AUBF Flashcards
1
Q
CSF is first recognized by ____ in ______
A
Catugno, 1764
2
Q
Functions of CSF
A
Supply nutrient to nervous tissue
Remove metabolic waste
Cushion the brain & spinal cord against trauma
3
Q
Normal adult volume of CSF
A
140-170
4
Q
Normal volume of CSF neonates
A
10-60
5
Q
Reduce the amount of CSF in the brain by draining it to the abdomen or directly into the chambers of the heart
A
Ventricular Shunt
6
Q
helps reduce the pressure on the brain
A
Shunting of CSF
7
Q
Hollow plastic tube that is placed in the ventricle of the brain
A
Shunt
8
Q
Ventricular peritoneal shunt located from the
A
brain to abdomen
9
Q
Ventricular atrial shunt is located from brain to _____
A
heart
10
Q
Lines the brain and the spinal cord
Protective layer
A
Meninges
11
Q
directly in contact with skull bones
outermost
A
dura mater
12
Q
Web-like structure - middle layer of meninges
A
Arachnoid
13
Q
space where CSF flows
A
Subarachnoid space
14
Q
directly in contact with brain
Innermost
A
Pia Mater
15
Q
Capillary networks that form the CSF
A
Choroid Plexus
16
Q
light-fitting endothelial cells: separates blood tissues and brain tissue
A
Blood Brain Barrier
17
Q
functional barrier; separates blood tissues and cerebrospinal fluid
A
Blood CSF Barrier
18
Q
Normal volume production of CSF
A
20/mL per hour
19
Q
Cells that help production of CSF
A
Ependymal cells
20
Q
Specimen collection for CSF procedure:
A
Lumbar tap/Lumbar puncture between 3rd and 4th or 4th and 5th lumbar vertebrae
21
Q
Opening pressure is measured _____ in aspiration of CSF
A
First
22
Q
CSF collection tubes order of draw:
A
Tube 1: Chemistry or serology
Tube 2: Microbio
Tube 3: Hematology
*Tube 4 if possible: micro
23
Q
Storage for CSF tube 1
A
Frozen (0 to frozen)
24
Q
A
25
Storage for CSF tube 3
Refrigerated
25
Increase in blood CSF may indicate
traumatic tap
25
Storage for CSF tube 2
Room temperature (20 to 24 deg C)
25
Appearance of CSF: Cloudy, Milky, Turbid
Protein, Lipid, WBC
26
Appearance of CSF: Normal
Crystal Clear
27
Appearance of CSF: Bloody
Intracranial hemorrhage, Traumatic tap
28
Appearance of CSF: Xanthochromic
Hemoglobin, Bilirubin, Carotene, ↑Protein, Melanin
29
Appearance of CSF: Pink
Oxyhemoglobin
30
Appearance of CSF: Yellow
High bilirubin content
31
Appearance of CSF: Orange
combination of oxyhemoglobin and bilirubin
32
Appearance of CSF: Clotted
Clotting factors introduced by traumatic tap
33
Appearance of CSF: Pellicle
Tubercular meningitis, seen after overnight of refrigeration
34
Appearance of CSF: Oily
Radiographic Contrast Media
35
Traumatic tap indication:
Uneven blood distribution
Clot formation
Supernatant: Not Xanthochromic
36
Intracranial Hemorrhage indication:
Even distribution of blood
No clot formation
Supernatant: Xanthochromic
Additional: Erythrophagocytosis: microscopically- macrophages with ingested RBCs
(+): D-Dimer
37
Cell count that is routinely performed on CSF
Leukocyte/wbc count
38
When is Leukocyte/WBC count performed on CSF
Traumatic tap
39
_______ are usually determined only when a traumatic tap has occurred and a correction for leukocytes or protein is desired
RBC counts
40
RBC disintegrates within
1 hour
41
CSF: ↓ by 40% in WBC disintegrates after
2 hours
42
increase in the number of cells in CSF
Pleocytosis
43
Normal values of WBC in ADULT CSF
0-5 cells/uL
44
Predominant cells in ADULT CSF
lympthocytes
45
Predominant cells in neotates CSF
monocytes
46
Normal values of WBC in neonates
0-30 cells/uL
47
Manual method for counting cells in CSF
Neubauer Counting Chamber
48
Counting calls of CSF
4 larger corner squares and large center squares
49
Area of large square neubauer chamber:
1 mm^2
50
Total Cell Count:
Cell counted x Dilution / Area x Depth
51
Needed for the correction of WBC Count & CSF Protein Results
RBC Count
52
