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Analysis of Urine and Other Body Fluids > Chapter 12 - Cerebrospinal Fluid > Flashcards

Chapter 12 - Cerebrospinal Fluid Flashcards

1
Q

CSF is considered as the ____ major body fluid

A. 1st
B. 2nd
C. 3rd
D. 4th

A

C. 3rd

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2
Q

Fxns of CSF

A

supply nutrients, remove metabolic waste, mechanical barrier to cushion the brain & spinal cord againts trauma

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3
Q

Lines the brain& spinal cord

A

Meninges

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4
Q

3 layers of meninges

A

Dura mater, arachnoid mater, pia mater

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5
Q

Outer layer, lines the skull & vertebral canal

A

Dura mater

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6
Q

Spiderweb-like, filamentous inner membrane

A

Arachnoid mater

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7
Q

Below arachnoid, portion where CSF flows

A

Subarachnoid space

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8
Q

Innermost layer, lines the surface of brain & spinal cord

A

Pia mater

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9
Q

Can albumin pass through the BBB?

A

Yes

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10
Q

Can IgM pass through BBB?

A

No

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11
Q

Can WBCs pass through the BBB?

A

No

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12
Q

Produces CSF by selective filtration

A

Choroid plexus

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13
Q

Rate of CSF production by the choroid plexus

A

20 mL/hr

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14
Q

Reabsorbs CSF

A

Arachnoid villi

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15
Q

Protects brain from chemicals & other substances circulating in the blood that can harm the brain tissue

A

Blood Brain Barrier

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16
Q

Up to _____ (how much) CSF can be collected as spx?

A

20 mL

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17
Q

Tube 1 of CSF spx is used for ____ tests and stored at _____

A

Chem/sero, freezer

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18
Q

Tube 3 CSF spx is used for ____ tests and stored at ____

A

Hema, ref

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19
Q

Tube 2 of CSF spx is used for ____ tests, and stored at ____

A

Microbio, room temp

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20
Q

Tube 4 of CSF spx is used for _____, and stored at ____

A

Microbio or sero, depends on test

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21
Q

Which CSF spx tube is described by the ff?

  1. Usually designated for microbiology
  2. Better exclusion of skin contam or for additional tests
  3. Least likely contain cells introduced by spinal tap
  4. Least affected by blood or bacteria introduced by spinal tap
A
  1. Tube 2
  2. Tube 4
  3. Tube 3
  4. Tube 1
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22
Q

True or false: left over supernatant fluid should not be used for additional chemo or sero tests

A

False

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23
Q

True or false: excess fluid should not be discarded and should be put in ref until there is no further use to it.

A

False. Dapat sa freezer ilalagay, hindi sa ref

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24
Q

What is the correct order of tests if only 1 CSF tube was collected?

A

Micro then hema then chem/sero

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25
Q

CSF total vol in adults

A

90-150 mL

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26
Q

CSF total vol in neonates

A

10-60 mL

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27
Q

Determine the appearance of the ff conditions of CSF:

  1. Normal
  2. Inc WBCs & RBCs
  3. Inc Lipids and proteins
  4. Slight amt of oxyhemoglobin
  5. Heavy hemolysis
  6. Bilirubin
  7. Hgb degradation products
  8. Inc carotene
  9. Inc melanin
  10. Inc protein (>150 mg/dL)
  11. Traumatic tap
  12. Intracranial hemorrhage
  13. Inc microorganisms
  14. Inc rifampin
  15. Inc RBCs (>6000/uL)
A
  1. Crystal clear
  2. Hazy/turbid/milky/cloudy
  3. Hazy/turbid/milky/cloudy
  4. Xanthochromic (Pink)
  5. Xanthochromic (orange)
  6. Xanthochromic (yellow)
  7. Xanthochromic
  8. Xanthochromic
  9. Xanthochromic
  10. Xanthochromic
  11. Bloody
  12. Bloody
  13. Hazy/turbid/milky/cloudy
  14. Xanthochromic
  15. Bloody
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28
Q

Identify whether traumatic tap or intracranial hemorrhage

  1. Uneven distribution of blood on 3 tubes
  2. Supernatant is xanthochromic
  3. Presence of erythrophages
  4. Negative D-dimer
  5. Absent erythrophages
  6. Clear supernatant
  7. Positive clot formation
  8. Negative clot formation
  9. Even distribution of blood on 3 tubes
  10. Positive D-dimer
A
  1. Traumatic tap (TT)
  2. Intracranial hemorrhage (IH)
  3. IH
  4. TT
  5. TT
  6. TT
  7. TT
  8. IH
  9. IH
  10. IH
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29
Q

