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CLINICAL MICROSCOPY > Cerebrospinal Fluid > Flashcards

Cerebrospinal Fluid Flashcards

1
Q

Functions of Cerebrospinal fluid

A

Supply nutrients to the nervous tissue
Remove metabolic wastes
Produce a mechanical barrier to cushion the brain and spinal cord against trauma

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2
Q

The brain and spinal cord are lined by

A

Meninges

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3
Q

3 layers of meninges

A

Dura mater
Arachnoid mater
Pia mater mater

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4
Q

Outer layer that lines the skull and vertebral canal

A

Dura mater

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5
Q

Dura mater is latin for

A

Hard mother

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6
Q

Filamentous inner membrane

A

Arachnoid mater

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7
Q

Appearance of arachnoid mater

A

Spiderweb-like

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8
Q

Thin membrane lining the surfaces of the brain and spinal cord

A

Pia mater

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9
Q

Pia mater is latin for

A

Gentle mother

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10
Q

It is where CSF flows

A

Subarachnoid space

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11
Q

Location of subarachnoid space

A

Between the arachnoid and pia mater

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12
Q

CSF is produced in

A

Choroid plexuses of the two lumbar ventricles and the third and fourth ventricles

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13
Q

Rate of CSF production in adults

A

20 mL/hour

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14
Q

Normal volume of CSF for adult

A

90-150 mL

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15
Q

Normal volume of CSF for neonates

A

10-60 mL

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16
Q

CSF flows through the subarachnoid space and reabsorbed back into the blood capillaries in the arachnoid granulations/villae at a rate equal to its production. True or Fasle?

A

True

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17
Q

The cells of the arachnoid granulations act as one-way valves that respond to pressure within the central nervous system (CNS) and prevent reflux of the fluid. True or False?

A

True

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18
Q

Capillary networks that form the CSF from plasma by mechanisms of selective filtration under hydrostatic pressure and active transport secretion

A

Choroid plexuses

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19
Q

The chemical composition of the CSF resemble an ultrafiltrate of plasma. True or False?

A

False; does not resemble

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20
Q

Tight-fitting structure of the endothelial cells in the choroid plexuses that prevent the passage of many molecules

A

Blood-Brain Barrier (BBB)

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21
Q

Functions of BBB

A

Protect the brain from chemicals and other substances circulating in the blood that could harm the brain tissue. Also prevent the passage of helpful substances including antibodies and medications

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22
Q

Disruption of the blood–brain barrier by diseases results to

A

Leukocytes, proteins, and additional chemicals to enter the CSF

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23
Q

CSF is routinely collected by

A

Lumbar puncture/tap
Cisternal puncture

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24
Q

Location for lumbar puncture

A

Between the third, fourth, or fifth lumbar vertebra

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25
Q

Volume of CSF collected under normal pressure

A

20 mL

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26
Q

Volume of CSF collected if pressure is less than or greater than normal

A

1-2 mL

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27
Q

CSF is collected in how many tubes?

A

3

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28
Q

The use of 1st tube

A

Chemical and serologic tests

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29
Q

The use of 2nd tube

A

Microbiology

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30
Q

The use of 3rd tube

A

Hematology

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31
Q

A fourth tube may be drawn for

A

Microbiology
Serology

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32
Q

Order of testing for CSF

A

Micro → Hema → Chemistry/Serology

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33
Q

CSF tests are performed on a STAT basis. True or False?

A

True

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34
Q

How to maintain the specimen if STAT is not possible?