Diluent for CSF RBC count
NSS
53
Diluent for WBC count CSF:
3% Glacial Acetic Acid
54
Can be added to diluting fluid of WBC count
Methylene Blue
55
Correction for Contamination of CSF
WBC added = WBC Blood x RBC CSF
RBC Blood
56
Subtract 1 WBC for every ____ RBCs present in the CSF
700
57
CSF Electrophoresis primary purpose:
detection of OLIGOCLONAL bands
58
Can determine if a fluid is indeed CSF
CSF Electrophoresis
59
Most Common Method of CSF electrophoresis
Agarose Gel Electrophoresis
60
Indicates immunoglobulin production
Oligoclonal Bands
61
Oligoclonal bands are located in the ____ region of the protein electrophoresis
GAMMA
62
Oligoclonal bands in CSF only
Multiple Sclerosis; Neurologic Disorder, Encephalitis, Neurosyphilis, Guillain Barre Syndrome
63
Oligoclonal Bands in CSF and Serum
HIV infection
64
Oligoclonal bands in Serum only; CSF banding because of BBB leakage or blood contamination during lumbar tap.
Leukemia, Lymphoma, Viral Infections
65
Indicates recent destruction of the myelin sheath that protects the axon of the neurons
Myelin Basic Protein
66
Myelin Basic Protein can be used to monitor ________-
Multiple sclerosis
67
Myelin Basic Protein theorized that the inflammatory response in multiple sclerosis is triggered by ________
molecular mimicry
68
Normal volume of CSF Glucose:
60-70% of plasma glucose
69
Blood glucose should be drawn ________ prior to lumbar tap (CSF)
2 hours
70
Can be used to determine the cause of meningitis
CSF glucose
71
Increased levels of CSF glucose is always a result of
plasma elevations
72
Decreased levels of CSF glucose
caused by alteration in transport in BBB ↑ used by braincells
73
Destruction of tissue within the CNS due to hypoxia causes the production of
Increased CSF lactate
74
Aid in the diagnosis and management of meningitis cases
CSF Lactate
75
Elevation of CSF lactate is consistent with:
Bacterial, Tubercular, and Fungal Meningitis
76
Level of CSF lactate when treatment is successful
declines rapidly
77
Used to monitor severe head injuries
CSF Lactate
78
Falsely elevated CSF lactate is due to
xanthochromic or hemolyzed samples
79
Preferred over direct measurement of CSF ammonia
CSF Glutamine
80
CSF Glutamine normal values
8-18 mg/dL
81
Elevated levels of CSF glutamine is associated with
liver disorder that result in blood and CSF ammonia
82
CSF glutamine is produced from ____ and ____ by the brain cell
Ammonia & α-ketoglutarate
83
______ is an indirect test for the presence of excess ammonia in CSF
Glutamine
84
Frequently requested procedure for patients with coma of unknown origin
CSF Glutamine
85
CSF glutamine is ↑ in approximately 75% of children with
Reye Syndrome
86
Bacterial meningitis is recovered after ____
24 hours
87
Tubercular meningitis is recovered after ___
6 weeks
88
CSF centrifuged at _____ for ___ minutes
1500 g for 15 minutes
89
used for slides and culture of CSF
sediments
90
Confirmatory rather than Diagnostic Procedure
CSF Culture
91
Microbiology laboratory test for a preliminary diagnosis of CSF
Gram Stain
Acid Fast Stain
India Ink Preparation
Latex Agglutination Test
92
Predominant cell in bacterial meningitis
Neutrophil
93
Predominant cell in Viral meningitis
Lymphocyte
94
Predominant cell in Tubercular
Lymphocyte, Monocyte
95
Predominant cell in Fungal meningitis (LEM)
Lymphocytes, Monocytes, Eosinophil
96
↑ Protein: Marked
Glucose: Markedly ↓
Bacterial meningitis
97
Increased protein: Moderate
Glucose: Normal
Viral meningitis
98
↑ Protein: moderate to marked
Glucose: decreased
Tubercular meningitis
99
↑ Protein: moderate to marked
Glucose: normal to ↓
Fungal meningitis
100
Lactate: > 35 mg/dL
Bacterial meningitis
101
Lactate: normal
Viral meningitis
102
Lactate: >25 mg/dL
Tubercular or Fungal meningitis
103
Routinely performed on CSF from all suspected cases of meningitis