Csf appearance for presence of radiographic contrast media

A

Oily

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30
Q

Csf appearance for the presence of protein & clotting factors

A

Clotted

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31
Q

Csf appearance for Froin syndrome

A

Clotted

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32
Q

Csf appearance for tubercular meningitis

A

Pellicle

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33
Q

Csf appearance for blockage of CSF circulation

A

Clotted

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34
Q

Any cell count should be performed IMMEDIATELY. This is because WBCs & RBCs begin to lyse within ____ (how long), and ____% WBCs disintegrate within ____ (how long)

A

1 hr; 40%; 2 hrs

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35
Q

True or false: WBC count is not routinely performed on CSF

A

False

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36
Q

Normal values for CSF WBC ct for adults

A

0-5 wbcs / uL

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37
Q

Normal values for CSF WBC ct for neonates

A

0-30 WBC/uL

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38
Q

CSF dilution for WBC ct:

  1. Clear
  2. Hazy
  3. Bloody/turbid
  4. Slightly cloudy
  5. Cloudy/slightly bloody
  6. Slightly hazy
A
  1. Undiluted
  2. 1:20
  3. 1:10000
  4. 1:100
  5. 1:200
  6. 1:10
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39
Q

Formula for CSF WBC ct:

A

WBC ct (/uL) = (# of cells counted x dilution) / (area x depth factor [0.1])

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40
Q

Area of each WBC square

A

1 mm^2

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41
Q

Area of each RBC square

A

0.04 mm^2

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42
Q

CSF WBC count diluting fluid

A

Acetic acid w/ methylene blue

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43
Q

RBC count is done only in cases of ____

A

Traumatic tap

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44
Q

To correct for WBC count & total protein conc:

_______ WBC for every 700 RBCs seen

A

-1

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45
Q

To correct for WBC count & total protein conc:

______ Total protein conc for every 1,200 RBCs/uL

A

-1 mg/dL

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46
Q

To correct for WBC count & total protein conc:

_____ total protein conc for every 10,000 RBCs/uL

A

-8 mg/dL

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47
Q

CSF diff count is performed on ____

A

Stained smear

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48
Q

Regarding CSF diff count, spn should be concentrated before smearing by using the ff methods:

A

Cytocentrifugation, centrifugation, sedimentation, filtration

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49
Q

Regarding cytocentri, cells are forced into a monolayer within a ____ diameter circle on the slide

A

6 mm

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50
Q

Regarding cytocentri, ______ is added to increase cell yield or recovery and to decrease cellular distortion

A

30% albumin

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51
Q

Predominant cells in CSF

A

Lympho & mono

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52
Q

Adult mono to lympho ratio

A

30:70

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53
Q

Neonates CSF normal cell value

A

Up to 80% mono

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54
Q

Abnormal condition, increased # of normal cells in the CSF

A

Pleocytosis

55
Q

Identify the type/s of cell that may be present in CSF given the ff descriptions:

  1. Multiple sclerosis
  2. Bacterial meningitis
  3. Acute leukemia
  4. Viral
  5. Metastatic carcinomas
  6. Diagnostic procedures
  7. Disseminated lymphoma
  8. Cerebral hemorrhage
  9. Contrast media
  10. RBCs in spinal fluid
  11. Fungal meningitis
A
  1. Lympho, mono, plasma cells
  2. Neutro
  3. Blast forms
  4. Lympho, mono
  5. Malignant cells
  6. Ependymal, choroidal, spindle-shaped cells
  7. Lymphoma cells
  8. Neutro
  9. Macrophage
  10. Macrophage
  11. Lympho, mono, neutro
56
Q

Normal value for adult CSF protein

A

15-45 mg/dL

57
Q

Normal value for infant CSF protein

A

150 mg/dL

58
Q

Most common cause of increased CSF protein

A

Damage to BBB

59
Q

Identify whether CSF protein is increased or decreased in the ff:

  1. CSF leakage / trauma
  2. Recent puncture
  3. Meningitis
  4. Multiple sclerosis
  5. Rapid CSF production
  6. Water intoxication
  7. Neural tissue degeneration
  8. Decreased normal protein clearance from the fluid
  9. Hemorrhage
A
  1. Dec
  2. Dec
  3. Inc
  4. Inc
  5. Dec
  6. Dec
  7. Inc
  8. Inc
  9. Inc
60
Q

Major CSF protein

A

Albumin

61
Q

2nd most prevalent CSF protein

A

Prealbumin

62
Q

2 alpha globulins found in CSF

A

Haptoglobin, ceruloplasmin

63
Q

A beta globulin, carbohydrate-deficient transferrin, found in CSF but not in serum

A

Beta2-transferrin (tau)

