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MTAP1: AUBF > CHAPTER 10: CSF > Flashcards

CHAPTER 10: CSF Flashcards

1
Q

What are the three layers of meninges?

A

dura mater (hard mother), arachnoid (spiderweb-like), pia mater (gentle mother)

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2
Q

What is the normal volume of CSF in adults?

A

90 to 150 mL

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2
Q

CFS is produced by the?

A

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

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3
Q

It reabsorbs the circulating fluid back into the blood capillaries at a rate equal to its production

A

arachnoid granulations/villae

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3
Q

In adults, approximately ______ of fluid is produced every hour

A

20 mL

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3
Q

What is the normal volume of CSF in neonates?

A

10 to 60 mL

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4
Q

These are 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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5
Q

They act as one-way valves that respond to pressure within the central nervous system (CNS) and prevent reflux of the fluid

A

Cells of the arachnoid granulations

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6
Q

This is a very tight-fitting junctures that prevent the passage of many molecules

A

blood–brain barrier

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6
Q

CSF is routinely collected by lumbar puncture between the?

A

third, fourth, or fifth lumbar vertebra

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7
Q

This tube is used for chemical and serologic tests because these tests are least affected by blood or bacteria introduced as a result of the tap procedure

A

Tube 1

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8
Q

This tube is usually designated for the microbiology Laboratory

A

Tube 2

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9
Q

This tube is used for the cell count because it is the least likely to contain cells introduced by the spinal tap procedure

A

Tube 3

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10
Q

A fourth tube may be drawn for the _____________ to better exclude skin contamination or for additional ____________.

A

microbiology laboratory & serologic tests, respectively

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11
Q

It can be the result of an increased protein or lipid concentration, but also be indicative of infection

A

Cloudy, turbid, or milky specimen

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12
Q

If it is not possible to perform tests STAT, the CSF specimen for hematology must be?

A

refrigerated up to 4 hours

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12
Q

If it is not possible to perform tests STAT, the CSF specimen for microbiology must be?

A

remained at room temperature

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13
Q

If it is not possible to perform tests STAT, the CSF specimen for chemistry and serology must be?

A

frozen

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14
Q

A xanthochromic color due to the conversion of oxyhemoglobin to unconjugated bilirubin

A

Yellow

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15
Q

The most common cause of xanthochromia is?

A

Presence of RBC degradation products

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15
Q

It is not unusual for cell counts requested to be performed on both ______ and ______ to check for cellular contamination by the puncture

A

Tubes 1; Tube 4

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15
Q

This can be an indication of intracranial hemorrhage, but it may also be due to the puncture of a blood vessel during the spinal tap procedure

A

Grossly bloody CSF

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15
Q

A xanthochromic color due to heavy hemolysis

A

Orange

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15
Q

A xanthochromic color due to a very slight amount of oxyhemoglobin

A

Pink

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15
Q

Cells must be counted within _____________ when the specimen is maintained at room temperature.

A

1 hour of collection

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15
Q

It is a term used to describe CSF supernatant that is pink, orange, or yellow.

A

Xanthochromia

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15
Q

If only one tube can be collected, it must be tested first in?

A

microbiology

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15
Q

Other causes of xanthochromia aside from RBC degradation include:

A
  • Elevated serum bilirubin
  • Presence of the pigment
    carotene
  • Increased protein concentrations
  • Melanoma pigment
  • Bilirubin due to immature liver function
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16
Q

T/F: It is not unusual for cell counts requested to be performed on both Tubes 1 and 4 to check for cellular contamination by the puncture

A

TRUE

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16
Q

The most common factor that causes xanthochromia

A

presence of red blood cell (RBC) degradation products

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17
Q

Examination of the fluid occurs first at the _______ and also is included in the _________

A

bedside; laboratory report

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17
Q

Xanthochromia that is caused by bilirubin due to immature liver function also is seen commonly in?

A

infants, particularly premature infants

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17
Q

The appearance of the CSF is crystal clear what is its major significance?

A

Normal

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17
Q

The appearance of the CSF is hazy, turbid, milky, and cloudy what is its possible cause and major significance?

A

Cause: WBCs
Major Significance: Meningitis

Cause: Microorganisms
Major Significance: Meningitis

Cause: Protein
Major Significance: (1) Disorders affecting blood-brain barrier
(2) Production of IgG within the CNS

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18
Q

The appearance of the CSF is oily what is its possible cause?

A

Cause: Radiographic contrast media

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19
Q

The appearance of the CSF is bloody what is its possible cause and major significance?

