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
2
Q
Fxns of CSF
A
supply nutrients, remove metabolic waste, mechanical barrier to cushion the brain & spinal cord againts trauma
3
Q
Lines the brain& spinal cord
A
Meninges
4
Q
3 layers of meninges
A
Dura mater, arachnoid mater, pia mater
5
Q
Outer layer, lines the skull & vertebral canal
A
Dura mater
6
Q
Spiderweb-like, filamentous inner membrane
A
Arachnoid mater
7
Q
Below arachnoid, portion where CSF flows
A
Subarachnoid space
8
Q
Innermost layer, lines the surface of brain & spinal cord
A
Pia mater
9
Q
Can albumin pass through the BBB?
A
Yes
10
Q
Can IgM pass through BBB?
A
No
11
Q
Can WBCs pass through the BBB?
A
No
12
Q
Produces CSF by selective filtration
A
Choroid plexus
13
Q
Rate of CSF production by the choroid plexus
A
20 mL/hr
14
Q
Reabsorbs CSF
A
Arachnoid villi
15
Q
Protects brain from chemicals & other substances circulating in the blood that can harm the brain tissue
A
Blood Brain Barrier
16
Q
Up to _____ (how much) CSF can be collected as spx?
A
20 mL
17
Q
Tube 1 of CSF spx is used for ____ tests and stored at _____
A
Chem/sero, freezer
18
Q
Tube 3 CSF spx is used for ____ tests and stored at ____
A
Hema, ref
19
Q
Tube 2 of CSF spx is used for ____ tests, and stored at ____
A
Microbio, room temp
20
Q
Tube 4 of CSF spx is used for _____, and stored at ____
A
Microbio or sero, depends on test
21
Q
Which CSF spx tube is described by the ff?
- Usually designated for microbiology
- Better exclusion of skin contam or for additional tests
- Least likely contain cells introduced by spinal tap
- Least affected by blood or bacteria introduced by spinal tap
A
- Tube 2
- Tube 4
- Tube 3
- Tube 1
22
Q
True or false: left over supernatant fluid should not be used for additional chemo or sero tests
A
False
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
24
Q
What is the correct order of tests if only 1 CSF tube was collected?
A
Micro then hema then chem/sero
25
CSF total vol in adults
90-150 mL
26
CSF total vol in neonates
10-60 mL
27
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)
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
28
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
1. Traumatic tap (TT)
2. Intracranial hemorrhage (IH)
3. IH
4. TT
5. TT
6. TT
7. TT
8. IH
9. IH
10. IH
29
Csf appearance for presence of radiographic contrast media
Oily
30
Csf appearance for the presence of protein & clotting factors
Clotted
31
Csf appearance for Froin syndrome
Clotted
32
Csf appearance for tubercular meningitis
Pellicle
33
Csf appearance for blockage of CSF circulation
Clotted
34
Any cell count should be performed IMMEDIATELY. This is because WBCs & RBCs begin to lyse within ____ (how long), and ____% WBCs disintegrate within ____ (how long)
1 hr; 40%; 2 hrs
35
True or false: WBC count is not routinely performed on CSF
False
36
Normal values for CSF WBC ct for adults
0-5 wbcs / uL
37
Normal values for CSF WBC ct for neonates
0-30 WBC/uL
38
CSF dilution for WBC ct:
1. Clear
2. Hazy
3. Bloody/turbid
4. Slightly cloudy
5. Cloudy/slightly bloody
6. Slightly hazy
1. Undiluted
2. 1:20
3. 1:10000
4. 1:100
5. 1:200
6. 1:10
39
Formula for CSF WBC ct:
WBC ct (/uL) = (# of cells counted x dilution) / (area x depth factor [0.1])
40
Area of each WBC square
1 mm^2
41
Area of each RBC square
0.04 mm^2
42
CSF WBC count diluting fluid
Acetic acid w/ methylene blue
43
RBC count is done only in cases of ____
Traumatic tap
44
To correct for WBC count & total protein conc:
_______ WBC for every 700 RBCs seen
-1
45
To correct for WBC count & total protein conc:
______ Total protein conc for every 1,200 RBCs/uL
-1 mg/dL
46
To correct for WBC count & total protein conc:
_____ total protein conc for every 10,000 RBCs/uL
-8 mg/dL
47