64
Q

How many transferrins are present in CSF

A

2 namely beta 1 and beta 2 transferrins

65
Q

Name 3 biochemical substances not normally found in CSF but normally found in serum

A

IgM, fibrinogen, lipids

66
Q

Identify whether the ff tests for total protein or protein fractions:

  1. IgG index
  2. Tubidimetric
  3. Dye-binding
  4. CSF/serum albumin index
A
  1. Protein fractions
  2. Total protein
  3. Total protein
  4. Protein fractions
67
Q

Preferred turbidimetric method that precipitates both albumin and globulins

A

3% trichloroacetic acid (tca)

68
Q

Dye used in the dye binding technique for CSF

A

Coomassie blue

69
Q

Color result for increased proteins in CSF dye binding technique

A

Dye turns from red to Blue (using Coomassie blue)

70
Q

Test used to assess the integrity of BBB

A

CSF/Serum albumin index

71
Q

In the formula:

CSF/serum albumin index = CSF albumin / serum albumin

In what unit/s should CSF albumin and serum albumin be in order to use the formula?

A

CSF albumin should be in mg/dL

Serum albumin should be in g/dL

72
Q

A turbidimetric technique that precipitates albumin only

A

3% sulfosalicylic acid (ssa)

73
Q

In the turbidimetric 3% SSA, to precipitate globulins, add _____

A

Sodium sulfate (Na2SO4)

74
Q

Normal value for csf/serum albumin index

A

<9

75
Q

Identify the qualitative interpretation of the ff csf/serum albumin index results:

  1. 20
  2. 30
  3. 105
  4. 40
  5. 9
  6. 14
  7. 16
A
  1. Mod impairment
  2. Mod impairment
  3. Complete dmg to BBB
  4. Severe impairment
  5. Slight impairment
  6. Slight impairment
  7. Moderate impairment
76
Q

Test used to assess conditions w/ IgG production w/in the CNS (e.g. multiple sclerosis)

A

IgG index

77
Q

IgG index formula

A

IgG index = (csf IgG in mg/dL / serum IgG in g/dL) / (csf albumin in mg/dL / serum albumin in g/dL)

78
Q

Normal IgG index value

A

<0.77

79
Q

An IgG index of 0.80 is indicative of?

A

IgG production within the CNS like in multiple sclerosis

80
Q

Csf electrophoresis is done to detect for ____

A

Oligoclonal bands

81
Q

In which region can you find oligoclonal bands

A

Gamma region

82
Q

Oligoclonal bands indicates?

A

Immunoglobulin production

83
Q

Csf electrophoresis is done in conjunction with ____ to ensure that banding is due to neurologic inflammation

A

Serum electrophoresis

84
Q

How many oligoclonal bands should be present in the CSF but not in serum is valuable for diagnosing?

A

2 or more

85
Q

Presence of 2 or more okiclonal bands in csf but not in serum is valuable for the diagnosis of ___

A

Multiple sclerosis

86
Q

Matching type:

A. Oligoclonal banding in csf but not in serum
B. Oligoclonal banding in serum but not in csf
C. Oligoclonal banding in serum and csf

  1. Leukemia
  2. Lymphoma
  3. Encephalitis
  4. Guillain-Barre syndrome
  5. BBB leakage
  6. HIV
  7. Neoplastic disorders
  8. Traumatic tap
  9. Persistent multiple sclerosis
  10. Viral infxn
  11. Neurosyphilis
A
  1. B
  2. B
  3. A
  4. A
  5. B
  6. C
  7. A
  8. B
  9. A
  10. B
  11. A
87
Q

Demyelinating disorder

A

MS

88
Q

Protein component of the lipid-protein complex that insulate the nerve fibers

A

MBP

89
Q

Presence of MBP in CSF indicates?

A

MS / destruction of myelin sheath

90
Q

Used to monitor the course of multiple sclerosis

A

MBP

91
Q

Which test for protein fractions is ised to detect MS

A

IgG index

92
Q

Autoantibody present in MS

A

Anti-myelin sheath autoantibody

93
Q

Spx for blood glucose (when comparing it with CSF glucose) should be drawn ____ prior to spinal tap

A

2 hrs

94
Q

Normal csf glucose value

A

60-70% of blood glucose (50-80 mg/dL)

95
Q

Determine whether glucose is inc or dec in the ff:

  1. Viral meningitis
  2. Increased plasma glucose
  3. Tubercular meningitis
  4. Fungal meningitis
  5. Bacterial meningitis
  6. Alteration in mechanism of BBB
  7. Inc use of glu by brain cells
A
  1. Normal
  2. Inc
  3. Dec
  4. Dec
  5. Dec
  6. Dec
  7. Dec
96
Q

Which csf substance is inversely proportional to glucose and a sensitive method for evaluating the effectiveness of antibiotic therapy?