A

Cause: RBCs
Major Significance: Hemorrhage, Traumatic tap

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19
Q

The appearance of the CSF is xanthochromic what are its possible causes and major significance? (cite at least two)

A

Cause: Hemoglobin
Major Significance: Old hemorrhage, Lysed cells from traumatic tap

Cause: Bilirubin
Major Significance: RBC degradation, Elevated serum
bilirubin level

Cause: Carotene
Major Significance: Increased serum levels

Cause: Protein
Major Significance: Disorders affecting blood-brain barrier

Cause: Melanin
Major Significance: Meningeal
melanosarcoma

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20
Q

The appearance of the CSF is clotted what are its possible causes and major significance? (cite at least one)

A

Cause: Protein
Major Significance: Disorders affecting blood–brain barrier

Cause: Clotting factors
Major Significance: Introduced by traumatic tap

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21
Q

The appearance of the CSF is pellicle what are its possible causes and major significance?

A

Cause: Protein
Major Significance: Disorders affecting blood–brain barrier

Cause: Clotting factors
Major Significance: Tubercular
meningitis

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22
Q

Blood from a _______________ will be distributed evenly throughout the three CSF specimen tubes, whereas a _____________ will leave the heaviest concentration of blood in tube 1, with amounts gradually diminishing in tubes 2 and 3.

A

cerebral hemorrhage; traumatic tap

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23
Q

Fluid collected from a traumatic tap may form clots due to the introduction of ____________ into the specimen

A

plasma fibrinogen

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23
Q

Bloody CSF caused by __________ does not contain enough fibrinogen to clot

A

intracranial hemorrhage

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24
Q

What are the conditions that cause damage to the blood-brain barrier and also cause clot formation but usually do not produce a bloody fluid

A

meningitis, Froin syndrome, and blocked CSF circulation through the subarachnoid space.

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25
Q

This is associated with tubercular meningitis and can be seen after overnight refrigeration of the fluid

A

classic web-like pellicle

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25
Q

Usually RBCs must remain in the CSF for approximately _______ before noticeable hemolysis begins

A

2 hours

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26
Q

To examine a bloody fluid for the presence of xanthochromia, the fluid should be _______ in a microhematocrit tube and the supernatant examined against a white background

A

centrifuged

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27
Q

The microscopic findings of macrophages containing ingested RBCs (erythrophagocytosis) or hemosiderin granules indicates

A

Intracranial hemorrhage

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27
Q

Detection of the fibrin degradation product D-dimer by latex agglutination immunoassay indicates __________ at a hemorrhage site

A

fibrin formation

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28
Q

Normally _____ are not present in CSF

A

RBCs

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28
Q

Any cell count should be performed immediately because ______ and _____ begin to lyse within 1 hour, and 40% of the _______ disintegrate after 2 hours.

A

WBCs (particularly granulocytes); RBCs; leukocytes

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29
Q

Specimens that cannot be analyzed immediately should be ________

A

refrigerated up to 4 hours.

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30
Q

How many WBCs in CSF does a normal adult

A

0 to 5 WBCs/µL

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30
Q

The number (WBCs in CSF) is higher in ________, and as many as 30 mononuclear cells/µL can be considered normal in _________

A

children; newborns

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31
Q

Used routinely for performing CSF cell counts

A

Neubauer counting chamber

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32
Q

This increases precision, standardization, and faster turnaround time for results

A

Automation

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32
Q

Traditionally, _____________ have not been used for performing CSF cell counts because of the instrument’s high background counts and poor reproducibility of low counts

A

Electronic cell counters

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33
Q

This may be counted undiluted, provided no overlapping of cells is seen during the microscopic examination

A

Clear specimens

33
Q

This provides better differentiation between neutrophils and mononuclear cells

A

Adding methylene blue to the diluting fluid stains the WBCs

33
Q

The standard Neubauer calculation formula:

A

Number of cells counted × dilution/ Number of cells counted × volume of 1 square = cells/µL

33
Q

This must be obtained before performing the WBC count on either diluted or undiluted specimens

A

Lysis of RBCs

34
Q

Cells are counted in the _________ squares and the ______ square on both sides of the hemocytometer

A

four corner; center

35
Q

If nondisposable counting chambers are used, they must be soaked in a bactericidal solution for at least ________ and then rinsed thoroughly with water and cleaned with ______________ after each use.

A

15 minutes; isopropyl alcohol

36
Q

Methods available for specimen concentration include

A
  • sedimentation
  • filtration
  • centrifugation
  • cytocentrifugation
37
Q

These methods are not used routinely in the clinical laboratory, although they do produce less cellular distortion

A

Sedimentation and filtration

38
Q

When the differential count is performed, how many cells should be counted, classified, and reported in terms of percentage

A

100 cells

39
Q

If the cell count is low and finding 100 cells is not possible, how do you report it?

A

report only the numbers of the cell types seen.

39
Q

The cells found in normal CSF are primarily?

A

lymphocytes and monocytes

39
Q

Adults usually have a predominance of?

