AUBF CSF Flashcards by bongbong kurap

CSF is produced where

choroid plexus

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In adults, approximately ___ mL of fluid (CSF) is produced every hour

20 mL/hr or 120-150 mL/day

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CSF flows through the _______ located between the arachnoid and pia mater

subarachnoid space

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Normal total CSF volume that adults need to maintain

90-150 mL

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Normal total CSF volume that neonates need to maintain

10-60 mL

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T or F

One of the functions of CSF is to remove metabolic wastes

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In neonates, the circulating fluid is reabsorbed back into the blood capillaries in the _______ / villae at a rate equal to its production

arachnoid granulations

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In the choroid plexuses, the endothelial cells have very tight-fitting junctures that prevent the passage of many molecules. This tight-fitting structure of the endothelial cells in the choroid plexuses is termed the ______

blood-brain barrier

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where is CSF collected in lumbar/spinal tap

3rd/4th/5th lumbar vertebra

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where is CSF collected in ventricular puncture

infants with open fontanels

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where is CSF collected in a cisternal puncture

suboccipital region

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Enumerate the sections where CSF is distributed in chronological order (Tube 1-4)

Tube 1 = Chemistry/Serology
Tube 2 = Microbiology
Tube 3 = Hematology
Tube 4 = Microbiology/Serology

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T or F

The CSF collected in tube 1 requires storage at room temperature

F; FROZEN

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T or F

The CSF collected in tube 2 requires storage at frozen temp

F; ROOM TEMP

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T or F

The CSF collected in tube 3 requires refrigeration of up to 4 hrs

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normal appearance of CSF

crystal clear

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identify the cause:

hazy, cloudy, turbid, milky appearance of CSF

WBC = 200-500 WBC/mm³
RBC = >400 RBC/uL
increased protein & lipid

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identify the appearance:

CSF has radiographic contrast media

oily

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non-pathogenic cause of bloody CSF

traumatic spinal tap

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pathogenic cause of bloody CSF

subarachnoid hemorrhage

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identify the cause:

clotted CSF (or with pellicle)

protein
clotting factors

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identify the cause:

brown CSF

methemoglobin
hematoma
melanin

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identify the appearance:

protein >150 mg/dL
rifampin therapy

Xanthochromic

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CSF tube is exposed to direct sunlight at a 90 degree angle from the observer which would appear sparkling or snowy

Tyndall’s effect

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describes CSF supernatant that is pink, orange or yellow

Xanthochromia

identify if traumatic tap or intracranial hemorrhage is being described: uneven distribution of blood

Traumatic tap

identify if traumatic tap or intracranial hemorrhage is being described: xanthochromic supernatant

intracranial hemorrhage

identify if traumatic tap or intracranial hemorrhage is being described: + clot formation

traumatic tap

identify if traumatic tap or intracranial hemorrhage is being described: + D-dimer test

Intracranial hemorrhage

identify if traumatic tap or intracranial hemorrhage is being described: presence of erythrophagocytes

intracranial hemorrhage

normal CSF cell count in adults

0-5 WBCs/uL

normal CSF cell count in neonates

0-30 mononuclear cells/uL

T or F 3% glacial acetic acid is used as diluent for total cell count of CSF

F; diluent = NSS *3% glacial acetic acid = diluent for WBC COUNT

_____ is used routinely for performing CSF cell counts

Improved Neubauer counting chamber

Procedures for Specimen Concentration

1. Sedimentation 2. Filtration 3. Centrifugation 4. Cytocentrifugation (alternative: cytospin)

stain used for DIFFERENTIAL count of CSF

wright's stain

number of cells counted in differential count of CSF

100

recommended method for differential counting of CSF

cytocentrifugations

30% albumin increases cell _____, while decreasing cell ____

cell yield cell distortion

CSF lymphocyte to monocyte ratio of adults

70:30

CSF lymphocyte to monocyte ratio of children

30:70

increase in the normal cells of CSF

Pleocytosis

identify the predominant cell (seen in CSF) being described viral, tubercular, and fungal meningitis

lymphocytes

identify the predominant cell (seen in CSF) being described multiple sclerosis

lymphocytes

identify the predominant cell (seen in CSF) being described bacterial meningitis

neutrophils

identify the predominant cell (seen in CSF) being described cerebral hemorrhage

neutrophils

identify the predominant cell (seen in CSF) being described early cases of viral, tubercular, and fungal meningitis

neutrophils

identify the predominant cell (seen in CSF) being described viral, tubercular, and fungal meningitis, multiple sclerosis

monocytes

identify the predominant cell (seen in CSF) being described multiple sclerosis

monocytes

identify the predominant cell (seen in CSF) being described RBCs in spinal fluid

macrophages

identify the predominant cell (seen in CSF) being described contrast media

macrophages

identify the predominant cell (seen in CSF) being described acute leukemia

blast forms

identify the predominant cell (seen in CSF) being described disseminated lymphomas