A

Hematology tubes are refrigerated
Microbiology tubes remain at room temperature
Chemistry and serology tubes are frozen

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35
Q

Normal appearance of CSF

A

Crystal-clear

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36
Q

Cloudy or turbid, milky indicates

A

Increase WBC that is >200 /µL
Increase RBC that is >400/µL
Increased protein or lipid concentration
Presence of infection (meningitis)
Disorders affecting the blood-brain barrier

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37
Q

Xanthochromic CSF indicates

A

Presence of RBC degradation products

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38
Q

Color of CSF if there is a very slight amount of oxyhemoglobin

A

Pink

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39
Q

Color of CSF if there is a heavy hemolysis

A

Orange

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40
Q

Color of CSF due to conversion of oxyhemoglobin to unconjugated bilirubin

A

Yellow

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41
Q

Color of CSF due to methemoglobin formation, hematoma, melanin

A

Brown

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42
Q

> 6000 RBCs /µL in CSF indicates

A

Hemolysis

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43
Q

Nonpathologic cause of bloody CSF

A

Traumatic tap

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44
Q

Pathologic cause of bloody CSF

A

Intracranial hemorrhage / cerebral hemorrhage

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45
Q

Viscous CSF is caused by

A

Cryptococcal meningitis
Metastasizing mucin producing adenocarcinoma

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46
Q

Cause of oily CSF

A

Radiographic contrast dye

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47
Q

Cause of clotted CSF

A

Disorders affecting the blood-brain barrier

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48
Q

CSF with pellicle formation

A

Tubercular meningitis

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49
Q

Distribution of blood in case of intracranial hemorrhage

A

Even in all 3 tubes

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50
Q

Distribution of blood in case of traumatic tap

A

Uneven; tube 1 has the heaviest concentration of blood, and gradually diminishing amounts in Tubes 2 and 3

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51
Q

Difference between intracranial hemorrhage and traumatic tap in terms of clot formation

A

Absent in IH; present in TT

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52
Q

Difference between intracranial hemorrhage and traumatic tap in terms of xanthochromic supernatant

A

Common in IH; not common in TT

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53
Q

Difference between intracranial hemorrhage and traumatic tap in terms of erythrophagocytosis

A

Present in IH; absent in TT

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54
Q

Difference between intracranial hemorrhage and traumatic tap in terms of D-dimer test

A

Positive in IH; negative in TT

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55
Q

Most common or routinely performed test on CSF specimens

A

WBC count

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56
Q

How to calculate for CSF RBC count

A

Perform a total cell count and a WBC count and subtract the WBC count from the total count

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57
Q

WBCs (particularly granulocytes) and RBCs begin to lyse within

A

1 hour

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58
Q

Amount of leukocytes that disintegrate after 2 hours

A

40%

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59
Q

Specimens that cannot be analyzed immediately should be

A

Refrigerated

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60
Q

Normal WBC in CSF of adult

A

0-5 WBCs/µL

61
Q

Normal WBC in CSF of newborn

A

0-30 mononuclear cells/µL
>35 cells/µL: normal (Brunzel)

62
Q

Formula for CSF cell counts

A

cells/µL = (Number of cells counted x Dilution)/(Number of squares counted x Volume of 1 square)

63
Q

Routinely used for performing CSF cell counts

A

Improved Neubauer counting chamber

64
Q

Used to lyse RBCs

A

3% glacial acetic acid

65
Q

Stain that provides better differentiation between neutrophils and mononuclear cells

A

Methylene blue

66
Q

Done only in case of traumatic tap to correct Total Protein and WBC count

A

RBC count

67
Q

Correction for Total Protein and WBC count

A

Subtract 1 WBC for every 700 RBCs seen
Subtract 8 mg/dL TOTAL PROTEIN for every 10,000 RBCs/µL seen
Subtract 1 mg/dL of TP for every 1,200 RBCs/µL seen

68
Q

How often to check cytocentrifuge?