A

lymphocytes to monocytes (70:30)

Whereas the ratio is essentially reversed in children

40
Q

A high CSF WBC count of which the majority of the cells are neutrophils is considered indicative of?

A

bacterial meningitis

41
Q

A CSF WBC count with a high percentage of lymphocytes and monocytes that is moderately elevated suggests meningitis of?

A

viral, tubercular, fungal, or parasitic origin.

41
Q

In addition to bacterial meningitis, increased neutrophils are seen in the early stages (1 to 2 days) of?

A

viral, fungal, tubercular,
and parasitic meningitis

42
Q

These are common in cases of viral, tubercular, and fungal meningitis

A

A mixture of lymphocytes and monocytes

43
Q

CSF is centrifuged for how many minutes?

A

5-10 minutes

44
Q

Stain used for CSF

A

Wright’s stain

45
Q

These are lost more rapidly in CSF

A

Granules

46
Q

Neutrophils associated with bacterial meningitis may contain?

A

phagocytized bacteria

47
Q

Neutrophils with pyknotic nuclei indicate?

A

degenerating cells

48
Q

Seen as a result of contamination from bone marrow during the spinal tap and is found in approximately 1% of specimens

A

Nucleated red blood cells (NRBCs)

48
Q

Capillary structures and endothelial cells may be seen after a?

A

traumatic tap

49
Q

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

A

multiple sclerosis or other degenerative neurological disorders

50
Q

An increase of these is seen in the CSF in association with parasitic infections, fungal infections (primarily Coccidioides immitis), and introduction of foreign material, including medications and shunts, into the CNS

A

Eosinophils

51
Q

Seen in cases of both asymptomatic HIV infection and AIDS.

A

Increased lymphocytes

52
Q

Its purpose in the CSF is to remove cellular debris and foreign objects, such as RBCs

A

Macrophages

52
Q

Macrophages appear within how many hours after RBCs enter the CSF?

A

within 2 to 4 hours

Macrophages are also frequently seen after repeated taps

52
Q

The finding of increased macrophages indicates?

A

previous hemorrhage

53
Q

Further degradation of the phagocytized RBCs results in the appearance of?

A

dark blue or black iron-containing hemosiderin granules

54
Q

Represent further degeneration. They are iron-free, consisting of hemoglobin and unconjugated bilirubin

A

Yellow hematoidin crystals

54
Q

These are seen most frequently after diagnostic procedures, such as pneumoencephalography, and in fluid obtained from ventricular taps or during neurosurgery

A

Nonpathologically significant cells

55
Q

These are from the epithelial lining of the choroid plexus. They are seen singularly and in clumps.

Usually nucleoli are absent, and nuclei have a uniform appearance

A

Choroidal cells

56
Q

These are from the lining of the ventricles and neural canal.

They have less defined cell membranes and frequently are seen in clusters.

A

Ependymal cells

57
Q

Represent lining cells from the arachnoid. Usually they are seen in clusters and may be seen with systemic malignancies

A

Spindle-shaped cells

58
Q

These cells in the CSF are seen frequently as a serious complication of acute leukemias. Often nucleoli are more prominent than in blood smears

A

Lymphoblasts, myeloblasts, and monoblasts

59
Q

These are seen in the CSF also and indicate dissemination from the lymphoid tissue.

They resemble large and small lymphocytes and usually appear in clusters of large, small, or mixed cells. Nuclei may appear cleaved, and prominent nucleoli are present

A

Lymphoma cells

60
Q

Primarily from malignancies in the lung, breast, renal system, and gastrointestinal system

A

Metastatic carcinoma cells of nonhematologic origin

61
Q

Cells from primary CNS tumors include:

A

astrocytomas, retinoblastomas, and medulloblastomas

62
Q

The chemical test performed most frequently on CSF is?

A

Protein determination

63
Q

T/F: Normal CSF contains a very huge amount of protein

A

FALSE. It contains a very small amount of protein

63
Q

Reference values for total CSF protein usually are

A

15 to 45 mg/dL

higher values are found in infants and people over age 40

64
Q

This makes up most of the CSF protein

A

Albumin

65
Q

The second most prevalent protein fraction in CSF

A

transthyretin (previously called prealbumin)

66
Q

The major beta globulin present

A

Transferrin

67
Q

A carbohydrate-deficient transferrin fraction seen in CSF but not in serum

A

“tau”

68
Q

The primary CSF gamma globulin

A

Immunoglobulin G (IgG)

with only a small amount of immunoglobulin A (IgA) and Immunoglobulin M (IgM)

69
Q

IgG index formula:

A

IgG index = CSF IgG (mg/dL)/serum IgG (g/dL) /
CSF albumin (mg/dL)/serum albumin (g/dL)

