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AUBF-Lec-CSF Flashcards

1
Q

3RD major body fluid

A

CSF

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2
Q

CSF is the 3RD major body fluid
Discovered by?

A

Cotugno

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3
Q

Functions of CSF (3)

A
  1. Supply nutrients to the nervous system
  2. Remove metabolic waste
  3. Produce mechanical barrier to cushion the brain and spinal cord against trauma
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4
Q

Layers of our Head (4)

A

Skin
Skull
Meninges
Brain

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5
Q

3 Layers of Meninges +1

A

DURA MATER
ARACHNOID MATER
*SUBARACHNOID SPACE
PIA MATER

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6
Q

What layer of Meninges?
OUTER LAYER
LINES THE SKULL AND VETEBRAL CANAL

A

DURA MATER

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7
Q

What layer of Meninges?
SPIDERWEB-LIKE
FILAMENTOUS INNER MEMBRANE

A

ARACHNOID MATER

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8
Q

What layer of Meninges?
BELOW ARACHNOID
WHERE CSF FLOWS

A

*SUBARACHNOID SPACE

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9
Q

What layer of Meninges?
INNERMOST LAYER
LINES THE SURFACE OF THE BRAIN AND SPINAL CORD

A

PIA MATER

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10
Q

DURA MATER (Latin:_____)

A

Hard Mother

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11
Q

PIA MATER (Latin:_______)

A

Gentle Mother

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12
Q

Specific part of the brain that produces CSF through selective filtration

A

Choroid Plexus

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13
Q

Choroid Plexus
Specific part of the brain that produces CSF through selective filtration
At a rate of?

A

20 mL/hour

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14
Q

-reabsorbs CSF back into the blood (if not=HYDROCEPHALUS)
-act as a one-way valves to prevent reflux

A

ARACHNOID VILLI/GRANULATIONS

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15
Q

ARACHNOID VILLI/GRANULATIONS
-reabsorbs CSF back into the blood (if not=__________)
-act as a one-way valves to prevent reflux

A

HYDROCEPHALUS

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16
Q

Protects the brain from chemicals and other substances circulating in the blood that can harm the brain tissues

A

Blood Brain Barrier (BBB)

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17
Q

Blood Brain Barrier (BBB)
If damage, other chemicals, WBCs and proteins will enter the CSF that will lead to? (2)

A

Meningitis and Multiple Sclerosis

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18
Q

Up to ______ of CSF can be collected

A

20 mL

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19
Q

CSF Method of Collection: ______ Puncture (between 3rd, 4th, or 5th lumbar vertebrae)

A

Lumbar

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20
Q

Method of Collection: Lumbar Puncture (between _______ lumbar vertebrae)

A

3rd, 4th, or 5th

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21
Q

Normal Value of CSF in Adults:

A

90-150 mL
140-170 mL

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22
Q

Normal Value of CSF in Neonates:

A

10-60 mL

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23
Q

______CSF tubes are collected (sometimes 4)

A

3

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24
Q

3 CSF tubes are collected (sometimes ____)

A

4

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25
Q

CSF tube 1 test

A

For Chemistry & Serology

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26
Q

CSF tube 2 test

A

For Microbiology

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27
Q

CSF tube 3 test

A

For Hematology and Cell count

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28
Q

CSF tube 4 test

A

Additional testing for Microbiology and Serology

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29
Q

CSF tube 1 storage

A

Frozen

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30
Q

CSF tube 2 storage

A

Room Temperature

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31
Q

CSF tube 3 storage

A

Refrigerator

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32
Q

What tube number in CSF? least affected by blood or bacteria introduced as a result of the tap procedure.

A

Tube 1

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33
Q

What tube number in CSF? Least likely to contain cells introduced by the spinal tap

A

Tube 3

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34
Q

What tube number in CSF? Better exclusion of skin contamination

A

Tube 4

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35
Q

Left-over_______ may also be used for additional chemical or serologic tests

A

supernatant fluid

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36
Q

Excess fluid should _____ and should be frozen until there is no further use of it.

A

not be discarded

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37
Q

Order of testing of CSF if only 1 tube of sample is available?

A

Micro—> Hema—> Chem/Sero

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38
Q

inflammation in the membrane of the brain and spinal cord

A

meningitis

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39
Q

yellow color & coagulate rapidly & with high protein, blockage in spinal circulation due to tumor

A

Froin syndrome

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40
Q

What is the appearance of CSF if the following is observed:
Increased WBCs (>200/uL)
RBCs (>400/uL)
Lipids, Proteins
Microorganisms

A

Hazy, turbid, milky, cloudy

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41
Q

What is the appearance of CSF if the following is observed:
Increased RBCs (>6000/uL)

A

Bloody

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42
Q

What is the appearance of CSF if the following is observed:
Meningitis: inflammation in the membrane of the brain and spinal cord

A

clotted

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43
Q

What is the appearance of CSF if the following is observed:
Froin syndrome: yellow color & coagulate rapidly & with high protein, blockage in spinal circulation due to tumor

A

Pellicle

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44
Q

What is the appearance of CSF if the following is observed:
Due to hemoglobin degradation product

PINK: slight amount of oxyhemoglobin

YELLOW: Oxyhemoglobin-🡪unconjugated bilirubin

ORANGE: Heavy hemolysis

Other causes of xanthochromia include elevated serum bilirubin, presence of the pigment carotene, markedly increased protein concentrations, and melanoma pigment, Rifampin

A

xanthochromic

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45
Q

Due to hemoglobin degradation product
PINK is caused by?

