HARR (CSF-SER-SYN) Flashcards
1
Q
1. Cerebrospinal fluid (CSF) is formed by ultrafiltration of plasma through the: A. Choroid plexus B. Sagittal sinus C. Anterior cerebral lymphatics D. Arachnoid membrane
A
A
2
Q
- Which statement regarding CSF is true?
A. Normal values for mononuclear cells are higher
for infants than adults
B. Absolute neutrophilia is not significant if the
total WBC count is less than 25/μL
C. The first aliquot of CSF should be sent to the
microbiology laboratory
D. Neutrophils compose the majority of WBCs in
normal CSF
A
A
3
Q
- When collecting CSF, a difference between
opening and closing fluid pressure greater than
100 mm H2O indicates:
A. Low CSF volume
B. Subarachnoid hemorrhage
C. Meningitis
D. Hydrocephalus
A
A
4
Q
- Which of the following findings is consistent
with a subarachnoid hemorrhage rather than a
traumatic tap?
A. Clearing of the fluid as it is aspirated
B. A clear supernatant after centrifugation
C. Xanthochromia
D. Presence of a clot in the sample
A
C
5
Q
5. The term used to denote a high WBC count in the CSF is: A. Empyema B. Neutrophilia C. Pleocytosis D. Hyperglycorrhachia
A
C
6
Q
- Which of the adult CSF values in the following
table are consistent with bacterial meningitis?
A. WBC: 50/uL; LYM: 44%; MON: 55%; EO: 0%; NEU: 0%; NED cells: 1%
B. WBC: 300/uL; LYM: 75%; MON: 21%; EO: 3%; NEU: 0%; NED cells: 1%
C. WBC: 2,000/uL; LYM: 5%; MON: 15%; EO: 0%; NEU: 80%; NED cells: 0%
D. WBC: 2,500/uL; LYM: 40%; MON: 50%; EO: 0%; NEU: 10%; NED cells: 0%
A
C
7
Q
- Given the following data, determine the corrected
CSF WBC count.
CSF RBC: 6,000/uL
PBS RBC: 4.0x10^6/uL
CSF WBC: 150/uL
PBS WBC: 5.0x10^3/uL
A. 8 WBC/μL
B. 142 WBC/μL
C. 120 WBC/μL
D. 145 WBC/μL
A
B
8
Q
- SITUATION: What is the most likely cause of the
following CSF results?
CSF glucose: 20mg/dL
CSF protein: 200mg/dL
CSF lactate: 50mg/dL (NV: 5-25mg/dL)
A. Viral meningitis
B. Viral encephalitis
C. Cryptococcal meningitis
D. Acute bacterial meningitis
A
D
9
Q
- Which of the following conditions is most often
associated with normal CSF glucose and protein?
A. Multiple sclerosis
B. Malignancy
C. Subarachnoid hemorrhage
D. Viral meningitis
A
D
10
Q
- The diagnosis of multiple sclerosis is often based
upon which finding?
A. The presence of elevated protein and low glucose
B. A decreased IgG index
C. The presence of oligoclonal bands by
electrophoresis
D. An increased level of CSF β microglobulin
A
C
11
Q
11. Which of the following results is consistent with fungal meningitis? A. Normal CSF glucose B. Pleocytosis of mixed cellularity C. Normal CSF protein D. High CSF lactate
A
B
12
Q
12. In what suspected condition should a wet prep using a warm slide be examined? A. Cryptococcal meningitis B. Amoebic meningoencephalitis C. Mycobacterium tuberculosis infection D. Neurosyphilis
A
B
13
Q
- Which of the following CSF test results is most
commonly increased in patients with multiple
sclerosis?
A. Glutamine
B. Lactate
C. IgG index
D. Ammonia
A
C
14
Q
- Which of the following is an inappropriate
procedure for performing routine CSF analysis?
A. A differential is done only if the total WBC
count is greater than 10/μL
B. A differential should be done on a stained CSF
concentrate
C. A minimum of 30 WBCs should be differentiated
D. A Wright’s-stained slide should be examined
rather than a chamber differential
A
A
15
Q
- Which cell is present in the CSF in greater
numbers in newborns than in older children
or adults?
A. Eosinophils
B. Lymphocytes
C. Monocytes
D. Neutrophils
A
C
16
Q
16. Neutrophilic pleocytosis is usually associated with all of the following except: A. Cerebral infarction B. Malignancy C. Myelography D. Neurosyphilis
A
D
17
Q
- Which statement about CSF protein is true?
A. An abnormal serum protein electrophoretic
pattern does not affect the CSF pattern
B. The upper reference limit for CSF total protein
in newborns is one-half adult levels
C. CSF IgG is increased in panencephalitis,
malignancy, and neurosyphilis
D. Antibodies to Treponema pallidum disappear
after successful antibiotic therapy
A
C
18
Q
- Which of the following statements regarding
routine microbiological examination of CSF
is true?
A. A Gram stain is performed on the CSF prior to
concentration
B. The Gram stain is positive in fewer than 40% of
cases of acute bacterial meningitis
C. India ink and acid fast stains are indicated if
neutrophilic pleocytosis is present
D. All CSF specimens should be cultured using
sheep blood agar, chocolate agar, and
supplemented broth
A
D
19
Q
19. Which organism is the most frequent cause of bacterial meningitis in neonates? A. Neisseria meningitidis B. Group B Streptococcus C. Streptococcus pneumoniae D. Klebsiella pneumoniae
A
B
20
Q
- Following a head injury, which protein will
identify the presence of CSF leakage through
the nose?