69
Q

These proteins are not found in normal CSF

A

Fibrinogen and beta lipoprotein

69
Q

This method has been adapted to automated instrumentation in the form of nephelometry

A

turbidity method

70
Q

Clinical Causes of Elevated CSF Protein:

A
  • Meningitis
  • Hemorrhage
  • Primary CNS tumors
  • Multiple sclerosis
  • Guillain-Barré syndrome
  • Neurosyphilis
  • Polyneuritis
  • Myxedema
  • Cushing disease
  • Connective tissue disease
  • Polyneuritis
  • Diabetes
  • Uremia
70
Q

The two techniques used most routinely for measuring total
CSF protein:

A

the principles of turbidity production and dye-binding ability

70
Q

Clinical Causes of Decreased CSF Protein:

A
  • CSF leakage/trauma
  • Recent puncture
  • Rapid CSF production
  • Water intoxication
71
Q

CSF/serum albumin index formula:

A

CSF/serum albumin index = CSF albumin (mg/dL) / Serum albumin (g/dL)

71
Q

This is used as a comparison for CSF/serum albumin index

A

IgG index

72
Q

These stimulate the immunocompetent cells in the CNS to show a higher proportion of IgG

A

Diseases, including multiple sclerosis

73
Q

CSF/serum albumin index value that represents an intact blood–brain barrier

A

9

74
Q

IgG index value that indicates IgG production within the CNS

A

values greater than 0.70

74
Q

Used to detect oligoclonal bands, which represent inflammation within the CNS

A

CSF protein electrophoresis

75
Q

Serum banding that appears in the CSF as a result of leakage at the blood-brain barrier or traumatic introduction of blood into the CSF specimen is caused by?

A

Disorders, such as leukemia, lymphoma, and viral infection

76
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 diagnosing?

A

Multiple sclerosis

76
Q

Oligoclonal banding remains positive during remission of ________ but disappears in other disorders.

A

multiple sclerosis

76
Q

Serological testing of the CSF is
performed to detect the presence of?

A

neurosyphilis

76
Q

Banding representing both systemic and neurological involvement is seen in the serum and CSF with?

A

HIV infection

77
Q

This is not recommended to diagnose neurosyphilis because it is less sensitive than the VDRL

A

rapid plasma reagin (RPR) test

77
Q

The procedure recommended by
the CDC to diagnose neurosyphilis

A

Venereal Disease Research Laboratory (VDRL)

78
Q

The use of this antibiotic in the early stages of syphilis has greatly reduced the number of neurosyphilis case

A

Penicillin

79
Q

If the FTA-ABS is used, care must be taken to prevent contamination with blood because?

A

FTA-ABS remains positive in the serum of treated cases of syphilis

80
Q

A specific method for detecting bacteria in CSF, but lacks sensitivity

A

Gram staining

81
Q

RBCs contain high concentrations of lactate, and results that are falsely elevated may be obtained on?

A

xanthochromic or hemolyzed fluid

81
Q

Can detect the cause of meninigitis with a small amount of the pathogen’s DNA

A

Nucleic acid amplification tests

82
Q

Provide a rapid method for detecting C. neoformans with a high sensitivity and specificity

A

lateral flow assay (LFA)

82
Q

Based on the amplification of regions of ribosomal RNA (rRNA) genes to detect and differentiate causative pathogens of meningitis

A

PCR assays

82
Q

Provide a rapid means for detecting and identifying microorganisms in CSF.

A

Latex agglutination and enzyme-linked immunosorbent
assay (ELISA)

83
Q

Detect the presence of C. neoformans antigen in serum and CSF provide a more sensitive method than the India ink preparation

A

Latex agglutination tests

83
Q

Performed routinely on CSF from all suspected cases of meningitis, although its value lies in detecting bacterial and fungal organisms

A

Gram stain

84
Q

Does not appear to be as sensitive to N. meningitidis as it is to the other organisms

A

bacterial antigen test (BAT)

85
Q

The normal concentration of glutamine in the CSF is?

A

8 to 18 mg/dL

85
Q

Reference CSF glucose

A

approximately 65 mg/dL

86
Q

Its presence indicates recent destruction of the myelin sheath that protects the axons of the neurons (demyelination)

A

Myelin Basic Protein (MBP)

87
Q

The course of multiple sclerosis can be monitored by measuring the amount of?

A

Myelin Basic Protein (MBP)

88
Q

Valuable aid in diagnosing and managing meningitis cases

A

CSF Lactate

89
Q

Levels greater than _______ are seen frequently with bacterial meningitis, whereas in viral meningitis, lactate levels remain lower than _______

A

35 mg/dL; 25 mg/dL

89
Q

This is not limited to meningitis and can also result from any condition that decreases oxygen flow to the tissues

A

Elevated CSF lactate

MTAP1: AUBF (17 decks)

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