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AUBF Finals > CSF analysis > Flashcards

CSF analysis Flashcards

1
Q

it is a major fluid of the body. CSF provides a physiologic system to supply nutrients to the nervous tissue, remove metabolic wastes, and produce a mechanical barrier to cushion the brain and spinal cord against trauma

A

Cerebrospinal fluid (CSF)

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2
Q

Enumerate the purposes of CSF examination

A

1) Evaluate the function of the Central Nervous System

2) CSF greatly indicates presence of infections, autoimmune disorders, diseases of the brain & the spinal cord (such as encephalitis, meningitis, multiple sclerosis, & hemorrhage)

3) Detects early signs of seizures & dementia

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3
Q

CSF covers what parts of the CNS?

A
  • Brain
  • Spinal cord
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4
Q

Main source of CSF; Comprises 70% of the CSF formation

A

Choroid plexus

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5
Q

Comprises 30% of the CSF formation

A

Subarachnoid space

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6
Q

Epithelial cells that lines the choroid plexus; main cells responsible for the formation of the blood- brain barrier

A

Choroidal cells

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7
Q

Regulates the movement of ions, molecules, and cells between the blood and the brain

A

Blood brain barrier

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8
Q

What are the layers of the brain (meninges)?

A
  • Dura mater
  • Arachnoid space
  • Pia mater
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9
Q

what are the three (3) types of epithelial cells?

A
  • Ependymal cells
  • Choroidal cells
  • Pia Arachnoid Mesothelial cells (PAM)
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10
Q

*Cells that lines the cerebral ventricles & neural canals of the spinal cord
*Range in shape from squamous to columnar
*May be ciliated

A

Ependymal cells

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11
Q

these cells lines the mesoderm of the pia & arachnoid layers

A

Pia Arachnoid Mesothelial cells (PAM)

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12
Q

what are the CSF ion components?

A
  • H, K, Ca, bicarbonate and, Mg
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13
Q

T or F: Glucose, urea and creatinine diffuse freely and require 2 or more hours to regulate

A

True

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14
Q

How many CSF is produced each day?

A

500 mL (0.3 - 0.4 mL/min)

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15
Q

Volume of CSF in adults?

A
  • 90 - 150 mL
  • 25 mL in the ventricles and subarachnoid space
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16
Q

Volume of CSF in neonates?

A

10 to 60 mL

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17
Q

How many hours does CSF is replaced?

A

every 5 to 7 hours

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18
Q

Common site for lumbar puncture is the intervertebral space
Adult:
Children:

A
  • between L3 and L4
  • between L4 and L5
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19
Q

CSF obtained through what procedure?

A

cisternal or lumbar puncture through ventricular cannulas or shunts

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20
Q

Normal opening pressures
adults:
obese:
infants & children:

A
  • 90 to 180 mm of water
  • 250 mm of water
  • 10 to 100 mm of water (6-8 yrs)
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21
Q

greater then 250 mm of water opening pressure indicates what underlying conditions?

A
  • increased intracranial pressure which might be caused by meningitis, intracranial hemorrhage & tumors
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22
Q

what precaution should be observed when there is >200 opening pressure in a relaxed patient?

A
  • no more than 2.0 ml should be withdrawn
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23
Q

this tool indicates the pressure of the CSF fluid

A

Manometer

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24
Q

Distribution of CSF tubes
Which lab section does tube #1 belongs to and what tests are applied?

A
  • Chemistry and/or Serology section
  • protein, glucose, lactate, VDRL, latex agglutination test
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25
Q

Distribution of CSF tubes
Which lab section does tube #2 belongs to and what tests are applied?

A
  • Microbiology section
  • Gram stain, culture and India ink
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26
Q

Distribution of CSF tubes
Which lab section does tube #3 belongs to and what tests are applied?

A
  • hematology section
  • cell count and differential
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27
Q

Microbiology should be stored in what tube?

A
  • tube 2 (sterile)
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28
Q

Gross examination
Normal CSF color and appearance

A
  • Crystal clear and colorless
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29
Q

Gross examination
What are the causes for turbidity or cloudiness of CSF specimens?

A
  • WBC > 200/uL
  • RBC > 400/uL
  • Microorganisms
  • radiographic contrast media
  • aspirated epidural fat
  • proteins > 150 mg/ dL ( 1.5 g/L)
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30
Q

Gross examination
What are the causes for bloody/pink specimen

A
  • RBC > 6000/uL
  • Subarachnoid and Intracerebral hemorrhage;
  • cerebral infarct or traumatic spinal tap
31
Q

pertains to the presence of oxidized hemoglobin from lysed RBCs

A

Xanthochromia

32
Q

Give the corresponding causes for xanthochromia of CSF
pink: ________
orange : ________
________ : RBC lysis/hemoglobin breakdown
________ : Hyperbilirubinemia (biliverdin)
Brown : ________

A
  • RBC lysis
  • RBC lysis/hemoglobin breakdown
  • yellow
  • green
  • Meningeal matastatic melanoma
33
Q

*2-4 hrs after subarachnoid hemorrhage and take as long as 12 hrs, peak 24- 36 hrs and disappears on 4-8 days
*Hypervitaminosis A (carotenoids)

A

Orange xanthochromia

34
Q

*Hyperbilirubinemia; develops after 12 hrs after subarachnoid bleed, peaks 2-4 days and persists for 2-4 weeks
*CSF protein > 150 mg/dL (1.5 g/L)

A

Yellow xanthochromia

35
Q

Differentiate Hemorrhage from traumatic tap in terms of appearance, supernatant. and presence of clots