A

Monthly

69
Q

Tool used to measure cytocentrifuge speed and timing

A

Tachometer and stopwatch

70
Q

The CSF differential count should be performed on a

A

Stained smear

71
Q

Specimen for CSF differential count should be

A

Concentrated

72
Q

Concentrated specimen for CSF differential count is achieved thru

A

Sedimentation
Filtration
Centrifugation
Cytocentrifugation

73
Q

Duration of CSF centrifugation

A

5-10 minutes

74
Q

Stain used for differential CSF count

A

Wright’s stain

75
Q

Process where cells present in the fluid are forced into a monolayer within a 6 mm diameter circle on the slide

A

Cytocentrifugation

76
Q

As little as 1 mL of CSF combined with one drop of 3.0% albumin produces an adequate cell yield when processed with the cytocentrifuge. True or False?

A

False; 0.1 mL CSF and 30% albumin

77
Q

Primary WBC in CSF

A

Lymphocytes
Monocytes

78
Q

Lymphocytes:Monocytes ratio in adults

A

70:30

79
Q

Lymphocytes:Monocytes ratio in children

A

30:70

80
Q

The presence of increased numbers of lymphocytes and monocytes

A

Pleocytosis

81
Q

Pleocytosis is normal. True or False?

A

False; abnormal

82
Q

CSF differential count is valuable in determining the type of microorganism causing meningitis. True or False?

A

True

83
Q

Pleocytosis involving neutrophils

A

Bacterial meningitis

84
Q

Pleocytosis involving lymphocytes and monocytes

A

Meningitis of viral, tubercular, fungal, or parasitic origin

85
Q

Neutrophils with pyknotic nuclei indicate

A

Degenerating cells

86
Q

NRBCs seen in CSF indicates

A

Bone marrow contamination during spinal tap

87
Q

Type of lymphocytes frequently present during viral infections

A

Reactive lymphocytes

88
Q

A moderately elevated WBC count (<50 WBCs/µL) with increased normal and reactive lymphocytes and plasma cells may indicate

A

Multiple sclerosis or other degenerative neurologic disorders

89
Q

Increased eosinophils are seen in the CSF in association with

A

Parasitic infections
Fungal infections
Introduction of foreign material, including medications and shunts, into the CNS

90
Q

The purpose of macrophages in the CSF

A

Remove cellular debris and foreign objects

91
Q

Macrophages appear within _____ after RBCs enter the CSF

A

2-4 hours

92
Q

The finding of increased macrophages indicates

A

Previous hemorrhage

93
Q

Nonpathologically significant cells seen in CSF

A

Choroidal cells
Ependymal cells
Spindle-shaped cells

94
Q

Cells seen in acute leukemia

A

Lymphoblasts, myeloblasts, and monoblasts in the CSF

95
Q

Malignant cells of nonhematologic origin

A

Metastatic carcinoma cells
Primary CNS tumors

96
Q

Reference values for CSF chemicals are the same as the plasma values. True or False?

A

False; not the same

97
Q

Reference values for total CSF protein

A

15-45 mg/dL

98
Q

Major CSF protein

A

Albumin

99
Q

Second most prevalent fraction in CSF

A

Prealbumin (Transthyretin)

100
Q

Alpha globulins

A

Haptoglobin, ceruloplasmin

101
Q

Major beta globulin present

A

Transferrin

102
Q

Used to identify CSF

A

Tau

103
Q

CSF gamma globulin

A

IgG, with only a small amount of IgA

104
Q

Not found in normal CSF

A

IgM, fibrinogen, and beta lipoprotein

105
Q

Used to evaluate the integrity of the blood-brain barrier

A

CSF/serum albumin index

106
Q

Normal value of CSF/serum albumin index

A

<9

107
Q

Normal value of CSF/serum albumin index indicates

A

Intact BBB

108
Q

Abnormal value of CSF/serum albumin index

A

> 9

109
Q

CSF/serum albumin index of 100 is indicative of

A

Complete damage to BBB

110
Q

Used to measure IgG synthesis within the CNS

A

CSF IgG index

111
Q

Normal value of CSF IgG index

A

<0.70

112
Q

Abnormal value of CSF IgG index

A

> 0.70

113
Q

IgG production within the CNS indicates pathologic immune reaction

A

Multiple Sclerosis

114
Q

The primary purpose for performing CSF protein electrophoresis

A

Detect oligoclonal bands

115
Q

Oligoclonal bands in CSF protein electrophoresis indicates

A

Inflammation within the CNS

116
Q

The presence of two or more oligoclonal bands in the CSF that are not present in the serum can be a valuable tool in diagnosis of:

