Laboratory - Sampling

Question 1

Why do we carry out an FNA?

Answer 1

• To examine cutaneous masses.
• Assess cell morphology.
• Allows examination of any part of the body (including abdomen, thorax and joints).

Question 2

What is the patient preparation for FNAs? In terms of positioning and chemical restraint.

Answer 2

• Generally done conscious and well tolerated.

- Positioning will depend on location of the lump.

Question 3

What sized needle would you use for an FNA?

Answer 3

• 21G-25G.

Question 4

If you had a sample of pleural fluids, where is this from?

Answer 4

• The pleural cavity lining the lungs.

Question 5

If you had a sample of peritoneal fluids, where would this be from?

Answer 5

• The abdomen.

Question 6

If you had a sample of synovial fluids, where is this from?

Answer 6

• The joints.

Question 7

If you had a sample of cerebrospinal fluids, where is this from?

Answer 7

• The spinal cord.

Question 8

What components make up a transudate?

Answer 8

• A fluid with LOW PROTEINS and LOW WBCs. Moved out of capillaries due to abnormality in pressure. E.g congestive heart failure.

Question 9

What is an exudate?

Answer 9

• During the inflammation process (i.e wounds, fluid leaks out - capillaries dilate). Lots of protein and WBCs!
• Can lead to infection and deterioration of wound.

Question 10

What is a modified transudate?

Answer 10

• Moderate level of protein and WBCs. Fluid build up. Can turn into exudate over time.

Question 11

what is an effusion?

Answer 11

• An abnormal accumulation of fluid in the body/body cavities discussed earlier.

Question 12

What might cause an effusion?

Answer 12

• If there’s inflammation it causes an increased volume of fluid.

Question 13

If the effusion is red what might this mean?

Answer 13

• Blood, signifies trauma or inflammation.

Question 14

What might it mean if the effusion was a white/cloudy colour?

Answer 14

• WBCs and proteins present. Infection or inflammation.

Question 15

What is the difference between the turbidity of a normal and abnormal fluid/effusion?

Answer 15

• Normal = not cloudy, clear.

- Abnormal = Cloudy (WBC and protein build up).

Question 16

What is the specific gravity?

Answer 16

• The density related to water.

Question 17

What does a higher specific gravity of this fluid signify?

Answer 17

• More WBCs and proteins present. Potential infection.

Question 18

What is an arthrocentesis?

Answer 18

• The collection of synovial fluid from the joints.

Question 19

What issues does collecting this sample investigate?

Answer 19

• Synovitis, lameness and arthritis.

Question 20

Does arthocentesis require flexion or extension of the joint and why?

Answer 20

• Flexion to create better access to the joint cavity.

Question 21

What containers are suitable to put the synovial fluid into?

Answer 21

• Plain tube or EDTA tube.

Question 22

What equipment is needed to carry out an arthrocentesis?

Answer 22

• Sample container, generally EDTA
• Needle & syringe
• Clippers
• Chlorhexadine
• Pen to label.

Question 23

Why might you take a cerebrospinal fluid sample?

Answer 23

• Collected from a neurological patient or prior to myelography for imagine a spinal cord for possible trauma or neoplasia.

Question 24

What are the 2 methods in which you can acquire this sample?

Answer 24

• Suboccipital puncture.

- Lumbar puncture.

Question 25

Why do we carry out a thoracocentesis?

Answer 25

- To remove air or fluid directly from the thoracic cavity.

Question 26

What 2 ways can we carry this out in terms of chemical restraint?

Answer 26

- GA | - Conscious with local anaesthetic.

Question 27

If there is a pleural effusion, what are 2 things we might need to do?

Answer 27

- Chest drain if lots of fluid to continually drain/ | - If emergency for sampling, butterfly catheter.

Question 28

What is the technique for this?

Answer 28

- Clip & surgically prep area. - Local anaesthetic administered s/c. - Insert drain or catheter into the ventral 3rd of the intercostal space between 7th & 8th rib. - For draining fluid - small incision is made with a scalpel and an "over the needle" catheter is used with a 3 way tap connection to avoid causing a pneumothorax.

Question 29

Where are you removing fluid from for a pericardial-centesis?

Answer 29

- The pericardium (the membrane surrounding the heart).

Question 30

What is an accumulation of fluid in the abdomen known as?

Answer 30

- Ascites

Question 31

Why might this build up be there?

Answer 31

- Trauma - Viral conditions - Heart or liver disease. - Infection. - Tumours. - Can happen from congestive heart failure.

Question 32

Why might you carry out a tracheal wash or bronchoscopy?

Answer 32

- To investigate; - Chronic coughing - Suspected bacterial or fungal infections. - Parasites (lungworm). - Antibiotic sensitivity.

Question 33

What equipment do you need to obtain a cerebral spinal fluid sample?

Answer 33

- specialised spinal needle. - collection tube - sterile gloves - sterile drape for equipment - sterile equipment.

Question 34

What are the complications of doing a chest drain/catheter for pleural effusions?

Answer 34

- Could puncture a lung. - Could introduce air via 3 way tap (pneumothorax). - Haemothorax.

Question 35

What machinery should you use to monitor during a pericardial-cenesis and what are you monitoring for?

Answer 35

- ECG. | - Can get arrhythmias during this procedure.

Question 36

What position should the patient be in for a pericardial-centesis?

Answer 36

- Left lateral.

Question 37

If you think you have punctured the heart during a pericardial-centesis, what should you do?

Answer 37

- Check the clotting. Blood will clot but fluid won't.

Question 38

Why is it good to try and do a tracheal wash with a endoscope?

Answer 38

- so you can see the damage/trauma.

Question 39

How much sterile saline should you flush with for both a tracheal wash and a bronchoscopy?

Answer 39

- Tracheal - 4-6mls | - Bronchoscopy - 10-20mls.

Question 40

What are the 3 different types of tissue biopsy techniques?

Answer 40

- Punch. - Wedge. - Tru-cut.

Question 41

What is the difference between a punch biopsy and a wedge biopsy?

Answer 41

- Punch, use a little device to punch a hole/chunk out. | - Wedge - Use a blade and manually take a wedge out.

Question 42

What is a tru-cut biopsy and what do you need for it?

Answer 42

- A special needle, looks like a pair of scissors and it's spring loaded. Takes a slither of tissue. Less trauma.

Question 43

What are tru-cut biopsies used for. Skin or organs?

Answer 43

- Organs.

Question 44

What is the intracapsular technique for obtaining a solid biopsy sample?

Answer 44

- Remove mass along with the capsule it's contained in.

Question 45

What is the marginal technique for obtaining a solid biopsy sample?

Answer 45

- Describes the area around the mass.

Question 46

What is the wide technique for obtaining a solid biopsy sample?

Answer 46

- Large amount of healthy tissue around the mass.

Question 47

What is the radical technique for obtaining a solid biopsy sample?

Answer 47

- Margin close to the mass.

Question 48

What is the wedge technique for obtaining a solid biopsy sample?

Answer 48

- Take a full thickness slice of the tissue with scalpel blade.