

What type of fluid is collected from the spinal tap or lumbar puncture procedure?

Accepted Answer

The spinal tap or lumbar puncture procedure is used to collect cerebrospinal fluid (CSF) from the spinal canal. CSF is a clear fluid that surrounds the brain and spinal cord, acting as a cushion and providing nutrients and oxygen to the nervous system. It is not pleural, pericardial, or synovial fluid.

Question 7

Joint fluid from a patient with knee pain revealed many monosodium urate crystals. These crystals are associated with:

Accepted Answer

Monosodium urate crystals are associated with gout, a type of arthritis caused by the buildup of uric acid in the joints.

Question 8

Examination of joint fluid on a 60-year-old patient with right knee pain reveals many intracellular needlelike crystals that polarize yellow to blue. What is the most likely identification of the crystal?

Accepted Answer

Monosodium urate crystals are identified by their needle-like shape and strong negative birefringence, appearing yellow when aligned parallel to the polarized light axis and blue when perpendicular, which is characteristic of gout.

Question 9

The following results are obtained from a 38-year-old woman with congestive heart failure: • Specimen: pleural fluid
• Fluid protein = 4.5 g/dl
• Serum protein = 9.5 g/dl
• Serum LD = 110 U/L
• Fluid LD = 60 U/L
These results are most consistent with which of the following?

Accepted Answer

Transudate is characterized by low protein and LDH levels in the pleural fluid compared to serum levels, which is consistent with the results provided.

Question 10

Artifacts that can be seen with cytocentrifuge-prepared slides can be interpreted as a clinically significant finding by mistake. Which of the following can be an artifact leading to a mistaken interpretation of bacterial organisms in a fluid?

Accepted Answer

Stain precipitate can appear similar in color and shape to bacterial organisms, leading to a mistaken interpretation. Cytoplasmic projections of lymphocytes, starch particles, and degenerating tissue cells do not resemble bacterial organisms and are less likely to lead to a mistaken interpretation.

Question 11

A peritoneal dialysate fluid is sent to the laboratory for analysis. Patient history reveals an 85-year-old woman with a previous history of duodenal cancer that is in remission. The laboratician reviews the cytospin and notices many large cells that are smooth in appearance and have abundant, basophilic cytoplasm with smooth nuclear membrane, evenly distributed chromatin, and no nucleoli. What is the most probable identification of those cells?

Accepted Answer

The large cells with smooth appearance, abundant basophilic cytoplasm, and evenly distributed chromatin without nucleoli are characteristic of reactive mesothelial cells. These cells are commonly seen in peritoneal dialysate fluid and are not indicative of cancer recurrence. Duodenal cancer cells would exhibit atypical features on microscopy, such as irregular nuclear membranes, clumped chromatin, multiple nucleoli, and might even appear as small cells. Similarly, adenocarcinoma cells would appear different from reactive mesothelial cells, with glandular structures, signet ring formations, and other atypical features. Ependymal cells, found in the central nervous system, would not be expected in the peritoneal dialysate fluid.

Question 12

Lamellar bodies can be counted on a hematology analyzer because they are similar in size to what cell type?

Accepted Answer

Lamellar bodies, also known as platelet dense bodies, are similar in size to platelets and can be counted on a hematology analyzer using the platelet channel.

Question 13

A laboratician is scanning a cytospin slide from a CSF specimen and notices a few solid-staining wrinkled bodies on the cytospin prep. A follow up India ink prep is positive. What is the most likely identification of this?

Accepted Answer

The presence of solid-staining, wrinkled bodies on a cytospin prep along with a positive India ink prep is indicative of Cryptococcus, a fungal organism commonly associated with meningitis. Histoplasma may be seen on a cytospin prep, but it typically appears as a small yeast with a halo around it, and a follow up urine antigen test would be needed to confirm the diagnosis. Candidiasis would not typically be identified on a cytospin from CSF and bacterial contamination would not appear as solid-staining wrinkled bodies.

Question 14

Morphologic evaluation of body fluids prepared by using the cytocentrifuge is an excellent method of concentrating cells for microscopic review. When the pleural fluid is cytocentrifuged for staining, what type of normal cells would one expect to see?

Accepted Answer

Mesothelial cells are the normal cells that line the pleural cavity and are commonly seen in pleural fluid cytocentrifuge preparations. Ependymal cells are found in the central nervous system, synovial cells are found in joints, and choroid plexus cells are found in the ventricles of the brain, and would not normally be seen in pleural fluid.

Question 15

An unknown cell in a body fluid possesses the following morphologic characteristics: 35 mcM in size, partially clumped chromatin, prominent nucleoli, jagged nuclear membrane, and clumped cell with nuclear molding. What is the most likely identification of the unknown cell?

Accepted Answer

The described characteristics, such as prominent nucleoli, jagged nuclear membrane, and nuclear molding, are indicative of an adenocarcinoma cell, which is a type of cancer cell often found in body fluids.

Question 16

Interpret the following results: • Specimen: pleural effusion on a 45-year-old lung cancer patient:
• Specific gravity = 1.025
• Total protein = 4.5 g/dl
• F:Se protein = 0.9
• Fluid LD/serum LD = 0.8
• Total WBC count = 2,205/mcL (μL)
What is the classification of this fluid?

Accepted Answer

The high specific gravity, high protein content, and elevated F:Se protein ratio suggest that this specimen is an exudate. Additionally, the low total WBC count is consistent with a non-inflammatory exudate, which is commonly seen in cancer patients. The fluid LD/serum LD ratio is less useful in this case because it is only slightly elevated, but it can be supportive of an exudate if the ratio is greater than 0.6.

Question 17

All of the following can be found in normal body fluid except:

Accepted Answer

Budding yeast is not typically found in normal body fluids, as it can be indicative of infection or disease. Neutrophils, lymphocytes, and histiocytes are all types of white blood cells that can be found in normal body fluids.

Question 18

Necrotic PMNs in a cytospin can be easily mistaken for which of the following?

Accepted Answer

Necrotic PMNs can often appear as nucleated RBCs due to their distorted shape and pale appearance. They may also be mistaken for other types of abnormal cells, such as hairy cells or leukemic blasts, but these are less common misinterpretations. Hypersegmented PMNs, on the other hand, have a characteristic appearance that typically distinguishes them from necrotic PMNs.

Question 19

Accumulation of fluid as a result of systemic disease is defined as:

Accepted Answer

The accumulation of fluid as a result of systemic disease is defined as transudate. Exudate refers to fluid that has leaked out of blood vessels as a result of inflammation or injury. Chylous fluid refers specifically to lymphatic fluid that contains chylomicrons. Peritoneal ascites refers to accumulation of fluid in the peritoneal cavity. None of these fully fit the definition given.

Question 20

What fluid is collected from the subarachnoid space?

Accepted Answer

Cerebrospinal fluid is collected from the subarachnoid space, which is located between the arachnoid mater and pia mater layers of the meninges surrounding the brain and spinal cord.

Quiz 30: Morphologic Analysis of Body Fluids in the Hematology