lymphoma cells

identify the predominant cell (seen in CSF) being described multiple sclerosis

plasma cells

identify the predominant cell (seen in CSF) being described lymphocyte reactions

plasma cells

identify the predominant cell (seen in CSF) being described metastatic carcinomas

malignant cells

identify the predominant cell (seen in CSF) being described resemble lymphocytes with cleft nuclei

lymphoma cells

identify the predominant cell (seen in CSF) being described seen in clusters with distinct nuclei and distinct cell walls

ependymal, choroidal, and spindle-shaped cells

identify the predominant cell (seen in CSF) being described seen in clusters with fusing of cell borders and nuclei

malignant cells

Neutrophils present A. Bacterial B. Viral C. Tubercular D. Fungal

A. Bacterial

Lymphocytes present A. Bacterial B. Viral C. Tubercular D. Fungal

B. Viral

Lymphocytes and monocytes present A. Bacterial B. Viral C. Tubercular D. Fungal

Both C & D

marked protein elevation A. Bacterial B. Viral C. Tubercular D. Fungal

A. Bacterial

moderate protein elevation A. Bacterial B. Viral C. Tubercular D. Fungal

B. Viral

moderate to marked protein elevation A. Bacterial B. Viral C. Tubercular D. Fungal

Both C & D

normal glucose level A. Bacterial B. Viral C. Tubercular D. Fungal

B. Viral

lactate level >35 mg/dL A. Bacterial B. Viral C. Tubercular D. Fungal

A. Bacterial

lactate level >25 mg/dL with pellicle formation A. Bacterial B. Viral C. Tubercular D. Fungal

C. Tubercular

lactate level >25 mg/dL positive india ink with C. neoformans A. Bacterial B. Viral C. Tubercular D. Fungal

D. Fungal

positive gram stain and bacterial antigen tests A. Bacterial B. Viral C. Tubercular D. Fungal

A. Bacterial

positive immunologic test for C. neoformans A. Bacterial B. Viral C. Tubercular D. Fungal

D. Fungal

T or F Elevated WBC count is expected in all types of meningitis

most frequently performed chemical test on CSF

CSF Protein determination

enumerate the protein fractions of CSF

- Gamma Globulins - Albumin - Transerythrin - Alpha Globulin - Transferrin *GATAT (c coco martin nagsabi ng gatas)

test to measure total CSF protein

turbidimetry or dye-binding

turbidimetric method precipitates both albumin & globulin

Trichloroacetic Acid (TCA)

turbidimetric method precipitates albumin only

Sulfosalicylic Acid (SSA) to precipitate globulins add sodium sulfate (Na2SO4)

In the dye-binding method using coomassie brilliant blue, the higher the protein, the more intense the _____ color

blue

formula for solving CSF/Serum Albumin Index

CSF Albumin (mg/dL) / Serum Albumin (g/dL)

give the interpretation based on the given CSF/Serum Albumin index: 9-14

slight impairment

give the interpretation based on the given CSF/Serum Albumin index: 14-30

moderate impairment

give the interpretation based on the given CSF/Serum Albumin index: >30

severe impairment

give the interpretation based on the given CSF/Serum Albumin index: <9

intact blood brain barrier

formula for solving IgG index

CSF IgG (mg/dL) / Serum IgG (g/dL) ---------------------------------------------------- CSF Albumin (mg/dL) / Serum Albumin (g/dL)

its primary purpose is the detection of oligoclonal bands

electrophoresis

identify the disease / infection oligoclonal banding pattern: (+) CSF, (-) Serum

- Leukemia - Encephalitis - Lymphoma - Neoplastic syndrome - Guillain-Barre syndrome

identify the disease / infection oligoclonal banding pattern: (-) CSF, (+) Serum

viral infection

identify the disease / infection oligoclonal banding pattern: (+) CSF, (+) Serum

Viral infection

identify the disease / infection oligoclonal banding pattern: (+) CSF, (+) Serum

HIV

indicative of recent destruction of the myelin sheath that protects the axons of the neurons

Myelin Basic Protein (MBP)

60-70% of plasma glucose

CSF Glucose

decreased in patient with bacterial, tubercular, fungal meningitis

CSF glucose *NO VIRAL (Viral = Normal CSF glucose)

T or F CSF Lactate is falsely decreased on xanthochromic or hemolyzed fluid

F; falsely ELEVATED

The normal concentration of glutamine in the CSF is _____ mg/dL

8-18 mg/dL

catalyzes the irreversible hydrolytic deamination of adenosine to produce inosine

Adenosine deaminase

What are the clinically important CSF chemicals usually found in the CSF chemistry test

