CSF and Other Bodily Fluids

Question 1

Development of ascites in a patient with liver cirrhosis
can be explained by which of the following mechanisms?
a. Decreased lymphatic resorption
b. Decreased plasma oncotic pressure
c. Increased capillary permeability
d. Decreased hydrostatic pressure

Answer 1

b. Decreased plasma oncotic pressure
| IN CIRRHOSIS, IN WHICH INCREASED RESISTANCE TO
BLOOD FLOW IN THE SINUSOIDS CAUSES PORTAL
HYPERTENSION, THE COMBINED EFFECT OF ELEVATED
HYDROSTATIC PRESSURE IN THE PORTAL SYSTEM AND
LOW COLLOID OSMOTIC PRESSURE RESULTS IN ASCITES,
A FREQUENT FINDING IN CIRRHOSIS.

Question 2

A patient diagnosed with an autoimmune disease was
admitted due to difficulty of breathing associated with
chest pain. Ancillary procedures were done including
chest- x-ray that revealed pericardial effusion. For further
evaluation, which of the following immunologic tests
should be requested after performing
pericardiocentesis?
a. Glucose
b. LD
c. ANA
d. CEA

Answer 2

c. ANA
| LAB STUDIES IN SUSPECTED PERICARDIAL EFFUSION:
RHEUMATOID FACTOR, IMMUNOGLOBULIN COMPLEXES,
ANTINUCLEAR ANTIBODY TEST (ANA), AND
COMPLEMENT LEVELS (WHICH WOULD BE DIMINISHED) -
IN SUSPECTED RHEUMATOLOGIC CAUSES

Question 3

A CSF total protein level of less than 20 mg/dL normally
occurs in patients with conditions associated with
increased CSF turnover. These conditions include the
following, except:
a. Hypothyroidism
b. Removal of large CSF volumes
c. Increased intracranial pressure due to
increased rate of protein resorption by the
arachnoid villi
d. CSF leaks induced by trauma or lumbar
puncture

Answer 3

a. Hypothyroidism
| INCREASED CSF TURNOVER CONDITIONS:
1. REMOVAL OF LARGE CSF VOLUMES
2. CSF LEAKS INDUCED BY TRAUMA OR LUMBAR
PUNCTURE
3. INCREASED ICP, PROBABLY DUE TO AN INCREASED
RATE OF
PROTEIN RESORPTION BY THE ARACHNOID VILLI
4. HYPERTHYROIDISM

Question 4

The CSF specimen is usually divided into three serially collected sterile tubes. Tube #1 is used for which of the following?

a. Microbiological examination
b. Cell count and differential
c. Cytology
d. Chemistry and immunology studies

Answer 4

d. Chemistry and immunology studies

THE CSF SPECIMEN IS USUALLY DIVIDED INTO THREE SERIALLY COLLECTED STERILE TUBES:
TUBE 1 FOR CHEMISTRY AND IMMUNOLOGY STUDIES ;
TUBE 2 FOR MICROBIOLOGICAL EXAMINATION;
AND TUBE 3 FOR CELL COUNT AND DIFFERENTIAL. AN ADDITIONAL TUBE MAY BE INSERTED IN THE NO. 3 POSITION FOR CYTOLOGY IF A MALIGNANCY I S SUSPECTED.

Question 5

Which of the following is the main reason why container
number 1 in CSF evaluation should never be used for
microbiology evaluation parameters?
a. It is strictly used for total cell count
b. It is usually contaminated with RBC due to
traumatic tap
c. It is only to be used for cytologic examination
for malignancy
d. It may be contaminated with skin bacteria

Answer 5

d. It may be contaminated with skin bacteria

Question 6

In CSF evaluation of an adult patient, the necessity for a
simultaneous serum glucose should be considered, and
this is best obtained within how many hours before
lumbar puncture because of the delay in serum-CSF
equilibrium?
a. 6 to 8 hours
b. 2 to 4 hours
c. 12 hours
d. 24 hours