A

Multiple Sclerosis
Encephalitis
Neurosyphilis
Guillain-Barré syndrome
Neoplastic disorders

117
Q

The presence of myelin basic protein (MBP) in the CSF indicates

A

Recent destruction of the myelin sheath that protects the axons of the neurons (demyelination)

118
Q

Reference value for CSF glucose

A

60%-70% that of the plasma glucose

119
Q

A markedly decreased CSF glucose level accompanied by an increased WBC count and a large percentage of neutrophils indicates

A

Bacterial meningitis

120
Q

A markedly decreased CSF glucose level accompanied by an increased lymphocytes instead of neutrophils

A

Tubercular meningitis

121
Q

Normal CSF glucose value is found with an increased number of lymphocytes

A

Viral meningitis

122
Q

Elevated CSF glucose values are always a result of plasma . True or False?

A

True

123
Q

Valuable aid in diagnosing and managing meningitis cases

A

CSF lactate

124
Q

Normal value for CSF lactate

A

10-24 mg/dL (1.1-2.4 mmol/L)

125
Q

CSF lactate of >25 mg/dL indicates

A

Bacterial, tubercular, and fungal meningitis

126
Q

CSF lactate of >35 mg/dL indicates

A

Bacterial meningitis

127
Q

CSF lactate of <25 mg/dL indicates

A

Viral meningitis

128
Q

Normal CSF glutamine

A

8-18 mg/dL

129
Q

Disturbance of consciousness is seen when glutamine levels

A

> 35 mg/dL

130
Q

Help diagnose meningitis by confirming the presence of PMN and lymphocytes

A

Lactate Dehydrogenase Isoenzyme

131
Q

Increased LD1 and LD2 Isoenzyme

A

Brain tissue destruction

132
Q

Increased LD2 and LD3 Isoenzyme

A

Viral meningitis

133
Q

Increased LD4 and LD5 Isoenzyme

A

Bacterial meningitis

134
Q

Normal serum LDH:

A

LD 2>1>3>4>5

135
Q

Flipped pattern (AMI) serum LDH:

A

LD 1>2>3>4>5

136
Q

Normal CSF LDH:

A

LD 1>2>3>4>5

137
Q

Bacterial meningitis CSF LDH

A

LD 5>4>3>2>1

138
Q

The role of the microbiology laboratory in analyzing CSF

A

Identify the causative agent in meningitis

139
Q

Duration of CSF culture for bacterial meningitis

A

24 hours

140
Q

Duration of CSF culture for tubercular meningitis

A

6 weeks

141
Q

In gram stain, CSF should be centrifuged at

A

1500 g for 15 minutes

142
Q

Source of false positive interference in latex agglutination assay

A

Rheumatoid factor

143
Q

Uses blood cells of the horseshoe crab (Limulus polyphemus) termed “amebocytes” which contains copper complex responsible for the blue color

A

Limulus lysate test

144
Q

Diagnosis of meningitis caused by gram negative organisms by detecting endotoxins found in their cell walls

A

Limulus lysate test

145
Q

Meningitis exhibiting pellicle/ weblike clot formation

A

Tubercular meningitis

146
Q

Appearance of Cryptococcus neoformans in gram stain

A

Classic starburst pattern

147
Q

Serologic testing of the CSF is performed to detect the presence of

A

Neurosyphilis

148
Q

Procedure recommended by the CDC to diagnose neurosyphilis

A

Venereal Disease Research Laboratories (VDRL)

CLINICAL MICROSCOPY (20 decks)

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