Gram stain
104
CSF specimen uses _______ that provides highly concentrated specimens
Cytocentrifuge
105
Common causes of bacterial meningitis for infants
S.agalactiae
E. Coli K1 strain,
L. monocytogenes
106
Common causes of bacterial meningitis for adolescent/adults
N. meningitides
H. Influenza type B,
S. pneumoniae
107
Common causes of bacterial meningitis for elderly
S. pneumoniae
N. Meningitides
L. monocytogenes
108
one the frequently occuring complications of AIDS
Cryptococcal meningitis
109
Cryptococcus neoformans india ink result:
Thick encapsulated organism
110
Cryptococcus neoformans gram stain result:
Starburst pattern (may be seen more often than a positive india ink)
111
Cryptococcus neoformans is associated with increased _______
eosinophils
112
Diagnosis of meningitis caused by Gram negative bacteria
Limulus lysate test
113
reacts with bacterial endotoxin of Gram (-) bacteria
Limulus amebocyte
114
Reagent for limulus lysate test
blood cells of horseshoe crab (limulus polyphemus)
115
(+) Result of limulus lysate test
Coagulation within 1 hour of incubation at 37 deg C
116
Rapid Test for CSF:
Latex
ELISA method
Bacterial Antigen Test
117
Performed to detect the presence of neurosyphilis
Serologic Testing
118
Procedure recommended by the CDC to diagnose Neurosyphillis
Venereal Disease Research Laboratories (VDRL)
119
More sensitive than VDRL
Fluorescent Treponemal Antibody-Absroption (FTA-ABS) Test
120
Prevent contamination with blood because the FTA-ABS remains ------ in the serum of treated cases of syphilis (Treponema pallidum)
positive
121
Semen - composed of four fractions that are contributed by the: (TSPB)
Testes (Epididymis)
Seminal vesicles
Prostate gland
Bulbourethral gland
122
paired glands in the scrotum that contain the seminiferous tubules
Testes
123
production of spermatozoa takes place
seminiferous tubules
124
storage of sperm
epididymis
125
Seminal Vesicles produces most fluid present in the semen (percentage)
60-70%
126
Seminal fluid contains high concentration of
fructose
127
use by sperm for energy needed for motility
fructose
128
responsible for gray appearance color of the sperm
flavin
129
aids in propelling the sperm through the urethra by contractions during ejaculation
Prostate Gland
130
percentage of acidic fluid produced by the prostate gland
20-30%
131
Milky acidic fluid from prostate gland contains:
It is also responsible for both coagulation and liquefaction of semen following ejaculation
Acid phosphatase
Citric acid
Zinc
Proteolytic enzymes
132
Bulbourethral gland contributes about ___ of the fluid volume
5%
133
Sexual abstinence for semen analysis:
at least 2 days but nor more than 7 days
134
Prolong abstinence
Higher volume and decreased motility
135
Fertility testing according to WHO:
2 or 3 sample be collected not less than ___ or more than ___
7 days or more than 3 weeks
136
Abnormal semen analysis result according to WHO
2 abnormal samples are considered significant
137
Specimen for semen analysis should be kept at _____ temp and delivered within ____
room temperature
(20-24) within 1 hour
138
Specimen awaiting for semen analysis should be kept
37 deg C
139
Container needed for semen analysis
only non-lubricant-containing rubber or polyurethane condoms should be used
140
Ordinary condom contains:
spermicides
141
Reference value for semen analysis: Volume
2-5 mL
142
Reference value for semen analysis: Viscosity
pours in droplets
143
Reference value for semen analysis: pH
7.2 - 8.0
144
Reference value for semen analysis: Sperm concentration
> 20 million/mL
145
Reference value for semen analysis: Sperm count
> 40 million/ejaculate
146
Reference value for semen analysis: motility
> 50% within 1 hour
147
Reference value for semen analysis: quality
>2.0 or a,b,c