CSF diff count is performed on ____
Stained smear
48
Regarding CSF diff count, spn should be concentrated before smearing by using the ff methods:
Cytocentrifugation, centrifugation, sedimentation, filtration
49
Regarding cytocentri, cells are forced into a monolayer within a ____ diameter circle on the slide
6 mm
50
Regarding cytocentri, ______ is added to increase cell yield or recovery and to decrease cellular distortion
30% albumin
51
Predominant cells in CSF
Lympho & mono
52
Adult mono to lympho ratio
30:70
53
Neonates CSF normal cell value
Up to 80% mono
54
Abnormal condition, increased # of normal cells in the CSF
Pleocytosis
55
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
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
Normal value for adult CSF protein
15-45 mg/dL
57
Normal value for infant CSF protein
150 mg/dL
58
Most common cause of increased CSF protein
Damage to BBB
59
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
1. Dec
2. Dec
3. Inc
4. Inc
5. Dec
6. Dec
7. Inc
8. Inc
9. Inc
60
Major CSF protein
Albumin
61
2nd most prevalent CSF protein
Prealbumin
62
2 alpha globulins found in CSF
Haptoglobin, ceruloplasmin
63
A beta globulin, carbohydrate-deficient transferrin, found in CSF but not in serum
Beta2-transferrin (tau)
64
How many transferrins are present in CSF
2 namely beta 1 and beta 2 transferrins
65
Name 3 biochemical substances not normally found in CSF but normally found in serum
IgM, fibrinogen, lipids
66
Identify whether the ff tests for total protein or protein fractions:
1. IgG index
2. Tubidimetric
3. Dye-binding
4. CSF/serum albumin index
1. Protein fractions
2. Total protein
3. Total protein
4. Protein fractions
67
Preferred turbidimetric method that precipitates both albumin and globulins
3% trichloroacetic acid (tca)
68
Dye used in the dye binding technique for CSF
Coomassie blue
69
Color result for increased proteins in CSF dye binding technique
Dye turns from red to Blue (using Coomassie blue)
70
Test used to assess the integrity of BBB
CSF/Serum albumin index
71
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?
CSF albumin should be in mg/dL
| Serum albumin should be in g/dL
72
A turbidimetric technique that precipitates albumin only
3% sulfosalicylic acid (ssa)
73
In the turbidimetric 3% SSA, to precipitate globulins, add _____
Sodium sulfate (Na2SO4)
74
Normal value for csf/serum albumin index
<9
75
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
1. Mod impairment
2. Mod impairment
3. Complete dmg to BBB
4. Severe impairment
5. Slight impairment
6. Slight impairment
7. Moderate impairment
76
Test used to assess conditions w/ IgG production w/in the CNS (e.g. multiple sclerosis)
IgG index
77
IgG index formula
IgG index = (csf IgG in mg/dL / serum IgG in g/dL) / (csf albumin in mg/dL / serum albumin in g/dL)
78
Normal IgG index value
<0.77
79
An IgG index of 0.80 is indicative of?
IgG production within the CNS like in multiple sclerosis
80
Csf electrophoresis is done to detect for ____
Oligoclonal bands
81
In which region can you find oligoclonal bands
Gamma region
82
Oligoclonal bands indicates?
Immunoglobulin production
83
Csf electrophoresis is done in conjunction with ____ to ensure that banding is due to neurologic inflammation
Serum electrophoresis
84
How many oligoclonal bands should be present in the CSF but not in serum is valuable for diagnosing?
2 or more
85
Presence of 2 or more okiclonal bands in csf but not in serum is valuable for the diagnosis of ___
Multiple sclerosis
86
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
1. B
2. B
3. A
4. A
5. B
6. C
7. A
8. B
9. A
10. B
11. A
87
Demyelinating disorder
MS
88
Protein component of the lipid-protein complex that insulate the nerve fibers
MBP
89
Presence of MBP in CSF indicates?
