LP and CSF

Question 1

how much CSF is there normally?

Answer 1

150ml

Question 2

how much CSF is produced daily?

Answer 2

500ml

Question 3

how many times is CSF replenished completely?

Answer 3

3

Question 4

which epithelial layer produces CSF?

Answer 4

choroid plexus

Question 5

what helps CSF flow around?

Answer 5

beating cilia

Question 6

where is the main production of the CSF?

Answer 6

lateral ventricles

Question 7

what structure resorbs the CSF?

in what space is this structure located?

Answer 7

arachnoid villi

sub-arachnoid space

Question 8

through what two foramens does CSF get into the sub-arachnoid space?

Answer 8

foramen of luschka & magendie

Question 9

through what structure does CSF flow in the 3rd ventricle?

through what structure does CSF flow into the 4th ventricle?

Answer 9

foramen of monro

cerebral aqueduct

Question 10

outline the flow of CSF?

-8

Answer 10

lateral ventricles
(main production)

↓

foramen of
monro

↓

3rd ventricle

↓

cerebral aqueduct

↓

4th ventricle

↓

via foramen of luschka & magendie & spinal cord opening

↓

sub-arachnoid space

↓

Arachnoid villi
(reabsoprtion)

Question 11

most common side effect after lumbar puncture?

how do you manage this se?

Answer 11

headache

analgesia + rest

Question 12

most severe se of LP?

explain mechanistically how this se can happen?

Answer 12

brainstem herniation

pt has high ICP –> LP causes big drop in ICP –> quick pressure drop can suck out brainstem

Question 13

between which vertebrae do you do the LP?

Answer 13

l4/l5

Question 14

what device is used to measure the pressure when doing LP?

Answer 14

Manometer

Question 15

route of needle in LP?

Answer 15

Skin
↓ 
SCfat
↓
back muscles
↓
supraspinous ligametnum, 
↓
ligamentum flavum
↓
sub-arachnoid space.

Question 16

what are the polymorph cells?

Answer 16

neutrophils (BEN)

Question 17

what are the mononuclear cells?

Answer 17

lymphocytes

Question 18

if pt has autoimmune disease.

what is the hallmark result seen on LP?

Answer 18

oligoclonal bands

Question 19

RBC in CSF on doing LP.

what is this a sign of?

Answer 19

trauma

Question 20

in a viral infection CSF fluid is usually what appearance?

Answer 20

clear

Question 21

in a bacterial infection CSF fluid is what appearance?

Answer 21

turbid

Question 22

in a fungal infection CSF fluid is what appearance?

Answer 22

turbid

Question 23

pt has viral infection.

which cell type increase in the CSF?

Answer 23

mononuclear (lymphocytes)

Question 24

pt has pyogenic infection.

which leukocyte type increase in the CSF?

Answer 24

Polymorphs

neutrophils

Question 25

pyogenic infection is a synonym for what microbial infection?

Answer 25

bacterial

Question 26

in which infection type does glucose decrease in CSF?

Answer 26

pyogenic (bacterial)

Question 27

in which infections does protein levels increase in CSF?

-name all if more than one

Answer 27

pyogenic
viral
fungi

Question 28

CI for an LP?

-5

Answer 28

raised idiopathic CSF
bleeding disorders
warfarin 
clopidogrel 
MSK deformities

Question 29

which ligament comes after supraspinous ligament?

Answer 29

ligamentum flavum

Question 30

which ligament precedes sub-arachnoid space?

Answer 30

ligamentum flavum

Question 31

you put needle through someone’s back.

what is the first ligament you hit?

Answer 31

supraspinous ligament

Question 32

which two medications (name them) if pt is on them means LP is contraindicated?

Answer 32

warfarin

clopidogrel

Question 33

in which infection type does protein increase a lot on LP?

Answer 33

pyogenic (bacterial)

Question 34

why does glucose decrease on LP in bacterial infection?

Answer 34

bacteria using glucose

Question 35

why does bacterial infection have very very high protein in LP?

Answer 35

so much bacteria you just end up measuring the bacteria’s protein