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History And Physical Exam II > Lumbar puncture > Flashcards

Lumbar puncture Flashcards

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1
Q

What connects the spinous processes?

A

Supraspinal ligaments

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2
Q

_______ _______ is an elastic membrane covering the intralaminar space in which you must go through.

A

Ligamentum flavum

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3
Q

​ ______ _________ is composed of tough, fibrous, and elastic tissue
​Outermost covering membrane of spinal canal

A

Dura mater/dural sac

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4
Q

​________ ________ is delicate, avascular membrane, Lines dural sac Encloses CSF filled subarachnoid space containing spinal cord and nerves.

A

Arachnoid mater

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5
Q

Lumbar punctures are performed at what anatomic landmarks?

A

L3-L4 or L4-L5

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6
Q

Angle the needle towards what ?

A

The umbilicus

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7
Q

What to do if you hit bone :

A

Remove needle and try again this time more downward (caudally).

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8
Q

If there are many neutrophils in the CSF analysis, the infection is most likely

A

Bacterial

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9
Q

If there are many lymphocytes in the CSF then this could indicate :

A

VIRAL aseptic meningitis

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10
Q

Normal RBC count in CSF analysis :

A

<10

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11
Q

Traumatic Tap is ruled out by the appearance of :

A

Xanthochromia

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12
Q

Normal glucose in CSF analysis :

A

50-80 mg/dL

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13
Q

CSF glucose might be low in which conditions ?

A

Bacterial meningitis
Sarcoidosis
Syphilis
Subarachnoid hemorrhage

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14
Q

Glucose levels are variable in :

A

Viral causes

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15
Q

SERUM hyperglycemia may be masking what ?

A

It may be masking low CSF glucose. Check serum as well.

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16
Q

Normal protein CSF? What if it’s elevated?

A

15-45 mg/dL. Elevated could mean infection from either bacterial or viral origin.

17
Q

Gram stain showing gram negative diplococci :

A

N. Meningitides

18
Q

Gram negative bacilli:

A

H. flu

19
Q

Gram positive cocci:

A

Step pneumoniae, strep, or staph

20
Q

How long do cultures take ?

A

24-48 hours

21
Q

__________ is a yellow / orange discoloration of CSF fluid, is a product of RBC lysis, and is a a result of subarachnoid hemorrhage.

A

Xanthochromia

22
Q

What is the normal opening pressure in LP?

A

18-20 mmH2O

23
Q

Bacterial infection if opening pressure is what?

A

> 30

24
Q

How to get opening pressure ?

A

Patient laying on side with the stop cock valve pointing up.

25
Q

This position is called what ?

A

Lateral recumbent position

26
Q

Clinical findings associated with pseudotumor cerebri ( intercranial hypertension) :

A

Headache, papilledema, diplopia, blurry vision.

27
Q

Diagnostic indications for LP:

A

CNS infection (meningitis), inflammatory processes, suspected spontaneous subarachnoid hemorrhage, unexplained seizure, malignancy

28
Q

Therapeutic indications for LP:

A

relieve intracranial pressure, deliver medication

29
Q

Indications for emergent CT before LP:

A

To rule out head bleed and meningitis. (Important not to delay antibiotics )

30
Q

What are the absolute contraindications for LP?

A

local skin infection, intracranial/spinal cord lesion, raised ICP w impending herniation, uncontrolled bleeding, Coumadin

31
Q

What are the relative contraindications for LP?

A

raised ICP, spinal cord deformity, body deformity, suspected lumbar epidural abscess, thrombocytopenia, elevated INR

32
Q

How many tubes are used to collect fluid ?

A

Four

33
Q

What is tube 1

A

Cell count, differential

34
Q

What is tube 2?

A

Glucose, protein

35
Q

What is tube 3?

A

Culture, gram stain.

36
Q

What is tube 4

A

Also cell count , differential

37
Q

Approximately how much fluid is collected?

A

4-8ml

38
Q

If RBC is higher in tube 4 than tube 1 this might indicate what ?

A

Traumatic tap

39
Q

The line connecting posterior iliac crests will intersect midline at approximately ____.

A

L4

History And Physical Exam II (6 decks)

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