Lumbar Puncture

Question 1

Lumbar puncture- needle into the _________ space

Answer 1

subarachnoid space

Question 2

The ___________ is the space in the canal in the spinal column that carries CSF between the brain and the spinal cord

Answer 2

subarachnoid space

Question 3

The spinal column is made up of ____ vertebrae

Answer 3

33

Question 4

The sacrum has ___ small fused vertebrae

Answer 4

5

Question 5

there are ____ coccygeal vertebrae

Answer 5

4

Question 6

The doctor measures the pressure during a lumbar puncture using a special tube called a ___________

Answer 6

manometer

Question 7

LP should ideally only be performed after a __________ exam

Answer 7

neurological

Question 8

Indications for performing CT before LP

Answer 8

older than 60
immunocompromised
known CNS lesions

Question 9

Indication for LP

Answer 9

seizure within 1 week of presentation
abnormal level of consciousness
focal findings on neurological exam

Question 10

Sites of LP

Answer 10

L2-L3
L3-L4
L4-L5
whichever is largest

Question 11

The LP needle should be at a _____________ angle, directing it towards the __________

Answer 11

cephalad angle

towards the umbilicus

Question 12

Normal opening pressure

Question 13

Normal neutrophils

Answer 13

0-6%

Question 14

normal lymphocytes

Answer 14

40-80%

Question 15

Normal monocytes

Answer 15

15-45%

Question 16

Normal protein

Answer 16

15-45

Question 17

Normal glucose

Answer 17

50-75 or 60-70% blood glucose level

Question 18

Bacterial meningitis, tubercular meningitis, cerebral abscess, subarachnoid bleeding, tumor

Answer 18

neutrophils

Question 19

viral, tubercular, fungal, syphilitic meningitis, MS, GB syndrome

Answer 19

lymphocytes

Question 20

Parasitic meningitis, allergic reaction to radiopaque dyes

Answer 20

Eosinophils

Question 21

tubercular, fungal meningitis, hemorrhage, brain infarction

Answer 21

macrophages

Question 22

Diseases directly affecting brain or spinal cord such as CVA is associated with _____ levels

Answer 22

LDH

Question 23

Traumatic tap blood will _____

Answer 23

clot

Question 24

Clear, cloudy, purulent 
elevated opening pressure 
WBC >100
low glucose
elevated protein

Answer 24

bacterial meningitis

Question 25

WBC 10-1000 glucose >60% blood glucose elevated protein

Answer 25

aseptic viral meningitis

Question 26

``` Clear/cloudy elevated opening pressure WBC 10-500 low glucose elevated protein ```

Answer 26

fungal meningitis

Question 27

``` Clear or opaque elevated pressure WBC 50-500 low glucose elevated protein ```

Answer 27

tuberculosis

Question 28

``` Xanthochromia, bloody or clear elevated pressure 1 additional WBC per 1000 RBC normal glucose elevated protein ```

Answer 28

subarachnoid hemorrhage

Question 29

WBC 0-20 normal glucose mildly elevated protein

Answer 29

MS

Question 30

clear or xanthochromia | everything else normal

Answer 30

Guillian barre syndrome