MS / destruction of myelin sheath
90
Used to monitor the course of multiple sclerosis
MBP
91
Which test for protein fractions is ised to detect MS
IgG index
92
Autoantibody present in MS
Anti-myelin sheath autoantibody
93
Spx for blood glucose (when comparing it with CSF glucose) should be drawn ____ prior to spinal tap
2 hrs
94
Normal csf glucose value
60-70% of blood glucose (50-80 mg/dL)
95
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
1. Normal
2. Inc
3. Dec
4. Dec
5. Dec
6. Dec
7. Dec
96
Which csf substance is inversely proportional to glucose and a sensitive method for evaluating the effectiveness of antibiotic therapy?
Csf lactate
97
Normal csf lactate value
10-22 mg/dL
98
Identify whether lactate is inc or dec in the ff
1. Bacterial meningitis
2. Hypoxia
3. Viral meningitis
4. Fungal meningitis
5. Tubercular meningitis
1. Inc
2. Inc
3. Normal
4. Inc
5. Inc
99
Product of ammonia and alphaketoglutarate; an indirect test for the presence of excess ammonia in the csf
Csf glutamine
100
Normal csf glutamine value
8-18 mg/dL
101
Csf glutamine in inc or dec in the ff conditions:
1. Reye’s syndrome
2. Disturbance of consciousness
1. Inc
| 2. Inc
102
Test to detect coma of unknown origin
Csf glutamine caused by ammonia
103
Arrange the ff LDH based on highest to lowest quantity in normal serum
2>1>3>4>5
104
Arrange the ff LDH if AMI is present in serum
1>2 (flipped pattern)
105
Arrange the ff CSF LDH in normal csf from highest to lowest quanti
1>2>3>4>5
106
Arrange the ff CSF LDH in a csf w/ neurological abnormalities from highest to lowest quanti
2 > 1
107
Arrange the ff CSF LDH in a csf w/ bacterial meningitis from highest to lowest quanti
5>4>3>2>1
108
Csf LDH isoenzymes in brain tissue
1 and 2
109
LDH isoenzyme in lympho
2 and 3
110
LDH isoenzyme in neutro
4 and 5
111
CSF enzyme increased in stroke, degenerative disorders, brain tumors, viral and bacterial meningitis, seizures
CK
112
Csf enzyme increased in intracerebral and subarachnoid hemorrhage, bacterial meningitis
AST
113
Recommended by CDC for the detection of neurosyphilis
VDRL
114
Sero tests for csf to detect bacterial antigen
Latex agglutination test and ELISA
115
Detects gram-neg endotoxin in body fluids & surgical instrument
Limulus lysate test
116
Reagent for limulus lysate test
Blood of horseshoe crab
117
Principle of limulus lysate test: in the presence of endotoxin, the ____ will release ____
Amoebocytes (WBCs) ; lysate (protein)
118
Positive result for limulus lysate test
Clumping / clot formation
119
Predominant wbc isotype in bacterial meningitis
Neutro
120
Identify wheter the ff are inc or dec during bacterial meningitis
1. Neutro
2. Protein
3. Glucose
4. Lactate
1. Inc
2. Inc
3. Dec
4. Inc
121
Predominant wbc in viral meningitis
Lympho
122
Identify whether inc or dec during viral meningitis
1. Protein
2. Glucose
3. Lactate
1. Inc
2. Normal
3. Normal
123
Identify whether the ff are inc or dec in tubercular meningitis
1. Protein
2. Glucose
3. Lactate
1. Inc
2. Dec
3. Inc
124
Predominant wbc in tubercular meningitis
Lympho and mono
125
Predominant wbc in fungal meningitis
Lympho and mono
126
Identify whether the ff are inc or dec in fungal meningitis
1. Protein
2. Glucose
3. Lactate
1. Inc
2. Dec
3. Inc
127
Agents of viral meningitis
Enteroviruses (poliovirus, echovirus, coxsackievirus)
128
Positive pellicle/weblike clot formation after 12-24 hr refrigeration
Tubercular meningitis
129
Agent of tubercular meningitis
M. tuberculosis
130
Agent of fungal meningitis
Cryptococcus neoformans
131
Gram stain pattern assoc w/ cryptococcus neoformans
Classic starburst pattern in gram stain
132
It is not unusual for cell counts performed in tubes ____ and ____ to check for cellular contam by puncture
1 and 4
133
______ represent further degradation of hemosiderin granules. They are iron-free, consisting hgb and unconjugated bilirubin
Yellow hematoidin crystals
134
______ meningitis is now commonly encountered in the clin lab
Cryptococcal