Answer 6

b. 2 to 4 hours
| THE SAMPLE SITE (E.G., LUMBAR, CISTERNAL) SHOULD BE
NOTED BECAUSE CYTOLOGIC AND CHEMICAL
PARAMETERS VARY AT DIFFERENT SITES. THE NECESSITY
FOR A SIMULTANEOUS SERUM GLUCOSE SHOULD ALSO
BE CONSIDERED. THIS IS BEST OBTAINED 2 TO 4 HOURS
BEFORE LUMBAR PUNCTURE BECAUSE OF THE DELAY IN
SERUM-CSF EQUILIBRIUM.

Question 7

In the gross examination of CSF, clot formation may be present in patients with the following conditions / disorders, except:

a. Obstruction of the thoracic duct due to
granuloma
b. Complete spinal block (Froin’s syndrome)
c. Tuberculous meningitis
d. Suppurative meningitis

Answer 7

a. Obstruction of the thoracic duct due to
granuloma

CLOT FORMATION MAY BE PRESENT IN PATIENTS WITH TRAUMATIC TAPS, COMPLETE SPINAL BLOCK (FROIN SYNDROME), OR SUPPURATIVE OR TUBERCULOUS MENINGITIS. IT IS NOT USUALLY SEEN IN PATIENTS WITH SUBARACHNOID HEMORRHAGE. FINE SURFACE PELLICLES MAY BE OBSERVED AFTER REFRIGERATION FOR 12 TO 24 HOURS. CLOTS MAY INTERFERE WITH CELL COUNT ACCURACY BY ENTRAPPING INFLAMMATORY CELLS AND/OR BY INTERFERING WITH AUTOMATED INSTRUMENT COUNTING.

Question 8

Which of the following is the most common abnormality encountered in the cerebrospinal fluid?
a. Sodium electrolyte
b. Ammonia
c. Glucose
d. Protein

Answer 8

d. Protein

TOTAL PROTEINS: IT IS THE MOST COMMON ABNORMALITY FOUND IN CSF. AN INCREASED CSF PROTEIN SERVES AS A USEFUL, ALBEIT NONSPECIFIC, INDICATOR OF MENINGEAL OR CNS DISEASE.

Question 9

In the process of collecting CSF at the lumbar area, what
is the normal opening pressure for an adult in a lateral
decubitus position with the legs and neck in a neutral
position?
a. 275 - 325 mm H2O
b. 200 – 250 mm H2O
c. 20 - 80 mm H2O
d. 90 – 180 mm H2O

Answer 9

d. 90 – 180 mm H2O
| THE NORMAL OPENING ADULT PRESSURE IS 90 TO 180
MM OF WATER IN THE LATERAL DECUBITUS POSITION
WITH THE LEGS AND NECK IN A NEUTRAL POSITION.

Question 10

An unknown patient who is severely malnourished was brought to the ER was pronounced dead-on-arrival. Medico-legal request for autopsy was performed and revealed approximately 500 mL of peritoneal chylous effusion. The following conditions are considered as causes of this type of fluid accumulation, except:

a. Ruptured gall bladder
b. Obstruction to the thoracic duct due parasitic infection
c. Damage to the thoracic duct due to tuberculosis
d. Obstruction of thoracic duct due to trauma

Answer 10

a. Ruptured gall bladder

EXTREMELY RARE CHYLOUS EFFUSIONS SEEN IN ASSOCIATION WITH RA, SLE, FILARIASIS, PANCREATITIS, AND TRAUMA, DAMAGE TO OR OBSTRUCTION OF THORACIC DUCT (E.G., TRAUMA, LYMPHOMA, CARCINOMA, TUBERCULOSIS, AND OTHER GRANULOMAS [E.G., SARCOIDOSIS, HISTOPLASMOSIS ], PARASITIC
INFESTATION)