148
Reference value for semen analysis: morphology (strict criteria)
>14% normal forms
149
Reference value for semen analysis: morphology routine
>30% normal forms
150
Reference value for semen analysis: round cells
<1.0 million/mL
151
Sperm Motility Grading: 4.0
Rapid, straight-line motility
152
Sperm Motility Grading: 3.0
Slower speed, some lateral movement
153
Sperm Motility Grading: 2.0
Slow forward progression, noticeable lateral movement
154
Sperm Motility Grading: 1.0
no forward progression
155
Sperm Motility Grading: 0
no movement
156
Alternative sperm motility grading criteria:
Progressive Motility
Sperm moving linearly or in a large circle
157
Alternative sperm motility grading criteria:
Non-progressive (NP)
Sperm moving with an absence of progression
158
Alternative sperm motility grading criteria:
Immotility
No movement
159
Normal semen appearance:
gray-white color, appears translucent, has characteristic of musty odor/bleach like odor; opacity (due to flavin)
160
Semen appearing almost clear
Low sperm concentration
161
Increase turbidity of semen indicates
presence of WBCs and infection within the reproductive tract
162
Useful in differentiating presence of WBC compared to immature sperm (spermatids)
Leukocyte esterase
163
Leukocyte esterase test positive result indicates
WBC
164
Leukocyte Esterase negative result
spermatids
165
Red coloration of semen is due to
presence of RBC
166
Yellow coloration of semen
urine contamination (toxic to sperm), prolonged abstinence, and medication
167
Fresh semen specimen is clotted and liquefy within ______ after collection
30 to 60 minutes
168
Failure of liquefaction within 60 minutes: caused by deficiency in
prostatic enzymes
169
If after 2 hours the specimen has not liquefied: an equal volume of physiologic ______ may be added to induce liquefaction and allow the rest of the analysis to be performed
Dulbecco’s phosphate-buffered saline or proteolytic enzymes (alphachymotrypsin or bromelain)
170
Normal semen volume
2-5 mL
171
Increased semen volume is due to
prolonged abstinence
172
Decreased volume of semen is associated with
infertility
incomplete specimen collection must be considered
173
Refers to the consistency of the fluid and may be related to specimen liquefaction
Viscosity
174
Viscosity: Incomplete liquefied specimen
clumped and highly viscous
175
Normal viscosity of semen:
easily drawn into a pipette and form small discrete droplets, do not appear clumped or stingy
176
Droplets that form longer than 2cm of semen
highly viscous, abnormal (problem with enzyme)
177
Normal pH of semen
7.2 to 8.0 (alkaline)
178
Increased pH of semen indicates:
infection within the reproductive tract
179
Decreased pH of semen:
increased prostatic fluid, ejaculatory duct obstruction, poorly developed seminal vesicles
180
Normal Sperm Concentration
greater than 20- 250 million sperm per milliliter
181
Borderline Sperm Concentration
10-20 million sperm per milliliter
182
Computation for sperm count:
Sperm count: Sperm concentration x Specimen Volume
183
Dilution of semen to diluting fluid:
Dilution: 1:20
184
Sperm should be capable of ______, progressive motility
forward
185
Motility should be assessed within
1 hour of collection
186
Head of sperm morphology:
oval shape approximately 5 um long and 3um wide
187
enzyme containing critical to ovum penetration;
(encompasses half of the head and cover approximately two-thirds of the sperm nucleus)
acrosomal cap
188
Enzyme present in acrosomal cap:
Hyaluronidase & Acrosin
189
attaches the head to the tail and midpiece
neckpiece
190
approximately 7 um long, thickest part of the tail (surrounded by mitochondrial sheath that produces energy required by tail for motility)
Midpiece
191
inherited only from the mother. Used for patient identification.