A

Csf lactate

97
Q

Normal csf lactate value

A

10-22 mg/dL

98
Q

Identify whether lactate is inc or dec in the ff

  1. Bacterial meningitis
  2. Hypoxia
  3. Viral meningitis
  4. Fungal meningitis
  5. Tubercular meningitis
A
  1. Inc
  2. Inc
  3. Normal
  4. Inc
  5. Inc
99
Q

Product of ammonia and alphaketoglutarate; an indirect test for the presence of excess ammonia in the csf

A

Csf glutamine

100
Q

Normal csf glutamine value

A

8-18 mg/dL

101
Q

Csf glutamine in inc or dec in the ff conditions:

  1. Reye’s syndrome
  2. Disturbance of consciousness
A
  1. Inc

2. Inc

102
Q

Test to detect coma of unknown origin

A

Csf glutamine caused by ammonia

103
Q

Arrange the ff LDH based on highest to lowest quantity in normal serum

A

2>1>3>4>5

104
Q

Arrange the ff LDH if AMI is present in serum

A

1>2 (flipped pattern)

105
Q

Arrange the ff CSF LDH in normal csf from highest to lowest quanti

A

1>2>3>4>5

106
Q

Arrange the ff CSF LDH in a csf w/ neurological abnormalities from highest to lowest quanti

A

2 > 1

107
Q

Arrange the ff CSF LDH in a csf w/ bacterial meningitis from highest to lowest quanti

A

5>4>3>2>1

108
Q

Csf LDH isoenzymes in brain tissue

A

1 and 2

109
Q

LDH isoenzyme in lympho

A

2 and 3

110
Q

LDH isoenzyme in neutro

A

4 and 5

111
Q

CSF enzyme increased in stroke, degenerative disorders, brain tumors, viral and bacterial meningitis, seizures

A

CK

112
Q

Csf enzyme increased in intracerebral and subarachnoid hemorrhage, bacterial meningitis

A

AST

113
Q

Recommended by CDC for the detection of neurosyphilis

A

VDRL

114
Q

Sero tests for csf to detect bacterial antigen

A

Latex agglutination test and ELISA

115
Q

Detects gram-neg endotoxin in body fluids & surgical instrument

A

Limulus lysate test

116
Q

Reagent for limulus lysate test

A

Blood of horseshoe crab

117
Q

Principle of limulus lysate test: in the presence of endotoxin, the ____ will release ____

A

Amoebocytes (WBCs) ; lysate (protein)

118
Q

Positive result for limulus lysate test

A

Clumping / clot formation

119
Q

Predominant wbc isotype in bacterial meningitis

A

Neutro

120
Q

Identify wheter the ff are inc or dec during bacterial meningitis

  1. Neutro
  2. Protein
  3. Glucose
  4. Lactate
A
  1. Inc
  2. Inc
  3. Dec
  4. Inc
121
Q

Predominant wbc in viral meningitis

A

Lympho

122
Q

Identify whether inc or dec during viral meningitis

  1. Protein
  2. Glucose
  3. Lactate
A
  1. Inc
  2. Normal
  3. Normal
123
Q

Identify whether the ff are inc or dec in tubercular meningitis

  1. Protein
  2. Glucose
  3. Lactate
A
  1. Inc
  2. Dec
  3. Inc
124
Q

Predominant wbc in tubercular meningitis

A

Lympho and mono

125
Q

Predominant wbc in fungal meningitis

A

Lympho and mono

126
Q

Identify whether the ff are inc or dec in fungal meningitis

  1. Protein
  2. Glucose
  3. Lactate
A
  1. Inc
  2. Dec
  3. Inc
127
Q

Agents of viral meningitis

A

Enteroviruses (poliovirus, echovirus, coxsackievirus)

128
Q

Positive pellicle/weblike clot formation after 12-24 hr refrigeration

A

Tubercular meningitis

129
Q

Agent of tubercular meningitis

A

M. tuberculosis

130
Q

Agent of fungal meningitis

A

Cryptococcus neoformans

131
Q

Gram stain pattern assoc w/ cryptococcus neoformans

A

Classic starburst pattern in gram stain

132
Q

It is not unusual for cell counts performed in tubes ____ and ____ to check for cellular contam by puncture

A

1 and 4

133
Q

______ represent further degradation of hemosiderin granules. They are iron-free, consisting hgb and unconjugated bilirubin

A

Yellow hematoidin crystals

134
Q

______ meningitis is now commonly encountered in the clin lab

A

Cryptococcal

Analysis of Urine and Other Body Fluids (18 decks)

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