1. CSF protein 2. CSF glucose 3. CSF lactate 4. CSF glutamine 5. CK BB Isoenzyme 6. Chlorides 7. Adenosine deaminase

its purpose is to determine the causative agent in meningitis

Microbiology tests

in a microbiology test, a microorganism that grew in 24 hours is indicative of ?

bacterial meningitis

in a microbiology test, a microorganism that grew in 6 weeks is indicative of ?

tubercular meningitis

organisms most commonly encountered in gram staining

- Group B Streptococcus - N. meningitidis - S. pneumonia - E. coli - H. influenzae - L. monocytogenes - Staphylococcus / Propionibacterium spp.

one of the most difficult slides to interpret because the no. of organisms present is usually small, and they can be overlooked easily resulting in a false (-) report

CSF Gram stain

In gram staining, false ___ can occur if precipitated stain/debris is mistaken for microorganisms

false (+)

in gram staining, what is added for patients with many PMNs but negative gram stain

acridine orange

stain used for identifying Cryptococcus neoformans

india ink

test that detects the presence of endotoxin

Limulus Lysate Test

reagent used for Limulus Lysate Test

horse-shoe crab (Limulus polyphemus)

LAL test: Positive gel clot

presence of endotoxins

LAL test: No clot

absence of endotoxin

in the Limulus Lysate (LAL) Test, culture is incubated within ___ hr @ ___ C

1hr @ 37C

detects the presence of C. neoformans antigen in serum & CSF and is a more sensitive method than the India ink preparation

Latex agglutination tests

interference by ___ is the most common cause of false-positive reactions in immunologic assays

rheumatoid factor

provide a rapid method for detecting C. neoformans with a high sensitivity & specificity

Lateral Flow Assay (LFA)

rapid means for detecting and identifying microorganisms in CSF

Latex agglutination Enzyme-linked Immunosorbent Assay (ELISA)

opportunistic parasite found in ponds, small lakes, and even chlorinated swimming pools

Naegleria fowleri

CSF is produced mainly in the: a. Bone marrow b. Peripheral blood c. Choroid plexuses d. Subarachnoid space

c. Choroid plexuses

The functions of the CSF include all of the following except: a. Removing metabolic wastes b. Producing an ultrafiltrate of plasma c. Supplying nutrients to the CNS d. Protecting the brain and spinal cord

b. Producing an ultrafiltrate of plasma

The CSF flows through the: a. Choroid plexus b. Pia mater c. Subarachnoid space d. Dura mater

c. Subarachnoid space

Substances present in the CSF are controlled by the: a. Arachnoid granulations b. Blood–brain barrier c. Presence of one-way valves d. Blood–CSF barrier

b. Blood–brain barrier

What department is the CSF tube labeled 3 routinely sent to? a. Hematology b. Chemistry c. Microbiology d. Serology

a. Hematology

The CSF tube that should be kept at room temperature is: a. Tube 1 b. Tube 2 c. Tube 3 d. Tube 4

b. Tube 2

Place the appropriate letter in front of the statement that best describes CSF specimens in these two conditions: a. Traumatic tap b. Intracranial hemorrhage ___ Even distribution of blood in all tubes

b. Intracranial hemorrhage

Place the appropriate letter in front of the statement that best describes CSF specimens in these two conditions: a. Traumatic tap b. Intracranial hemorrhage ___ Xanthochromic supernatant

b. Intracranial hemorrhage

Place the appropriate letter in front of the statement that best describes CSF specimens in these two conditions: a. Traumatic tap b. Intracranial hemorrhage ___ Concentration of blood in Tube 1 is greater than in Tube 3

a. Traumatic tap

Place the appropriate letter in front of the statement that best describes CSF specimens in these two conditions: a. Traumatic tap b. Intracranial hemorrhage ___ Specimen contains clots

a. Traumatic tap

The presence of xanthochromia can be caused by all of the following except: a. Immature liver function b. RBC degradation c. A recent hemorrhage d. Elevated CSF protein

c. A recent hemorrhage

A web-like pellicle in a refrigerated CSF specimen indicates: a. Tubercular meningitis b. Multiple sclerosis c. Primary CNS malignancy d. Viral meningitis

a. Tubercular meningitis

Given the following information, calculate the CSF WBC count: cells counted, 80; dilution, 1:10; large Neubauer squares counted, 10. a. 8 b. 80 c. 800 d. 8000

c. 800

A CSF WBC count is diluted with: a. Distilled water b. Normal saline c. Acetic acid d. Hypotonic saline

c. Acetic acid

A total CSF cell count on a clear fluid should be: a. Reported as normal b. Not reported c. Diluted with normal saline d. Counted undiluted

d. Counted undiluted

The purpose of adding albumin to CSF before cytocentrifugation is to: a. Increase the cell yield b. Decrease the cellular distortion c. Improve the cellular staining d. Both A and B