A

Hemorrhage: all tubes equally red (bloody), xanthochromic, and absent

Traumatic tap: subsequent clearing in each tube, clear, and present due to fibrinogen

36
Q

Causes for Clot formation in CSF samples

A
  • Traumatic taps
  • Complete spinal block (Froin’s syndrome)
  • Suppurative or tuberculous meningitis
37
Q

Causes for Viscous CSF samples

A
  • Metastatic mucin producing adenocarcinomas
  • Cryptococcal meningitis
  • Liquid nucleus pulposus
38
Q

T or F: Proper storage of CSF must be at room temperature and should be examined immediately

39
Q

*18 large squares (1mm^2)
*depth of 0.2 mm
*total volume of 3.6 uL
*CV = 48%

A

Fuch’s-Rosenthal chamber

40
Q

*9 squares (1mm each)
*depth of 0.1mm
*CV = 45%

A

Neubauer hemocytometer

41
Q

Yield rapid and reliable WBC and RBC counts

A

UF-100 flow cytometer

42
Q

Normal leukocyte count
adult:
neonates:

A
  • 0-5 cells/uL
  • 0-30 cells/uL
43
Q

recommended method for the differential count of all body fluids

A

cytocentrifuge

44
Q

Disadvantages in performing differential count in counting chamber

A
  • unsatisfactory because of low numbers and low precision
  • Direct smears of the centrifuged CSF sediment are also subject to significant error from cellular distortion and fragmentation
45
Q

WBC added = ?

A

leukocytes added to CSF by traumatic tap

46
Q

Stain used for CSF

A

Wright’s stain

47
Q

Lymphocyte to monocyte ratio among adults

A

70:30 ratio

48
Q

CSF examination for tumor cells has the sensitivity to:
Leukemic patients
Metastatic carcinoma
Primary CNS malignancies

A
  • 70%
  • 20-60%
  • 30%
49
Q

dark blue cytoplasm & clump chromatins; can also be seen during Multiple sclerosis

A

Reactive lymphocyte

50
Q

Presence of ___________ in CSF indicates previous hemorrhage

A

Macrophage

51
Q

1% of the plasma level
Increase proteins = pathologic conditions
Decrease proteins = fluid leakage

A

CSF Protein

52
Q

Reference value
Adults: ________
CSF protein fell rapidly from birth to 6 months of age ___________
plateaud 3-10 years __________
rose slightly from 10-16 years of age __________
Classic Lowry method __________
Trichloroacetic acid- ponceau S method ___________
Biuret method

A
  • 15-45 mg/dL
  • 118 →40 mg/dL
  • 32 mg/dL)
  • 41 mg/dL
  • 24.1- 48 mg/dL
  • 15-49 mg/dL
  • 22.3-50.3 mg/dL
53
Q

___________ makes up most of CSF protein

54
Q

___________ is the second most prevalent fraction in CSF.

A

Serum albumin

55
Q

*Seen in MS Correlate with CSF leukocyte count,
*Surrogate marker during acute MS exacerbations

A

Myelin Basic Protein

56
Q

Increased in pinocytic vesicles which reflects hemorrhage or breakdown of BBB, as occurs in bacterial meningitis

A

Alpha-2-macroglobulin (A2M)

57
Q

*Marker of neuro-Bechet’s syndrome
*HIV-1 and various malignancies have been associated

A

Beta-2-macroglobulin (B2M)

58
Q

Differentiating viral (aseptic) meningitis from bacterial meningitis

A

C-Reactive Protein

59
Q

Cell adhesion allows leukocytes to adhere and pass through the vascular endothelia and migrate to the inflammatory site

A

Fibronectin

60
Q

*present in Creutzfeldt-Jacob disease (CJD)
*Determined by immunoassay
&False (+) = stroke and meningoencephalitis

A

Protein 14-3-3

61
Q

Subarachnoid hemorrhage and intracerebral hemorrhage

A

Methemoglobin and bilirubin

62
Q

________ present in the body

________ that is only present in the CNS

A

Beta-1-transferrin
Beta-2-transferrin

63
Q

this enzyme converts Beta-1-transferrin

A

neuroaminidase

64
Q

Normal values for CSF glucose

A

50-80 mg/dL (60% plasma values)

65
Q

T or F: Results should be compared with plasma following 4 hour fast

66
Q

Normal values for CSF lactate
children & adults
newborns for the 1st 2 days of life
3 to 10 days old
tissue hypoxia

A
  • 0-26 mg/dL (1.0- 2.9 mmol/L)
  • 10-60 mg/dL
  • 10-40 mg/dL (1.1- 4.4 mmol/L)
  • Elevated levels reflect CNS anaerobic metabolism
67
Q

Normal values for CSF Lactate
Viral meningitis
Bacterial meningitis

A
  • > 25 mg/dL
  • > 35 mg/dL; cut off value 30-36 mg/dL
68
Q

Elevated levels in existing hepatic encephalopathy

A

CSF Glutamine

69
Q

synthesized from ammonia and glutamic acid serves as the means for CNS ammonia removal

A

cerebral Glutamine

70
Q

Normal values of CSF Glutamine

A

8-18 mg/dL

71
Q

Gram’s stain sensitivity ranges from __________ with greatest sensitivity corresponding to higher concentrations of bacteria

72
Q

Immunochromatographic membrane assay with Streptococcus Latex agglutination bacterial antigen on which microorganisms?

A
  • Haemophiles influenzae,
  • Neisseria meningitidis
  • Streptococcus pneumoniae
73
Q

When performing microbiological studies, CSF samples must kept at?

A

room temperature

AUBF Finals (2 decks)

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