A

slight amount of oxyhemoglobin

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46
Q

Due to hemoglobin degradation product
YELLOW is caused by?

A

Oxyhemoglobin-🡪unconjugated bilirubin

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47
Q

Due to hemoglobin degradation product
ORANGE is caused by?

A

Heavy hemolysis

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48
Q

Other causes of xanthochromia include (5)

A

elevated serum bilirubin
presence of the pigment carotene
markedly increased protein concentrations, melanoma pigment
Rifampin

49
Q

Traumatic Tap: DISTRIBUTION OF BLOOD ON 3 TUBES

A

Uneven (1 heaviest conc.>2>3)

50
Q

Traumatic Tap: CLOT FORMATION

A

(+) due to plasma fibrinogen

51
Q

Traumatic Tap: SUPERNATANT

52
Q

Traumatic Tap: ERYTHROPHAGES
(MACROPHAGES W/ INGESTED RBCS)

53
Q

Traumatic Tap: D-DIMER

54
Q

Intracranial Hemorrhage: DISTRIBUTION OF BLOOD ON 3 TUBES

55
Q

Intracranial Hemorrhage: CLOT FORMATION

A

(-) CSF has no fibrinogen

56
Q

Intracranial Hemorrhage: SUPERNATANT

A

Xanthochromic

57
Q

Intracranial Hemorrhage: ERYTHROPHAGES
(MACROPHAGES W/ INGESTED RBCS)

58
Q

Intracranial Hemorrhage: D-DIMER

59
Q

CSF Cell Count: Any cell count should performed?

A

immediately

60
Q

CSF Cell Count: WBCs and RBCs begin to lyse within?

61
Q

CSF Cell Count: 40% of WBCs disintegrate within?

62
Q

CSF Cell Count: ______ of WBCs disintegrate within 2hours

63
Q

WBC Count
Routinely performed in CSF
Normal values:
ADULT: ______
NEONATES: _______

A

0-5 WBCs/uL
0-30 WBCs/uL

64
Q

CSF Dilution: Clear

65
Q

CSF Dilution: Slightly Hazy

66
Q

CSF Dilution: Hazy

67
Q

CSF Dilution: Slightly Cloudy

68
Q

CSF Dilution: Cloudy/Slightly bloody

69
Q

CSF Dilution: Turbid/Bloody

70
Q

WBC Diluting fluid for CSF: ______________________

A

3% acetic acid with methylene blue

71
Q

RBC Count is Done only in cases of?

A

traumatic tap

72
Q

RBC Count: ______ count and ______ concentration should be corrected

A

WBC; protein

73
Q

RBC Count:
WBC count and protein concentration should be corrected
Subtract (-) _______ WBC for every 700 RBC seen
(-) _______ Total protein concentration for every 10,000 RBCs/uL
(-) _______ Total protein concentration for every 1,200 RBCs/uL

A

Subtract (-) 1 WBC for every 700 RBC seen
(-)8 mg/dL Total protein concentration for every 10,000 RBCs/uL
(-)1 mg/dL Total protein concentration for every 1,200 RBCs/uL

74
Q

CSF Differential Count is Performed on?

A

stained smear

75
Q

CSF Differential Count
Specimen should be concentrated before smearing by using applicable methods: (4)

A

Cytocentrifugation
Centrifugation
Sedimentation
Filtration

76
Q

Fluid is added on conical chamber
Cells are forced into monolayer within a 6mm diameter circle on the slide

A

Cytocentrifuge

77
Q

Cytocentrifuge:
Fluid is added on _______ chamber
Cells are forced into monolayer within a ______ diameter circle on the slide

A

Fluid is added on conical chamber
Cells are forced into monolayer within a 6mm diameter circle on the slide

78
Q

Cytocentrifuge: Addition of Albumin:

A

Increases cell yield/recovery
Decrease cellular distortion

79
Q

Predominant Cells in CSF:
Predominant: (2)
Ocassional: (1)

A

Predominant: lymphocytes & monocytes
Ocassional: Neutrophils

80
Q

Adult ratio of lymphocytes & monocytes in CSF

A

Adults (70:30 ratio)
70%-lymphocytes
30%- monocytes

81
Q

Neonates ratio of lymphocytes & monocytes in CSF

A

Neonates (Inversed ratio)
Up to 80% monocytes is considered normal

82
Q

Increased ____________ are seen in the CSF in association with parasitic infections, fungal infections (primarily Coccidioides immitis)

A

Eosinophils

83
Q

CSF Protein:
Normal values:
Adult: ______
Infants: _______
Immature: _______

A

Normal values:
Adult: 15-45 mg/dL
Infants: 150 mg/dL
Immature: 500 mg/dL

84
Q

CSF Protein: Increased in: (4)

