10.2 more cards Flashcards
List the 2 urgent indications for an LP
Suspected CNS infection (meningoencephalitis)
Suspected SAH in pt with negative head CT
LP should not be done with increased ICP & space occupying lesions with risk for what?
LP may cause brain herniation through foramen magnum due to acute downward pressure gradient
Infection, bleeding, and headaches are 3 potential complications of what?
LP
A persistent CSF leak can cause what Sx?
Headaches
obstruction of jugular veins or superior vena cava can do what?
Increase ICP
What does the breakdown of hemoglobin cause in CSF?
Xanthochromia
Does normal CSF have cells?
No; normal CSF is acellular (no cells), but may have a small number of certain cells when sampled by LP
WBC elevations (pleocytosis) can occur in what 3 conditions?
1) Infection
2) Traumatic tap
3) Noninfectious inflammatory states
Acute infectious meningitis: Neutrophils (PMNs) usually predominate in ___________; lymphocytes usually predominate in ___________.
bacterial; viral
Molecular tests can detect what?
Viruses, bacteria, and fungi
[molecular tests use a variety of methods, including NAAT, serology (antibodies), antigen detection]
Infectious and noninfectious conditions, those associated with obstruction of CSF flow, and bleeding can all cause what?
Increased CSF total protein
Albumin-to-globulin ratio normally higher in CSF than blood. Why?
Albumin molecule is smaller than globulins
Should CSF have a lot of immunoglobulins, or a few?
Very few
[CSF inflammatory disorders]
How do you ID increased immunoglobulins in CSF?
1) Increased IgG index
2) Spikes/bands on CSF protein electrophoresis + immunofixation
[of increased immunoglobulin production]
What 2 types of immunoglobulin bands are on CSF protein electrophoresis + immunofixation can be found when immunoglobulins are increased?
1) Oligoclonal: neuroinflammatory disorders such as Multiple sclerosis (MS)
2) Monoclonal: B cell/plasma cell disorder (e.g., malignancy)
When might CSF glucose be low?
Bacterial/fungal CNS infections
1) When might CSF glucose be normal?
2) When might it be high?
1) Viral CNS infections
2) Hyperglycemia
Is CSF glucose normally lower or higher than in serum?
Lower
Elevated CSF levels of lactic acid may occur in what 3 situations?
1) Hypoxic-ischemic cerebral injury
2) SAH
3) Infectious meningitis
Lactic acid is often elevated in _____ ____________meningitis (prior to abx) but normal in ______ meningitis
acute bacterial; viral
What CSF analysis may help identify malignancy/metastasis?
Cytology and Tumor markers
In what type of meningitis will CSF WBC count be very high?
Bacterial
When may opening pressure be high? (2)
Subarachnoid hemorrhage (SAH)
Acute Bacterial Meningitis
Is there xanthochromia with traumatic LP?
No
What is a predisposing factor for gout?
Hyperuricemia
You collect CSF via LP. RBC count is elevated in first tube (initially red) but normal in final tube (clears with collection of fluid). What is the likely cause?
Traumatic LP
Isolated high protein indicates what?
Guillain-Barré syndrome
Oligoclonal bands and high IgG index may be seen with what?
MS
Lymphocytic predominance may occur when?
1) Acute Viral meningitis
2) Multiple Sclerosis (MS)
What is increased serum uric acid called?
Hyperuricemia
What is the most common cause of hyperuricemia?
Decreased efficiency of renal uric acid excretion
[CKD, ketoacidosis, diuretics]
What is the most important indication for Arthrocentesis & Synovial (Joint) Fluid analysis?
Septic arthritis
Joint effusion or signs of suggestive inflammation are both indications for what?
Arthrocentesis & Synovial (Joint) Fluid Analysis
Synovial fluid is normally highly _________, clear, and colorless
viscous
True or false: Normal synovial fluid is nearly acellular
True
Differentiate between the shapes in gout and pseudogout (important)
1) Gout: “Negatively” birefringent (and strong/bright birefringence); needle-shaped
-[Monosodium urate (MSU)]
2) Pseudogout: “Positively” birefringent (but weak) or no birefringence; rhomboid/rectangular shape
-[Calcium pyrophosphate dihydrate (CPPD)]
What % neutrophils in synovial fluid would indicate a septic condition?
> 75%
What amount of neutrophils in synovial fluid indicates an inflammatory condition?
2,000-20,000
What may demonstrate uric acid or CPPD crystals in synovial fluid?
Inflammatory conditions
When may a gram stain culture for microorganisms in synovial fluid be positive?
Septic conditions
Semen analysis is a measure of ____________ function
testicular
Bronchoalveolar Lavage (BAL) is collected how?
Flexible bronchoscopy
Where is BAL generally collected?
Location of disease (or if diffuse at the R middle lobe or L upper lobe lingula)
BAL can be used to evaluate immunologic, inflammatory, and infectious processes occurring at alveolar level in ____________ lung diseases
diffuse
Give some examples of BAL uses
Bacterial cultures
Legionella infections
Fungal infections
Viral infections
Malignancies
True or false: Tumor markers are usually not sensitive or specific enough to be used for cancer screenings or to diagnose cancer, but can track response to therapy or recurrence
True
True or false: tumor markers can be produced by cancer cells OR in response to them
True
Are PSA tests sensitive or specific?
Neither
Hepatocellular carcinomas are associated with what tumor marker?
Alpha-fetoprotein (AFP)
PRL (tumor marker) is associated with what?
Pituitary adenomas
CEA can be elevated when?
Colorectal cancer and breast cancer
CA 19-9 is assoc. with what?
Pancreatic cancer
CA 15-3 and CA 27-29 are assoc. with what?
Breast cancer
Ovarian cancer can be shown by what cancer antigen (CA)?
CA 125
Highly infectious bacteria and viruses can be used as agents of bioterrorism; inhalation of __________ or ____________ would be most likely means of transmission
aerosols; ingestion