A. Transthyretin
B. Myelin basic protein
C. Tau protein
D. C-reactive protein
A
C
21
Q
- Which of the following statements regarding
serous fluids is true?
A. The normal volume of pleural fluid is 30–50 mL
B. Mesothelial cells, PMNs, lymphocytes, and
macrophages may be present in normal fluids
C. X-ray can detect a 10% increase in the volume
of a serous fluid
D. Normal serous fluids are colorless
A
B
22
Q
22. The term effusion refers to: A. A chest fluid that is purulent B. A serous fluid that is chylous C. An increased volume of serous fluid D. An inflammatory process affecting the appearance of a serous fluid
A
C
23
Q
- Which of the following laboratory results is
characteristic of a transudative fluid?
A. SG = 1.018
B. Total protein = 3.2 g/dL
C. LD fluid/serum ratio = 0.25
D. Total protein fluid/serum ratio = 0.65
A
C
24
Q
- Which observation is least useful in distinguishing
a hemorrhagic serous fluid from a traumatic tap?
A. Clearing of fluid as it is aspirated
B. Presence of xanthochromia
C. The formation of a clot
D. Diminished RBC count in successive aliquots
A
C
25
Q
- Which of the following laboratory results on a
serous fluid is most likely to be caused by a
traumatic tap?
A. An RBC count of 8,000/μL
B. A WBC count of 6,000/μL
C. A hematocrit of 35%
D. A neutrophil count of 55%
A
A
26
Q
26. Which of the following conditions is commonly associated with an exudative effusion? A. Congestive heart failure B. Malignancy C. Nephrotic syndrome D. Cirrhosis
A
B
27
Q
- Which of the following conditions is associated
with a chylous effusion?
A. Necrosis
B. Pulmonary infarction or infection
C. Systemic lupus erythematosus or rheumatoid
arthritis
D. Lymphatic obstruction
A
D
28
Q
- Which of the following conditions is most
often associated with a pleural fluid glucose
below 30 mg/dL?
A. Diabetes mellitus
B. Pancreatitis
C. RA
D. Bacterial pneumonia
A
C
29
Q
- In which condition is the pleural fluid pH likely
to be above 7.3?
A. Bacterial pneumonia with parapneumonic
exudate
B. Rheumatoid pleuritis
C. Esophageal rupture
D. Pneumothorax
A
D
30
Q
- Which of the following hematology values best
frames the upper reference limits for peritoneal
fluid?
A. WBC: 300/uL; PMNs: 25%; RBC: 100,000/uL
B. WBC: 10,000/uL; PMNs: 50%; RBC: 500,000/uL
C. WBC: 50,000/uL; PMNs: 50%; RBC: 500,000/uL
D. WBC: 100,000/uL; PMNs: 75%; RBC: 1,000,000/uL
A
A
31
Q
- Which of the following characteristics is higher for
synovial fluid than for the serous fluids?
A. SG
B. Glucose
C. Total protein
D. Viscosity
A
D
32
Q
- In which type of arthritis is the synovial WBC
count likely to be greater than 50,000/μL?
A. Septic arthritis
B. Osteoarthritis
C. RA
D. Hemorrhagic arthritis
A
A
33
Q
- What type of cell is a “ragocyte”?
A. Cartilage cell seen in inflammatory arthritis
B. A PMN with inclusions formed by immune
complexes
C. A plasma cell seen in RA
D. A macrophage containing large inclusions
A
B
34
Q
34. Which of the following crystals is the cause of gout? A. Uric acid or monosodium urate B. Calcium pyrophosphate or apatite C. Calcium oxalate D. Cholesterol
A
A
35
Q
35. Which crystal causes “pseudogout”? A. Oxalic acid B. Calcium pyrophosphate C. Calcium oxalate D. Cholesterol
A
B
36
Q
- A synovial fluid sample is examined using a
polarizing microscope with a red compensating
filter. Crystals are seen that are yellow when the
long axis of the crystal is parallel to the slow
vibrating light. When the long axis of the crystal
is perpendicular to the slow vibrating light, the
crystals appear blue. What type of crystal is
present?
A. Calcium oxalate
B. Calcium pyrophosphate
C. Uric acid
D. Cholesterol
A
C
37
Q
37. In which condition is the synovial fluid glucose most likely to be within normal limits? A. Septic arthritis B. Inflammatory arthritis C. Hemorrhagic arthritis D. Gout
A
C
38
Q
- Which statement about synovial fluid in RA
is true?
A. Synovial/serum IgG is usually 1:2 or higher
B. Total hemolytic complement is elevated
C. Ninety percent of RA cases test positive for
rheumatoid factor in synovial fluid
D. Demonstration of rheumatoid factor in joint
fluid is diagnostic for RA
A
A
39
Q
- Which of the following organisms accounts for
the majority of septic arthritis cases in young and
middle-age adults?
A. H. influenzae
B. Neisseria gonorrhoeae
C. Staphylococcus aureus
D. Borrelia burgdorferi
A
B
40
Q
- Which of the following hematology values best
frames the upper reference limits for synovial
fluid?
A. WBC: 200/uL; PMNs: 25%; RBC: 2,000/uL
B. WBC: 5,000/uL; PMNs: 50%; RBC: 10,000/uL
C. WBC: 10,000/uL; PMNs: 50%; RBC: 50,000/uL
D. WBC: 20,000/uL; PMNs: 5%; RBC: 500,000/uL
A
A