d. Both A and B

The primary concern when pleocytosis of neutrophils and lymphocytes is found in the CSF is: a. Meningitis b. CNS malignancy c. Multiple sclerosis d. Hemorrhage

a. Meningitis

Neutrophils with pyknotic nuclei may be mistaken for: a. Lymphocytes b. Nucleated RBCs c. Malignant cells d. Spindle-shaped cells

b. Nucleated RBCs

The presence of which of the following cells is increased in a parasitic infection? a. Neutrophils b. Macrophages c. Eosinophils d. Lymphocytes

c. Eosinophils

Macrophages appear in the CSF after: a. Hemorrhage b. Repeated spinal taps c. Diagnostic procedures d. All of the above

d. All of the above

Nucleated RBCs are seen in the CSF as a result of: a. Elevated blood RBCs b. Treatment of anemia c. Severe hemorrhage d. Bone marrow contamination

d. Bone marrow contamination

After a CNS diagnostic procedure, which of the following might be seen in the CSF? a. Choroidal cells b. Ependymal cells c. Spindle-shaped cells d. All of the above

d. All of the above

Hemosiderin granules and hematoidin crystals are seen in: a. Lymphocytes b. Macrophages c. Ependymal cells d. Neutrophils

b. Macrophages

Myeloblasts are seen in the CSF: a. In bacterial infections b. In conjunction with CNS malignancy c. After cerebral hemorrhage d. As a complication of acute leukemia

d. As a complication of acute leukemia

Cells resembling large and small lymphocytes with cleaved nuclei represent: a. Lymphoma cells b. Choroid cells c. Melanoma cells d. Medulloblastoma cells

a. Lymphoma cells

The reference range for CSF protein is: a. 6 to 8 g/dL b. 15 to 45 g/dL c. 6 to 8 mg/dL d. 15 to 45 mg/dL

b. 15 to 45 g/dL

CSF can be differentiated from serum by the presence of: a. Albumin b. Globulin c. Transthyretin d. Tau transferrin

d. Tau transferrin

In serum, the second most prevalent protein is IgG; in CSF, the second most prevalent protein is: a. Transferrin b. Transthyretin c. Prealbumin d. Ceruloplasmin

c. Prealbumin

Elevated values for CSF protein can be caused by all of the following except: a. Meningitis b. Multiple sclerosis c. Fluid leakage d. CNS malignancy

c. Fluid leakage

The integrity of the blood–brain barrier is measured using the: a. CSF/serum albumin index b. CSF/serum globulin ratio c. CSF albumin index d. CSF IgG index

a. CSF/serum albumin index

Given the following results, calculate the IgG index: CSF IgG, 50 mg/dL; serum IgG, 2 g/dL; CSF albumin, 70 mg/dL; serum albumin, 5 g/dL. a. 0.6 b. 6.0 c. 1.8 d. 2.8 The CSF IgG index calculated above indicates: a. Synthesis of IgG in the CNS b. Damage to the blood–brain barrier c. Cerebral hemorrhage d. Lymphoma infiltration

c. 1.8 a. Synthesis of IgG in the CNS

The finding of oligoclonal bands in the CSF and not in the serum is seen with: a. Multiple myeloma b. CNS malignancy c. Multiple sclerosis d. Viral infections

c. Multiple sclerosis

Which condition is suggested by the following results: a CSF glucose of 15 mg/dL, WBC count of 5000, 90% neutrophils, and protein of 80 mg/dL? a. Fungal meningitis b. Viral meningitis c. Tubercular meningitis d. Bacterial meningitis

d. Bacterial meningitis

A patient with a blood glucose of 120 mg/dL would have a normal CSF glucose of: a. 20 mg/dL b. 60 mg/dL c. 80 mg/dL d. 120 mg/dL

c. 80 mg/dL

CSF lactate will be more consistently decreased in: a. Bacterial meningitis b. Viral meningitis c. Fungal meningitis d. Tubercular meningitis

b. Viral meningitis

Measurement of which of the following can be replaced by CSF glutamine analysis in children with Reye syndrome? a. Ammonia b. Lactate c. Glucose d. a-Ketoglutarate

a. Ammonia

Before performing a Gram stain on CSF, the specimen must be: a. Filtered b. Warmed to 37°C c. Centrifuged d. Mixed

c. Centrifuged

All of the following statements are true about cryptococcal meningitis except: a. An India ink preparation is positive b. A starburst pattern is seen on Gram stain c. The WBC count is over 2000 d. A confirmatory immunology test is available

c. The WBC count is over 2000

The most sensitive and specific method to detect the causative organism in meningitis is: a. Gram stain b. Culture and sensitivity c. India ink stain d. PCR assay

d. PCR assay

The test of choice to detect neurosyphilis is the: a. RPR b. VDRL c. FAB d. FTA-ABS

b. VDRL

AUBF CSF Flashcards

(156 cards)