A
  • Damage to the BBB (most common): meningitis & hemorrhage
  • Production of immunoglobulins within the CNS: Multiple sclerosis
  • Decreased normal protein clearance from fluid
  • Neural tissue degeneration
85
Q

CSF Protein: Decreased in: (4)

A
  • CSF leakage/ trauma
  • Recent puncture
  • Rapid CSF production
  • Water intoxication
86
Q

major CSF protein

87
Q

2nd most prevalent CSF in protein

A

Prealbumin

88
Q

Alpha globulins in CSF protein (2)

A
  • Haptoglobin
  • Ceruloplasmin
89
Q

______ is the major beta globulin present

A

Transferrin

90
Q

Gamma globulin in CSF (2)

A
  • Immunoglobulin G (IgG)
  • Immunoglobulin A (IgA)- in small amounts
91
Q

PROTEINS NOT FOUND IN THE CSF: (3)

A
  • Immunoglobulin M (IgM)
  • Fibrinogen
  • Beta lipoprotein
92
Q

CSF Protein Determination
TOTAL PROTEIN
Turbidimetric (2)

A

Trichloroacetic acid (TCA)
Sulfosalicylic acid (SSA)

93
Q

CSF Protein Determination
Dye-binding (1)

A

Coomassie Brilliant Blue

94
Q

CSF Protein Determination:
preferred method (precipitates albumin & globulin)

A

Trichloroacetic acid (TCA)

95
Q

CSF Protein Determination:
precipitates albumin only
to precipitate globulin, add sodium citrate

A

Sulfosalicylic acid (SSA)

96
Q

CSF Protein Determination:
protein binds to dye— dye turns from red to blue

A

Coomassie Brilliant Blue

97
Q

assess the integrity of BBB

A

CSF/Serum Albumin Index

98
Q

CSF/Serum Albumin Index:
Normal value: ___
Abnormal: ____
- _____= slight impairment
- _____ = moderate impairment
- _____= severe impairment
- ______= complete damage to BBB

A

Normal value: <9
Abnormal: >9
9-14= slight impairment
15-30= moderate impairment
>30= severe impairment
100= complete damage to BBB

99
Q

assess conditions with IgG production within the CNS (ex. Multiple Sclerosis)

100
Q

IgG Index:
Normal value: ______
Abnormal value: ______ —> indicative of MS

A

Normal value: <0.77
Abnormal value: >0.77 —> indicative of MS

101
Q

-for detection of oligoclonal bonds (y-region)
-indicates immunoglobulin production

A

CSF Electrophoresis

102
Q

CSF Electrophoresis:
2 or more oligoclonal bands in CSF but not in serum

A

Multiple Sclerosis

103
Q

CSF Electrophoresis: oligoclonal bands in serum but not in CSF

A

Leukemia, Lymphoma, Viral infections

104
Q

CSF Electrophoresis:
oligoclonal bands in serum and CSF

105
Q

Demyelinating disorder
Findings:
(+) anti-myelin sheath autoantibody
(+) oligoclonal band in CSF but not in serum
(+) myelin basic protein- monitor the course of MS
Increase IgG index

A

Multiple Sclerosis

106
Q

CSF Enzymes: (3)

A

Lactate Dehydrogenase (LDH)
Creatinine Kinase
Aspartate Aminotransferase (AST)

107
Q

CSF Enzymes:
Lactate Dehydrogenase (LDH)
Serum LDH:
Normal:_____________
Flipped pattern (AMI): _____

A

2>1>3>4>5; 1>2

108
Q

CSF Enzymes:
CSF LDH
Normal: ________________
Neurological abnormalities: ______
Bacterial meningitis: _______

A

CSF LDH
Normal: LD1>2>3>4>5
Neurological abnormalities: LD 2>1
Bacterial meningitis: LD 5>4>3>2>1

109
Q

CSF LDH Isoenzymes: LD1 &2:

A

brain tissues

110
Q

CSF LDH Isoenzymes: LD2& 3:

A

lymphocytes

111
Q

CSF LDH Isoenzymes: LD4 & 5:

A

neutrophils

112
Q

AGENTS OF BACTERIAL MENINGITIS: Birth to 1 month old

A

Streptococcus agalactiae, Gram-negative rods

113
Q

AGENTS OF BACTERIAL MENINGITIS: 1 month to 5 years old

A

Haemophilus influenzae

114
Q

AGENTS OF BACTERIAL MENINGITIS: 5-29 years old

A

Neisseria meningitidis

115
Q

AGENTS OF BACTERIAL MENINGITIS: >29 years old

A

Streptococcus pneumoniae

116
Q

AGENTS OF BACTERIAL MENINGITIS: Infants, elderly, immunocompromised

A

Listeria monocytogenes

117
Q

CSF: Serologic Testing: for detection of bacterial antigens

A

Latex agglutination test and ELISA

118
Q

CSF: Serologic Testing: recommended by CDC for the detection of Neurosyphilis

A

VDRL (Venereal Disease Research Laboratories)

Finals (20 decks)

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