mtDNA
192
Tail - approximately ___ long
45 um
193
Problem with sperm tail
decreased motility
194
Problem with sperm head
ovum penetration
195
stain for sperm vitality by counting the number of dead cells in 100 sperm using bright field or phase contrast microscopy
Eosin nigrosin
196
Normal sperm concentration with markedly decreased motility
decreased sperm vitality
197
remains bluish white in eosin nigrosin stain for sperm
living cells
198
stain red against purple background in eosin nigrosin stain for sperm
dead cells
199
Normal Vitality for sperm
50% or more living cells
200
Normal seminal fluid fructose
≥13 umol per ejaculate
201
Low seminal fluid fructose indicates:
abnormalities of the seminal vesicle
bilateral congenital absence of the vas deferens
obstruction of the ejaculatory duct
partial retrograde ejaculation and androgen deficiency
202
Seminal fluid fructose should be tested within ___ or ___ to prevent fructolysis
2 hours or frozen to prevent fructolysis
203
present in both men and women
Anti-sperm antibodies
204
anti-sperm antibodies can be detected through:
semen, cervical mucosa or serum
205
detects the presence of IgG antibodies of anti-sperm antibodies
Mixed agglutination reaction test
206
more specific procedure that detects IgG, IgM, and IgA antibodies of anti-sperm antibodies
Immunobead test
207
(semen analysis) Microbial and Chemical Testing: indication of infection is detected through the presence of
> 1.0 million/mL (leukocytes)
208
Microbial testing for semen analysis involves routine aerobic and anaerobic cultures and tests that usually detects:
chlamydia tracomatis
mycoplasma hominis
and ureaplasma urealyticum
209
Reference value of chemical testing for semen analysis:
Neutral-a-glucosidase
>=20 uml/ejaculate
210
Reference value of chemical testing for semen analysis: Zinc
>= 2.4 umol/ejaculate
211
Reference value of chemical testing for semen analysis: Citric acid
>= 52 umol/ejaculate
212
Reference value of chemical testing for semen analysis:
Acid ejaculate
Glutamyl Transpeptidase
≥ 200 units/ ejaculate
213
Reference value of chemical testing for semen analysis:
Fructose
≥ 13 umol/ejaculate
214
Indication (↓ levels) of chemical testing for semen analysis:
Neutral-a-glucosidase
Glycerophosphocoline
L-carnitine
Disorder of epididymis
215
Indication (↓ levels) of chemical testing for semen analysis:
Zinc
Citric Acid
Acid phosphatase
Glutamyl transpeptidase
Lack of prostatic fluid
216
Indication (↓ levels) of chemical testing for semen analysis:
Fructose
lack of seminal fluid
217
Cutting of vas deferens
vasectomy
218
Post Vasectomy Semen Analysis detects:
presence or absence of spermatozoa
219
Sperm function test
Hamster Egg Penetration
Cervical Mucus Penetration
Hypo-Osmotic Swelling
In Vitro Acrosome Reaction
220
Sperm are incubated with species nonspecific hamster eggs and penetration is observed microscopically
Hamster egg penetration
221
Observation of sperm's ability to penetrate partner's midcycle cervical mucus
Cervical Mucus Penetration
222
Sperm exposed to low sodium concentrations are evaluated for membrane integrity and sperm viability
Hypo-osmotic Swelling
223
Hypoosmotic swelling indication of normal cell morphology
Swelling = normal
224
Evaluation of Acrosomoe to produce enzymes essential for ovum penetration
In Vitro Acrosome Reaction
